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Thursday, September 3, 2015

When is enough, enough?

Much of the past few years, I have regretted decisions I've made... The decision to stay in medical school, the decision to... Well, mostly that.  I knew about a week into medical school it wasn't for me.  I looked into PA school, and transferring to dental school, but was too afraid to make any moves.  So I kept on with the flow, and eight years later I am a fellow.  I have thought about the decision not to quit many times, and have wished I could go back and shake myself and do what I was so afraid of doing:  disappoint my parents, not become a doctor, do something different, not become a doctor, disappoint my parents.  I was young and living alone and terrified, and if my parents were more supportive I maybe would have quit, but that's no excuse and I have absolutely no doubt that I definitely should have, because here I am on a random weekend night, still regretting my decision not to take action then.

What makes me really think about this again, you ask?  No, I don't drive myself crazy on a daily basis; but as I mentioned, I'm now in fellowship and I don't like it.  The field isn't what I thought, the program isn't what I thought, and really, I just don't need it!  Since I've matched and committed to the year, I'm willing to complete the year (to be a responsible adult, but really so on my resume I don't have to say I quit fellowship after two months).  But I don't want to stay for next year (it's a two year fellowship.)  My husband supports me no matter what I decide, but he says, "But it's only one more year!  Then you can be board certified in another field and be even more marketable!" True, true.

My big hesitation again with quitting after this year is:  I'm still afraid to disappoint my parents.  And boy will they be disappointed if I end up practicing just psychiatry.  Eight years later, and that young, scared girl hasn't grown up much.

I wish I could have quit then, and I want to quit now.  When is enough regrets, enough?  When can I just make decisions for me, and not for others?  When can I do what I want?  When can I just be happy with my job?

Disclaimer:  This post is not meant to discourage anyone looking to go into medicine.  Just like some people like chocolate and some vanilla, everyone's desires are different.

17 comments:

  1. I'm sorry to hear this, and I do feel badly for you. At the same time, when I read the following:

    "I'm still afraid to disappoint my parents. And boy will they be disappointed if I end up practicing just psychiatry."

    Might I suggest there's there's nothing wrong with "just" practising psychiatry? General psychiatrists provide tremendous value and in fact mental health is sadly undervalued by our society. I'm not a psychiatrist, but I tremendously appreciate our colleagues.

    I'm afraid I don't quite follow why you fear disappointing your parents as an adult? Particularly when it comes to a decision such as fellowship vs no fellowship? As well, unless your parents are physicians, would they even be able to help you with specific advice regarding fellowship vs no fellowship? If not, then why are you concerned with what they think about fellowship vs no fellowship?

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  2. DoctorMommy: it probably wasn't easy for you to write this. I'm glad you did. I can identify with the part about not wanting to let others down.

    When I was in internal medicine residency, I applied and was accepted into the general medicine fellowship at my institution. It was a 3 year fellowship where you get a MPH for the first year and do two years of mentored research afterwards. I would never have considered it if it weren't for my program director who had strong feelings about specializing and who had told me that I would be wasting my talents if I didn't do that fellowship. "Just" being a hospitalist or primary care doctor would be failing my potential. Despite my love for patient care and teaching, I convinced myself this was the path I needed to take.

    As my third year of residency went on, it became more clear how much I secretly dreaded the years to come of classes and research and minimal patient contact. I didn't want to do it. This wasn't the career I wanted or how I wanted to spend the next years of my life. But, if I backed out, the fellowship would be out a spot. I had funding already secured for me. I didn't want to let the fellowship director or my PD down. Ultimately, I decided that I needed to withdraw from the program for ME. It was the spring of my R3 year. The fellowship director was surprisingly okay with it. My PD was disappointed. I scrambled to find a job.

    In the end, I have no regrets. It was the right decision for me. It's different of course when it's your parents and whatever long history you share. They clearly mean a lot to you. But, what about looking around to see what job openings there are? Explore some possibilities. Ultimately, it's about your happiness and fulfillment. Your life and your family's life. Quitting is not failing, it's realizing you've made a wrong turn and correcting it before you drive too far in the wrong direction.

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  3. DoctorMommy,
    I was in the same place in IT. I too regretted my decision, but was scared to make the moves. For me, my family was depending on my salary. So I stayed in a place I knew wasn’t right for me. People said similar things to me – It will get better, you will be more marketable… and now finally 10 years later I am working to get into medicine. If I had worked for it the first time I thought about it, I would be a doctor by now. The only thing that has changed is I am now 10 years older.
    If medicine isn’t right for you, change to where you are going. Your parents will get used to the idea. Mine, who flat out told me they wouldn’t support my going into medical school, now tell everyone they know that I wrote the MCAT. Your parents will ultimately be proud of you taking control of your life and pursuing your goals.
    The only thing you achieve by waiting is the loss of time. And enough will be enough when you are ready to decide it is. When you decide to quit – and do what you want to do, then you will find it’s a lot easier to be happy about your job.
    My advice is this. First come up with a plan of what you want to do instead. Look at different scenarios, and what it will take to get to each. You mentioned psychiatry. See what it will take to get there, and plan your transition strategy. Look at other options as well. For me, because I’m not in it yet – I know I may get to medicine and not love it. And that’s ok. What I do know is I never want to sit in a cubicle again, I want to be a scientist and I want to help people. So I am leaving my doors open. Leave yours open too. Look into what it is about your fellowship, and medicine that you absolutely don’t want. Look at what you like about the idea of psychiatry. Look into things you have never considered, that may be entirely unrelated.
    Make a list of what you want, what you don’t want and the career paths that fit those criteria. While you work towards your transition strategy – then tell people before you quit. That was the hardest part when I did it.
    You can do it. Its not easy, but it can be done.
    - S (From Taking the plunge)

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  4. I'm wondering if there's a cultural reason why you're still afraid of disappointing your parents - that certainly complicates things. It's easy to sit back and say to live your life for you and make your own choices and to hell with everyone else - which is what I personally would encourage almost everyone to do - but if there's cultural barriers, that adds a whole other layer of guilt that's difficult to deal with. Maybe I'm off-base and this has nothing to do with culture. It's not like you loved medicine and then once you started fellowship you realized you were unhappy; you have disliked it all along. You've given it a good effort and if you don't think you would be happy pursuing a different path in medicine, why not cut your losses now and look for something that really does make you happier? If it's only about sticking it out one more year and then many more doors open, I'd strongly consider that as well, then you're not completely slamming that door shut, then you may feel better about leaving. Whatever it is, I'd make the decision for what's best for you and your family. How old are you and how old are your parents? They're not going to live forever.

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    1. It also doesn't sound like they're happy with your career choice in psychiatry regardless so while leaving medicine altogether would be disappointing to them, they're still going to be disappointed if you stay, too.

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  5. Um...there are no resume police. You don't have to say you quit fellowship after 2 months on your resume. If you quit, you don't even have to tell anyone about it. Just say you wanted time to study for the boards, or spend time with your family, or um, find yourself. Whatever. Don't let the idea that this blemish might follow you on a document which is under your own control keep you from doing what you know you want to do.

    Even if there are cultural reasons for not wanting to disappoint your parents, I think it's important to remember that you are the one living this life and you have to live with the consequences. I agre with PP above--if a lot of doors open after finishing fellowship maybe it would be worth sticking it out. If you know those doors don't lead anywhere you want to go, it's time to cut your losses Be Happy Now.

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  7. For me it was a job - my first job in the state we'd moved to so my husband could fulfill his dream. It was a perfect job for me, on paper. In real life - I was never comfortable there. They didn't like me. I didn't like them. But leave? When my salary paid the mortgage and my husband had his dream job? I couldn't *leave*. And it must have been my fault that they didn't like me, so it must have been possible to fix it.

    I stayed for 10 years. The last three years, I suffered through the worse episode of depression I've ever had. My health suffered, and eventually I behaved so badly out of sheer misery that they had enough ammunition to fire me. That's honestly the one thing in my 55 years that I regret: that I didn't walk out the door when I realized how bad a fit it was. I try - and often succeed - to have empathy for my younger and terrified self.

    What do you want to do?

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  8. I have loved reading all of these comments! I want to reply to each one...

    Brumby, no they aren't physicians and I don't know why I still let them have an opinion at all. Sometimes I do wonder if they would even know that I quit! I suppose I'd have to tell them, and this brings back so much anxiety that I had fourth year of medical school when I had to announce that I would be going into psychiatry. It was really stressful and they didn't accept it for a long time and only reconsidered when I promised I would do this fellowship. They never ever tell anyone that I'm a psychiatrist. They always say, "She's a child psychiatrist."

    KC: That's great that you were able to see what you wanted/needed and to follow your heart. "Quitting is not failing, it's realizing you've made a wrong turn and correcting it before you drive too far in the wrong direction." I love this! I'm going to say it to myself over and over again until I believe it.

    S: I'm already a psychiatrist! I finished residency. I'm now in a fellowship that I'm not happy in--I can quit and still be a physician! That's why it's so hard. I so don't "need" this.

    Amlyboo: It is most definitely a cultural issue :) And you are so right! They won't be happy if I do general psychiatry; I think quitting medicine altogether is a dream within a dream. I've always wanted to, but it is much much harder than the idea of quitting fellowship.

    Vellai: That is actually so true and I never thought of it--maybe it could just be my own little secret?? I've been terrified of actually looking into job prospects, with the fear I'll find something I actually like. But I probably should start.

    Jay: I can totally relate to the "behaving badly." Sometimes I wonder why my co-fellows are putting up with me. I literally have to stop myself from blurting out negative comments all day long. (Sometimes it's hard to stop myself.)

    The morning after I wrote this post, I drove to my program director's office, convinced I would tell him I was leaving. I didn't get out of the car. I just sat for a while and drove away. Another reason I stayed in medical school was that I was afraid I would regret the decision to leave later in life (this was more minor, but was always on my mind... who quits after putting in so much effort and being one of the lucky few to get in??) Now I'm having a similar thought. I got in, and maybe I will regret it later if I don't just finish it. Maybe the first thing I should do is get some therapy :)

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    1. Oh, yes. If only to have someone who is supportive and on your side, because it doesn't sound like your parents are on your side. You deserve that. And you probably know this, but I'l say it anyway - if the first therapist isn't a good fit, get another one.

      Does anyone in your "real" life know how miserable you are?

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  9. Whether you quit now or at the end of fellowship, I strongly recommend that you get counseling to help you stop living your life for your parents. I suspect there are other aspects of your life in which you try to please your parents rather than yourself. I am so struck by the feelings of fear and anxiety running through your post and comments and sense that it has imprisoned you for many years. I see you in 20-30 years looking back on your life with extreme regret. Is that something you're willing to face? I hope you are able, with outside help, to overcome your emotional issues.

    A fellow mother in medicine

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  10. I think it might help if you tried to identify things that you do that make you feel happy/find satisfying. Really difficult to do, I know, when it feels like you hate absolutely everything about what you're doing and you're emotionally exhausted. That might help enable you to create an exit plan for yourself. There really are SO MANY things you can do with an MD both within medicine and also which involve no patient care whatsoever. if you do leave, be prepared for the first thing you try not to be perfect. Sometimes it takes a while to find the right job, and that's ok.

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  11. DoctorMommy,
    I have so much empathy for you. So, so much.
    When I was in first year medical school I doubted my decision, to the point that I consulted a financial adviser to look at the $$ impact of withdrawing. I loved medicine, but I REALLY wanted a family, and as training went on, I didn't think I could do both. Well, I was 80k in debt by end of first year with a husband whose many wonderful qualities did not include any sort of major career aspirations / plans / goals, and I left that meeting in tears. I decided I was trapped. I felt trapped in a different way than you do (by your parents and culture), but still, that was my conclusion. So I stuck with medicine, joined the military as per my original plan, and kept going. Two babies in med school, one in residency, and on to my military duties.
    Then I, inevitably (in hindsight) burnt out. I believe that is what you and Jay above may be describing. Pathological and uncharacteristic negativity. Panic attacks. Horrible somatic symptoms of stress. I thought I was dying. I thought I must be made of wood because I felt so dead inside.
    Now my children are 8, 7, 4 and I still struggle with the crushing weight of my guilt about missing so much (estimate 80-90% time-wise) of their waking childhood hours. Debt is over 200k. It is not what I wanted.
    So when is enough, enough? For me it is now. I cannot leave medicine or the military (I owe service), but I do everything I can that is currently within my control to prioritize myself and my home life. I wasn't like that before. When my service is complete, I will stay in medicine (I do love it) but I will find a job that suits me and my family best, prestige or accolades be damned. I hold onto that plan every day. It keeps me going. "Soon, I will have control. Soon." Enough IS enough.

    So - I no longer wish to leave medicine (or fellowship) as you do, but I wanted to share with you this sense of being trapped. Of knowing that you can't walk away - whether it's a contractual or cultural obligation, real or virtual, debt, etc, whatever it is that keeps you there, that is what you are describing. Being trapped. And I empathize with you as a fellow mother in medicine.

    I think you have been given some wonderful advice by the other commenters. I hope that you can find a path that makes YOU happy. I hope that one day you will be able to walk into that office and do what terrifies you the most. Then, you will be on your way to being free of feeling trapped. And we'll all be cheering for you.

    Good luck Doctor Mommy!

    PS - psychiatrists are awesome. just saying.

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  12. Umm - do you have a good therapist? A life coach?

    Please take control of your life! It's yours and you only have 1 to live. Your parents have their own. The best time is NOW!

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  13. Hi DoctorMommy,

    I am so sorry to hear about your challenges. I am an adult psychiatrist (never wanted to be a kiddie shrink) and I struggled with medical school, residency, and parts of fellowship. All along I took it as a one day at a time proposition, but I could never think of anything else I would rather do. I am in private practice now and I LOVE and like my patients. The system can leave a lot to be desired, but the time face to face with patients I find fundamentally so life affirming that I am glad to be here. Caveat: I have been on Facebook for 45 minutes after a very challenging morning. I am now recovering and ready to finish my paperwork.

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  14. Dear Doctor Mommy... THIS IS SO ME AND MY LIFE. Thank you so, so, SO much for being able to articulate your thoughts. This essay could have easily been written by me. It is such a relief to know that I am not alone. I may just print out your essay and frame it. Thank you!

    We will both get through this together... I also need a therapist.

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  15. DoctorMommy - a very courageous post that I think many people can relate to. I, too, have a lot of ambivalence about medicine. I changed my path many, many times (changed my residency choice, dropped out of two fellowships). My parents - both doctors - were shocked and saddened. But it's your life and you have to love what you do on a daily basis.

    Don't worry - you're not alone. There's even a website called the Dropout Club for doctors looking for alternate careers: www.dropoutclub.org

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