If you’ve made it this far with me, you’ve probably asked yourself, “How did he do this for so long?” To go to medical school, finish a residency, and become a psychiatrist, this guy must be crazy!
First, not all of it was bad. I learned a ton. I grew. I invested in passions. I traveled.
Second, my relationships—the connections, conversations, and life experiences—are things I’d never give back. Just thinking about all the people on this journey makes me want to turn on Chasing Cars and summon a sobfest.
Yet, for all that good and deserved acknowledgment of meaning, there were demons under lock and key. Compromises to keep pacified.
Here’s how I did just that, before it all broke two months ago. My two favorite tactics were shadow callings and mirages.
Shadow Callings
Termed by Steven Pressfield in his work Turning Pro, shadow callings are pursuits that align obliquely with our true calling. They are snacks, feigning satiation but not real sustenance. I know mine well.
These pursuits aren’t detrimental in and of themselves. Most are passions I still care about, and they helped me keep the torch lit through caves of burnout and depression. They were multi-purposed.
Veganism
I booked my ticket on the vegan identity train a year before medical school started. I loved the health benefits, ethical considerations, and the virtue signaling opportunities (please don’t hear this as a criticism if you’re currently plant-based, this an evaluation of my motives only).
I tried with all my might to insert veganism into medicine, like a passion transplant. I did a rotation in Santa Rosa at a vegan fasting center. I read piles of books by plant-based physicians, even earning a certificate in plant-based nutrition from Cornell. I searched high and low for a purposeful path forward that included plant-based medicine, but at the end of the day, it was just a cool thing I was interested in for a stretch of life (now I eat meat).
Not a reason to be a doctor.
Integrative Medicine
Much of what I said about veganism applies here. Integrative medicine is a cool discipline. I completed an online, two-year fellowship from the Integrative Psychiatry Institute in Boulder. Learning to treat depression and anxiety with supplements, helping people take over their own health with lifestyle change, and knowing the research in support of the outdoors, was awesome. But in the end, I didn’t care, because I didn’t want to be a doctor. I went to the yearly conference by Zoom, stayed for the first hour, then went and surfed while the conference ran in my empty living room.
Psychiatry
I love people. I love listening. I love thinking about root causes. My brain works in whys. Psychiatry was naturally the next cover up. And becoming a psychiatrist was probably the best thing that could’ve happened to me. I absolutely cherish every second of those therapy sessions with my patients.
Yet, when you’re chasing a shadow calling, the suffering one must endure to become great is hard to bear. When asked to dig deep, on a day of back-to-back-to-back-to-back-to-back depressed patients in the emergency department, you need to want that life. I did not.
Mountain biking and surfing
My muses. My solace. My savior.
When I say my main motivation for Step 1 (a then crucial board exam for the residency applications) was surfing, I do not lie. While on the residency interview trail, I found a nice left-handed peeler of a point break in Portland, Maine, while it was snowing and 27 degrees, just to make sure surf was available in Maine. I often ditched class to mountain bike when the conditions were right. These were motivating shadow callings.
As wonderful as it was, the discovery of waves along the West Coast, it didn’t pay the soul’s tab. And it distracted me from working on my issues.
Little highs that kept me from sobering up.
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Mirages
It’ll get better when I get… there.
It’s not that it didn’t get better, sometimes it did. Coming off nights was always nice. Leaving the internal medicine rotation was always a relief. Vacations were great. But it never stayed better. This defined the mirage pursuit.
Step 1
The penultimate glory, a medical student’s manifest destiny, and the hope of permanent salvation. At least it used to be, now it’s a pass/fail board exam. “Back in my day”, it was a no-limit poker game. While a high step 1 score didn’t book your spot into a residency program, it opened doors. I committed everything to that exam. And did well. Still, I will never forget opening the score after a long day in the hospital, feeling momentary elation, then immediately thinking, Was it even worth it?
Fourth Year of Medical School
Fourth year is a glorified vacation for the medical student. The hardest thing I did after interview season was organize our rec league softball team. All of third year, I imagined the possibilities of rejuvenation and restoration of passion, and some of that came, briefly. And then it was over.
The degree of separation between the pride you feel, and your family feels, is never greater than on medical school graduation day. All I saw was a residency grind ahead, while my family saw me as a newly minted physician.
That mounted degree on my office wall didn’t do it either.
Orange County
I had a dream that it would all be fine in California; a magic threshold that would strip away my issues. It was a necessary defense, because if I were to acknowledge the futility of the whole endeavor, I would have gone insane. I had to go live The Grapes of Wrath myself.
No amount of fish tacos, 70 degree January days, or epic waves could solve it.
Part-time practice
I got through residency, barely keeping my hide, and figured surely, I could manage a part-time practice. It’s 20 hours per week man, c’mon.
We needed the money, needed to get settled after marriage, and it was significantly less work than residency. And it paid 2.5x more. One month in, I was depressed. Honestly, if I could have kept doing it, I probably would have, because I’m that stubborn.
That’s how I did it. Eight years of pacification and compromise, all toward the aim of making medicine work. For many years, I searched for something that didn’t require full commitment of soul. All that mirage chasing across the desert just made me thirsty. It only got better when I dug a well.
A beautiful gift of this journey has been my newfound disdain for mirages and shadow callings. The hope, allure, and deferral of responsibility is intoxicating and blinding. I cannot be trusted with them. Here begins my pledge of abstinence.
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