Opting out

“You’re shitting me.” Brief pause. “You’re not kidding? I can’t tell if this is a really intense joke or if you’re being serious right now.” 

So far this has been my favorite response to telling someone that I am quitting residency.

It is a decision I have been working on for several months for reasons I will discuss at length momentarily, but I’ve made my peace with it. Better than that, I’m even excited about it.

I have already passed the point of no return and selected the path that will allow me to complete intern year and get my license to practice medicine as a general practitioner. As much as I dread a few more months of being an intern, I still want to change the world and treat the sick – even if it is in a different way than I had recently envisioned. My resignation is pre-dated for when my rotations are complete and already signed and submitted. My hearing in front of the Graduate Medical Education committee to discuss my resignation is already scheduled. (I have no idea what to expect from this, I anticipate that they will ask me “You sure?” I’ll say ‘no’ – they will exchange uncomfortable looks because this is a big decision to make if you aren’t sure. And then I will elaborate… probably saying much of the same things I’m about to share here… although if I don’t feel eloquent, I may just say YOLO. Or Jesus take the wheel. … Probably not the best idea.)

So here I am. It’s happening. Now I get to tell the people at work. I’ve played my cards pretty close to my chest regarding this decision because it’s a big deal. I really wanted to be sure. By now I’ve realized that sure isn’t something you get often in life. Its an easy thing to appreciate in hindsight but is rarely clear in advance. So I’m not sure, but it is happening anyways. … Is this the right time to use YOLO?

 It is a taboo thing among other residents to drop out- people aren’t sure what to say. Should they should apologize or simply change the subject? Like I’ve been excommunicated. Led astray. Seduced by the possibility of more sleep and free time.

I amuse myself by dropping this factoid into random conversations with colleagues without any real build-up at all. They will see me, in the office or around the hospital in civilian clothes (for all those who don’t work at military hospitals, this is akin to wearing a large sign around my neck that says “I’m not scheduled to work now, but I’m here anyways!!”) and they will often ask “Oh, day off?” or “Are you post-call?” or “are you working tonight?” because those are the sole explanations in the world of residency as to why I would have free time. I reply, “actually I’m quitting residency”.

It says something that the most common retort by far is laughter, followed by “Me too.” Or “I know how you feel”. Or a more subtle form of agreement “Right?!”.

I wonder what patients would think if they realized how quitting is a fantasy for nearly every resident that takes care of them?

Of course, most with this fantasy don’t actually do it. They remember that residency is temporary. They remember that these 80 hour weeks will only last for a few more years. Maybe they remember that they’ve already gotten this far to be a doctor, no sense turning back now. They remember their passion – that small but powerful encouragement when a patient refers to you as their doctor. How it feels to understand a treatment plan. The sensation of literally bringing someone back to life.

Those moments may be plentiful or they may be few and far between. Regardless of their number, it is up to each individual resident to decide if they are enough. Enough to make up for long hours, sleepless nights, stacks of paperwork, and being the lowest man on the totem pole. Enough to make up for subjecting yourself to pimping, questioning, criticism veiled as ‘professional feedback’ and smiling through it all. Enough to make up for frustrated patients, overworked nurses who walk a touchy line with new interns, and slow pharmacies that you get blamed for. Enough to make up for the guilt when the decision you make is wrong, the sadness when the treatment was too little or too late, and the despair when there is nothing you can do. Enough to make up for sacrificing relationships, working on Christmas day, and not making an appearance at the funeral of a dear family friend. Enough to make up for getting home from a 12 hour shift and still having to read about work, for spending your only night off working on a presentation, and for beginning preparation questions for boards years before the actual test.

Just now, that list of downsides is far longer than the rewards, which was unintentional. Being a physician requires a lot be forfeited, but the remuneration may be equally lengthy – it is just much harder to put into words. As I said, we must each choose our balance. If the good outweighs the cost – brilliant. Bully for you, you amazing and miraculous person. In my case, it simply cost more than I was willing to give.

After they realize I’m not kidding about quitting residency, the mood quickly changes to apologetic and embarrassed. As though some mental breakdown has led to my current situation, which in a way, I suppose it has… But only in the sense that it gave me the clarity and distance to make the right decision for myself.

It is like the end of The Office. (I can relate most things in life to an excerpt from the office, but bear with me). Andy Bernard (who essentially filled the shoes of Michael – someone had to be the self-obsessed, socially unaware, buffoon of a figurehead) has an emotional breakdown during an audition for a reality TV show. It is caught on film, ultimately goes viral and becomes a source of public humiliation for him. When he returns to Scranton in the final episode, his coworkers go over the top to tell him they still like him and everything is okay. They all feel as though his life is now derailed and he is clearly suffering from his choices. However, Andy has utilized his newfound internet fame to get a job he wants and is actually quite happy with where his life has led him.

My situation is different in that I didn’t undergo public humiliation but similar in that I often end up convincing the people around me that this is a good thing. I’m happy about not completing residency. Honest. I've thought about this.  Decided. Chosen. I haven’t gone off the rails. You don’t need to worry about me.

I’m still going to finish intern year then quit. Resign. Or, in my preferred diction, I’m opting out. It’s not that I can’t do this. I’ve been soldiering on (no pun intended) for the last 5 years through pretty miserable circumstances. As anyone who has attended medical school or done any part of intern year can tell you – it’s not for the faint of heart. No, I’m choosing something else. Opting for something better.  Honestly, I’m not sure what that entails at this moment. But I can tell you that it will not be unending work weeks with “it will be worth it someday” tattooed on my soul as I waste more and more years of my life being less happy than I could.

I was dreading intern year before it started. Everyone was. Transitioning from 4th year med student where attendings are often surprised when you show up on time to the responsibility your own patients and real (ish) power is a rude awakening. Fourth year of medical school includes time purposely scheduled as empty to allow for students to make up any outstanding work, travel to interviews and after matching to new cities to find homes and set up lives. It may not be intended also as a partial vacation to give mental relaxation before the marathon that is intern year (or an indulgence more similar to a favorite last meal for a death row inmate) but that is what I used it for. As early as the end of third year I was having doubts that I was on the right path, that I wanted to be a doctor, that I could maintain this marathon of studying for the rest of my life.

Cue fourth year. Laid back rotations (an hour per day in the pathology lab, anyone?), time off. I did a rotation in Uganda and then went on safari with some friends I’d met there. After that I went to Europe by myself and was met by a close med school friend and we lived like gypsies, carrying all our belongings on our back and enjoying what it felt like to be young and responsibility-free.

I hadn’t taken time off between high school and college, nor college and medical school. In undergrad I had multiple various jobs, grueling schedules often packed with over 20 credit hours so I could fit in the various classes I wanted to take in addition to the ones I needed to take. Needed – for med school. Because I had decided that was my path.

Flash forward and I’m 25 and experiencing my first real sense of being an adult – I had rent and a roommate and a cat, but beyond that no real obligations. My time was my own and I could travel and do as I pleased.

Perhaps a similar hiatus from the demands of higher education earlier on could have given me a much needed break to refocus and return energized. Perhaps I simply would have learned sooner that my trajectory was unstable and ultimately misguided. But those things hadn’t happened, and I was trapped.

I became deeply depressed and called my parents tearfully and explained that I didn’t want to be a doctor.

I realized that if I dropped out of medical school, it would be rather sad not to graduate with my classmates. (My ever-wise father also pointed out that since fourth year is the easy part, why bail out now? No sense quitting the race when the finish line is close enough that you could crawl to it) So I graduated.

In the graduation program, they list the residency where you will be continuing your training. I did not want the space below my name and picture to be blank. (Although, in my opinion, they could have left the picture out, thank you very much – why don’t professional and flattering ever coincide?) So I swallowed my doubts and I matched at the Walter Reed National Military Medical Center in Pediatrics.

I had gone to medical school for four years cost free thanks to the Army Health Professions Scholarship Program. The deal was – I go to med school, they pay for me, then I do residency with them and work for them – paying back a year of active duty for each year of my life they footed the bill. Given the prohibitive cost of school and having never owed a dime in my life as a college senior, I jumped at the opportunity. This was clearly the logical next step in my pre-determined trajectory. Things were simply falling into place.

I attended BOLC (it's an acronym, but, in typical army fashion, it reads as a word, pronounced BO-luck) before medical school even started. There, we were indoctrinated into the army. A bunch of wimpy medical students and new doctors, the hardened cadre were there to whip us into shape. My memories of BOLC are rather hazy and incomplete – I spent a good chunk of our field training time with an IV in my arm due to heat stroke, dehydration, and starvation. (Vegetarians are rare and mysterious creatures for uncle sam. I think he systematically eliminates them via the Veggie Burger MRE – for those of you who disagree, I dare you to eat one.) That is as close as I came to the real army for all of medical school.

Point is, there were two major transitions happening at the beginning of intern year: 1. Student to actual doctor and 2. Girl in her mid twenties with purple hair and a nose ring largely unaffected by military tradition to same girl – sans colorful hair and facial decoration who is now wearing the rank of a Captain and expected to act accordingly. Add to that I said goodbye to many friends in Toledo who I had lived my life with for the past 4 years and considered family. Add to that I was moving far away from my actual family who had always been a short car ride (read: if I felt homesick enough to cry, it was only a reasonable drive home to hug my daddy and momma). Add to that my recently treated depression and poor responses to major life changes. In this perfect storm of ingredients, a negative reaction isn’t entirely outside the realm of possibility. Perhaps I should have seen it coming.

My program director did see it coming. There were many attempts to reach out to the interns and all residents as the year unfolded. It is no secret that intern year is a trial even for the most content and well-adjusted of future doctors. It is hard on purpose – because you can’t do it half-way. As an attending, you may have fewer hours and a better lifestyle, but when you are in the hospital and your name is on that chart – that is where your soul focus needs to be. You will not leave until the patient is stable, regardless of whatever storm you are weathering in your own life.

There is no way to know if this is the most effective method to produce compassionate, intelligent, innovative and driven new physicians. But I suppose I can see the logic… although the reasoning offered as explanation more often is simply, “that’s just how it has always been done.” Truly, I hope that the people who use this as their rationale are doing so simply because it is a short and quick way out of what deserves to be a far more in-depth conversation. Given the long-term psychological effects on those involved, and the high suicide, depression and burn-out rates among physicians today, “how it has always been done” is clearly failing us.

I digress.

I want to make it clear, my program reached out to me, my co-residents reached out to me. I was in absolutely the best possible program to face crippling depression because it was identified and I was then told that my mental health, my sanity and my existence matter more than another name on the call sheet. In any crowd, there are people you work well with and those you don’t. People you enjoy and those you … don’t. (As a child, I remember hearing a pastor in a sermon refer to these people as ‘dipsticks’ – they function to test your patience. Similar to the stick you use to dip into the oil in the car to see that it is adequate… My best friends mom referred to these people as peons. Don’t know the logic here but the mental image that I’ve peed on them adds at least 30 seconds to my ability to interact civilly.)

So, as the days grew darker and colder, we heard frequently “look out for each other”, “check in on each other”, and “depression is very common during residency and this time of year”. Cool. I knew I was depressed but didn’t see how telling anyone would do anything about it. I knew I needed time and space, but both of those things are hard to come by. I couldn’t imagine that if I were not available to take call how the others would re-adjust to shoulder the weight I had dropped on them. I was a burden.

In med school we rotate through all the basic specialties – to give us a taste of each as well as a working knowledge of their general diagnoses and treatment. For instance, we all know that “In the past two weeks, have you felt down depressed or hopeless?” and “Do you ever have thoughts of hurting or killing yourself or that the world would be better off without you?” are screening questions for depression and suicidality. When you check daily, or almost daily or really anything except never – something is going to happen.

I didn’t care. I was at the point where something was going to give, and I did not have the strength to fake it – even to this stupid form that was part of a study regarding how information is best received during rounds. The questions were snuck in and irrelevant to the study data. The form was blinded, so only my ID number connected me to it. The researcher would have no idea who number 8 was. (I was not number 8… it was a 6 or 7 digit number that I don’t remember. 8 would have been better. Rhymes with Kate. … close to Katie. Maybe not so blind after all, good thing I wasn’t 8.)

Given that it was a cry for help, I continued to spiral downward after checking whatever I checked. I waited to see what consequences lay in store for my honesty. I slept and cried and did my best to fake it. I was short tempered and moody. I lost interest in family and could barely summon the energy to spend time with them.

I mentioned this to a co-resident on one of our fairly regular phone calls. We would often discuss whatever had annoyed us about work on that given day. These venting sessions were extremely therapeutic and we trusted each other to keep the conversations between us. I told him how I didn’t care that my family was coming. That I wanted to sleep forever. That I didn’t care about a lot of things I used to care about. That I didn’t know what they meant when they said ‘look out for being depressed' when there was absolutely nothing that could be done about it.

He told me I needed to tell someone. I did... that someone was him. I made him promise that like many other things I had told him, it was in complete confidence. He gave me his word.

I faked it. Until I couldn’t. Until one day, I was called to an office for a meeting about “important feedback regarding my performance”. “It needed to be addressed before the holidays”. I wasn’t busy at that moment and left what I was doing immediately – heart pounding as I sprinted across the hospital. What could I have possibly done so wrong?

The content of the meeting turned out to be: my hair is sometimes not in regulations and sometimes I wear an earring (act of forgetfulness – not defiance). Something snapped. Really? I had been working my whole life to get to this point and it seemed that all I had heard since arriving was negative. I knew I interacted well with patients and families, but was told my sense of humor was too much (by people above me – not those in close proximity or patients or families). I knew I had a long way to go as far as learning curve but was told I was way behind my co-interns (a comment that has been disputed by many now). I knew my case presentations at morning report were humorous (Which I embraced because 1. IT'S EARLY. 2. This was as close as I would ever get as a doctor to doing stand up comedy #bucketlist), but I was told “remember not everyone appreciates your sense of humor”. I knew I was comfortable talking to attendings but had been told I was too non-chalant. Unprofessional. Didn’t care. Shirt was once wrinkled. Did not have her ID on. Her white coat was not buttoned. Hair was messy. Once sat on knees in front of patient (I wish this one were made up, because...seriously?). Appears youthful. (...I'm 26, but I dyed my hair grey so maybe that will help) Overall message: you don’t belong here.

This was not all from one meeting or one person, but that initial meeting was the tipping point. I broke down and ugly cried in a super unprofessional manner in front of my mentor who was apparently only trying to help me by sharing how I was being perceived. “Do you need to talk to someone?”… What do you think, lady? “Yes, that would be helpful, ma’am.”

Many of my co-residents are fantastic people who I am so lucky to call friends and I know (now) that if any of them truly understood where I was mentally, things would not have been the same. But I didn’t know that. I didn’t have energy to talk or bond. I withdrew.

As anticipated, after checking the box, consequences played out. But they didn’t start until several months later. When you answer the red-letter questions (euphemism, they aren’t actually in red letters) in ways that you aren’t supposed to, your name and number get matched up. Someone, somewhere gets told. The cogs begin to turn and the system churns to life.

At that point I had already been referred to the physician wellness clinic – a group of physicians specifically intended to treat other physicians in the hospital: to identify burnout, stress and depression and intervene in a timely fashion.What came of my appointment was the declaration that I was still functional, and capable of doing my job adequately. What I received from it was “until you make a mistake that hurts a patient, we do not need to do anything”. It was disheartening and I felt more alone and isolated than ever.

So when I had a separate meeting where I was asked about checking the box (finally), I was worse than I had been initially. I was offered time off which I rejected – how could I do that to all of my co-residents? They would have to work so much harder. Take more call. Carry me. I could not do that to them.

That same day I had received my feedback from my clinic month. A difficult month for me given that outpatient is not my ideal setting, but I had worked hard to be pleasant and learn the ins and outs. Well baby visits are a conundrum and I’m never sure what I am supposed to be asking if the baby is eating, sleeping, peeing and pooing appropriately. Small talk is vital to clinic – it is how you make families like you. I was doing my best, but was unable to summon the vivacious chatty darling that we all know I can be. I avoided the dipsticks as I could and tried to work with attendings that were good teachers and also managed to make me feel like I was not a complete idiot. It was akin to patching a sinking canoe with duct tape – it isn’t pretty and it is only delaying the inevitable but at least you are still moving forward, right?

Wrong. What I was told regarding my performance was again contrary to how I felt I had been doing. Too informal. Doesn’t take it seriously. Doesn’t want to be here. (That last one was actually true for a whole myriad of reasons beyond the actual work involved, but that is beside the point and probably would not have helped my case.) This is a paraphrased version of what was said to me, but I was told: you are clearly not the typical army resident, things may go more smoothly for you if you value what they value and try to be less like yourself to fit in. You know, just for a few years.

So I went home and I mulled (Read: cried – that happens a lot in this post, wow., ate my feelings – smores poptarts anyone?, and drank some wine – malbec pairs well with poptarts for future reference). I wandered through my next full week of clinical responsibility in a daze. I couldn’t remember answers, I didn’t know diagnoses, I could only hear my program director saying over and over again “it would not be that difficult for you to take time off”. I was coming up on my call-free block – the one month per year which I would not have to work any weekends or cross-cover on any other units. If I was going to get breathing room and there were only bad times, this was the best bad time to do it.

I was referred to psychiatry, reassuringly it turns out they still want to see you, even if you haven’t hurt a patient. I was started on medication. I slept for probably two days in my new found leisurely lifestyle. Then I started painting. I went to therapy. I went for a run. I started boxing again. I spent time with my friends outside of work. I visited my family. Things were looking up.

Until I had to address my return to residency.

I think I can pin it down to the moment when the tables turned. A mere 4 months later after the fateful checkbox, there I was, on a now-extended leave of absence from my first real grown-up job and sitting in psychiatrist-recommended therapy. Given my progress, the topic of discussion in therapy was my return to work. This particular topic froze my stomach and induced unparalleled anxiety. Trying to explain this to her, I stated “the only thing that appeals to me about returning to that job is that I will get to see my friends (meaning the co-residents) more often”.

There was a loaded silence for a few seconds as we both digested what I had just said. I don’t know that even I realized it before I said it, but after I did it was more clear to me than ever that I didn’t want to go back.

It’s quite the realization to discover that what you have been working toward for the better part of your life is not what you want to do. It is alarming and freeing all at the same time. On one hand, I sure have wasted a lot of time and money getting somewhere I don’t want to be. On the other hand… well, it feels a little like getting out of a cult. Here you are in the place where everyone else believes is the best place and wants to be there… and you just want to escape. It feels like getting off of a conveyor belt. Breaking ranks.

That realization. That moment: I haven’t been the same since.

When I was a child, the movies I was allowed to watch had very clear “good guys” and “bad guys”. There was also the “in-between guys”, which were neither good nor bad but served to further delineate the other two categories. These were Disney’s best approximations of societal pressures associated with doing the wrong thing, included to further emphasize that the “good guys” often didn’t have it easy.

For example, Belle, in Beauty and the Beast. At the outset of the movie, the authors go to great lengths to establish that she is different. She likes to read, does not care about the attention of the neighborhood hot guy (although, he has a pretty gross ponytail in her defense) and all in all spends her time happily lost in her own little world where she sets her own standards and lives her life according to what she deems right.

This seems to be a common childhood moral: be true to yourself. It’s seen in the ugly duckling, who doubts himself but later grows into a beautiful swan. Also in Robin Hood who breaks the law in order to serve the greater good. Even in the movies I indulged in later in childhood, the Disney channel original movies where the girl plays the boys sport and succeeds, or the unlikely friendship thrives in the face of apartheid / social circle differences, etcetera.

Given the extent to which it is engrained into our minds as children be true to yourself seems to be an important societal value that will serve you well in everyday life as an adult.

So, when I found myself in a situation in which I was told to not be myself, it was extremely demoralizing. In fact, it felt that the life I had been promised: a life of success, self-acceptance and happily ever after as my cheerful monologue plays while the end credits roll was all a farce. It was as though I had toiled away my years to get back to ‘GO’ only to find out, I would not get the $200 payout I had been counting on. I didn't know why I was doing it anymore.

Thus, I’m opting out. Time to reset my focus and select new standards. Still me.  If residency is not helping me meet the goals for my life, then it is not a place I need to be.

This is who I am: I have always wanted to make the better place. I have no idea on what scale or to what extent, but I believed that medicine was the route to do that. I have always wanted to work in a place that seems forgotten by the rest of the world: where people die of treatable diseases simply because no one cares or knows enough to get the medicine to them: where saving a life may be as simple as stopping the bleeding or starting an antibiotic. Maybe the Congo. Maybe Syria. Maybe India. Maybe isolated areas in the U.S. It is terribly sad that as our technology grows more advanced and the earth becomes smaller these places become more abundant, not less.

I find freedom in traveling to new and exciting places where I don’t know anyone even though it is simultaneously terrifying. I believe that I owe it to the world to do the things that awaken my passion. The things that make you feel alive and free and afraid all at the same time are absolutely things that you should keep doing.

I believe that material wealth is not the key to happiness. If I have to live in a shack and take a daily bucket shower to be where I want to be, I am okay with that. It may mean being in close proximity to spiders that I feel are much larger than spiders should be... I’m actually not okay with that, but I will deal with that as it arises.

I believe that what you do matters more than how you look while you do it. I understand that the army is governed by very strict rules to regulate appearance so for the next several years of my contract I will do my best to fulfill my duty and honor the agreement that I have signed. I hope dearly that none of it becomes engrained in me and when I shed my required fashion choice for the final time and shake out that final hair headache (a very real and painful problem) I will lose all sense of the culture where someone’s status is literally emblazoned on their chest. In my experience, many times when someone is messy it is because they have been working too hard to clean up.

I believe that if you have the means to help someone, then you should do it. Regardless of their ability to pay, their enrollment in your practice, or if they are on your side. We have enough division, violence and hate in this world already – if you have a beating heart, I have an obligation to you. It’s part of an oath that I took one day and intend to honor, as I can, to the best of whatever ability and training I acquire.

I believe that life itself is a team sport. I don’t know why residency has such a cruel streak – the pimping, the bullying. There are people I’ve worked with that I feel go out of their way to make it more difficult. Hopefully, I am not one of them.

I am so thankful for all for all of the co-residents I’ve worked with and owe special thanks to Mike for the endless vent sessions, bro time and keeping our standards for nights off high. Thank you especially for encouraging me to seek help when I was getting really low and respecting my privacy when I chose not to. To Molly for the beautiful card you wrote me on an especially bad day encouraging me to “keep doing you, never ever change, and show those Bitchez what an amazing doctor looks like” (it included much more, but this line was my favorite). I will treasure it and your friendship forever – so lucky to have a kindred free spirit in a place where free spirits are often unappreciated. To Jenn who would constantly express the sass that I kept bottled up inside: Thank you for taking up my fight and for standing up for me or next to me as the time called for it (and for giving me the emotional breaks needed like watching Bridesmaids during one of our not busy shifts). To Claire for playing devils advocate when I would focus on one terrible thing, for encouraging me to keep trying and to not let them get to me. Thank you for walking the fine line of humor and professionalism and being an excellent role model. To Katie for being there on Monday afternoons and shouldering 50% of the questions directed at “Katie” even when they might not have been intended for you. Thank you for commiserating, reaching out, listening and just being you. And for making a fantastic Moscow mule. To LC for being easily the most positive person in our program, for taking more than your fair share of inpatient rotations and not complaining. Thank you for finding non-medical things to talk about and sharing stories of your adventures – can’t wait to travel to Africa together next year (hopefully!) To Kara for being the best ward senior I could have ever wanted: embracing talk like a pirate day, throw back Thursdays and making the ward a fun place to be. You never made me feel like I was a lesser member of the team or not important in any way. Thank you for unbuttoning your jacket during your CPC, a small but powerful act of solidarity. I am really sad to have not been around for the last few months of this year because I really enjoyed working with you. I may come visit you in California – whether you want me to or not! To Bethany for the endless late night NICU talks, for putting up with my obsession with Frederick Douglass and for always being game for a fro-yo run. Thank you for your patient teaching, gentle encouragement, you’ve been such a good friend and I’m glad you will be in the area but sad you won’t be at Walter Reed. To Katrina for your sarcasm and time spent puppy bonding. Thanks especially for the hug after the Lola-Niko run in – easily one of the worst moments of my life, thanks for asking if I was okay and reminding me it wasn’t my fault. I really needed that.

If I keep going, this post would be endless because of all I could say, so to Meg, Topher, Grant, Dimas, Abigail, Jim, Steph, Sebastian, Jason and the rest of the WRNMMC peds residency, you have all been fantastic to work with in your own ways. The best aspect of this year by far has been the people I have spent it with. While I am not going to be a pediatrician, I will know that there are some fantastic ones out there. Thank you for your dedication, commitment and service. You all are amazing.

I don’t know what’s next. I am returning to finish intern year so that I can complete my  requirements to obtain a medical license. After that, I will be around the Capital area for a few years as I begin to repay my army commitment possibly doing General Medical Officer work,  although I have no idea what that entails.

For the first time in a long time, there are options. After my army commitment is done and I get to choose my own adventure, maybe I will try to write. Maybe I will use my license and do global health work. Maybe policy work. Maybe advocacy. Maybe I’ll work in a medical school.  Maybe it will be something completely new that has not occurred to me yet - maybe some mix of all the above.

Right now, I am okay with not knowing. All that I know is that several months ago I came too close to losing myself. I was living a life that was not what it should be. Hopefully, I’ll never be there again.