The A in MD
The first time I really thought about mental health was right after a psychiatry lecture in second year medical school. I turned to a friend in the class and said, “I think I have OCPD.”
He replied, “I also think I have OCPD.” We laughed. Medical school selects for people who are perfectionists.
“You know what they say about physicians?” he asked.
“What?” I asked.
“We are like batteries. We come in Type A, Double A, and Triple A.”
“I’m a Double A.” Then we proceeded to identify the Triple As in our class, the people who heightened our feelings of being not good enough.
“Some of them also look perfect. How do they achieve this?” I asked.
“Steroid abuse and anorexia,” he replied facetiously. We laughed even harder.
It wasn’t until I ran into a couple of my classmates in the hospital during third year medical school that I realized how serious these issues were amongst my peers. Steroid abuse and anorexia, exactly as we had joked. Taking perfectionism including toward their body image to the extreme had a toll on their health. I had expected that as part of the rite of passage to becoming physicians, there would come a time when we’d practically be living at the hospital. I just thought it would be as physicians, not as patients.
A few years later, when I met another colleague at a restaurant with an amazing tasting menu, I learned about the sudden passing of one of our colleagues. He had died by suicide. I wondered what happened. He was a Triple A. I remembered seeing his cheerful face when he talked about his amazing achievements. What happened to all this happy energy? Was this a façade? I recalled one of our mottos was, “Fake it ‘til you make it.” I thought he was talking about how we felt like imposters who are not good enough. It could also have meant that he was pretending to be okay. I thought his great attitude would carry him through. What happened to the “there were so many applicants and we were chosen to be physicians” attitude?
I remember him saying that there were so many things we could have chosen to do with our lives, but instead we chose to be physicians. He questioned what we were doing with our lives. He seemed to be burned out. Was I?
“We are eating a twelve-course tasting menu,” I answered, not wanting to think about the questions he asked any more.
“Dessert?”
“Sure,” I said. We got a brief exercise from walking two doors down before going into a different restaurant. I recalled a motto at a restaurant that served Taiwanese cuisine: “Desserts is stressed spelled backwards.” It also fits that How are you? in Taiwanese directly translates into Have you eaten yet? and a response of Not well translates into I have not eaten yet. Hence, my response was to share two desserts and make it a fourteen-course meal. Afterward, I felt extremely full and yet unable to ignore a sense of emptiness. Why was this emptiness so unfillable? Soon, the unanswered questions and the horror were muted by a calm grogginess. However, the desserts only temporarily took the edge off my distress.
There came a time when the band aid solution of ‘food-coping’ and avoidance coping no longer worked and I was forced to confront my own problems. I was disappointed that even as a staff, I was still in survival mode and realized I could not continue like this indefinitely. In truth, I had felt burned out at some point during almost every stage of my education. I took multiple second year courses in my first year of undergraduate degree to expedite my education and I got my MD at age twenty-four. I started my career working five different clinical jobs plus doing academic work. I went at life with an unsustainable intensity and rigor. It was as if I was going through life like it was a crash course - with multiple crashes. Perhaps it was simply easier to occupy myself with work than to pause, look inwards and confront my past and current problems. The doing, the over-doing, the compensating, and the over-compensating were attempts to fill the bottomless pit of feeling not good enough.
Working as a solo MD on call 24/7 at a retirement home with a COVID outbreak, facing a shortage of personal protective equipment and staff, and watching the infection spread as more of my patients died was the final breaking point. With the feeling of ‘not good enough’ consuming me, I questioned every one of my decisions. I oscillated between feeling numb and distressed, an intense feeling of horror, helplessness, frustration, dread and other indescribable feelings. I realized how difficult it was to reach out for help. I felt that hard work is celebrated and helping others is expected for physicians. At the same time, reaching out and getting help myself came with a great sense of shame and guilt. I had a double standard where it was okay to care for others, but not okay to care for myself. Battling the ambivalence, I finally found the courage to e-mail a psychiatrist running a support group. We met that night. Taking off the white coat and becoming a patient made me feel extremely vulnerable. I couldn’t shake the feeling that somehow admitting my flaws would mean that I was not good enough to be a doctor.
One of the most comforting things I heard was from a psychiatrist who talked about working in mental health and how we viewed people in mental health. “It is not us versus those people. We are those people,” he said. It reminded me of the common struggles of being human and how hard life sometimes gets. It helped me take off the mask that everything was fine and acknowledge my own problems.
The journey of healing really took off when the psychiatrist from the support group referred me for individual therapy. In therapy, I developed a new kind of awareness and the courage to explore my inner self. I was better able to process and tolerate what had happened and make sense of it in a more self-compassionate way. As difficult as it was to reach out for therapy and confront all my painful feelings and memories, I was glad that I did it. The insights made me a better physician and psychotherapist. When I looked back on the craziness of the doing (and over-doing), I felt too much A in an MD only got me to MAD. I developed a new relationship with myself, one involving a new kind of openness and honesty. It also allowed me to have greater compassion towards others and accept that sometimes things are simply perfectly imperfect.
