The Secret

Medicine can suck sometimes. It’s ok to say it.

Each year of medical school presents its own unique challenges. The first two years of basic sciences are marked by fear – fear of disappointment, fear of failure, fear of the unknown. 3rd year is defined by the sheer amount of work; with no time to think and no way to relax, students would definitely be more depressed if they weren’t so busy.

But 4th year is different: we are seniors once again, the pain of medical school numbed somewhat by our excitement for the future. These days, we spend less time writing patient notes and more time with our noses buried in our inboxes, anxiously waiting for that next tantalizing interview invitation. Whatever time is not spent enjoying our hobbies and planning vacations is spent daydreaming about just how good we’ll look in that long white coat. We’re finally at the top of the heap: we’ve put in the hours, the majority of our testing days are behind us, and we’ve earned a break.

Of course, 4th year still has its challenges. It takes about three full years of medical school to really figure out the truth – that medicine can get quite boring at times. The cholecystectomy you observed with awe in 1st year suddenly becomes much less fascinating when you’re forced to watch the same operation for the thousandth time at 2 AM. The patient you once had such a special relationship with in 3rd year becomes just another “Diarrhea Guy” or “Depression Girl” on the endless conveyor belt of faces that you’ll probably never remember. The “magic” of medicine that initially drew you to medical school will fade away, and that’s normal. No matter how much you might like a certain specialty, it will eventually become repetitive and monotonous – tedious, even – just like anything else in life. Trust me, it will happen – just give it enough time.

squidward
Remember this episode?

But that’s fine. It’s ok. We are still excited for the future.

We are so excited, in fact, that we actually get scared. That’s the interesting thing about 4th year: we are terrified of the future, just as much as we are looking forward to it. We are afraid of many things – afraid that we will not match, that we will not get a job, or that we will fail as doctors. But perhaps our worst nightmare is something much more sinister: the haunting possibility that after all our hard work, we will not get into the program we want, or even worse than that – we will not be happy in the specialty we decide on. Choosing a specialty and a program is not easy after all, and many students spend years agonizing over the decision. Even the most “sure” person cannot be 100% assured. Essentially, we are making the biggest decision of our lives based on a single year, after spending a minimal amount of time on just a handful of rotations. We spend a month here and a month there, sometimes less, and are never fully exposed to the entire medical gamut. In summary, there is really no way to know for certain whether or not something “better” is out there; and exaggerated thoughts – stupid thoughts – creep into our minds: “Did I apply to the right specialty? Will I even get into the program I want? Will I have a peaceful and happy career? Or did I choose wrong, and doom myself to an eternity of misery?” It turns out that excitement and fear are really two sides of the same coin: we are so incredibly eager to have our dreams fulfilled, that the mere possibility of not getting what we want makes us tremble with anxiety.

Now, if you don’t go to medical school, you may be thinking to yourself that this whole ordeal sounds quite silly. “It’s not worth it,” you might say. But medical students live in a different world than most people; we believe that all the hardship and all the stress we have endured so far will indeed be worthwhile. We may have tunnel-vision, but our vision of the future is crystal clear. We have a golden carrot hanging in front of our faces, a prize at the end of the road: the promise of security, of fulfillment, of a happy life. This is what we have been told, and we hold on to it for dear life. We think about it, we talk about it, and we repeat it to ourselves day after day. We embrace it as if there is nothing else for us in this world. In fact, we hold on to this mantra of happiness so tightly that we do not even consider the possibility that medicine may not make us happy.

And it is a possibility that is actually very likely, according to the evidence. Over the years, countless studies, experiments, and surveys have been performed on this topic. It is a well-known fact that by the time medical students reach residency, depression rates are four times the national average, with up to 30% of medical students and residents screening positive for depressive symptoms. And burnout rates (a.k.a. depression for doctors) have been reported as high as 54%. But perhaps the most shocking statistic is that doctors have the highest rate of suicide among all professions in America, a rate even higher than that of the military. Every year we lose up to 400 physicians to suicide, with a suicide rate more than double that of the general population. Though the numbers vary slightly between studies, the basic idea is that physician depression is far from the exception.

depression 2

But really, you shouldn’t need statistics to see what’s already in plain view. Take a closer look at any hospital or clinic and you’ll see that we are absolutely inundated with unhappy doctors. And those who swear they’re happy seem to be the ones who are perpetually on vacation, far away from the careers they claim to love. Personally, I have known many medical students who have been consumed with sadness at some point in their education – myself included. I guarantee that if you are in medical school you will know at least one or two people who are depressed; some of us have even had friends who have taken their own lives.

Yes, medicine can suck sometimes. It’s ok to say it. It really is.

But we won’t. We won’t even whisper it. We are afraid, as if simply speaking the words will somehow summon our fears into existence, in the same way that superstitious wizards do not dare say the name “Voldemort” out loud. It’s almost as if a spell has been cast over our schools and hospitals, and if we admit the truth, the very foundations of our buildings would collapse and be swallowed up into the earth. The illusion would fail; the splendidly-clothed emperor has really been naked the entire time. The scales would fall from our eyes and we would see things as they truly are: that we are thousands of dollars in student debt and have sacrificed the prime years of our adult lives, all for nothing. And so, in light of such overwhelming evidence around us, we do the only thing we can do in order to survive – we close our eyes and pretend it doesn’t exist. Indeed, the worst thing possible for a medical student is to imagine that medicine will not be fulfilling. “If medicine cannot make us happy,” we scoff, “then there is no point in pursuing it.”

But how did we become this way? When did we become so fearful, so blind, and so obsessed with finding the “perfect” career?

I believe the answer goes deeper than just medical school. Our elders joke that we are a generation of narcissists, and they are not wrong. We live in a Gilded Age, in the wealthiest society that has ever existed in the history of mankind. Unlike our ancestors, we no longer have to worry about simple survival, and we no longer fear famine, sickness, or the afterlife. Unlike most of the world, we can actually afford to have dreams. In the past, suffering drove our ancestors to seek higher ideals such as duty and sacrifice, but wealth has made us selfish – these days, our own happiness comes before anything or anyone else. With nothing else to do but serve our own appetites, we grope in the dark for purpose, and end up looking in the most shallow and ridiculous of places. As a result, we no longer have jobs, but careers: the romantic notion that work can somehow make us happy and give our lives meaning. The main purpose of a career is to fulfill our own desires, and thus, careers have become the ultimate expression of our vanity. This is nothing new: from the beginning of time people have always been vain; however, we live in an era in which selfishness has actually become a point of pride. “Self-love” – the most extreme form of selfishness – has become so prevalent in our society, that it is now considered wrong if you don’t put your happiness above all else. Truly, we are the generation that the Apostle Paul spoke of regarding the end times: men and women who are “lovers of their own selves, covetous, boasters.” (I too, belong to this generation, and have not written these things to shame anyone, but rather as a way to inquire into the source of my own misery.)

In summary, medicine has always been around, but what has really changed is our perception of medicine. These days, the purpose of medicine is not to serve others, but to serve ourselves. Therefore, in order to understand our depression, all we really have to do is look at the hearts of our physicians, and we would see that our misery is clearly rooted in our self-love. We have put our own careers on a shining pedestal and have fallen deeply and hopelessly in love with medicine. With such lofty and unrealistic expectations, how could we not end up utterly devastated and heartbroken? Out of desperation, we have tried to find happiness in something that is inherently unhappy. We entered into medicine because we craved purpose and happiness, but we have been looking in the wrong place. The world is full of unhappy places, and unfortunately for us, medicine just happens to be one of the unhappiest.

Screenshot_20181005-134619_Instagram
Taking off the rose-colored glasses: Going to medical school is a lot like falling in love. In my teens, I met a handsome boy on the internet from Tennessee, and we swore we loved each other. Soon after, I found out that he was actually kind of a bum and had become a Wiccan (a.k.a. witch worshipper).

For decades, doctors have blamed their depression on many things: subpar hospital conditions, long work hours, poor compensation, pessimistic blog writers, the list goes on. Accordingly, they have tried to fix our schools and hospitals, improve our mood with therapy, and have given us tips on how to smile more or how to pick up a new hobby. But these superficial strategies are nothing more than quick fixes, like painting the walls of a broken-down house instead of building it a new foundation.

There is no easy solution to our problem, and I have no answers to give. The best I can do, perhaps, is to give my own humble opinion and offer a new and radical suggestion: that we change our own perspective before we change anything else. Rather than change others, we can change our own mindset. In order to move forward, we must first acknowledge the truth: that medicine is clearly depressing. I am aware, of course, that not all doctors are miserable, and there is definitely much good to be found in medicine. Personally, I am extremely grateful for the opportunity to be where I am today. Those who have devoted their lives to medicine should be praised for their accomplishments, and it would be wrong to take that away from them. But to guarantee that medicine will make you happy is misguided, and to claim that a career can give your life purpose is a lie. Medicine is nothing more than a job; it is not your family, and it is not God. I cannot tell you what the purpose of life is, but I can tell you with complete confidence that it sure as hell is not medicine

So then, what is the secret to being happy in an unhappy profession?

Truthfully, there are no secrets, but there have been hints. Hudson Taylor, who spent over 50 years in China as a missionary, battled sickness and depression for years, and lost his wife and 7 of his children to an early death. Whereas most would curse God for their misfortune, at the end of his life, Taylor was actually happy. Regarding this mystery, he shared this insight: that “the real secret of an unsatisfied life lies too often in an unsurrendered will.” Similarly, Siddhartha Gautama, the founder of Buddhism and the Four Noble Truthswas also a man of suffering. As the Buddha observed many centuries ago, to live a life of attachment and desire is to condemn yourself to a life of loss and suffering. These two wise men are not alone; many great men and women throughout history have also arrived at this same conclusion. True happiness, it seems, lies in not seeking happiness. Indeed, the irony of living for ourselves is that in our pursuit of happiness, we will never be truly happy – at least not in the way that we want.

So forget what you’ve been taught. Rather than holding on tighter to our dreams, we must let go. Contentment is not tied to one job, and attachment to your career will only cause you pain. In this regard, it might help to remember the bigger picture: that life will go on whether you become a doctor or a janitor, because in the grand scheme of things, it really doesn’t matter. Yes, God has a plan for each of us, but I don’t exactly see Jesus agonizing over the decision to become a carpenter rather than a tent-maker. Remember that medicine is just a job. You are so much more than your career, and there is so much more to life than just medical school.

Let go. Medicine will never be everything we want it to be, and we must learn to accept that. Though I can’t really say that we have a choice in being depressed or anxious, I find that most of the time we unnecessarily torture ourselves with our “big plans” for the future. There is freedom in being realistic. It’s a tricky balance – being grateful for where you are in medicine, while at the same time recognizing the limitations of what you can have. Medicine can suck sometimes. It’s ok to say it. It’s good to say it. Only then can we begin to heal. But remember that narcissism can take the form of both self-aggrandizement and self-pity. While you shouldn’t glorify medicine, you shouldn’t agonize over it either – it’s just not worth it. Acknowledge your suffering without digging yourself into a hole of despair. Learn to let go and move on.

Of course, such matters are easy in theory, but nearly impossible in practice. Recognition of the problem is one thing, but acceptance is something else entirely. I am 26, but every day I realize more and more that I am a child. I am selfish, spoiled even. I crave control; I want to know the future. I still find myself screaming for happiness into a universe that owes me absolutely nothing. A wise friend once told me that it is in our human nature to want to solve problems, but oftentimes in life there is simply no problem to be solved. The biggest challenge, and the mark of true maturity, is this: accepting your situation no matter what, and finding contentment in all things, whether you are a king or a slave.

calvin
It’s a bad sign when you can relate to Calvin.

Unfortunately, a deeper discussion on how to achieve such a peaceful mindset would go beyond the scope of this essay. The rare ability to find satisfaction in all situations – this is a state of mind that I still aspire to, as I know that I am nowhere close to it. At this point in my life, there is still so much I don’t know and many lessons I have yet to learn. But there are at least 2 things I know for sure: that our struggle will never cease, and that we must never stop growing. We do not have as much control over our lives as we’d like to think. Let life happen as it happens; the only thing we can control is our response to it.

So carry on. Don’t worry if medicine doesn’t make you happy. It’s not supposed to. That part’s up to you. Learn to accept it.

Carry on. Graduation is almost here and there’s work to be done.

I’ll see you on the other side.

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– Jackie

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