Risk averse

One quality that is great in general internists is risk aversion. In my experience, general internists do not like to take chances. We play it safe. We measure twice and cut once. We are safe people.

In practice, that means we avoid risky behavior. We go with the established method. We recheck test results. We say things like, 'Don't trust the radiology reports. Look at the films yourself.' In reality, if the radiologist missed it, what chance do I have? We also preach from the rooftops about evidence based medicine. We know what we know. We are applied epistemologists.

But the problem with risk aversion is that I've taken it to another level in my personal life. I am totally gun shy. I like to gamble, but it's nickel slots. I like fine dining, but won't venture past five restaurants. I haven't asked a girl out in five years.

Regardless of the reward, I'm unwilling to take risks, and that is a quality that probably drew me to internal medicine in the first place. I'd be a terrible surgeon. But personally, my life is empty. Without risks, life is shallow and empty. I have no excitement, no joy. It is strange that a quality that helps so much with my professional life can be such a limitation in my personal life...

At arm's length

In medical school, I remember quite distinctly the day we talked about personality disorders. We discussed schizoid personality disorder. These are the folks who prefer solitude. They are lighthouse keepers or wander the desert. This is in stark contrast to social anxiety disorder, where a person is unable to interact with people, and this inability causes great distress.

I remember this because it was when I realized that I have made some terrible decisions in my life, choices that I am not proud of, in order to wake up in the morning and not shoot myself.

I was recently forced to do a lot of introspection. This is something that I am relatively comfortable with. I keep this blog, I write in a journal, I feel like I am pretty in touch. But surprisingly, putting a voice to my inner monologue was quite horrifying.

In my life, I've had my fair share of romantic disappointments and failures. Couple this with other issues with intimacy and relationships growing up, and somewhere along the line, I decided that I could not take it anymore. I made the quite conscious decision to hold the world at arm's length, to distance myself emotionally from all this turbulence. And without that horror, I've thrived. I've done well in medical school and residency, and I feel like I've managed to accomplish quite a bit in my life.

But it comes at a steep price. Sure enough, I have not had my heart broken in a long time, and I haven't felt that pain again, but the problem is that the pain and joy come from the same place. I have cut myself off from a world of happiness, because the risk of pain was unacceptable.

And I've watched life pass me by from my little castle, with all interlopers thwarted by the high walls and deep moat. And actually, if I am really honest about it, women have tried, some trying pretty hard, to get inside. And rather than welcome them in, I have put up more walls, and closed myself off.

This distance has its pluses. I can unflinchingly deal with most patient interactions. I've had people cry, people yell at me, the whole gamut of emotions, and I have been able to be empathic, and none of it hurts me, because I don't let them get close. They have to work on my schedule. I can deal with patients in convenient 15-20 minute chunks. They open their doors to me, but it isn't reciprocal.

It's too bad that joy and sorrow come from the same place, and that it is our greatest loves who can hurt us the most. I just don't know if I can risk it. I don't know if my heart can take it. I so desperately want to be loved, but the thought of me loving another person is absolutely petrifying.

I portray to the rest of the world a man of confidence, an outgoing and gregarious guy, but at heart, I am none of those things. They are adaptations so that I can operate in this extroverted world. And I think of how wonderful it would be to meet a girl who could cut through all of this façade and get to know the real me, and not this face that I portray to the world. She would tell me, "Hey, it's okay. This is safe, you and me," and I could finally, finally let my guard down.

"Experience is a hard teacher because she gives the test first, the lesson afterwards." –Vernon Sanders Law

I was talking with a friend a little while back that my expectations for med school were just too high. "'How high?" he asked. "Did you think you'd be married by now?" I have to say that yes, I kind of did. That was unrealistic from the beginning, but it sort of speaks to the height that I was to fall over four years. And my friend did relay a simple truth. "I'm not sure why you thought med school would fix your problems. Med school's just an event. It doesn't change who you are."

But the real problem is that instead of making med school different from college, I sort of turned it into a repeat of the previous four years. It had the same crappy ups and downs, similar challenges, and similar results. And of course, similar regrets. Regrets like chasing after the wrong girl, like not studying harder, like making a boatload of friends but only trusting my high school ones, stuff like that.

There's a fantastic quote said by Franklin P Jones: "Experience is that marvelous thing that enables you to recognize a mistake when you make it again." So at least I'm walking away from med school with experience. I can say that much. And hopefully, next time I meet a girl that's my type and the world seems convinced I should try to go out with, I won't be a moron and chase after another girl for a year or two and fuck everything up in the process.

Don't be single on Match Day

I RSVPed for my school's Match Day reception. Just me. That's flat out depressing. It's not that it's depressing that I'm single. Nah. The depressing part is that there really is no one in a 500 mile radius that could come to this deal who gives a rat's ass about where I go for residency. There's something infinitely disturbing about the thought that no one really cares where I do my training. Someone should care. Someone should want to be there. And I think ultimately this is what disturbs me the most about being single. There's no one to share things with. There's no one to share the good times with, or to weather the tough times with.

I'm sure my family is interested. But interested is a long way off from caring. It's not like where I go will affect them all that much. I'm not going to train near any of them, based on my rank list, so it's sort of a moot point where, really.

It just seems sort of unfair that one of the biggest decisions in my life should have so little impact on anyone else. To any other medical students reading this that are not 4th years, I'd suggest getting yourself a boyfriend or girlfriend to have for Match Day. And maybe you'll end up matching in a program so far away that you'll be forced to break up, and that's okay, because someone should view this decision as huge other than yourself.

When you're the only one who cares about where you match, the decision begins to seem as trivial as whether you super size your extra value meal or not. I was talking to my friends about Match Day, and someone mentioned that he'll be on the phone for a lot of Match Day, telling people where he's going. It dawned on me at that moment that I hadn't even thought about informing my family or friends. It's become meaningless to me, just another excuse to get out of a day of rotations.

Crushes have nothing to do with love

I've known a lot of girls in my lifetime, and I have gotten my silly heart hung up on a whole bunch of them. And it seems like all the girls in my life, the ones that matter anyway, have fallen into two columns.

There are girls that I've had sickening, maddening crushes on. They are attractive to me in every sense. In their presence, I feel woozy and trip over my words. I never know what to say or how to say it. I admire everything they do or say. I find myself mildly obsessed with their lives. This is, for the most part, entirely unhealthy.

Then there are girls I'm so comfortable with that it's like we were joined at the hip. We get along like milk and cookies. We talk every day as if we haven't spoken in 15 years. And uniformly, I've been entirely uninterested in these girls, save one. It's not that they are unattractive, and it's not that they haven't been interested in me. It's just that I had my mind on other things, I guess.

I often gripe that a lot of women I know are interested in everything about me, but not me. There is nothing so annoying as having a girl describe her ideal mate, and she describes you down to what color boxers you're wearing. But you know that if she was presented with the choice between you and being locked in a foot locker full of spiders, she'd have to think about it.

I've had a pretty pitiful love life, and I have a whole list of people and situations that I enjoy blaming. But maybe it's because I've been trying after the wrong girls all along. Maybe it's because the women that are right for me are not the ones that I've been chasing after. Maybe I'm just as guilty of chasing after something I don't really want. And maybe I need to rethink the last ten years of my life.

The definition of lonely

I'll admit it right here, right now. I am lonely. I am lonely in a way that I can only describe as painfully so. I'm not lonely for company. I've got plenty of friends around. I'm lonely in that lonely way, when you see other people who've found one another, when you see a couple holding hands in the parking lot, when you hear the lilting laughter of a woman giggling at some remark, when you hold the door open for a girl wrapped in the coat of her boyfriend.

Loneliness is a terrible thing. It eats at you constantly. It reminds you that even unhappiness is better sometimes. It's like a sweater that itches, but you can't take it off. Loneliness is what drives a person to go through old letters from crushes and exes, neatly kept in file folders, letters still kept in their original envelopes. Loneliness is what makes you appreciate that a beautiful woman is more than skin deep. Loneliness is what reminds you that life is horrible and cruel because it gives you so much but never enough. Loneliness is what makes you realize that you are so very unhappy with who you are, not because there is anything wrong with you, but because the rest of the world has no appreciation for who you are. Loneliness is what tells you that the most beautiful object in creation is meaningless if you can't share it with someone else.

I am lonely. And with that, a healthy dose of despondent. I don't say depressed because I'm not depressed. I know depression. I could ramble on about depression for quite some time. Depression is not the same thing. Despondent is simply the lack of hope. It's the active realization that there is no hope for the future or the present. Despondency is what tells you that you should be depressed and you should consider putting a bullet in your brain. That's not depression. Depression is thinking that a bullet in your brain would be an improvement.

I think that people have no comprehension of me. I am some sort of enigma or puzzle that is entirely not worth unraveling. I am a Rubix cube that sits in the toy chest unsolved, and undeserving of such effort. I am a pair of white shoes the day after Labor Day. I am khakis at a semi-formal event. I am soft serve ice cream in the middle of winter. I have spent so much time in trying to sell a product that has no market. I'm trying to be a jelly donut, but I'm really a bowl of oatmeal.

And that's why I hate myself really. It's not that there's anything to hate. It's that what is there is so unwanted, that I too do not want it. It's that pecan roll whose only fault in life was being a pecan roll. And it sits, growing stale, in a case full of frosted cinnamon rolls, watching them snatched up with great pleasure. But that poor pecan roll just sits in the case and dries out. And how can it NOT hate itself? Why shouldn't it hate itself, for being something that is so unwanted?