You may be right, I may be crazy ...

... but it just may be a lunatic you're looking for.

- Billy Joel

Through college, grad school, med school, and residency I did well academically, but I struggled with the tests. Until my junior year of college, I had never taken a multiple choice exam. I know that sounds ludicrous to my American friends and readers, but it's true.

Growing up in Canada, the school system was very different from what I have encountered in the USA. There was no emphasis on standardized testing. We did have high-stakes exams in high-school, but they were nothing like what I have seen here. We had mid-terms and finals. Exam week was set up much like college exam week in the US. Exams for any given subject were given on a specific day and time. You would show up to the gym and there would be a dozen or more rows of desks. Rows were divided by subject with three or four subjects being tested at the same time. Like in college, you may have had to take more than one exam in a single day. I once took the wrong exam (French, I think) by sitting in the wrong row and didn't realize until the exam was over and I looked at my schedule. My next exam ... French (oops)!

Exams were multiple pages long, and they were all long answer, essay, diagrams, etc. No matching, no multiple choice. If I recall correctly, they were usually 2-3 hours duration.

When I moved to the US, I started out at a small college in Hawaii.

Can't believe I still have this old thing

Most of the classes were smaller than my highschool classes ... 20 students in a class was pretty big, and I had a few classes with less than 10 students. Again, the depth and breadth of our knowledge was tested with explanations, answers, and essays. No multiple choice.

Imagine my shock and dismay when I walked into my first class (chemistry), held in a movie theatre, at Boston University my Junior year. There were 300+ students in that class. Exams were given in a booklet with answers bubbled in on the familiar Scantron sheet most Americans remember with much adoration. I actually had to read the instructions to figure out how to take the damned exam. The next two years of classes were mostly like this. I did well, graduating with honors, but it was more of a struggle than I expected.

A consistent theme ever since has been that I know the material, can explain and summarize the concepts, and can usually even draw an accurate diagram, but I just can't pick the best right answer from the list of 4-5 similar sounding phrases on multiple-guess exams. This problem followed me through grad school, med school, and two residencies. I was never able to overcome it, despite my best efforts and the best efforts of my tutors and mentors.

After my Emergency Medicine residency, I moved to a high-volume, high-acuity practice. I thought that my practical, every day experience, coupled with what studying I could fit in would be enough to pass the Emergency Medicine Boards. Boy, was I wrong. I failed my first attempt by 2% ... probably 3-4 questions. My next couple of attempts had similar results. I was working in a place that didn't require board certification and we were happy where we were, so I had decided not to continue further attempts. I was a good doctor, but not a good test-taker and I was ok with that. I knew it would limit our options a little, and my income would max out somewhere south of my potential, but again I was ok with that.

Then we decided to go work overseas. I was able to find some jobs without being board certified, but the locations and pay were terrible. No way we could afford to go with what I was being offered, so the pressure was on to once again attempt board certification.

I took yet another expensive, out of town, board prep course and I significantly reduced the amount I was working to focus on studying.

Working nights, I tend to be most awake and productive at night even on my days off, so most of my studying was done at night. Late at night, in my office, I started smelling cigarette smoke. Not every night, but most nights. I hadn't really noticed it much before and it was definitely cigarette smoke. None of my neighbors smoke, but there are several houses with tweens and teens. I have a creek and woods behind my house and I assumed that someone was sneaking off into the woods at night to smoke. The problem was that the woods are easily 50+ feet from my house and it smelled like someone was smoking right outside my window. On more than one occasion, I walked out of my house, creeping along trying to catch Steve Miller* in the woods.

One night, the smoke smell was so strong I swore the smoker was next to me. And that's when I lost it. In the recesses of my primitive lizard brain I dredged up a memory of reading a news report describing someone with a similar experience. I can't remember if it was smoke, or noises, or what, but she had had multiple service people out to her house trying to find the source. Finally, one of the service people entered her crawlspace and discovered someone living there.

See this link: Stranger Living in Crawl Space

I was convinced that there was someone living in my crawlspace smoking cigarettes at night. I put coveralls on over my clothes, grabbed my MagLite and my Glock and headed outside.

Mice, snakes, and hoboes beware ...

I was going under the house and I was prepared to shoot if necessary. I briefly thought about calling my neighbor, a county police officer, but it was 3 am and I realized how crazy I might sound at that moment ... "Hey Joe. Do you mind coming over and backing me up while I crawl under my house to shoot the person under there smoking cigarettes at night?" The thing is, he probably would have said "I'll be right over."

So there I am, crawling around under my house, flashlight in one hand, semi-automatic pistol in the other. And I found nothing. NOTHING. The crawlspace was empty and there was no evidence anyone had ever been under there. While I may be crazy, I do not lack insight. I realized that I was going nuts chasing after phantom cigarette smoke in the middle of the night. I engaged my scientific and medical brain and set about diagnosing myself. I discovered a condition called Phantosmia. In short, the cigarette smoke was an olfactory hallucination. Usually phantosmia can result from stress or nasal polyps/infections, but occasionally it can be caused by a brain tumor known as a neuroblastoma.

I saw an ENT who put a camera up my nose and took a look around, and then I had an MRI.

It's not a tooma'.

The smells went away shortly after having my MRI and I passed my boards about a month later.

I finally have that piece of paper ... I'll let you know later if it was worth it

I haven't smelled cigarette smoke late at night since.

Not for any related reason, of course, I added a padlock to the outside access panel for the crawlspace.

Not sure if I'm keeping things out ... or in!

*He's a joker, a smoker, a midnight toker.