Losing Face – A Promise to Myself

There is an Asian concept of “losing face.” We are a culture of appearances, and it can be deeply embarrassing to have a crack or flaw in the mask we have striven so hard to maintain in society.

I feel a bit like Mulan here, setting out to start over and forge my own path at age 30, after shaming my family by failing to comply with the traditional one that “normal” women take. Get good grades, get a stable job, get married, now have a kid or two on the way.

For so long, I had wanted to please my family, be like everyone else, and fit in, to feel a sense of belonging and pride. I thought I would finally be loved unconditionally if I kept to the conditions.

I now see how ironic that is. I felt so happy and loved when I was “successful,” such as when I unwittingly became salutatorian of my high school, so focused I was on doing the best I could in every class, especially after being extensively shamed for getting my lowest grade ever on a 7^th grade math quiz, a 78.

Or when I somehow stumbled into a very competitive and prestigious college, Brown University, and even more so, got into its 8 year combined college-medical school program that only accepted 50 people per year from all across the country.

I suppose that probably set the bar very high for my parents’ expectations of how the rest of my life would turn out. It’s not like I “failed,” though in their eyes I did, by not continuing on to practice full-time medicine as a fully graduated and trained “attending” physician now, and still being unmarried.

I had an easy enough time getting through the program; I never once failed or had to repeat a task, though the last several years I had to shut off my emotions to slug through. My emotions of discomfort and panic that this was definitely NOT what I wanted to do for the rest of my life.

I matched into a residency program, one of my top choices, in fact, when every medical student’s worst nightmare is not getting into one as there is a huge shortage of spots compared to medical school graduates and it is one of the worst stigmas imaginable. I even completed a full residency program and obtained the graduation certificate, though not in the original field I had chosen.

After trying out obstetrics and gynecology for 2 full years, a surgical field, and feeling increasingly unaligned, I switched to family medicine primary care and had to start almost entirely from scratch with a new 3 year program.

It was definitely a better fit; however, I continued to yearn for more gratification in my work, even though I knew it was benefiting people and it was a noble and much needed service. By all accounts, it should have worked. It just didn’t.

I did enjoy touching some of the lives that I did meet, the few snippets of light in the otherwise overwhelming and exhausting darkness. I see now why over 1,400 doctors have committed suicide already since Dr. Pamela Wible started counting them. They occur at all stages, be it in medical school, residency, or after years of practice as an attending physician.

There are a multitude of reasons, including toxic, inhumane working conditions, repeated exposure to death and suffering without the option of time or space to process it, unreasonable expectations of perfection, and crushing guilt when any mistake IS made since the stakes are so high from having people’s lives in your hands.

Also not to mention a broken healthcare system ruled by insurance companies that focus more on business than service, leading to high costs, low access, inefficiency, and unequal treatment. If you do reach out for help, you may face stigma, punishment, and exacerbation of your situation, such as possibly losing your license.

Oh, and the crushing $250,000 average debt from medical school tuition. I thank God and my family, for not having this stressor. Most doctors are not so lucky, and they cannot find a way out, other than suicide, if they stopped this path. If they choose to live, in order to pay this debt off, they feel forced to continue working for years in a field they found out was not for them, as it can be so different from what they imagined it to be.

Passionate, kindhearted young doctors can be beaten down by the 15-minute time constraints which dehumanize the patient encounter (the reason many went into this field in the first place), the chains placed on them by insurance company reimbursements and an unforgiving malpractice system, and the trauma from the things they have seen.

We need to become hardened, able to compartmentalize our lives in order to keep going, to work at our 80-100 hours per week job and still attempt to take care of needs at home.

I somehow found a way to boil down my essential routines, such as cooking, grocery shopping, laundry, and personal hygiene, into a streamlined system, and people wondered how I was able to do it all and still socialize.

It was only after I stopped doing it that I realized I was operating at 200%, all the time, and while it felt productive, the stress I’m sure also took years off of my life. I felt antsy when I wasn’t doing anything, like a lazy, unproductive member of society.

I forgot how to just be present and enjoy being a human being instead of a human “doing.” My body suffered as well; I had chronic aches, insomnia, and my back and neck muscles completely forgot how to relax, except in the brief moments immediately after an intense massage.

Whoever likened medical training to military training was very astute, as both can cause PTSD (post-traumatic stress disorder). But of course, we don’t have the chance to take time off work for a therapy appointment or personal time to process, since we have patients to care for.

There is such a hypocrisy in being so-called role models of health and lecturing our patients on how to better take care of themselves when we ourselves are forced to neglect our physical, mental, and emotional well-being.

Taking care of others when we have not fully taken care of ourselves is not only unfair to us, but also to our patients. Every patient deserves a balanced, healthy, fully present and engaged physician, which is why I felt like such an impostor most of the time I was there.

Was I being too hard on myself? Probably. But could I also do better? Yes, definitely. Doctors are only human, so I did not expect to not make any mistakes, but I always wanted to give it my best. I asked for help from colleagues and made notes to myself to follow up on my blind spots and keep on improving, to make sure the patients always met the standards of care.

I was lucky to have the sanity to still do this; I realized that many who suffer do not. I think this was driven by my empathy for others and security in knowing I could technically afford to quit at any time, due to my financial situation, though emotionally it would have meant disaster, shame, stigma, and possibly even abandonment from my family. I was also lucky to have supportive colleagues, whom I genuinely liked and admired, even though I did not quite feel like “one of them.”

Back to this sense of fitting in. I long to fit in but also to be unique in some way at the same time. It’s a natural human instinct. Now I can see that I am unique already, just as I am, since no one will have my exact set of talents, quirks, passions, and perspectives. I’m not going out into the world on this crazy quest just to prove I’m different; rather, it is to seek a sense of true belonging, my people, my tribe. I do not feel that I’ve found them yet.

I have only tried one thing in my 30 years of life. I think I gave it a fair shot, a really good shot. I tried so hard to make it work, and I wanted so badly for it to work. There is about a lingering thought of maybe the fully graduated attending physician life will be better than what I’ve experienced thus far.

Which is why I graduated the postgraduate training, got my Board Certification, got a license. They sit on my desk at home waiting for me to do something with them. I know that now is not the time, though. If I am to have a hope of liking this in the future, I need to take some time away from it now.

I do feel okay dabbling in telemedicine, since it can be on my own terms, still support of my remote work digital nomad life.

I need to give my attention to the parts of me I have neglected for the past 10 years—the creative artist, the avid language learner, and the curious wanderer who carries an inexplicable desire to inspire and enhance life, rather than just to fix it.

Though my family considers me as “losing face” for them, I hope to bring them pride and joy in my own way in the future, even if it takes many, many years.

Thus in the dawn of this New Lunar Year, I have made a promise to myself that I will not show my face to them again, until I have found my people and achieved a firm footing on what brings me true joy in a career.

It will likely not be the same definition of success for them, but I will be happy, and I know that will be enough for me, and I can only hope it will be enough for them.