“How’s this one?” your friend asks.
“Looks good to me,” you respond.
You both sit down on the bench and you let out a sigh. You think to yourself, “Was I always this tired?” It’s a beautiful day.
“It’s a beautiful day,” you say aloud.
“Isn’t it?” your friend agrees.
There’s a pause as you both take in the yellow, orange, and red palette in front of you. You remember the drink that’s been warming your hand through the cardboard sleeve.
After a while, you ask, “So, how have you been?”
“I’ve been good,” they respond.
“Yeah?” you ask.
“Yeah. I’ve been busy. But aren’t we all?” they ask rhetorically. “Work. Friends. Family. The usual.”
“It’s always work first,” you note.
“It’s not too bad,” they say, dismissively. “How have you been?”
You think for a second, trying to measure up the last year into a word.
“I’ve been okay,” you say.
“Okay good, or okay bad?” they ask.
“Okay okay, I guess,” you respond.
You both take a sip and there’s a silence.
“I’ve been worried about you,” they start. “You seem distant.”
“I appreciate it. I’m doing ok,” you respond, almost reflexively.
“Are you sure?” they ask. You hesitate.
“I guess I’ve been tired,” you admit. Your friend nods and says nothing.
You continue, “I’ve been doing a lot. I’m not really sure where the time goes. There never seem to be enough hours in the day.”
“I can understand that,” they say.
There’s a light breeze.
You add, “I don’t know. Everyone is busy. Everyone here is doing a lot. Many are doing much more than me. And outside of medicine, people are working just as hard, if not harder. I know you know how that is.”
Your friend nods in acknowledgement. There’s a pause.
Then, they ask, “Are you enjoying the things you’re doing?”
“I guess,” you say, sighing. “To be honest, I’m usually so caught up in doing them that I don’t have time to think about how much I like them. I like them in theory. And I like when my mind is occupied. But when you’re studying, you know, you have a purpose other than enjoying the material. We’re all just trying to pass. Enjoyment is not exactly prioritized in the curriculum.”
“Why is that?” they prompt.
“Well, I guess it’s just an expectation that at baseline, medical students know what they’re signing up for and have decided that it’s worth it. That anything that we experience in medical school can be justified because we filled out the applications, did the interviews, and accepted the position; we chose this. Sometimes it seems like the whole process was a big screen to find people who, among other things, would either enjoy medical school for what it is or could at least delay their own gratification through preclinical, and clerkships, and residency, and maybe a fellowship.”
There’s another pause.
“I thought I was the first kind of person when I was applying. But now, I’m just trying to be the second,” you say.
Your friend looks like they’re thinking. You take another sip.
They ask, “Is medical school what you thought you signed up for?”
“I don’t think so,” you admit. “I mean I talked to people – medical students – beforehand. I was warned…”
Your friend laughs.
“…but nobody really knows what it’s going to be like. You just have to do it and be in the middle of it. And then you can understand what it is to be in medical school. How tired you are in just about every way.”
“That doesn’t sound healthy,” your friend remarks.
“It’s probably not,” you respond. “But what are we supposed to do about it? What is there to do? We signed up for this. The time to do something would have been before we accepted a spot in the incoming class. And people tried. But we didn’t listen. I’m not sure if there is a way that we could have been convinced not to.”
“Is there a reason you couldn’t be convinced not to go to medschool?” your friend asks.
You scoff at your past self.
“Probably hubris,” you say.
The word hangs in the air for a second with the sounds of leaves catching on the pavement.
Your friend is the one to break the silence.
“That’s a heavy accusation for all 50,000 applicants,” they say.
“I suppose it is,” you reply. You sigh again. “I really can only speak for myself. But I guess maybe part of my hubris is that I think that I’m not the only one.”
“So then you think you still have that same hubris from a year ago?” they ask. “You don’t think you’ve changed?”
“I guess I have. I mean, I know I have. I’m not the same person I was when I came into med school. I’ve learned a lot, I guess. Or at least I’m supposed to have. I’ve changed as a student. I’m probably a worse student now,” you say with a laugh, before growing serious again. “But I’m also tired. I feel overwhelmed a lot. And sometimes, when I feel overwhelmed, I also feel this sense of emptiness. Deeply. Like this is just how it is now. This is life. And, we joke about it a lot, but sometimes when you’re joking, you have a moment where you stop and ask, why did I do this?”
You pause to see if your friend wants to comment. They seem deep in thought.
After a moment, you start to backpedal. “Sorry, I’m just ranting again. You asked if I had changed as a person. And I think I have. I think I’m more disillusioned with medical school and medicine than I was before. I think I’m less optimistic now, and less creative, and probably more anxious than I was ever before.”
Your friend nods and says, “Perhaps those things aren’t lost, though,” they say.
“Perhaps not,” you reply. “But sometimes, it’s hard not to think they aren’t lost. Some weeks I barely have a moment to do something for myself. And it’s only supposed to get worse in clerkships and residency. You see what I mean about the hopelessness thing?”
“I do,” they say, and you believe them. They seem at a loss for words, and you feel you’ve said too much. The silence grows once more.
There are two brightly colored lawn chairs in the grass, one turquoise and the other coral blue.
Slowly, your friend says, “It sounds like there’s a lot that you didn’t expect, and, within that, a lot you haven’t enjoyed. Are there things that you anticipated enjoying as well?”
“Yeah, definitely,” you say, relieved to be on a lighter topic. “There were a lot of things I had hoped for that have since come to pass. We learn many cool things about the practice of medicine. Sometimes, we get brief glimpses into how what we learn in lecture can be used to help real people. And that’s incredibly rewarding. For a moment there, we feel like real doctors.”
“That sounds really nice,” they affirm.
“It is. It’s why most of us are here in the first place,” you say. “And I like a lot of the things that I’m doing, too. I like my patient-facing volunteer activities and organizing events that bring people together and my research. The people here – both my classmates and faculty – are amazing, and I feel very privileged to be here with them. I don’t mean to make it sound like it’s all awful.”
“That makes sense, and I’m happy to hear that,” they say, smiling. Then, they ask you something you haven’t really thought about. “Is there anything you’re looking forward to in the future?”
“That’s a good question,” you say, and you think about it.
“Honestly, I guess I’m looking forward to clerkships, even though I know that it will be truly difficult,” you say. “But it’s closer to what I wanted, to what I envisioned medical school to be, even knowing that we would have a preclinical part of the curriculum. And, I’m tired. I’m tired of waiting to do the things that I want to do, the things that brought me to medicine in the first place. Taking care of people. Learning what it is to actually be a doctor. I know that the preclinical curriculum prepares us with the knowledge needed to understand what happens in sickness and in treatment. But I’m tired of delaying gratification, as flimsy of a reason as that seems.”
“I don’t think that’s a flimsy reason,” your friend contends. “We’re only human. We can’t put off our happiness forever.”
“You’re right,” you acknowledge. “I suppose the same goes for residency, and, eventually, being an attending. I’ll have more responsibilities then. But I’ll also have the knowledge, experience, and autonomy to practice medicine. To make a difference in people’s lives. To care for people in ways that I wasn’t able to do before – ways that I’m not capable of right now. And that’s when medicine will be truly rewarding. When I can finally believe that I am doing everything I can to prevent suffering.”
They don’t say anything, and you pause for a moment in anticipation.
Then, you add, “It will also be hell, and I know that. I have a friend who started residency this year, and it seems insane, even compared to medical school.”
“And you still want to do it?” your friend asks.
“Yeah, I think so. It’s what I’ve wanted since I decided to pursue medicine,” you answer.
Far away, a car slows down on the street and turns on its hazard lights. Slowly, the car backs into a small space between two larger cars, the wheels crunching against the pavement as the tires turn. The angle is too narrow, and they shift forward to pull out of the spot before reversing again. This time, they come in at a wider angle and inch slowly backward, but the space is small, and it’s a tight fit. Your drink is starting to get cold.
Finally, you ask, “What do you think?”
Slowly, deliberately, your friend says, “I guess I’m concerned. For as long as I’ve known you, you’ve wanted to get into medical school and eventually practice medicine. And now, you’re here. And it sounds like there are things that you love about medical school. But there are also many unexpected things that you’re just tolerating. Delaying gratification, as you put it. But you’re tired.”
“Yeah,” you agree.
“You said you were warned, but you still didn’t really know what you were signing up for.”
“Yeah,” you repeat.
“I guess I’m worried. Have you ever asked yourself if residency might be similar?” he asks. “You have this vision of what practicing medicine will be like, and that’s where you pin your hopes. That’s where it sounds like your happiness is, whether you’re a resident or even an attending.”
Part of the orange and yellow canvas bobs in front of you. A bluejay lands on a branch.
“You were warned. You knew it was going to be bad, and that hasn’t deterred you. But what if you don’t know what you’re signing up for? What if your idea of residency or being an attending is about as true to reality as your idea of what medical school would be?”
The bluejay perched between the leaves cocks its head to the side, its black eyes searching.
“But now, it’s more time. Decades of your life instead of a couple years. And maybe it’s worse than you anticipated, even compared to the things you didn’t anticipate with medical school. Things that weren’t what you expected. Maybe it’s the things that weren’t even on your radar that end up being the most draining.”
The splash of blue freezes and fixates, its white belly heaving gently.
“And now, you’re stuck with those things. Tolerating them. Delaying gratification for sometime later when you’ll be happy. And in the meantime, you just get more tired and more empty. And I don’t want that for you.”
You’re silent, deep in thought.
“I don’t want that for me either,” you reply.
There’s a pause. The bluejay takes off.
Then your friend says, “I guess what I’m asking is, how can you know if this – being a resident or an attending or practicing medicine – if this is what you want if you don’t know what it is that you’re signing up for? How can you know that you will eventually receive gratification after putting it on delay for so long?”
Your coffee is cold.
Brendan Ho is an MS2 at the Perelman School of Medicine.
Image by Grace Wu, an MS2 at the Perelman School of Medicine.
