“This guy sure didn’t miss any meals,” a classmate said, pointing at a cadaver.
I paused for a moment, struck by the insensitivity of what was happening around me. This is not normal behavior, I thought to myself.
Moments later, a little after 8 p.m. on a weeknight, I sat outside the anatomy lab eating a ham and cheese sandwich, acutely aware that 90 percent of taste is smell. When the five-minute break ended, I headed back into the lab to finish the evening cram session, cynically thinking that the aroma of formaldehyde may help ease my digestion. I walked toward a stepstool as the thick air, saturated with chemicals, awaited an impending desecration.
I put one foot up on the metal-alloy table as a colleague handed me the necessary tools. I lifted the other foot and planted it so that now I was straddling the remains of a human body. Only a few feet off of the ground, I wasn’t prepared for the rarefied air I was about to breathe in.
A blunt wooden handle supported a row of hacksaw teeth dulled from so many students cutting into deceased human beings. Using a hacksaw on another person felt like a crime against humanity. Yet I had instructions to follow, an assignment to complete, and it was necessary to dissociate emotionally from the task at hand. As students, we weren’t told the cadaver’s real name, so we named him Oliver. Giving him a name felt like the only human thing we could do. His hair was still long in the back but balding on the top. He seemed to have only lived into his early 60’s, and from the anchor and chain tattoo on his shoulder, I assumed his years of Navy service. All I knew of Oliver was sacrifice, from his ink mark symbol of service to his bodily gift to our medical classroom. So, I thanked him, and then I sawed into Oliver’s skull. Cut after cut, I embarked on a sensitive emotional voyage with only a crude set of tools in hand.
A few weeks later, our first exam scores were posted. On that single piece of paper, I saw a flurry of red-inked insults against everything I once thought I knew. In medical school, the top academic students are skimmed from the bell curve and redistributed across a new curve without any consideration for the psychological impact this has on their fellow students’ self-worth.
Now, I had seemingly fallen from being one of the top students in my entire school to one of the dumbest in my classroom. Overnight, validations of 98 percent turned into an insulting 63 percent. Smiley-face stickers morphed into slash marks and inner monologues on how I should do better.
I wondered, If I am no longer excelling as a student, who am I?
I struggled with this intellectual leveling, in a feeling of metaphorical thuds down the ladder of academic achievement. I felt the reality of having to readjust to underachievement, when academic success had been one of the core aspects of my identity. Since early childhood, I learned to mask feelings of physical and emotional insecurity through high academic achievement. In the medical school leveling, the mask was stripped away, and I felt exposed as a failure, an imposter, and as someone unworthy of the opportunity before him.
To compensate, I studied harder and longer, burning the candle at both ends, since medical schools recruit and reward perfectionist personalities. Pushing myself more and more, I pulled all-night study sessions, staying up thirty or more hours and then taking tests. I didn’t drink often during those initial medical school years, as I simply didn’t have the time. I studied, occasionally ate, slept when I could, and lost ten pounds from an already slender frame. The cycles of night and day blurred into a recognition of only artificial versus natural light shining on the words of a turning textbook page. Superstitiously, I only ate certain meals before tests and always wore the same undershirt for anatomy reviews. I shaved my head as if that would remove barriers preventing the words in the physiology book from getting into my head. I calculated that less hair somehow meant more intellectual osmosis.
The grind became exhausting, and after a year I began to feel its cumulative effect. I no longer wanted to get out of bed in the morning, I struggled to care about the events of the day, and I started to isolate myself from family and friends. I went to class, studied, and slept, then repeated that cycle again and again.
I knew something was physically wrong, so I visited the campus health office to see a doctor. A unique thing that happens to medical students over the course of their studies; they develop a hypochondrialike condition in which they experience the symptoms of illnesses they study. In the abnormality of intense hours of endless studying, I read about one abberant bodily malfunction after another, and finally started to feel the diseases lying within me. Once I felt the symptoms, the shock waves of anxiety returned, heightening the perception of danger of a rapidly progressive disease. This is referred to as medical student syndrome, or second-year syndrome, when every isolated twitch of your body is the acute onset of amyotrophic lateral sclerosis (ALS), commonly referred to as Lou Gehrig’s disease, and every cough must be the end stages of a progressive lung cancer. Putting this philosophy into practice, I went into the campus health center saying, “I think I am hypothyroid. I need to have my TSH checked.” Abnormal thyroid-stimulating hormone (TSH) levels could have explained the fact that I had no energy and felt like sleeping all the time. High TSH levels might have also explained my loss of appetite and lack of focus. But my levels were normal.
At the time, I had no conscious awareness that I was actually experiencing symptoms of clinical depression; I simply checked the hypothyroid diagnosis off the list and went on my way. I could not wait to see what the next day would bring—maybe Raynaud’s disease or systemic lupus erythematosus.
At the beginning of my third year of medical school I started on clinical rotations, routinely seeing patients for the first time in my career. The first rotation was a six-week assignment in a surgical intensive care unit. Medical students were required to arrive by 4:30 a.m. to gather all the overnight information on the patients from the medical charts and the bedside nurses. Then the clinical rounds with the surgery residents took place a little before 6 a.m. Usually, this just meant waking patients up from deep slumbers, which pissed them off something fierce, and then running off to the operating room by 7 a.m. There, sometimes for twelve hours at a time, I would stand and watch, mindful not to make any sudden movements, talk louder than a whisper, or touch anything at all. I knew what happened with any deviation from this protocol; rumors circulated that a few months earlier a medical student had been kicked out of the OR and made to stand in the hallway for the final three hours of a complex bowel-perforation surgery. So, I just stood in silence, imagining the joy of a restroom break or a nice sit-down meal at the hospital café. This schedule did not deviate, six days a week. I would get home at around 9 p.m., shower, maybe eat, collapse, and dread the 3:45 a.m. alarm clock ring. The hours were long, the sleep was short. And social encounters (at least those that weren’t dreams) were minimal, brief, and filled with the inevitable frustration of a patient whose sleep I interrupted.
One of our adult patients was in a prolonged coma after an unsuccessful attempt to remove a cancerous obstruction from his lower intestine. He was on a ventilator machine, and his body wore all the bruises of an extended fight. He was in his late forties, had a young family, had everything to lose, and was actively losing it all. A few days after his surgery, one of the resident surgeons asked our group of medical students if we wanted to practice blood draw arterial sticks on him. I sat shocked by the offer, and the casual nature of the replies. Chipper classmates sounded eager to check the procedure off their lists of technically achievable goals. Seeing this all as highly unethical, I protested.
“You can’t just poke around on someone for no good reason.” The words I forced out sounded like a nagging country music song.
“He can’t feel it anyway,” I heard someone say as I turned to walk away.
It was a moment where hypocrisy and Hippocrates collided. I hoped the other students didn’t take up the offer. I never found out if they did, though, and I never asked.
There are memories we all hold firmly, sometimes without fully understanding why. I can vividly recall being in the shower at 9 p.m. with my head hanging down, not knowing how I could wake up and do it all over again. I remember this moment like it was yesterday; it’s a memory I once wished I could forget. I did not realize the image of the hanging head in the shower had nothing at all to do with being on a surgery rotation; it was a foreshadowing of the brokenness I would feel in the years to come.
A few months later, I spent time working in an inpatient child psychiatric hospital, in what became my first exposure to patients with mental health stories of their own. Here, I saw signs of abuse and neglect, of children kept in dog cages, burned with cigarettes, and beaten to within an inch of their lives. These are moments the mind cannot unsee or unhear, and they are difficult to decompress from. I struggled with anger and sadness from the gut-wrenching cruelty I was exposed to. In my own emotional maturation process, I was not ready to accept these realities, and they haunted me for years. I did not know how to escape the fraught image of a child tied to a bed or sexually assaulted by their own parent. I had no concept of how to unpack the unspeakable weight of bearing witness to this level of suffering. None of my colleagues spoke about the gravity of it; for me the trauma meant an extra layer of stress on an already weary mind.
My most fulfilling experiences were working in the pediatric intensive care unit and on the pediatric oncology and stem cell transplant floors doing difficult but meaningful and impactful work. During those rotations, I grew close to a patient—a little girl named Zoe—and her family.
Zoe was a two-year-old living with a rare autoimmune condition associated with frequent life-threatening infections, and her only chance for long-term survival was to receive a stem cell transplant. Zoe was beautifully shy, an inquisitive toddler with piercing blue eyes and an illuminating smile. She loved Thomas the Train and watching early-afternoon cartoons.
I met Zoe and her family after her stem cell transplant. Over the course of her months in the hospital we formed an intimate bond. I would go visit her after rounds and we would lie on her hospital bed and watch TV or play with her trains. Over time, her sterile, quarantined room felt more like a toddler’s playroom, a testament to her indomitable spirit. I marveled at her persistent ability to remain a kid while living through so much hour by hour. The resolute nature of her innocence was truly something to witness. Years later, her mother told me I had helped to maintain a bit of normalcy amidst the medical chaos unfolding before their eyes, though at the time I didn’t know that was humanly possible.
Tragically, a few months later, Zoe died from complications of her transplant. I was out of town, working at another hospital, and felt ashamed that I could not be there for her in those final days or even say goodbye. Hers was the first funeral I ever attended for a child, with flower wreaths over a three-foot casket. Surrounding the receiving line were photographs of Zoe in her Easter dress and ponytail in a backyard swing. With tearful eyes, I imagined her family picking those photos off her bedroom dresser to post them on a sterile funeral-parlor wall.
Zoe was the beginning for me—she brought out who I wanted to be in medicine. She became my first true mentor, showing me what it meant to show up, how to vulnerably expose a heart to a patient, and how to care for them as a person first.
I loved that little girl, and I still do.
Years later, during our second pregnancy, my wife and I received our eighteen-week ultrasound report. I messaged Zoe’s mother to ask for her blessing, as we had a name picked out: Zoe Grace.
After the funeral, I said my goodbyes and went straight to a basketball court—ninety-four feet of Indiana therapy, I suppose. It was the final game of a summer recreational league, and at the beginning of the second half I came down with a rebound and another player fell underneath me. I felt a crunch and an unnatural sensation of bone grinding against bone. I fell straight to the floor, writhing in pain, with the excruciating sensation of a piece of me tangibly breaking. A few teammates helped me off the floor and a friend took me to the hospital.
An MRI confirmed the tibial plateau fracture. No surgery required, only one day allowed off from medical school, and for eight weeks I would have to use crutches. In constant pain, I returned to work at an outpatient neurology office, after which I spent a month at a family practice. Working day after day with a braced, immobile leg for the full eight weeks, the physical injury, and the temporary loss of independence, pushed my wounded psyche over the edge.
I smiled through the day, but the internal turmoil kept rising. I had spent years hiding my vulnerability, ashamed of standing out from the crowd and afraid of what people would say or how I might be judged. But now I couldn’t hide the limping any longer; I felt broken, helpless, and exposed. The physical injury became a convenient excuse for the brokenness I had carried for years. It felt okay to not feel okay, when everyone could see and understand the pain I felt from the fracture. It became clear to me for the first time, then, that I was depressed. My family helped me find a psychiatrist and counseling group and I started taking an antidepressant. At the time I did not even think twice about it. My family saw I needed help, so I accepted the help. I just wanted to feel better.
The next eight weeks were difficult, but my mood seemed to stabilize over the course of the following rotations. Honestly, one of the hardest parts was being on two outpatient electives and having to see twenty-five or more patients per day. It was not the workload or even navigating the narrow halls on crutches that proved difficult; it was that every single time I walked into a patient’s room, they would ask, “What happened to you?” I grew to hate the unwanted sympathy. I did not want to be pitied; I just wanted to be left alone. Comically, my sister made me a T-shirt after I told her about the barrage of questions from colleagues and patients. It had block letters stating, “Yes, it is broken. I did it playing basketball. Yes, it hurts. I will still be a good doctor.”
I loved that T-shirt, but truth be told, I really wanted one that said, “Yes, I am broken. It happened during medical school. It really hurts. I do not feel like a good person.”
With family support, the antidepressant, and counseling, I finished the final year of medical school in a better emotional space and readied for the next step in my young career, a residency in pediatrics in St. Louis, Missouri. After a year of doing well, I decided with my doctor to discontinue the antidepressant, believing that a lot of the triggering events were due to the broken leg and the strains of medical school.
But hindsight is not always 20/20.