Trigger Warning: Suicide
Dear MS1s,
Y’all no doubt have already been bombarded with messaging about wellness at orientation or maybe read online on the internet. Jumping topics rapid fire from “imposter syndrome” to “professionalism” and even “team-based learning.” It’s tough to learn anything about what these terms really mean when it comes to your personal experience as a medical student. I want to speak a little bit about the idea of “delayed gratification”. Every step of your education, you probably have someone whispering in your ear that things will get better in the future. “Oh it’s going to be better in medical school, that’s when you know you’ve really made it”, “Oh it’s going to be better in clerkship, at least you’ll be treating patients”, “Oh it’s going to be better in residency, you’ll at least be getting paid”, “Oh, it’s going to get better as an attending, you’ll….”
Stop. Right there.
Let me tell you a little bit about my personal experience these past couple of years. My March 2020 wasn’t much different from anyone else’s. I had taken the spring semester off from school to do a research fellowship. So when COVID hit, I was ripped from the lab and left with nothing to do except to spend time on my Animal Crossing island, failing on end to catch a sturgeon before they went out of season. Without any lab data or classwork to occupy my mind, I was stuck alone with only my own thoughts to keep me company. To put it bluntly, I was miserable. And that was before I got the phone call saying that my childhood dog, Boba Fett, needed to be put down due to cancer that had metastasized multiple times. Looking back at it, I was depressed, but I kept telling myself that this feeling was normal. That everyone going through this kind of experience, being stuck in their home with a poorly understood illness ravaging the world would make anyone feel sad. And in the grand scheme of things, others had lost more than me so I can’t have it that bad. Right? I forced myself to focus my energy on my medical school applications, trying to tell myself that the hard times would pass and I would be happy when I got into medical school.
Fast forward to the summer of 2021. I had done it! I got into Penn! At the time, I had felt a brief sense of elation, but that feeling quickly faded as I returned to grind out my senior thesis and teach my workshops/problem sets. I thought it might come back when I graduated, but the stress of working out the logistics of moving across the country for the first time smothered any real sense of pride in my accomplishment from growing. This too shall end, right? Once I’ve settled down for medical school, I’ll have some time for myself to celebrate all my hard work culminating in this accomplishment.
I spent as much time as I could that summer trying to hang out and catch up with any and all of my friends who were around. One night I was hanging out in a voice call with a couple of friends doing my own thing while they were playing League of Legends, when one of them asked me the question: “Justin, what do you do like to play for fun?” I didn’t take him seriously: you’re playing League and the mid-laner is feeding, of course you’re not having fun. After insisting it was a real question, we had a conversation where they revealed that they hadn’t been having fun recently playing video games, and eventually we concluded that maybe this was just that process of growing up. I remember going to bed thinking that something seemed slightly off, but didn’t think much of it at the time.
A week later I read one of the worst messages of my life thus far:
“hi everyone, this is X’s brother Y. thank everyone who helped make him happy. thank you for playing with him and helping distract him from this life. on the night of the Zth he left us. if y’all have any stories please feel free to text me @….”
I was devastated. I could not stop thinking back to that conversation we had just that little bit ago. The red flags were flashing a bright neon, and I still was too blind to catch them. I had grown up with him, played with him, and had only recently started exploring the undeniable sexual tension that we shared with each other. But what had been an ever-evolving story with my friend was now but just a memory that only ever grows more distant. The rest of that summer was a blur between the funeral and everyone in our friend group doing their best to support each other. And then suddenly I found myself in Philly.
I was miserable the first couple of months adjusting to Medical School. I suddenly found myself in a completely new environment over 1,000 miles from home without a lick of a support system in place with no family or friends or anyone I even just knew a little around. Philly sometimes felt hollow and empty on the weekends where everyone else took short trips home while I hoped I could find flight prices that dipped below $200 dollars. That “better” future I had so desperately hoped for and clung to had not arrived. I remember being spoken to about that idea of delayed gratification and just wondered “when does it end? How long can I put off my own happiness?” Everything around me was just telling me to wait for that next major milestone, but the previous two hadn’t done anything. Conquering a COVID senior year, graduating college, getting accepted into medical school, these were but bandaids over a festering wound. So why should I expect any of the next 10 milestones to be suddenly the one where everything falls into place and make things better?
♪ It’s hard to light a candle, easy to curse the dark instead♪
Why do I share all this? Maybe a little bit of it is personal catharsis, but I want you to understand going into your MS1 year, that you are the same person you were before you started. If you weren’t happy before medical school, then no donning of your white coat or residency match is going to change that feeling and suddenly make you happy. That doesn’t mean that there isn’t a light at the end of the tunnel, just that light won’t suddenly appear because of the arbitrary passing of time. That light will appear because you made it appear. So don’t be afraid to ask for help, to seek therapy, start an SSRI, start taking yoga classes, go to Igloo more times than can be healthy, do whatever you need to do to get yourself to a happy place. The onus for that is on you because—trust me—you will not find personal happiness from the medical school itself. You will have friends from the school, but do not give the school credit for the joy and happiness those friends will provide you. And remember that lighting that candle is going to be hard, so feel proud of yourself every single step along the way, even if that step is as small as getting the matchbox or just striking the match. Stop delaying your gratification, because the most important patient of all is yourself. So close your notes, put down your anki cards, leave that lecture when you realize your morning coffee isn’t hitting, it’s time to take care of yourself in the here and now.
The longer you wait for the future, the shorter it will be.
To those who may not currently be going through any personal struggle of their own, be there for your classmates. Before writing this piece, I had never shared this story and my struggles because I thought I wanted to have some modicum of separation between what I wanted to be different chapters in my life. In hindsight, that was not the best way to handle my tribulations and I likely would have been better off reaching out to those around me for their support (I fully expect that I may be receiving loving, but angry, messages from my learning team and other friends when they eventually stumble on this piece online for not sharing my struggles earlier). But I can still see how the siren’s song that allured me to silence may entice others down the road.To get to the the point of even having the privilege to attend medical school, a lot of us have been conditioned to accept nothing less than perfect or at least close to it. The fear of being honest with yourself and admitting that “I’m not okay” can be crippling.. So be there for your classmates, don’t pry into it, but know that they may be going through struggles that they’re not comfortable sharing. What helped me push through the first year was the good company provided by my classmates. They may not have known it, but it was them who helped steady me when I was teetering. Form a community that focuses on lifting each other up even when it isn’t asked for, and you will always have someone there to catch you whenever you may fall.
Justin Greisz is an MS2 at the Perelman School of Medicine.
