When he knew his career as a surgeon was behind him

I feel like I’m in prison. Vacation was a small taste of freedom. A fresh breeze on my face at 9:00 a.m.—the feeling of my mom’s breakfast casserole in my stomach—the small things that remind me I’m still human. I don’t know what I stand for anymore. I just yelled at the intern for not feeling comfortable consenting our kidney transplant patient.

“Aren’t you a physician?!” I asked.

How did I get to this point? I have never in my life been so angry. What is this feeling? It races from my heart to my fingertips. It’s a pit in my stomach. It’s a fear I’ll never sleep again. The moods, the irritability, the uncertainty. All the while, I hide it from all my superiors. I do what I can to make them happy. I want them to know I’m obedient. I want them to know I’m thriving. I want them to know I’m competent—that I’m fierce.

Meanwhile, every night I’m not on call I puff a few hits. It makes my reality more bearable. I can finally laugh. The moment is bliss, and I can venture on another day. But then I don’t want to go to bed on these nights. I want to hold on to the last good feeling before it all starts again. Don’t make me go to sleep. Let me enjoy it. Just one more episode. I eventually set my alarm for 5:15 a.m. I count the number of hours of sleep I’m about to get and pray it will last me for the next two days. I got this. This is why I went to medical school. I’m John Smith, and I can handle anything.

But the feeling reminds me of when I was in middle school. Some of the darker, most stressful days. It reminded me of the time I signed up to play football. I did what I thought I should. I was the white, Catholic grade school boy who desperately wanted the world to know I was straight. I went to practice every day. I’m a dedicated, hard-working individual. I don’t give up. And not one day went by where I wasn’t made fun of. Pushed to the ground: “You’re a sissy.” I hated it, but I kept with it. We aren’t a family of quitters.

The day I finally told my mother I’m not going back, the pressure was lifted. I saw hope. I’m doing what I want. This is my life. I feel like that little boy is sitting with me now, whispering in my ear, “You don’t have to do this.” It gives me joy and sadness all at the same time. The angst. Why is it even harder now to break away with so many more years under my belt?

This prison is deep. It’s twisted. It’s seemingly never-ending. It feels like a game, stuck on repeat. I know I’m getting better. I have proof I’m not a failure. I can do anything. My confidence grows. But my empathy weakens. I need a cigarette. Just one big, deep inhale to fill my alveoli with the anxiolytic of my family’s choice. It was my grandmother’s smoking habits that introduced me to medicine. I knew it would eventually kill her, and I was going to find a way to get her to stop. Ironically, it’s now the gift medicine has given back to me.

Is this what it’s always been about? Smoking is what got me interested in medicine, and now medicine has got me interested in smoking? I got in this business to heal. But it has only taken me down. Slammed me against the wall, sucked out my joy, and dangled the most beautiful carrot in front of my face. “Next year will be better,” it murmured in my ear as a mirage of my house in the hills past me by. One day.

I should be sleeping. I’m on call, and the reality of it just hit me. The cold, stone walls closing in around me. I try not to look at my pager for fear it may go off.

“Hi! This is Jason in the ED—we have a guy with hematuria. We thought you might want to irrigate him.” “Hi! This is Candice. Thanks for calling me back. We have a 43-year-old female with right flank pain and fevers …”

No! Just let me be. I want out, and I don’t want to play the game. Why do I feel like I’m being punished? Why did I work so hard to work harder?

“What’s the patient’s potassium?” My senior texts me. “I don’t know—he just got there,” I lied.

And that’s when I knew my career as a surgeon was behind me.