We enter the cathedral of medicine with a specific architecture of the soul: high ambition, perfectionism fueled by a productive neuroticism, and a boundless capacity for self-sacrifice. For many of us, the “best years” (the physical and cognitive prime of our 20s and 30s) are traded for the fluorescent hum of the wards and the weight of six-figure debts. This financial burden does more than strain the bank account; it ossifies our personality traits into a relentless work ethic, making unusual demands on our time feel not just necessary, but virtuous.
The blur of the middle years
As the years pile up, the practice of medicine shifts. The pure clinical encounter is increasingly crowded by the “landmines” of the modern era: hospital administration politics, the relentless cadence of the EMR, and the quiet, background radiation of medicolegal anxiety. I hear it from colleagues and patients alike: Decades pass in a blink. We spend our lives managing practices and mitigating lawsuits, only to wake up one morning as “the older physician.” We find ourselves partly burned out, yet paradoxically ready to finally practice the “chiropractic” (the soulful, hands-on alignment of care) we always intended. Sometimes that transition is possible; sometimes, the clock has run too thin.
The existential reckoning
There is a unique existential vertigo in aging as a physician. For decades, we are the central protagonists in the lives of others. We are the conduits for the dearest secrets and the most intimate moments of a family’s history. We make the decisions that shift the trajectory of lives. But then, we have to face ourselves. This is the task for which medical school provides no syllabus. While the White Coat Investor blogs can skillfully navigate us through the balance of stocks, bonds, and tax-advantaged accounts, they cannot answer the primary queries of the soul:
- Who are we when the pager stops beeping?
- What are our strengths when they aren’t measured by RVUs?
- How do we age gracefully in a system that prizes utility over being?
A letter to my younger self
If I could reach back through the decades (or speak to the resident currently sacrificing their sleep and their “self” on the altar of the hospital), I would suggest that identity must be built in parallel to the career, not as a reward at the end of it. The commonalities we share (the drive, the debt, the eventual burnout) cannot be ignored. They are part of the journey. But we must remember that we are more than a vessel for our patients’ traumas and secrets. We are the architects of our own lives. To age gracefully in medicine is to realize that while we have been a conduit for the healing of others, we must eventually become the primary patient of our own compassion. It truly is a journey, one that requires us to look in the mirror as often as we look at the chart.
Farid Sabet-Sharghi is a psychiatrist.
