I imagine you’re excited to receive this letter, but please listen to me for a moment. I’ll need you to suspend your disbelief here. I am writing to you from the future, and you are me from the past. I needed to reach out to you about the choice you’ve made.

I realize — again, because I am you — that you are super excited about the hare-brained idea to go to medical school. You got your liberal arts degree and took that job as a scribe in the emergency department, for lack of another employment opportunity at that time. Now you have it in your head that your next destination will be medical school. You’re about to go back to college pre-med coursework, and this is going to be remembered as an inspirational and exciting time in your life. I, as your future self, would encourage you to hold onto this moment for all that it is worth.

Medical school will work out. You’re going to meet some incredible friends here, and I suspect you’ll remain close with them for the rest of your life.

Then comes residency. Someone will tell you beforehand that it’s going to be the best-worst time of your life. You will not hear a more accurate statement. You will get through this as well, but something will change. Many years later, I’m still trying to pinpoint what that was. The only way I could put it, to young me, is that you’re going to be different at the end of it. That, like much of your experience with medicine, will be a mixed bag. I’m not sure it’s entirely a good or bad thing.

The first years as an emergency medicine doctor will be a mixture of excitement and self-imposed terror. You, like everyone around you, will deal with your own imposter syndrome. You’ll become better at your craft and more comfortable with the role. You will stand on your own on overnight shifts, and you will manage complicated cases with the help of colleagues in your specialty and others.

All the while, that little something in your mind that seemed to change in residency will persist.

It will invade more of your thoughts. Your frustration will increase. This will come largely from working within the present health care system. You will loathe the system after years of experience. Patients will leave against advice for fear of insurance costs. You’ll wonder how many bankruptcies you caused. You can’t imagine your resentment towards charting for billing purposes. You will live in fear of malpractice.

You will wake up in the middle of the night and worry about a test or diagnosis you could have missed. You’ll hear the ambulance phone in your sleep, and you’ll be stark awake for the rest of the night, dreading your morning shift. You will practice in an excellent hospital with an excellent group, and yet you will grow to resent so many aspects of your job. This will fester like a wound.

Around the time that you realize this, you will face an incredible challenge. A deadly worldwide pandemic. Think turn-of-the-last-century influenza type morbidity and mortality but within an atmosphere of virulent misinformation. You will come to know a new sense of fear during your shifts. So much will be unknown in the early days of this that you, and many of your colleagues, will go to work with existential dread. The bright side is that friends, family, and others in your community will be thankful for your efforts. You will go to work to find a sign outside the hospital reminding you that “Heroes work here.”

This will be brief. Within the year, there will be protests, and you and your profession — along with everything that it stands for — will be dragged across the coals of social media. Admiration will turn into feelings of resentment towards your job and everything you represent as a health care worker.

You’ll wear a mask all day at work and in the community, and you’ll be hated for it by a not insignificant number of the populace. Believe it or not, people will tell you that you are killing people for money because of a “fake virus.”

The sick and dying every day will deny the existence of the very problem. An increasing tone of hostility will enter the discourse of your daily practice. This will rot further the wound that started long ago.

It is at this point that you realize something further troubling. You hate your job, and you can’t help it. This will be another pivotal moment in your life, and you’ll greet it with a combination of excitement and mourning.

With that, you will be once again driven to succeed at a seemingly insurmountable goal.

This time, it’s not getting into medicine but rather escaping it. You will be consumed with the desire to leave clinical medicine and, because you chose to live modestly, this becomes a reasonable proposition. With a clear conscience, you pronounce the time of death of your career as an emergency physician a handful of years after residency and look towards a different future.

I know what you’re thinking. We’re wondering the same things. Was it worth it? You and I will share some hesitation here because I’ll suggest that we’re both unsure. I do know that some good came from this.

You will achieve many things that would not be possible in another career. You will keep a file of “thank-you” letters from patients whose lives you saved. You’ll have wonderful colleagues and co-workers. You’ll meet your significant other along the way and, if you’re honest with yourself, this whole trip will be worth that one event alone.

In the end, however, you will want nothing more than to walk away from that life.

You do what you will with all this information. I don’t know if anyone could know what I know now when I was you then. Maybe someone out there, who is young in this process, will read this. If that’s you, I’m not really sure what to tell you.

The author is an anonymous physician.

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