Thread by @TheRealDoctorT

They say you should feel lucky to be here. And I do.

They say it’s a privilege, many people would kill to take my spot, so I should be grateful. And I am.

But there are things they never tell you.

There are things that you’re left to discover.

Things taken from you. 1/

The day I make it into medical school is one of the happiest of my life.

I’ll never forget my parents’ smiles, their pride.

Things begin so well too.

White coat ceremony.

Hippocratic Oath.

I feel like a doctor already. I feel the weight of this path.

I have no idea. 2/

I am plunged into a world of high stakes exams, and subject matter so challenging that it pushes me to my limits.

My whole life, I’ve been able to excel if I just worked hard enough.

Not here.

I’m struggling just to keep my head above water.

My grades drop.

I work harder. 3/

My sleep patterns are being disrupted as I stay up late trying to master a vast new terminology.

Information comes at a breakneck pace, like drinking from a broken fire hydrant.

Through it all, a lingering doubt.

Do I belong here? 4/

Not everyone is having the same experience.

Some are the children of physicians.

Some work two jobs.

Some are raising small children by themselves.

Some are taking out second and third loans to share apartments.

Some eat ramen, some eat steak.

Some swim, some drown. 5/

And then there are the gunners.

Students who are determined to stand out, even if it means stepping on others.

Like a car that overtakes you, just to be stuck in the same traffic.

Yeah, it might be ahead of you, but we’re all on the same damn highway.

Gunners don’t care. 6/

Not everyone makes it through.

The unspoken rule is that you’ve gotta make it.

Nowhere is it ever explicitly said it’s okay to change your mind.

Many of us are buried in debt, and the weight of expectations.

We never thought we’d lose some part of ourselves along the way. 7/

It’s a question I grapple with every day. Some days the voice is louder than others.

Is this what I want to do with the rest of my life?

They don’t warn you about the toxicity.

They don’t warn you about a lot of things.

Maybe I could have been a director. I love movies. 8/

They tell you things will get better.

And on some level, they do.

As the education becomes more clinical, more hands-on, more patient-centered, the constant stress becomes slightly more bearable.

Perhaps there’s light at the end of the tunnel. Perhaps.

Not for everyone. 9/

So much of this path feels like it’s out of your hands.

You don’t belong here.

You never did.

Voices never stop.

Match in your residency, or don’t.

What were the reasons you didn’t match? Nobody will ever tell you. 10/

Become a resident.

Face an entirely new world of fears and stressors.

Become overwhelmed again.

Sleep deprivation never leaves.

Now buried under a veritable mountain of debt, you’re paid just barely enough, and the prospect of your lifetime ahead looms. 11/

Become an attending.

Now you’re fully liable.

Wrangle with insurance companies. Struggle with the decisions you make, and the system makes for you.

Cog in the machine.

Bear the slings and arrows from a distrusting public.

Deal with death so closely, it’s woven into you. 12/

Through it all, on every level, you wrestle with a system.

A system that wasn’t designed for you, that wasn’t designed for your patients.

A system that is steeped in resistance to change at every level, a system designed to propagate itself.

Whose roots run deep. 13/

There are wonderful things about being a doctor. Immense and unique privileges.

But understand…

Doctors aren’t just taught.

Doctors are forged.

Melted down, and reformed. Made shapeless then given structure.

Destroyed then pieced together.

To slowly be broken again. 14/

So when people leave medicine in record numbers, understand it isn’t always just a choice in the moment.

It’s a choice that can be years in the making.

There’s so much they take, so much you give.

We all leave medicine, eventually.

Some retire.

Some set themselves free.