Recently, a brilliant, caring and warm-hearted friend of mine approached me asking if I would help her with MCAT studying. She’d be a non-traditional medical school applicant due to a few gap years. Thus, she needed to prove to herself and prospective schools she still had the academic chops.

Immediately, I froze.

Over the years, I have served as mentor to medical students, interns, and residents. To be there at someone’s aha moment has always been something I’ve enjoyed, and the thought of paying it forward in homage to my mentors leaves me utterly sentimental. We’ve created a supportive community — we’re all in this together!

But this was different.

She wasn’t yet drawn into the medical machine — fresh meat destined for the grinder to be repackaged as a doctor. She wasn’t yet trapped into a life that compelled my colleagues and me to band together for our survival.

Seeing that I’ve been pulling myself out of burnout and in the process have heard others’ similar struggles, I looked at her and thought:

Do I have a moral and ethical responsibility to protect you from yourself and your idealism?

Every fiber of my being wanted to warn her AGAINST a career in medicine, but words evaded me. Then, a Facebook post snapped everything into clear view: a colleague’s friend from medical school committed suicide.

It laid out like every other physician’s obituary. Always there to lend a helping hand, smile or word of encouragement. Pillar of her community. Nobody saw it coming.

Everyone knows these costs of a career in medicine — student loans, the time spent studying and training.

But no one talks about the cost to self.

Why are 40 to 60 percent of doctors burned out? Why do 5 to 9 out of 10 doctors not recommend going into medicine? What happens over the years, turning us from bright-eyed, idealistic and compassionate people to feeling the only way out is to take our own lives?

Why do over 400 doctors a year commit suicide?

The process

As I think of my friend and her journey into medicine, I see a future of systematic dehumanization.

I see her guilt at not studying during holidays as she has started to prioritize her career over time with family and friends.

I see her crying at work after a bad outcome as an intern, but her senior resident tells her to get ahold of herself. Patients and their families aren’t there to manage her emotions — she’s there to help support them through theirs. If she wants to cry, she can do that on her own time.

I see her joy and warmth stomped out by the misery that consumes her at the 70th hour at work that week, currently on day 18 of 21 scheduled in a row.

I see the arguments on her days off when her significant other wants to go out, but all she wants to do is crawl under her comforter and get some rest.

I see patients become obstacles — she doesn’t have time for their absurd questions that don’t change management anyway. She’s got so many other things on her to do list right now, and these conversations are not a priority.

I see her make the comment at someone’s death, “Glad we could artificially keep her alive so her long-lost son could relieve himself of his guilt. Great use of $20,000. I’m sure they’ll be paying that themselves.”

I see her getting into another argument with her significant other when he’s trying to take her out to dinner after a long day of putting out fires left and right. He keeps pushing her to tell him what she wants, but she can’t. She’d rather starve than make one more decision.

I see her at holidays again, trying to function after being up almost 24 hours from a terrible overnight call. She doesn’t want any part in family conversations discussing her “great job” she has secretly been contemplating quitting.

I see her cynicism increase exponentially while the joy, compassion, and warmth she used to have snuffed out by the same margin. Now frustration and anger are the only emotions she has become comfortable with — since sadness from caring too much was unacceptable.

I see her emerge from residency and try to reclaim her humanity and compassion like putting together the shards of a broken vase — the pieces may fit, but the vase will never be the same.

She wants to mourn the death of a patient but doesn’t remember how. So she lets his death summary sit in her inbox for two weeks so at least he still exists there.

She wants to cry when the ER doc calls to let her know the two-year-old patient she sent in has leukemia, but instead, she calmly expresses her gratitude and finishes watching a TV show with her husband without any mention of the turmoil in her heart.

She wants to reclaim her idealism, but it’s gone forever. She has seen too much.

She’s asked by a friend to help her on her journey into medicine.

She freezes.

Do I perpetuate the cycle?

These are all things that occurred during my 11 years in medicine. My story is not unique and is not the worst story I’m aware of, by far.

Dare I hope by the time my friend gets through, things will have changed? Am I not giving her enough credit to wonder if she may not have the strength to withstand the changes that will happen? Do I live in fear of her obituary plastered on social media because of my support during this early hour?

Would the cost to her life be different than the cost to mine?

Ultimately, people should pursue medicine if they truly believe it is their calling. But they should know along the way, they will lose bits and pieces of themselves due to the process. They may emerge a different person than they expected to be.

I know I did.

“Millennial Doctor” is an internal medicine-pediatrics physician who blogs at Reflections of a Millennial Doctor.

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