Saturday, May 4, 2013

Time to stop lying to myself.

I haven't updated this blog in over a year so I don't expect anyone will read this, which may be for the best. This entry is going to be ugly.

I am trying to wrap my head around the cognitive dissonance underlying the fact that I desperately want to become a doctor someday, but have come to despise medical school and the devastation it has wreaked on my personal life.

Before you start medical school, people tell you it will be hard. You don't go into this expecting it to be a stroll through the rose garden. And yet, knowing this can't prepare you for how arduous it will be. Awareness of something and experiencing it are painfully different.

We're almost finished with the first two years of school and about to swap classroom education in favor of hospital training (finally). I could pontificate endlessly about how mind-numbing these two years have been. Sure there have been high points here and there. But the vast majority of this time has been spent sitting in front of a book or a computer screen for 10+ hours/day, almost every day, memorizing the most boring minutiae imaginable (what irrelevant intracellular mechanism does this outdated and useless drug work through?). This is not what I signed up for. Every exam made me lose a bit more of my sense of humanity. I unwillingly yielded more of my sanity each time. It's like fighting a war that you are slowly but inevitably losing. Like watching cancer inexorably subsume a loved one from within. I have fallen completely out of practice with every one of the hobbies I had before I started, and slowly lost touch with more friends as time went on. I desperately need a break from school to work on my personal life; I am at wit's end.

As luck would have it, there is a not-insignificant obstacle preventing me from taking care of everything else in my life. The behemoth: the United States Medical Licensing Exam Step 1.

I have been putting in 80 hours per week *minimum* studying for this shit. And the stress has slowly but surely broken me. I am spiraling into the depths of depression -- something I thought I left behind 10 years ago in high school. I will spare you the details but life has not been terribly kind to me. I'm talking physical and sexual abuse as a child, social exile (constantly bullied and beaten up, couldn't make friends until I was in college), along with having a fucked up family. The odds were stacked against me and I became depressed.

My life's greatest accomplishment has been overcoming a dark past that I honestly think would have driven some people to suicide. I fought for years to completely turned my life around. I worked so hard on my emotional and cognitive well-being and became perhaps the most emotionally self-aware person I know. And I have emerged from this process with empathy for the entire spectrum of human suffering. I know that these experiences will make me a good physician someday, because I feel that my suffering gives me a tremendous capacity for compassion. I owe all of my successes in life to the guidance of a few teachers and psychologists, and I want to pay what I have been given in life forward as a physician.

It is utterly demoralizing to be revisited with depression again, after I did so much to leave it behind. I know the way I feel now would never impact my capacity to be a competent, compassionate physician. Especially because I am going to preemptively start treatment for it before my problems worsen. Unfortunately, I fear that seeking treatment for these problems will negatively impact my career. For instance, in some states you must report a history of depression while applying for a medical license. This is unfortunate because it dissuades people from pursuing treatment before it becomes a problem. Doctors are people too but our profession is notorious of forgetting that inconvenient truth. I can talk about my problems with my family, but I must never mention a word of this to my colleagues and teachers. That is why I write, now.

I am in the process of seeking treatment right now because the only thing worse than having to deal with uncomfortable questions while applying for a medical license would be to have these emotional problems cripple me of my ability to succeed in medical school and become the physician I dream of being.

No matter the cost, no matter how painful it gets, I am going to see med school and residency through. I am not sure if that is masochistic, but that is the commitment I have made to myself. I will become a doctor. I worship no gods and hold nothing sacred, but what I want to spend my short time in this life doing is healing. I feel that this is what I was meant to do. It is just too bad that med school is so stressful that it drives many emotionally healthy people into depression. Despite all of my efforts to mitigate this, it has begun happening anyway. It's not just me: depression is prolific. It gets better after residency, but the rates are actually twice as bad in med school as they are in residency.

Suicidal ideation is also rampant in medical school, no matter how hard students try to hide it. It creeps into the small conversations with innocuous grim humor. The workload is sometimes so immense that people sometimes wish they would die, just to be released from these obligations. It would be dishonest of me to say that I hadn't thought of that before -- a simple "fuck this life" or "I wish this shit would just end, kill me already" floating through my consciousness on occasion. But I will never do anything to harm myself because this life is too short, beautiful, and precious to me. I will have plenty of time to be dead when death happens. I will not hasten that inevitability.

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