Medical school has been a rich, challenging experience for me. I want to write about how medical school has challenged me to confront my sense of self-worth. Even though this is a tough topic for me to synthesize into a small blog post, I feel it’s worth sharing my growing understanding of how med school has—like a crucible— helped me grow as a person.
There are few things as challenging as med school in my life thus far. The challenge hasn’t been necessarily an intellectual one, however the emotional tests have been significant. How I conceptualize and appraise my self-worth has become extremely important, because medicine is a practice that is difficult to learn to do well. It requires memorizing huge bodies of knowledge and then being ranked among your peers via standardized exams that test your ability to remember that knowledge. Medicine is also something that only the best-of-the-best are “allowed” to do, hence making the field of learners an exceptionally high-achieving and “successful” group. It’s hard to rise above the urge to compare one’s self to others. Furthermore, the learning curve is steep and littered with emotional land mines. It’s the kind of work that requires sitting with the most troubling, perplexing, complex, and often scary parts of others; it’s also the kind of work that pushes me to reckon with life and death among other big philosophical questions daily. That process brings to light my own fears and my own existential tensions. It’s also physically demanding; it pushes me and others to the point of exhaustion from sleep deprivation or standing for hours on end in surgery. And despite the fatigue, medicine also demands extreme ethical integrity and a deep, deep sense of compassion. The work—whether with a textbook, with patients, or in regard to self-development— never seems to be done. To top it off, I’m also a brown, indigenous woman in a field where Black, Latinx, and Native people make up less than 20% of the workforce (according to AAMC data from 2010). These medical school realities are what challenged me most because they required that I re-evaluate my sense of self-worth and reconsider by what criteria I measure my value. Was I going to let what other people think of me (or my perceived beliefs regarding what other people think of me) determine how I felt about myself? I decided it was time to develop a new way of appraising my self-worth that was unattached to what others think.
A big part of coming to terms with an endogenous sense of self-worth was coming to terms with a fear I had (and still work with constantly). I feared people seeing who I “really” am (whatever that means!). At some point during these first years, I realized I was bottling up a lot of my feelings to simply make it through the week. I began to worry about this phenomenon. I worried that I couldn’t cry or feel the full range of my emotions, and that by holding it all in, it would make me sick. I worried my body was stuck in a perpetual state of epinephrine and cortisol fueled fight-or-flight. My tingling hands and the kick I’d feel in my solar plexus when things got stressful at school, in clinic, at the hospital, or even at home with my family only confirmed for me that I was having an autonomic nervous system response to my emotional state. I realized I was tucking feelings away because “things weren’t safe” enough for me to feel openly and be vulnerable with those around me, which really bothered me. How could medical school training feel so dehumanizing in that way? If I didn’t feel safe to voice my hurt or self-doubt or fear in front of my peers and mentors (nevertheless challenge a superior if I felt they were making a mistake), then what does that say about my/our training and my/our profession? Also on a more personal note, if I feel the need to emotionally shut down, then where did I learn that survival strategy, and how is it associated with my earlier life experiences? I took finding answers to these questions seriously.
I learned through my Healer’s Art course with other MS1s that I wasn’t alone. There were so many other people— especially people of color or first generation students who were struggling with a crippling sense of self-doubt and loneliness; they also felt the need to “hide” their “real” selves. It helped to talk with others to whom I could relate and learn I wasn’t alone.
I also learned that there are proponents of creating professional cultures of vulnerability and openness (e.g. the work of Brené Brown https://business.linkedin.com/talent-solutions/blog/talent-connect/2017/why-being-vulnerable-at-work-can-be-your-biggest-advantage-according-to-brene-brown and Mark Robbins https://www.forbes.com/sites/hennainam/2018/05/10/bring-your-whole-self-to-work/), and I met with a leadership mentor here at my medical school who was extremely encouraging. I also found a few physicians who embodied the traits of authenticity, gentleness, and vulnerability that I highly admired, and I befriended them. That also helped. But the deeper, personal work remained. Finding an intrinsic sense of self-worth– a self-worth unattached to what other people think of me– remained as a daily project.
The work to build self-worth couldn’t be rushed. After all it is a form of healing. I committed to finding a good psychologist to help me crack open this pattern. I was tired of feeling like I’d readily stuff my tears back down my throat and into my stomach than show them outwardly. All my fear and shame and sense of vulnerability I would tuck into my belly, and I felt like I was getting sick. I wanted balance among various parts of myself, including some part of me that wanted to keep my authentic experience of the world under lock and key.
But do you know what really kicked my self-healing impetus into high gear? My worry came true. The physical fruits of the exile of my emotions and my vulnerability cropped up earlier this year. I started getting hideous eczema flare-ups. And ovarian inflammation and unusually intense pain upon ovulation. And then GERD. In short: my body and mind were stressed and fired up (literally) and inflamed to the point of being acutely symptomatic.
“What do these symptoms mean…?,” I wondered. How have I — the budding healer– all of a sudden become the one in need of healing? My body is no longer able to compensate for these neglected stresses in my life, my suppressed feelings, my insistence on being strong. But instead of languishing in the shadow of this reality, I learned (from Susun Weed and another herbalist in North Carolina whom I admire) that I could see these fruits of my experience with a positive, growth mindset as symptoms of my healing. These “problems” are simply messengers, pointing me toward the path I need to follow. There is nothing wrong with me; my actions and my symptoms are simply extensions of adaptations (even if they’re not very sustainable or nourishing adaptations) to my environment. I thus embarked on a thorough process of bringing balance and healing into my life.
I’d like to highlight two important aspects of this process for me. 1) I’ve been working with an awesome psychologist who practices Internal Family Systems, and through talking with that practitioner, I’ve been inching toward understanding and releasing old habits and patterns. This has been building resilience in me. 2) In regard to my eczema, dermatology had nothing to offer me beyond corticosteroids, so I sought help from a renowned Traditional Chinese Medicine (TCM) doctor in my community who has treated my eczema by prescribing me a specific diet, herbal medicines, and a regular acupuncture routine. That helped immensely, and I haven’t had a single flare-up in the past two months.
All in all, I’m learning to be more honest with myself and others by leaning into a vulnerable and courageous space— personally and professionally. I worry less about what others think of me. I see the old patterns of thought that I carry with me from childhood and do not let them consume me. I seek authentic relationships at work and with my peers by being extremely upfront with people about what I don’t know and what I’d like to learn as well as how I feel. I cry with patients and don’t shy away from their suffering as much, because I’m less scared of my own suffering. I come home and let myself cry about the hurts and sadness I feel some days; I try not to hide from myself or my partner as much anymore. I also carry a more mindful perspective on food now. This is all to say that I’m still “in process”— not done, not perfect, but also not broken. Just emerging into a state of deeper integration with lots of good professional and personal support, for which I’m extremely grateful.
It’s been tough to synthesize all these different moving parts. I think I’ll look back on this time of my life later and see it with much more clarity, but for now, I know I’ve made some progress because I’m able to see all this stuff with a touch of perspective. While I write much of this post in the past tense, it’s still very much part of my present. The work continues. As med school will undoubtedly continue to be a challenge and being a physician will also have its challenges, I feel that I’m learning— on my own time!— the skills necessary to handle it with a little more grace.
karuṇā 