Posted on by omarmetwally

The Match

A sequel, with one interruption

By Omar Nabil Metwally, MD

First published 11 October 2026

I. The Review

My last essay ended with a census of my readership: North Korea, Syria, a pirate ship off the coast of Yemen, and ten or twenty Chinese Googles.

I can now report a human. His name is Ali. I sent him the link at night, and the next afternoon he sent back a review. He loved it. He hadn’t realized the interviews are all done on Zoom now. What a loss, he said. Then he thought about it some more: although, he guessed, it was expensive.

The AAMC needed a survey to get there. Ali needed four sentences.

My wife’s position is unchanged.

II. The Gunner

Ali thought it was a loss, so I told him what we lost.

Every medical school class has a gunner. For the pirates: a gunner is the student who treats medical school as a contest and intends to win it. I say this with respect. A gunner knows your patient’s potassium before you know your patient’s name.

A classmate of mine at Michigan wanted dermatology. Dermatology is about the hardest residency to get, for reasons every doctor understands: the pay is good, the hours are sane, and skin rarely has an emergency at 3 a.m.

He took no chances. He applied to fifty programs and flew to every one that would have him.

III. The G-Wagen

This was the old way. Every invitation meant a plane, a hotel, and the suit.

He paid the application fees. He paid Southwest. He paid Spirit. He paid a series of hotels selected for price.

By my estimate he spent a G-Wagen’s worth. I have no evidence of the G-Wagen. I had no evidence of the yacht either, and I stand by the yacht.

For the same money he could have bought the G-Wagen and driven it to the interviews. He would have pulled up to every dermatology program in America looking like a man who had already finished one.

Spirit went out of business this May. The loans, I assume, are still in the air.

IV. The Match

Residency is decided by a computer. You rank the programs. The programs rank you. On a Friday in March the computer reads both lists and tells you where you live now.

The computer considered fifty programs, a G-Wagen’s worth of travel, and every city Southwest serves. It sent him to the University of Michigan.

He was a medical student at the University of Michigan. He was already there. He could have walked.

I know the route. I walked it once, in a black suit.

I would like to feel superior about this. But I flew all over the country for medical school interviews, got into the one school I could walk to, and declined the rest. I did the same thing. He did it in a nicer car.

V. The Closet

I have never written about my own Match Day.

I did not want to go to residency. I have said elsewhere what I wanted, which was to start a company out of a childhood friend’s closet in San Francisco. He’s the only person I’ve known that I can sincerely still call a friend even after starting a company together, spending a year coding shoulder to shoulder during most of our waking hours, while also sharing rent for studio apartments in SF and NYC. I decided to take another “gap year”, which turned out to be the start of a career in gap years, after seriously considering a career in surgery during a mind-changing medical school surgery rotation (that deserves its own story).

The computer does not match to closets.

I did not have the courage to submit zero applications. That would have been obvious. So I applied to four programs in a specialty I had no interest in. I chose radiology. Although I admire visual art and consider myself someone with decent aesthetic taste, my mind tends to reach first to text and numbers when solving a problem before taking a visual approach.

I put on the black suit and interviewed at all four, with no serious intention of attending any of them. My classmate wore the suit for jobs he wanted. I wore it for four I did not.

In the end I decided to hold off on residency for at least a year. It turned out to be a year.

We all carried pagers then, the size of bricks. I once dropped one in the toilet in University Hospital and was under the impression that I had to fish it out and return it to security in order to be issued a new pager. But that deserves its own story too. Anyway, I knew what would happen when the algorithm finished its work. Everyone who matched would get a page congratulating them. Everyone who did not would be summoned to the dean’s office, slapped on the ass, and hustled into an unfilled residency spot in a specialty that may or may not be related to the applicant’s original interest. Bottom line is, you have a chance to redeem yourself and eventually become a licensed physician in a residency program.

I am no idiot. I knew what was coming. An email arrived silently in my inbox, telling me that I had not matched. Surprise, surprise. It was the inevitable outcome of my own making.

I turned off my pager and my phone. Then I did the only thing I could. I celebrated wildly with my friends, hugging and kissing, as though I had just landed a dermatology residency at an academic medical center with floors of perfectly reflective marble, and where the waiting lists are so long that patients perish outside on the front steps waiting for their first appointment. YES WE DID IT!!! I screamed in feigned ecstasy.

After about five minutes of celebrating, the receptionist huffed up the stairs to the small windowless room where my cohort of medical students was huddled.

“Omar, honey? You didn’t match. You need to come to the dean’s office, honey.” I quickly avoided eye contact with all of my classmates and darted to a remote bathroom that I reserved for emergencies like these.

My digestion is, overall, OK. On that particular day I made my way quickly to a bathroom deep in the bowels of the Medical Science II building and engaged in a continuous, fifteen-minute episode of watery diarrhea. It was catharsis in a gastroenterologic sense. The whole time I was trying to silence my pager. I had turned it off. It kept notifying me that I had not matched, even as I ripped out the AA batteries. I prayed that the woman who had huffed her way through a mile of indoor med sci labrynths wouldn’t track me down by my scent and walk into the bathroom. Omar, honey? I could imagine her  voice echo in the bathroom.

To make a long story short, I ended up learning to write iOS apps the old-fashioned way, which is a human actually writing the code. I had help from a friend, the only other physician coder I know. He is also a University of Michigan Medical School alumnus, an electrical engineer, and one of the most gifted programmers I know. He donated his time to meet me in cafés around Parnassus and in the UCSF medical library, where he helped me debug my GET and POST API calls. I owe him, at  least, a great deal of gratitude for all that time and help.

I did that for as long as I could, which was one year after medical school. Then I needed a paycheck, and I enlisted as a human battering ram for a local internal medicine residency program, where I met some of the most uniquely unforgettable and gifted people I’ve known: at St. Mary’s Hospital in San Francisco (now UCSF Health) and later at Highland Hospital in Oakland.

I am an internal medicine physician.

VI. Portland

An interruption.

This just popped into my brain.

Later I did it again, applying for a clinical informatics fellowship at Oregon Health & Science University. It is a  forward-looking university in one of my favorite cities. In reality, I ended up choosing UCSF. I was lucky enough to have many great options. In a parallel universe I went to Portland. The memory of a bright morning ride on the Seilbahn (Portland aerial tram) is a happy and lasting one.

I finished my shift at the county hospital in Oakland at 11 p.m. I got in my car with my white coat still on, drove to Oakland International, and flew to Portland. I checked into a hotel room that cost between $250 and $300 a night and slept in it for about two hours. That is roughly $140 per hour of sleep.

The morning after the interview I woke at 3:30 for the flight home. I woke with the hardest direction I have ever had. I am dictating this part, and the software has chosen the word direction. I am leaving it. It was the ordinary morning kind. Only the hour was unusual.

At security the scanner beeped. The TSA agent pointed to his screen. It showed the outline of a person, and on the outline, over my direction, a large red dot.

“I’m going to have to pat it down,” he said.

I was patted down without objection or resistance. Then I was on my way to the gate, to sip Portland-roasted coffee and wait for my flight back to Oakland.

Since then, when I go through airport security, I put my hands at my waist where they are clearly visible and ask the agent: do you need to pat me down?

Years later I told this to my family. Half of them are physicians. The other half are lawyers. My father snorted an insolent snort and said the TSA guy probably liked it.

I thought: he better have.

What was I saying?

VII. The Loss

So what did we lose?

Today’s gunner applies to fifty programs from his apartment. He does fifty interviews in one chair. On the screen there is no stool, and everyone is the same height. The camera shows him from the chest up. I was seen on a screen once during an interview trip, and the framing was different.

He spends nothing. In March the computer tells him he is staying where he is, and he has gone nowhere to find that out.

This is better. For decades we sent applicants around the country in black suits, on borrowed money, so that a computer could tell some of them to stay put. Ninety percent of applicants wanted the option of skipping it. I would have wanted it too.

The only thing lost is the story. Nobody pats today’s applicant down. My classmate has a story with fifty cities in it, and he paid a G-Wagen for it. I have Portland, and I paid for that too. That is experience.

His story cost me nothing. I just know the guy. That is reference.

VIII. Intellectual Property

I ended my message to Ali with a warning. If he writes a story about this before I get around to telling it, I’ll sue. I’ll sue him, and I’ll sue my classmate. For plagiarism.

I see the weakness in the case against my classmate. It’s his life. He lived it first, at great expense, and he has the receipts.

My position is that he only lived it. I’m the one who told somebody.

IX. Coda

The stopwatch is still running.

Experience is airport security with a 3:30AM direction. A machine can describe one. It has never been patted down for one.

Reference is a man who flew to fifty cities to end up where he started. I didn’t have to make him up.

Thank you for the opportunity.

Posted on by omarmetwally

Experience and Reference

An essay on writing, dictated, with interruptions

By Omar Nabil Metwally, MD

First published 10 October 2026

I. The Letter

My writing career began with a thank-you note.

I had just interviewed at the University of Michigan Medical School. I had not yet been accepted or rejected. I can say what follows because Michigan was my first choice then, and it would still be my first choice if I were applying today.

After an interview it is customary to write a follow-up letter. You thank the school for the invitation to take time off from your work and your family, spend a couple of grand you do not have, fly somewhere, and roll the dice. I flew to many of these, all over the country. For this one I was lucky. I was already an in-state undergraduate, so I did not have to fly. I walked across Ann Arbor from my apartment to the hospital in a black suit, alongside a group of other applicants in black suits. We looked like itinerant funeral attendees.

I am told this is now done mostly by video. The Association of American Medical Colleges recommends it, on the grounds that the old way cost applicants hundreds to thousands of dollars and pulled them away from school and work. They surveyed the applicants. Ninety percent wanted the option of staying home.

So I would like to recognize the sacrifice of everyone who did it in person, and everyone who still does. For college. For medical school. For graduate school. For residency. For fellowship. A person can do this five times in one career. We blew a great deal of time and money walking around in those stupid dark suits, and nobody surveyed us.

So I wrote the letter. I thanked them for the opportunity to interview at my first-choice medical school.

Then I started to complain.

II. The Stool

One of my interviewers was a small man from Thailand. He sat on a stool. It was the tallest stool I had seen up to that point in my life. The seat was about halfway between the floor and the ceiling.

He invited me to sit in a chair. It was the kind of chair your neighbor gives you once their grandchildren have outgrown it: toddler furniture that belonged first to their kids, then to one grandkid, then made the rounds of the other grandkids, and then came to you.

I sat in it. I looked up, in the general direction of the ceiling, and he interviewed me.

This is the custom. You travel the country racking up tens of thousands of dollars in debt in order to sit beneath an interviewer at his preferred altitude and explain, with glee, how badly you want to be a doctor and save the world and do something useful for society. I explained it with glee. I explained it to his shoes.

What was I saying?

III. Eye Level

In medical school they record you. They record you constantly, and then they play it back and point out every stupid thing you did on camera. Feedback, feedback, feedback. In the process they make you a better doctor. A better human being, actually.

One thing they teach you is to sit down level with the patient, eye to eye. It has been studied. You do not spend one additional second in the room, but the patient feels as though you did. It is a peer-reviewed illusion.

Today’s applicants get this for free. On a screen there is no stool. Everyone is the same height.

I had not learned any of this yet. For me it was just common sense, in the form of a question: who the heck is this guy?

So I put it in the letter. Thank you for the opportunity. Your interviewer was hovering. I was nearly on the floor.

The next day I received my acceptance to the University of Michigan Medical School. Other schools I had flown to accepted me as well. I declined them.

That was the start of ten years as a Michigan student: college, then medical school, with a two-year stint in the Department of Microbiology doing Ph.D.-level research and coursework. It was also the start of my writing career. I have been thanking institutions and complaining about them in the same document ever since.

IV. The Stopwatch

I keep a personal stopwatch for humanity. It stops on the day it is no longer possible to tell the writing of David Sedaris from the writing of a machine. On that day, as far as I am concerned, humanity is finished.

I say this with respect. I have to make myself laugh in order to get through each day. There are many things in life I do not need to waste time explaining, and laughter is the therapy for all of them. It is the medicine. I have never met David Sedaris. Two of my siblings have. All five of us read him avidly. I am not picking on him. He is the benchmark because he is a genius.

A machine can produce beautiful text. It can be funny, moving, and very easy to believe. What it lacks is two things: experience and reference.

Experience is the toddler chair. A machine can describe one. It has never looked up from one.

Reference is the other thing. When Sedaris writes, he is calling out people from his life. He does it in a funny way, often in an embarrassing way, and, I am assuming, in a consensual way. Also in an honest way, an educational way, and really a respectful way. The people are real. They can be reached for comment.

What was I saying?

V. The Readership

Without a readership a writer is nothing. A writer without readers is a human text generator.

Sedaris has millions of readers. I picture him keeping the fan mail in a Rolodex, a literal, physical Rolodex, aboard his yacht, flipping through it as he darts across the Pacific: the beaches of Vietnam, Japan, Australia, New Zealand, Tonga, Hawaii. I have no evidence of the yacht.

I am blessed with anonymity. Nobody knows who the hell I am. This empowers me. Occasionally my website has a visitor from North Korea, or from Syria, or from a pirate ship off the coast of Yemen. Now and then, an AI bot. I picture ten or twenty Chinese Googles crawling the internet, processing information, and arriving, eventually, at me.

That is probably the extent of my readership. It gives me the strength and the will to keep writing. Their feedback is extremely important to me.

VI. The Secret Sauce

The real secret is my wife.

I can say this because she is the smartest person I have ever known. She is afflicted with dyslexia, which means that she is illiterate and cannot read. She has never read anything I have written.

This is the secret to our harmonious marriage, our great sex life, and my career as a writer: we can’t even talk. And I have to talk to somebody. So I write it down, post it to a public website for the pirates and the crawlers, and then I go back to my wife.

Sedaris, I assume, gets consent. I have a more efficient arrangement.

VII. Coda

I dictated this essay. The transcription software spelled David Sedaris seven different ways, one of them correctly. The stopwatch is still running.

At the end I repeated my thesis out loud, to make sure I still had it. Experience and reference. The machine listened carefully and wrote down: experiencing our friends.

It is a better definition than mine. It has no idea why.

Thank you for the opportunity.

Addendum

Before posting this essay, I asked my wife for her consent. She said yes. She said it in English, in the English language, very clearly.

After she realized that I had posted it, she clarified that by yes, she had meant no.

I attribute this to the dyslexia.

Sedaris, I assume, gets consent. So did I, briefly.

I wrote above that the people in an essay are real and can be reached for comment. She has been reached. The comment is no.