An open letter to the hopeless romantics of medicine

“Are there other questions?” I asked the eager medical student who shadowed me that day at the clinic. He stared down at his notepad where he had meticulously taken notes during our session.

He replied, “How do you stay positive?”

Astonished because those who know me would not necessarily describe me as “positive”, I asked him what he meant. He replied that in his short career so far as a medical student on rotation he already felt cynical. The pandemic made him feel that the patients no longer cared what the providers had to say and decided from one day to the next that our degrees and years of education and hard work did not turn into anything.

While we all in the health care system have dealt with some degree of non-compliance (for medication, treatment, etc.) from patients, non-compliance is generally explained by social or economic constraints, such as not being able to afford a medication, not having transportation to a treatment session, or language barriers that cause incorrect communication. But once we have a detailed discussion with our patients, to make sure they understand their treatment and address all of their concerns and potential limitations, we expect them to follow our medical advice … or so we thought.

I reflected back on my own journey in medicine and the romantic idea I once had about what it would be like to be a doctor. I have always had an innate tendency to help people, and even though it sounds cliché, I have wanted to be a doctor for as long as I can remember. I was willing to do whatever it took to make my dream come true. While people were generally encouraging, there were always those who warned us to tread carefully. Voices of caution always warn us of the more tangible hardships: the impossible feat of getting into medical school followed by eternal nights of study and the challenges of getting a place to stay and actually surviving that stay. But no one tells you about the recurring moments of existential crisis and self-doubt.

You will experience some of your darkest days. Discouragement and inadequacy will occur when friends outside your medical world begin to “grow up”, earn wages that they can actually afford to live on, and start families while feeling stuck in an eternal extension of academia / high school (but without the fun parts), at the same time wondering if you will ever repay your loans. Hopelessness will permeate your psyche when you lose your first patient and then again with the next and the next and the next (it gets better with time, not because death ever gets easier, but because you start to expect it). You will see patients’ families fall apart. You will also fall apart more times than you can imagine. Anger will arise when you look back at how hard you have worked to reach where you are, and again when you look forward to the endless progress that needs to be made. Undoing will also raise its ugly head, causing you to wonder if the English or philosophical major could have been turned into a career instead.

But there will also be transient flashes of light at the end of seemingly narrow tunnels scattered through these trying moments. These glimpses are what encourage us to keep going, but admittedly, they become few and far between in these pandemic days.

People often talk about how going through the medical education, the stay and so on makes doctors numb and cynical individuals – who could possibly go through all the daily stress and emotional turmoil and come out unscathed? We doctors are becoming “desensitized”. This desensitization is often hailed as an advantage because we can now carry out our work without the emotional attachment. But this is a false narrative. We never become completely robots – cynics perhaps, but not robots. We just bury the emotions deeper than before, beneath the self-doubt, the fear, the rage, the anxiety far below the surface and move on to the next challenge.

These unpleasant feelings are boiled over with the stress of the pandemic because the part of us that loved to change patients’ lives and outcomes began to shrink. The pandemic has tested everyone, but especially those in the health care system. We no longer lose the battle to an incurable cancer or a neurodegenerative disease, but we lose the battle to misinformation. Yes, at one time COVID-19 was also an obstacle that seemed insurmountable, but our scientific community worked quickly and diligently to develop the vaccines. Yet people do not listen to our advice to disguise themselves and get vaccinated.

How did we get here? How did we get to a place where the moments that made it all worthwhile – saving a life, watching a family celebrate a loved one’s healing, receiving thanks from our patients – are thrown back in our faces while patients make it clear that our expertise is no longer needed? We have read the reports of “compassion fatigue” by health professionals who have worked tirelessly in the COVID-19 units and have no empathy left for those who decided not to be vaccinated. We have repeated the prayers to be vaccinated non-stop. We have done our part and will continue to do so every day until we are out of breath and out of words.

To all the hopeless, future romantic doctors who see all this unfold: While it’s stomach-churning to see our mission to help people get hit by political agendas and pseudoscience, do not lose your desire to do good. It’s okay to be a cynic. In fact, I think cynicism is healthy. It is in cynicism that we discover our longing to do more, that we push rather than prove that we ourselves and those around us are wrong, that we remain open to possibilities. For all the hopeless romantics, the journey is treacherous and filled with failure and heartache, but all good romances are.

Jessica Kiarashi, MD, is a headache specialist and neurologist in Dallas.

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