Is this a date, a new friendship, or a professional meeting?  I’m stoked for any of the above, but I could use the clarification because the rules seem different here.  This is a giant game of tease.  Where is the line between work and play?  Where is the line between personal and professional?  Am I no more, is my individual soul lost to what is now my professional and semi-professional persona?  Is it all pretty dresses and smiles, occasionally mixed with mild consternation and clinical concern, but never enough to be truly vulnerable?  Am I now in the land of never knowing, of assuming that all relationships, coffees, and beers are professional all the time, even in what used to be private spaces? The only thing that is well defined is that everything must be kept at arm’s length from the truly personal, intimately emotional.

What keeps you going late at night? When you’re on your 16th hour of studying, where do you draw your motivation to push forward?  A general “want to do good” is not good enough; it doesn’t pull enough.  A friend asked me this the other day over one of these vague beers described above. His fuel came from the memory of a psych patient who was dismissed by all the other staff, and thought to be trouble.  Turns out he was a virtuoso pianist, which my friend discovered after a genuine conversation, and they were able to get access to a piano which was outside of the normal bounds. Suddenly this man came alive.  I don’t know if his outcome changed because of this event, and it doesn’t matter.  The point is that we must connect person to person, not clinic note to clinic note.  If we don’t look each other in the eye, really look, what is the point?  We are all people, not numbers, not statistics.

Science is built on statistics, and therefore so is medicine. When I was working on a research project in medical narratives, I got to interview Darshak Sanghavi, Harvard pediatrician and author, and one of the things that he said that has stuck with me was that it’s only been about the last 100 years when the practice of medicine was able to have an impact on outcome with any probability greater than chance.  There is no question that the ability to have an actual and meaningful impact on outcomes necessitates the use of science, and research, and numbers, and statistics.  Science matters; so does our mastery of it. We need the science, but we also need to retain our essential humanness, unless of course, we don’t want it.  Personally, I don’t want to lose my soul to statistics.

I am not a robot.  I feel that everyone around me can just go like clockwork, tick tock, tick tock, study, exercise, tick tock, study, tock, eat, tick, study, tock, study, sleep, tick, study tock, ad infinitum. I have too many feelings for this.  There is too much grey in my world, my heart, my mind. In orientation we get a pep talk that if we are feeling depressed or anxious, that it’s totally normal (in fact, I think we actually got a statistic about it), and that we should not feel shy to reach out for help.  But what is that reaching out?  It is a formal meeting in an office where you get applauded for being proactive about seeking counseling.  It is a blurry coffee that ends with a brief hug and benevolences. I think I’m craving the tears, the sweat, the blood. This is the most stoic and clinical and most formulaic conceptualization of depression that I have ever witnessed.  But I suppose, where is the help supposed to come from?  We are all equally overwhelmed; we are all drowning in an every rising tide of information. Our advisors are kind and polite, but then again they also have a “duty to report” on your final residency application if there’s anything they know about you that meets certain (negative) criteria.  There’s no spirit of honesty and openness there.  “Yes ma’am, I’m doing fine.  I recognize that I am being challenged in many ways and will take the appropriate steps to address physical and mental health, thank you very much… “  … Goes home and bawls alone in room and feels like drowning… wishing for some semblance of humanity from this world of automatons…

My advisor mentioned the common occurrence of “imposter syndrome” for first year medical students; feeling like you’re an outsider, like you don’t belong, afraid that you will be exposed as a fraud.  For the first couple weeks I kept looking around thinking how lucky I was to be here.  Do you know how cool this is?  To have most of my bills paid for by loans that were pretty easy to get; to only have about 4 hours of class most days; to have accesses to oodles and oodles of student groups eager to volunteer and get involved; to be surrounded by this constant excitement of possibilities; to feel like the world is open to however much I want to work to get there?  I know that I earned my spot through years of working on my credentials and preparing myself in many avenues.  But I look around at all the smiling, ostensibly innocent faces around me: second, third generation doctors-to-be, doing what they’ve been bred for. This is the path that was expected and planned for them; maybe in some way that loss (lack?) of autonomy is worse, maybe more confusing if it wasn’t an active, intentional, deliberate choice of masochism supposedly in the service of others.  Perhaps, when different, the proscribed and the subscribed paths will always be at odds.  Six years ago, I was a college dropout working three jobs trying to pay my bills, and still falling behind.  Today I feel a greater kinship with the people checking me out in the cafeteria than with many of my fellow classmates. I am blue collar stock; I don’t come with papers.  To get this opportunity is such a privilege, and I almost can’t stand how it seems to be taken for granted by some.  And I know that for others, the journey has been even more difficult, and more winding, and more challenging than for me.  But as society goes, this is an extraordinarily privileged life, and I still don’t know what to do with that sense of privilege, or what it means to fail inside of that privilege.

For me the question is not “do I belong?” but  “do I WANT to belong?”  Do I want to fit in here?  Do I want this to be my life?  Do I want to assume this identity, one of a body of cooly composed providers trained to be competent caregivers exerting a calculated mix of clinical skills and critical reasoning, interjecting carefully constructed phrases like “that must be hard for you,” because those phrases have been studied, and proven with statistical significance (p<0.05), to increase patient satisfaction and perception of quality of care? Do I want all my relationships to be clouded with the haze of semi-professionalism, and lack of true grit?  Last week, I went to a grunge/rock/trance concert and for the first time felt like I was finally with my people, those with tattoos and piercings, with black clothes and wounded hearts, complicated families and twisted stories. For many that is one of the only places that we feel that we belong: in the dark, in the noise, surrounded by the pounding rhythm and sweaty bodies of those who are patriots in our emotional fight against this stoic world.  The chance to feel alive together means that we have the chance of being alive together, crying together, fighting together.  Many of us have too many feelings to march on like little ant soldiers; we see pain, beauty, torment, love.  I cannot give this up; it would be betraying a part of myself.

Why am I here?  What will keep me going at the n^th hour of studying minute, dry, scientific details that in all honesty I will probably never need in a clinic?  The answer hit me with my first conscious breath yesterday morning; I am doing this for the others.  I am an other; I will always be an other; and I am here for us. I can think of four separate incidents in four separate specialties when I was a patient and I was treated very poorly by providers based on how I look, how I present, how many piercings I have, how black my clothes are.  The most recent was in March of this very year, well after I’d been accepted to medical school.  Maybe I will elaborate on these in a later post, but in brief, I have been asked to leave a doctor’s office “because I wasn’t going to get what I wanted here,” I’ve been denied pain medication 24 hours after a shoulder reconstruction,  I’ve been pressured – while naked in a hospital gown – to sign a consent to undergo surgery to remove a dermal piercing because “isn’t it time you let go of that… why would you do that to yourself in the first place,” and I’ve had to endure an extraordinarily uncomfortable vaginal exam in front of a room full of blatantly homophobic staff just so I could get some Diflucan.

We can’t choose when we get sick.  We can’t choose when we need to go see a doctor.  Many of us don’t have the financial resources – or the time – to shop around for a provider we feel most comfortable with.  Most of us can’t choose our ER doc, our anesthesiologist, our surgeon, our psychiatrist.  I am here for the others.  I accept that I am – and must be – different from those around me, because I am not here for them.  I don’t want to lose my humanity.  I don’t want to lose my urge to scream at the sky or cry in the bathtub, because that is what makes me the most human.

Still, for the sake of survival until the finish, must I don a C-3P0 costume for this four-year-long-Halloween-party, and hope and pray that it doesn’t fuse to my fragile, scarred skin, later becoming impossible to remove?