UNPEELED

Those first days of my nascent medical career were filled with naïve certainty. Late nights memorizing immunological cells and pharmacological equations were supported by the rush of purpose—my head held afloat above a stream of flashcards and study guide pages by the excitement of being part of something that mattered, something that changed lives. Medicine and research seemed like the most meaningful work I could do. Everyone around me was seemingly driven by that same sense of purpose: the doctors, the nurses, the researchers, the social workers. It was all about striving toward answers, pushing toward something better, something that helped people.

Rarely, I feel the ghost of that White Coat Ceremony cardiomegaly arise in my chest. But it has become increasingly ephemeral over the past three years, fluttering for only a few beats before fading away. Looking back, that initial sensation feels slick with self-indulgence.

At first, it seemed to be a normal part of the process of becoming a doctor—dread, fatigue, the pressure of the long hours staring at a screen instead of other human beings. After all, the medical school pushed wave after wave of anti-burnout activities at us. “It’s normal to feel this way,” they said. “Here! Have a cookie! Do some yoga! Let’s go bowling!” 

But, as time went on, I could feel my certainty become frayed. I started seeing the machinery of the system for what it was: a complicated web of bureaucracy, funding constraints, and egos. I began to notice how often the human aspect of care took a backseat to efficiency, to finishing notes, to getting patients out the door. For many, patients stopped being whole people, their stories compressed into a list of symptoms and the plan. Research became about how many posters and publications one could squeeze out of a single project, not the people or communities whose lives were supposed to benefit.

A few weeks ago, I sat across from a well-known researcher I’d admired from afar for years. After a while, the conversation drifted from a discussion of his storied career path to mine, as yet undefined.

“I feel pretty disillusioned with it all,” I blurted, before I could stop myself.

It felt strange to say it out loud. In some ways, it felt like admitting failure—not just to him, but to myself. But there it was, the truth spilling out: the constant grind, the way everything was always about the next paper, the next application, the next patient. Not just in my own mind, but in the emails from mentors, the lack of eye contact from attendings during patient presentations, the medical school’s sirens about the looming phantom of residency applications. The bigger picture, the purpose, felt like it was slipping further and further out of reach, buried under a mountain of routine tasks and expectations.

He leaned back in his chair, a slight smile curling at the corners of his mouth.

“Good,” he said.

The word hung in the air between us.

He paused, taking his time before responding. “At the beginning of each semester I tell my students, if they’re not angry, frustrated, or disappointed at some time during my class then I’m doing something wrong,” he explained. “Yes, the world isn’t as you imagined it, but that’s when you can start to actually make a difference. If you still think everything is perfect, that your aspirations can slide along on greased wheels, you’re not really looking. If you’re disillusioned, it means you’ve begun to ask the hard questions—and that’s when you start to grow.”

I wasn’t sure if I felt better or worse after the conversation, but his words lingered.

The truth is, the more I’ve learned—about medicine, about the system, about the thousands of people involved behind the scenes in billing, legal, and other mysterious unnamed departments—the more complicated everything seems. Medicine isn’t the neat, heroic picture I had imagined. It’s full of contradictions: the doctors who care deeply but are forced to race against time; the research designed with good intentions but often affected by institutional agendas and funding realities. It was surprisingly easy to peel back the veneer of idealism, a thin-skinned tangerine, and see the messy, stinking guts underneath.

I’m not sure I’m any closer to understanding where this path is leading–it turns out a lot of medicine and research is the blind leading the blind–but, putting a name to the feeling has re-ignited my determination to have an (ideally positive) impact, even if it’s only for one person a day. And maybe that’s the discovery that matters most: learning to see the field for what it is, with all its imperfections, and finding a way to navigate it with integrity. Because the answers aren’t as clear-cut as I thought they were, but maybe the questions themselves are more important than I realized.

Description:

She hopes this piece resonates with anyone who has had similar moments of uncertainty or disillusionment with the field of healthcare but carries on with the hope for something better. Here's to discovering the good, the bad, and the ugly parts of something and choosing to love it anyway.