Opinion | An Open Letter to the Hopeless Romantics in Medicine

“Any other questions?” I asked the eager med student shadowing me that day in clinic. He stared down at his notepad where he had meticulously taken notes during our session.

He responded, “How do you stay positive?”

Stunned, because those who know me wouldn’t necessarily describe me as “positive,” I asked him what he meant. He responded that in his short career thus far as a med student on rotation, he already felt cynical. The pandemic made him feel like patients no longer cared about what providers had to say and decided overnight that our degrees and years of education and hard work didn’t amount to anything.

While all of us in healthcare have dealt with some degree of non-compliance (to medication, treatment, etc.) from patients, non-compliance is generally explained by social or financial limitations such as not being able to afford a medication, not having transportation to a treatment session, or language barriers causing miscommunication. But once we have a detailed discussion with our patients, making sure they understand their treatment and addressing all their concerns and potential limitations, we’d expect them to follow our medical advice … or so we thought.

I reflected back on my own journey in medicine and the romantic idea I once had about what being a physician would be like. I’ve always had an innate propensity to help people, and while it sounds cliché, I’ve wanted to be a doctor for as long as I can remember. I was willing to do whatever it took to make my dream a reality. While people were generally encouraging, there were always those who warned us to tread with caution. The voices of wariness always warn us about the more tangible hardships: the impossible feat of getting into medical school followed by perpetual nights of studying, and the challenges of landing a residency and actually surviving that residency. But no one tells you about the recurrent moments of existential crisis and self-doubt.

You will experience some of your darkest days. Despondency and inadequacy will set in when friends outside your medical world start “adulting,” making salaries they can actually afford to live on and starting families, while you feel stuck in an eternal extension of academia/college (but without the fun parts), simultaneously wondering if you’ll ever pay your loans back. Hopelessness will permeate your psyche when you lose your first patient and then again with the next one and the next one and the next one (this does get better with time, not because death ever gets easier, but because you start expecting it). You will watch patients’ families fall apart. You too will fall apart more times than you can imagine. Anger will set in when you look back on how hard you’ve worked to get where you are and then again when you look forward to the never-ending progress left to be made. Regret will also rear its ugly head, making you wonder whether that English or philosophy major could have been fashioned into a career instead.

But there will also be transient glimmers of light at the end of seemingly narrow tunnels dispersed throughout these trying moments. These glimmers are what encourage us to keep going, but admittedly, they are becoming few and far between during these pandemic days.

People often talk about how going through medical school, residency, and beyond turns doctors into callous and cynical individuals — who could possibly go through all that daily stress and emotional turmoil and emerge unscathed? We physicians become “desensitized.” This desensitization is often lauded as an advantage because now we can do our jobs without the emotional attachment. But this is a false narrative. We never quite become robots — cynics maybe, but not robots. We just bury the feelings deeper down than before, underneath the self-doubt, the fear, the rage, the anxiety, way below the surface and move on to the next challenge.

These unpleasant feelings have boiled over with the stress of the pandemic because the part of us that reveled in changing patients’ lives and outcomes started dwindling. The pandemic has tested everyone, but particularly those in healthcare. We are no longer losing the battle to an incurable cancer or a neurodegenerative disease, but we are losing the battle to misinformation. Yes, at one point, COVID-19 too was an obstacle that seemed insurmountable, but our scientific community worked swiftly and diligently to develop the vaccines. Yet, people are not heeding our advice to mask up and get vaccinated.

How did we get here? How did we get to a place where the moments that made it all worth it — saving a life, watching a family celebrate a loved one’s recovery, receiving tokens of thanks from our patients — get thrown back in our faces as patients make it clear that our expertise is no longer needed? We have read the accounts of “compassion fatigue” by healthcare workers who have been working tirelessly in the COVID-19 units and have no empathy left for those who decided against getting vaccinated. We have echoed the pleas to get vaccinated non-stop. We have done our part and will continue to do so every day until we are out of breath and out of words.

To all the hopeless romantic doctors-to-be watching this all unfold: while it’s gut-wrenching to see our mission to help people being stomped on by political agendas and pseudoscience, do not lose your desire to do good. It’s okay to be a cynic. In fact, I believe cynicism is healthy. It is in cynicism that we discover our yearning to do more, that we push forward to prove ourselves and those around us wrong, that we stay open to possibility. To all the hopeless romantics, the journey is treacherous and fraught with failure and heartache, but all good romances are.

Jessica Kiarashi, MD, is a headache specialist and neurologist in Dallas.