Going to medical school was a dream come true. I was excited; I couldn’t wait. I spent my childhood dreaming about it. It was this amazing fantasy in my head where nothing was impossible, and I would be able to help thousands of people, maybe millions? Biology, physiology, chemistry, physics — they resonated with me. I could not imagine doing anything else. I loved meeting new people. I loved learning about others and how I could help them in a positive way. I thought it was a perfect combination for my ultimate career choice of becoming a doctor.

Like others in my high school, we had big dreams. We would be the best. We would figure out the answers to medical questions that had not been answered yet, and of course, we would be just like doctor house — always asking questions and diagnosing the rarest and most challenging cases like it was a piece of cake. Most importantly, I would put a smile on the faces of patients and their families just like doctors had done for me when my family had been sick, and answers seemed like they were nowhere to be found. I was going to be a detective, solving the puzzles and making the world a better place.

I went into medicine because I was a dreamer, an overachiever. I had curiosity and fire, drive and passion, but somewhere along the way, things changed a bit. I never lost touch of why I practice medicine deep down, but with all the politics and challenges I, like everyone in medicine face, I started to lose sight. My vision got a little blurry, as I would like to call it. Luckily, I am happy to say recently I have rediscovered why I do what I do, and I have regained 20/20 vision once again.

I went to medical school when I was young; it was my first time away from home. It was a period of growth. I worked hard, and I loved learning. I would go to sleep stressed about the next test or topic, but it was worth it. I was content. It was for the greater good of my hopes and dreams, which I had in clear sight.

In 2014, I matched into residency. I laughed, I cried, and I was in shock. It was arguably one of the best days of my life. Residency was tough, but I can say, as grueling as it was, I enjoyed every minute of it. We had a strong group of residents. We stuck together and supported each other. Most importantly, I kept my eye on the prize. I had amazing mentors who guided me and helped me grow, both, medically and personally. It was a life-changing journey.

I remember my first long call shift. I already had a few admissions, and late into the shift, a patient was admitted with a pulmonary embolism to my team. They were sick. My resident helped me but was overwhelmed with many admissions, and I was left somewhat on my own to brainstorm and think. I ended up leaving work three hours too late, but I was so excited. I felt the adrenaline from what I now consider a simple admission. I thrived with talking to families, comforting patients and being a shoulder to cry on for loved ones. It brought me joy to be there for them. Often I didn’t want to leave their side and would always try my best to update them on everything that was happening, just like I’d want if I was in their shoes. I always told myself that I would never lose sight of this excitement and thrill. I promised myself to never lose sight of the importance of a simple two-minute conversation at the bedside. I think I did a pretty good job of keeping my passion alive during residency, but then I entered the real world of medicine, which is a magnificent force of its own.

Nowadays, I spend most of my time in primary care. I enjoy building longitudinal relationships, but I also love hospital medicine. Every few weeks, I work inpatient on a resident service, and I love it. As time after graduation progressed, a strange feeling started to resonate. It was like the world was against me. Whenever I tried to help a patient, whether it was starting a treatment plan, diagnostic testing or channeling them to the appropriate specialist, the insurance companies and prior authorizations were always in my way. I had obstacles trying to limit me from being the best doctor I could be for my patients. It was another dimension that I needed to take into consideration. I became frustrated, sad and wondered how to overcome so many deterrents on a daily basis. I didn’t see this side of things when I watched Dr. House as a kid or George Clooney in ER. I don’t remember them calling the insurance companies and explaining why an echocardiogram is necessary for a sick patient, or trying to explain to a patient that they have to wait a few days for a procedure to be approved by their insurance. The challenge of having a great medication yet lacking the inability to prescribe it because it isn’t tier 1 and may cost hundreds of dollars even if you manage to get it approved is disheartening.

Every time this happens, I wish I could do something to help change the system for the better. I feel for the individuals and families who struggle to afford healthcare.

I took a step back recently and realized the positive person I was when it all started had begun to slip away. I decided to remind myself why I do what I do; otherwise, the negativity would surely take over. Some would consider the feeling burnout, a much more widely recognized issue in recent times.

Being a physician in 2019 is difficult, and at times, the odds are against you. The most important thing that I have found is to keep my eyes on the bigger picture: the war rather than each daily battle.

I drive home with a smile on my face and focus on the joy I brought to a patient and their family, how smoothly I was able to help coordinate care or how I positively impacted a resident’s growth, as a young physician myself. I focus on how the day-to-day struggles we have to go through, as difficult as they may be, can make the world a better place. I focus on dreaming about ideas regarding medical reform and finding a way to bring them into action. I brainstorm about how to create change, even on a small scale. I am working towards trying to make a difference as much as I have seen my mentors do. Whether it is when they are fighting for what’s right with an insurance company, the impact they have on a patient or even making a patient smile. No win is too small.

This is why I practice medicine.

To my fellow colleagues, just know, your hard work is appreciated, by me, and by your other colleagues. Sometimes it gets tough but keep doing what you do. You are part of the bright future of medicine and part of change.

Always keep dreaming, no dream is too big. If your vision starts getting blurry, take a step back, reset, focus on the good you have already accomplished and envision the good you continue to work for. Always remind yourself about the first spark that ignited your dream of medicine, and you’ll never lose sight again.

Jasmine Toor is an internal medicine physician.

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