An excerpt from Disconnected: A Surgeon’s Search for Healing in a Broken System.
It’s 2022, and at age thirty-eight, I have finally arrived at the summit. Seventeen years. That’s how long it took to ascend this mountain: four years of college, four years of medical school, seven years of surgical residency and research, and two more years of subspecialty fellowship in vascular surgery. Seventeen years, all leading to this moment. My name on the door of my very own office, complete with windows, thriving plants (a minor miracle), and an artful display of all those exorbitantly expensive diplomas I spent a quarter of my life chasing.
I’m officially a fully fledged, practicing vascular surgeon. The mid-pandemic job search was not without its challenges, but I am grateful and optimistic about my choice. It’s close-ish to my parents (a mere 90 minutes by plane, practically neighbors!), and with that mythical unicorn of surgical jobs they call “work-life balance” (they actually pay me for my inevitable overtime). My partners are phenomenal, my cases range from mercifully straightforward to intriguingly complex, and I now will finally earn the salary all my non-medical friends and family assume I’ve been making for at least a decade.
I’ve done it. I made it. I’m f*cking miserable (FM).
I have everything I’ve worked for, everything I’ve sacrificed sleep, sanity, and social life for. And yet, here I am, perched atop the mountain of achievement, wondering why the view feels so bleak.
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When I first started this job, I envisioned building a rich life. I was going to enjoy the hell out of that “work-life balance.” I’d join a pottery class. Or a cycling club. Or both! I’d explore the city, sample its restaurants, swipe right on interesting strangers, get a season pass for the winter slopes in Tahoe. I even thought I’d drop in on my partners’ Dungeons & Dragons group, because why not?
Reality, however, had other plans. My weekends turned into rituals of aggressive recuperation: curled up with my cat Tiggs on the couch, clinging to the belief that absolute stillness might conserve enough ATP (cellular energy) to get me through the next week. Maybe, if I was lucky, my mind would follow suit and grant me the bliss of not thinking. I was not lucky. When that failed, I’d try to exorcise my mental demons with a high-intensity interval workout or a spin class. It helped, a little. Temporary relief at best. I know the self-care mantras; I’ve dispensed this wisdom to friends and patients with the brazen confidence of someone who not only missed the joke but is the punchline: “You can’t pour from an empty cup,” “Rest is productive,” blah blah blah. So why did I never feel rested? What I called “recuperation” was really something else entirely: It was “functional freeze,” a term I’ve since learned means survival mode masquerading as self-care.
Because no matter how many times I binged The Walking Dead (nothing like the zombie apocalypse to put life in perspective) or read Untamed (three and counting) or listened to A Discovery of Witches and its sequels on audiobook (Glennon and Deborah, I’m forever in your debt), it was never long enough. Come Sunday evening, the threat of the upcoming week hissed and moaned and marched inexorably forward at me like a horde of the undead.
My learned surgeon persona (Type-A, ego-driven, and relentlessly ambitious) has been both an invaluable asset and a crushing burden. Ambition has been woven into the warp and weft of my personality for as long as I can remember. In my younger years, it felt like a superpower, propelling me toward excellence, improvement, and the heady rush of being the best. And why wouldn’t it? Ambition realized was always rewarded: with praise, validation, and the occasional gold star. The lesson was clear: I achieve, therefore I matter (inner child wounds, anyone?). For most of my life, I have continued to steer my career as though a continued meteoric rise might someday eventually culminate in a stable orbit, a feeling of adequacy.
Instead, here I am, watching The Blacklist for the umpteenth time, my dreams of cycling and skiing and dating collecting dust alongside my untouched restaurant bucket list. As my nephews like to say, the math isn’t mathing.
There is, at least, one saving grace. I’m not alone in this existential dumpster fire. My best friend, Pritha, is living proof that misery has a sliding scale. She was FM two years ago, but her situation has since improved to the point where she now resides in the somewhat less dramatic state of Intermittently F*cking Miserable (IFM). On the other end of the spectrum is Elaine, my other best friend, who is so deep in the trenches of Absolutely F*cking Miserable (AFM) that she’s seriously considering divorcing medicine altogether.
The three of us, at first united by the adrenaline-soaked camaraderie of surgical training, now find solidarity in shared disillusionment. We text, call, and commiserate, constantly circling the same question: “What the hell happened to us?”
Excerpted from Disconnected: A Surgeon’s Search for Healing in a Broken System by Lily Johnston, MD, MPH. Copyright © 2026 Lily Johnston. Published by Amplify Publishing, an imprint of Amplify Publishing Group.
Lily Johnston is a vascular surgeon.
