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almost every day, memorizing the most boring minutiae imaginable (what irrelevant intracellular mechanism does this outdated and useless drug work through?).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.

Songs I'm listening to lately

Here are a few excellent songs that have helped me get through this exam week. The first two are ambient trance, and the last two are ambient/melodic black metal. Definitely contemplative music.

Amethystium - Silken Twine (this song makes me feel hopeful about my life, but also like the good things in your life are rushing past you)

Amethystium - Elegy

Summoning - Our Foes Shall Fall (these two kind of sum up my feelings on life lately. They are beautiful songs, but also very dark)

Woods of Ypres - Shards of Love (reminds me of my breakup)

Anyone out there listen to stuff like this, or enjoy what I posted? Let me know! Or just spam me with your favorite music. It can be pop music but the one requirement is that it has to be meaningful to you.

Alright, bedtime. It's gonna be a short night of sleep..

Neuroscience is... hard. So is not being motivated.

We just started learning neuroscience in school and, unsurprisingly, it is absurdly difficult. The internal anatomy of the brain is very complex and due to decidedly subpar teaching by most med school professors, I have no idea WTF is going down most of the time. All that is possible is to keep plugging away and hope that things eventually start to make sense. Good thing I chose right now to start feeling lazy for the first time all year, haha!

Doesn't this brain look complicated to you?

Lately, life has been pretty good to me. I got chosen to serve on the executive board for something at school that will give me great exposure and networking opportunities. My exam grades from last block came back and they went up again (constant improvement since the start, maybe they will give me a "most improved" award at the end of the year). We had spring break a little while ago and I had a lot of fun camping with some buddies from school. Somehow though, none of these positive events had any effect on my willingness to work, or even my level of satisfaction.

Burnout is an interesting phenomenon, especially since it seems that there is some cognitive incompatibility involved. I still am very passionate about the field of medicine and remain 100% committed to my career goals. Not a day goes by where I don't stop to appreciate the opportunity to pursue my dream career. Despite that though, I find myself incredibly unmotivated to do anything related to school at all. I'm definitely not alone. I see a lot of my fellow medical students in this same boat -- especially since almost everyone is struggling with neuroscience. There has also been a lot of literature published on burnout among medical students, why it happens, and how to counteract it (here's one JAMA article for reference). I do not think I am at the level of burnout yet, but I could easily go down that path if I weren't careful.

I have a lot of respect for my fellow students who are still able to keep up their pace, even when confronted with insurmountable difficulties. A few students I know are on the verge of having to repeat the year and so the stakes are especially high for them. Med school is a breeding ground for stress, anxiety, poor self-esteem, and frustration. It stands to reason that burnout and depression are significant factors in determining the success (both academic and personal) of medical students.

So how do we prevent (or treat) burnout? Wellness and having a strong social support network are critical, as this article would suggest. Eating well, exercising often, getting good sleep, having fun, maintaining closeness with family & friends, having a sense of spirituality -- the very things medical students are prone to deny themselves! It's not very useful to starve yourself and deprive yourself of sleep in the name of medicine, but sadly I know more than a few students who do this. It's a difficult situation because sometimes you have to choose between good scores and being happy. Woe to you if you are one of the medical students who struggles to pass even after putting 60-70+ hours/week into studying. At that point, maintaining a healthy life balance is nearly impossible.

What med students need to do more of.

I definitely am proud of the fact that I have tried very hard to maintain a good balance (post-breakup) with all of these things, and for the last month I succeeded while still doing well on my classes. I have been slipping up a bit and maybe that is a factor in why I am not feeling as motivated. Well, I will just have to work harder in the hopes that it will help shake this study funk off!

P.S. If the journal articles aren't working for you, let me know and I'll find a better way to link them.

Mission Accomplished

The weekend in numbers:

Minutes spent studying: 0
Beers drank: 10
Computers made worse, not better, by attempting to fix them: 1
Youtube videos watched: Over 9000
Days until next panic attack (aka exam): 11