“How to Graduate Medical School Without Killing Yourself”
I am 22 and I feel like I am dying from the inside out. I am sitting on a twin bed in my childhood bedroom, staring at the same spot on the wall I used to look at in high school, long before I knew the decay I was feeling was depression, and even longer before I would begin to treat it. It is a holiday break in November, and I am drowning in my first year of medical school.
I am two points away from passing a 19-credit-hour class, and as I contemplate the wall, I know I’m not going to make it.
I am not going to make it because in medical school, C’s don’t get degrees. Even I, someone who has wrestled with the 75% passing cutoff since day one, unequivocally know this is a good thing. We want to know our shit. And personally, I want to know more than 75% of it.
I could pass this class if I was right now, the person I am at my best: when I am functioning at my potential and not pinned to the ocean floor by the weight of apathy.
But I am not her right now, in fact, I barely even know myself. It feels as though I had climbed inside a dream and am hovering at a nose-level-angle with a stranger’s body, which frankly, does not look too great. I will find out later that this is called “dissociating,” and it is not an uncommon psychological response to extreme stress.
Shortly after being admitted to a medical school — one that I was proud to be offered a place in — I watched a video I’d found on the web called “How to Graduate Medical School Without Killing Yourself.” If this seems like a lousy omen to you, that’s because it is. I think my gut was telling me I wasn’t ready to take care of both myself and a curriculum, and I hadn’t stopped to ask it until it was too late.
In the months leading up to, and all throughout the first semester, I wished I had more time. I wanted to take a break — but you can’t. The only way out was through. I admitted it to several of my friends. I should have taken a gap year. I shouldn’t have sent in my applications last year. I’d made a mistake, and now I had to fix it. I thought about it constantly, settling on a decision that never sat right, but was the best I could come up with: I’ll just make it somehow.
This admittedly detail-sparse plan seemed okay because it had always worked for me. I like a good challenge; I’m a closer. In the past, winning for the sake of spiting the odds was enough motivation to get me out of bed at 4:30 AM. I used to like hard things. But that was then, and this is now.
The option of taking a leave of absence, then repeating the year — the option that seemed deep-sea-levels of dark and forbidding and possibly dangerous — was the one I was going to take. I felt like shit because I was failing so many people but also, I didn’t care (would you like some anhedonia with that existential dread, ma’am?). I survived the holiday break and I went back to school.
The independence I value and try to cultivate is somewhat at odds with the field of medicine. I take pride in challenging myself to do scary things alone. My dream job is to be left alone all day. Medicine is not a solo sport, though. When you zoom out to a macroscopic view of a hospital, it’s a web of professional interconnections so dense it looks dark. And that matters. It matters because your team is only as good as the weakest link — and even though I never articulated it to myself, every day that semester, I woke up knowing I was on the path to becoming the weakest link in a care team. That was not a pattern I wanted to continue or a life I wanted to live. In fact, it was a life I couldn’t continue living sustainably. I knew how to survive depression and a heavy load of responsibilities, but never in combination. I had lost over 10 lbs since the start of the semester, putting me well below 120 lbs for the first time since 9th grade. I had functionally stopped eating — only grabbing whatever was nearest when hunger started distracting me from work. It’s not that food was the enemy — anything that wasn’t “sitting in front of my laptop trying to burn through a cloud of apathy with varying but collectively-poor rates of success” was the enemy.
I stopped sleeping, getting between 2–4 hours of sleep a night on the worst weeks. My skin broke out in large, angry marks that made me laugh out loud because honestly, what the hell? I pounded caffeine and (prescribed) amphetamines in a way that made me notice the absence of my heart thumping hard against my chest wall, not the presence. Depression, anxiety, and med school had teamed up to create my own personal roller coaster into hell, and I was going to have to bail.
A few days later, I was in the Dean’s Office as he explained the paperwork I was signing. The moment I decided to take a leave, the weight on my shoulders lifted like a fog burned off by the sun.
I withdrew from classes, I went home, and I slept without setting an alarm.
Today and probably forever, I am grateful for second chances.
Medicine draws a lot of perfectionists. You sort of have to be, to some extent, to care about the 5-unit difference between arterial and alveolar partial pressures of oxygen in a small part of an airway in a small part of a lung in a body full of other organs in a person who’s turning blue. Perfectionism is beautiful to me. There is something noble and inherently hopeful about looking up to an impossible standard and trying to meet it anyway. But we also know perfectionism hurts. Doctors overall are twice as likely to kill themselves than the general population, and women physicians even more so. Depression and perfectionism, my Plan A, had pulled me into a deep despair, and although I joke that I’m too self-obsessed to ever harm myself, I understood how one day I might not be.
I’d been wanting to go back to therapy for a long time. I have a laundry list of things I want to talk through and work on. I want to develop healthier habits for coping with depression, work through the effects of violence and trauma, and assess my relationship with alcohol, drugs, and food — all of which have worsened since starting school. I’ve noticed I have impulse control issues, and anxiety that is the highest it has ever been — resulting in me staying awake sometimes all night and into the next day, or being unable to eat for long periods of time. I had worked by myself to develop and maintain a healthy measure of self-confidence, but each failure this year chipped away at it until I was left with nothing but intrusive negative self-talk — something I’d never normally do.
I love myself. And the negative self-image, guilt, and worthlessness I was feeling were not at all characteristic for me. Part of knowing when you’re sick is knowing what’s normal. And at that point, late in the semester, I hadn’t been normal for a long time. But my Plan A was to make it through school in one shot, come hell or high water. So I treated my mental and physical health like I treat the dashboard lights in my car, and refused to look at them despite increasingly frequent warning bells.
But as it turns out, you can’t will your brain to have more serotonin. Or your DNA to be less shared with a long line of people with disordered relationships with alcohol and drugs. There are some things in life you can’t control, and accepting that truth felt to me like rolling over and dying.
The upside that I refused to acknowledge was that, for each aspect of my life I will never be able to control, there are parts that I can. I can choose to do the work that will help me develop into the kind of person able to coexist with the uncontrollable parts without capsizing.
I refused to acknowledge my control over these parts partially because they take time and extra energy to fix — and as anyone who has ever known a medical student is well aware of — those are two items high on the list of things we don’t have.
I refused to acknowledge them in part, too, because my perfectionist nature dedicates a significant chunk of its time to convincing me There Is No Option Besides Option A. But, in the words of everyone’s favorite weirdo rapper, that was a fucking lie.
I can choose to take this time off and the sky will not fall. Because even though this is a failure, this is not about failure.
It’s about exchanging pride for honesty and denial for introspection. It’s about giving up the faulty software I’ve been functioning with, and learning to write something new. It’s about forgiving myself for not being perfect right away, and realizing I am still worthy in spite of that. Moreover, and perhaps most importantly, it’s about believing that I am capable of change in a healing direction.
Yes, being held back will cause some of my classmates to think differently about me. Hell — I think differently about me: I found out I am only human. But I am not here for them. I am here for myself, and I am here for the future human on a table whose chest cavity I’ve dreamed of being elbows-deep in since I saw my first steamy episode of Grey’s Anatomy. One day soon I will be a doctor, but I will always be human to the point of embarrassment and no amount of caffeine, inspirational quotes, or amphetamines will keep me safe from the pitfalls of humanity. Whatever ordained my existence at this particular intersection of space and time — whether it was millennia of evolution and stochasticity or a god I’ve inadvertently spent much of my life disappointing — it’s condemned me to be free.
I chose to take the time that was offered to me. Instead of putting M.D. after my last name when I’m 26, I’ll be 27. I won’t matriculate with the class I started with — I’ll watch my friends go on without me. But when I graduate into the world of 80-hour work weeks and small margins of error, I will hopefully take with me the healthier patterns and skills I learned during this time. I might have saved my life now, but I definitely saved it later. And one day in the near future I’ll be able to tell someone who needs to hear it, “I graduated medical school without killing myself.”