Years.

Years of learning that the smallest details of a patient’s life can be the most compelling and important part of their story.

Years of listening to to tales of love, anger, and loss until the patterns become less daunting and more obvious.

Years of hearing things that are so bizarre, so far-fetched, so on the fringe of humanity that nothing surprises anymore, but everything still fascinates unceasingly.

Years of trying every new thing under the sun until you finally realize that there isn’t.

Years of feeling guilty, so profoundly guilty, about losing a patient, even when you know in your heart of hearts that you did everything you could possibly do to keep them alive.

Years of feeling like a student, then a competent medical doctor, then a counselor, then a social worker, then a nurse, then a psychiatrist, and then a student again, and finally understanding why you had to be all of them in turn.

Years of learning how important timing really is. Too soon, and the patient is not ready to hear what you have to say. Too late, and the patient is no longer around to hear what you have to say.

Years of preparation to learn how to be wrong, and to admit it, in the best, most productive way possible.

Years filled with moments of pure joy when you see that little spark of insight, so hard won, roar into a giant flame of confidence.

Years to understand that if you do your job to the best of your ability, your patients should no longer need you, and that you can model for them how to say goodbye.

Years of learning that if all you carry in your tool kit is a hammer, everything that walks in your door will most certainly look like a nail.

Years of pride and satisfaction knowing that someone will tell you the darkest secrets of their heart and their most terrifying fears and will expect you to keep them to yourself.

Years of balancing the utter joy at seeing something rare and odd and wonderfully interesting, studying it objectively, but then always, always coming back to the humanity of the poor soul who suffers every day because of it.

Years of learning exactly what it is that you do not know, and realizing that the list grows longer every year.

Years of knowing that when things are spinning out of control and you are the most stressed you thought you could ever be, your teachers’ and mentors’ examples and training are something you can always fall back on.

Years of dreading your own obsolescence, but knowing that a listening ear, a kind word, and an understanding heart will never go out of style.

Years of your life when you could have been doing something, anything else.

Years that could never have been spent in a more noble enterprise.

What makes a psychiatrist?

Years.

Greg Smith is a psychiatrist who blogs at gregsmithmd.