Whenever I go to the hospital, I wear my grandpa’s socks. They looked distinguished on an older man, but a little childish on a me, a 25-year-old medical student. I’m okay with that. Feeling like an overdressed kid on Easter helps to balance the overwhelming pressure of becoming a physician.
I still see Pop sitting in a chair with his silver hair that was too strong to fall out during chemo. He’s half smiling, with a slight eyebrow raise. Even just thinking about him, I can smell that nostalgic mixture of moth balls and Polo cologne. While one elbow rests on the armrest, his fingers fiddle with a small scrap of paper he always seemed to have. He has one leg crossed over the other, his pants halfway up his shin to display his timeless socks that match his timeless sweater. They were usually wool, sometimes cashmere, solid or a traditional argyle, in classic shades of navy, maroon and grey. Noticeable, yet subtle, they represent maturity, humility and composure. Pop, like his socks and outfits, always seemed so together. This is the Pop I knew.
Then there’s the other Pop. The one I only heard hushed, whispered stories about. This man is belly up, sprawled out on a diving board. Iron weights dangle off his ankles a few inches above the surface of his backyard pool. As the breeze rustles the tree leaves, the winter sun casts a paltry spotlight on a suicidal alcoholic. My grandpa. Pop.
Pop set high expectations for himself. He had to be strong, independent, and successful. He hated the idea of burdening anyone else with his issues, so he swallowed whatever life threw at him. He wanted to be perfect.
With these heavy expectations, Pop, like all of us, had to cope. Opening up or asking for help wasn’t an option; it would have exposed the fact that he couldn’t handle it, whatever “it” was. At first, drinking eased his self-imposed pressure. Eventually, it yanked him into a self-destructive cycle, ripping away the curtain of security that hid his inability to live up to his ivory tower ideals. Unable to meet unrealistic standards, he felt like a failure. Failing, in his eyes, was a waste of life. So, he tried to end his.
Full of pills and alcohol, with weights tied to his legs, he waited on the diving board, hoping to pass out, fall forward, and sink to the bottom of the pool. Luckily, he passed out and flopped backwards.
I don’t just wear Pop’s socks, I wear his demons, too.
Like him, I fear failure. Like him, I want to be perfect. Like him, when faced with high expectations and left to my own devices, I feel the pull towards isolation and the self-destruction. Not wanting to expose my weaknesses or be a burden, my gut tells me to put on a smile, shove down the uncomfortable emotions, and white knuckle through the hard times.
The last time I talked to Pop, he was nearing the end of a steady, but peaceful decline. After overcoming the suicide attempt, a collapsed lung, pancreatic cancer and a heart attack, his body was finally giving out on the last of his nine lives.
As I sludged my way up to lecture, I tried to keep it together. My hood covered my tear streaked face, my silence covered my trembling voice. I walked extra slow, savoring one last chance to get one last lesson. Today, he opened his textbook on life to the chapter about A Bronx Tale, one of Pop’s favorite movies.
“Jack,” he said, “the saddest thing in life is wasted talent.” My talent, according to Pop, was my potential to become a good doctor. I would waste that talent if I followed in his footsteps, suppressed my internal struggles and walled myself off from support. Those behaviors, he told me, brought him to the diving board that day. Connecting, stepping out of his own head, and opening up to others helped keep him from going back.
Talking to Pop was like getting the answers to a test you didn’t know you were going to take.
Now, a year later, as I’m trying to come into my own as a physician, I doubt myself and fear failure everyday. The mental, physical and emotional demands of medicine compound these insecurities in a culture that often refuses to acknowledge they exist. The high-achieving, overly independent atmosphere pushes students to prop up a pristine, image of strength, competence and unwavering resilience. I wish it was that clean on the inside.
Amidst the long hours, competing demands and big tests, we struggle to find time to pee, let alone process the inner turmoil that comes with grieving families, dying patients and tracking our own fulfilling path in medicine. On top of that, none of us want to admit we can’t handle it. All the good doctors seem to be emotional fortresses. Most of our classmates, too, at least on the outside. No one really talks about the trying times, so they must always be fine.
Not me. What about you? What’s the cost of this culture of silence?
No single experience captures the trial by fire that is medical education better than the age old practice of “pimping” — the diarrhea-inducing time when an attending physician pelts you with a series of obscure, “read my mind” questions in front of all of your peers and superiors. The questions rain down until you get one wrong. If you’re lucky, it stops there. If you’re not (you usually aren’t), the pelting continues until you become a babbling mess that can’t decide whether to shrink into submission, cry or simply soil yourself. Meanwhile, everyone externally cringes for you and internally wipes the sweat off their forehead because they aren’t under the lonely spotlight.
One day, after my shift, I’m sitting at a coffee table in the hospital, trying to decompress after getting the intellectual noogie of a good pimp. This one came too soon after the death of a young man, husband and father I was caring for. As I obsessive-compulsively bite my nails, my mind jumps between ruminating on the barrage of questions I just got wrong and wondering what more we could have done for that man and his family. I’m rattled, festering in my own head, and feeling like a failure.
“You all right?” my friend asks as she walks up. She looks just as tired and a little less beaten down than I am.
I want to be strong and perfect like I’m supposed to, so I start reply with, “Yeah, I’m fi–.” Before I can finish, she cocks her head to the side and gives me a look of unbridled disbelief.
“Oh shut up. Come on.” She is unapologetically direct and unrelentingly caring.
I laugh. “It’s that obvious, huh?”
As she flops down into the seat next to me, I unload the last three weeks on her. Moments of grief and frustration, along with the wonderful ones that reinforce the reasons we go into medicine in the first place.
She does the same, recounting the patients who touched her life and the veritable storm that opened up during her Powerpoint presentation on “Diagnosis and Treatment of An Itchy Anus.” Her supervising physician decided to turn a grammatical error into a personal attack on her attention to detail. “What other mistakes will you miss?” he asked. She, too, feels like a failure.
I make a pitiful attempt at a joke about butts, and even though I swing and miss, it at least helps us laugh off some of the absurd aspects of this whole medical student thing. In our self-organized therapy session, we realize we have the same vulnerabilities, fears and insecurities. We’re not alone in this.
I think of the last conversation I had with Pop. This is why I wear his socks. To remind myself to break the silence. To remind myself that we settle our inner turmoil with the support of others. Most importantly, to remind myself perfection is neither a realistic human quality, nor one worth seeking.
“I needed this,” she says. I nod in reply.
Three hundred to four hundred physicians kill themselves every year. One in four of medical students suffer from depressive symptoms, and it just gets worse in residency. Refusing to ask for help, self-doubt, unrealistic expectations of perfection, and loneliness are at the core of these painful stats. We all agree that something has to change. But medicine is a big ship that takes a long time to turn. I’m not sure we can afford to wait for a top down cultural shift to start the conversations around the fundamental highs and lows of the medical student experience. The conversations that remind us we’re not alone.
Every time we choose to swallow the difficult emotions, we waste an opportunity to support ourselves and our colleagues. If we refuse to connect with and understand our own emotions in emotionally trying times, how can expect to connect with our patients’?
As his health deteriorated, Pop loved to discuss with me his echocardiogram results, medication changes, and fluctuating prognoses. ”My East Coast Doc!” he’d say when I answered the phone. “As your career goes on, you can think of me and all my woes.” He’s referring to the heart failure, the pancreatic cancer and the lung he damaged falling off a ladder.
I told him I would always think of him. And I do. Every time I put on his socks and go to the hospital, I think about Pop and all of his problems. Just not the ones he hoped.