My Doctor Dilemma

By Dr. Stacy Cohen, Clinical Director of Beit T'Shuvah

When I was growing up, there seemed to be one simple rule, which basically became the “key to life.”  Ultimately, as long as I did well in school, I was winning.  Oh, and Hebrew school didn’t count.  Hebrew school was a place to goof off and let off steam and laugh at those who took it seriously, as they were clearly wasting their time.  I just had to “pass” and become Bat Mitzvah’ed. The rest of the scholastic experience was graded.  And the grades determined if I was winning.   So, being that I have a pretty high IQ, life was basically a piece of cake through sophomore year of high school.  I would do my assignments during passing period or homerooms, read cliff’s notes, and occasionally pull an all-nighter.  The only parameters I didn’t get A’s in throughout grammar school were “behavior” and “self-control.”  But those grades stopped appearing on report cards after 5th grade, and teachers only cared if you were getting less than B’s.  So, despite getting a “talking to” here and there after parent-teacher conference, I was in the clear.  In fact, I was winning. 

This worked for me.  Not only did it work, it allowed me to fill my schedule with just about everything.  I took about 6 dance classes a week, played 3 sports a year, served as student counsil treasurer every term, edited the school newspaper, partied a little, dated a little, and even worked a little on the weekends so I could shop a little.  And I would go to Jewish summer camp every summer, which scored me extra points with the parents. 

This started catching up with my AP classmates and me around junior year of high school. One of my friends got her stomach pumped after a caffeine overdose the night before our AP English paper was due.  We all laughed at the strength of Starbucks coffee and moved on, not realizing that this was a foreshadowing symptom of an insidious life-long disease: perfectionism. 

When I got to college, things changed. The new standard was getting into medical school.  The grades were just one piece of the puzzle.  (And there’s no way to learn organic chemistry overnight.) The MCAT exam, research, volunteerism and “character” were the other parts of the package. We needed letters of recommendation, which meant I actually had to show up to classes regularly and show teachers consistent behavior that demonstrated that I would have what it takes to be a great doctor.  So, as the stakes grew, so did my perfectionism.  This perhaps parent-inflicted turned self-inflicted need to “win” drove me further and further into dis-ease.  Instead of pulling all-nighters, the pre-med crew and I would spend 2-3 nights a week at the library until midnight.  This allowed us to party 3 nights a week and relax 1 night a week because, after all, partying is a mandatory part of the Big 10 lifestyle.

Next thing you know, I’m in medical school.  The stakes grow, and the disease flourishes. I gained a lot of hospital “street cred” on New Year’s Day.  We did an emergency laparoscopic cholecystectomy on a pregnant woman at 7 am.  Not only was I the only medical student to show up that day, but the residents were all late due to hangovers.  I got to scrub in and be part of the surgery, as they needed extra hands.  I actually got to clip the common bile duct.  It was one of the coolest moments of my life.  We could see the baby in-utero through the high definition cameras.  And I was now part of the “in crowd” of medicine.  I was going to be a surgeon.  Nothing else really mattered.

During my surgical internship at a prestigious university hospital, my perfectionism peaked.  So did my dis-ease.  All my hard work paid off.  How I got there didn’t matter.  Yet, as the months rolled by, I became more and more miserable in this role.  What once was the prize was now a curse.  My girlfriends and I would pretend we were nurses or writers when we went out at night, because no man wanted to be with a surgeon.  And I started to understand why.  Few people outside of work really cared to spend time with me.  I lost myself—my eye was on a prize of becoming something rather than living as someone.  Being a surgeon became an excuse for not cleaning my room, forgetting birthdays, missing events, not calling people back and simply forgetting to care.  And I wasn’t alone.  When I was contemplating leaving the field, several seasoned surgeons told me to run fast and not look back. On the one hand, we were saving lives. But in doing so, some of us were destroying our own.

I’ll never forget the day I realized I needed to leave surgery.  It was the day after Halloween.  A few of my colleagues put IV’s in their arms to nurse their hangovers.  I ran into a psychiatrist the night before.  He was calm, happy, and well put together. He was telling me about his life.  It seemed whole.  I realized how distant the idea of living well felt to me. I realized that while kidney transplants were cool and all, I rarely got to speak to the patient about what it was like to take his brother’s kidney.  Or to the brother who donated it.  I would take out cancer, but never got to see the footage from the 80-year-old who decided he would go skydiving once he was in remission.  I rarely saw the sun.  I didn’t get to grieve with the family who found out that their 23-year-old daughter had inoperable melanoma.  It was devastating sending her home without a surgical follow-up plan.  The whole year was quite traumatizing. 

This particular psychiatrist had worked on Wall Street.  He wasn’t always so calm and he wasn’t always so whole.  He too had spent years and years racing to a finish line that was a destination far from where he wanted to be.  I felt a sense of relief learning that I wasn’t trapped, that it wasn’t too late to change professions.  Part of me wanted out of medicine all together, but the other part of me knew that I had something special to offer the world that would also fulfill me if I did it right.  I knew the story of “making a difference” wasn’t over, but I didn’t know how I would do so.  Certainly, I still didn’t consider living well myself to be an important part of that story. 

When I became a psychiatrist, I laughed at the people complaining about their call schedules in psychiatry.  It was nothing compared to surgery.  Wimps!  However, soon I started to learn that you must be much better rested to sit in a room and listen to someone for 50 minutes than to stand and operate for 8 hours straight.  Psychiatry is intense but in different ways.  We are looking at the whole picture, rather than the surgical field in front of us.  This was a serious change of pace.  Suddenly, if I wasn’t living well, it showed up in my work.  In fact, it infected my whole life.  The most important lesson I learned as a psychiatrist is what I was and am still learning as a psychotherapist:  In order to really help someone, you need to start with you. 

Many therapists will say that their own psychotherapy, supervision and life experiences taught them a lot of what they know about being a therapist.  If this is the case, we better hope that our therapists have good therapists!  While therapy is a large part of a psychiatrist’s training, medications, procedures, appropriate diagnosis and placement of patients, groups/family/couples counseling, ethics, emergency, forensic, lab interpretation, research, legal and policy knowledge, and program/treatment planning, etc. are also part of what we do.  In addiction psychiatry teamwork is essential. Teamwork isn’t easy for a perfectionist since it requires necessary “surrender.” 

When I showed up to my first day at work at Beit T’Shuvah, I was shocked to learn that everyone eats lunch together in the lunchroom.  You want to know the last time I had a designated lunch period?  High school.  It just didn’t exist for me.  In fact, I’m still learning how to take a break for lunch.  And the residents continue to give me a hard time for being a workaholic. 

But as Jewish spirituality teaches, it’s never too late to repair, to make T’Shuvah, and to do the right thing.  What can be a curse can also be a gift.  The perfectionism I’ve suffered with virtually my whole life will continue to exist, but what I do with it is the real “key to life.”  I’m no longer focused on an end game, or on “becoming something.”  Instead, I work daily to live as someone. I’ve earned the title of “Doctor” and will be branded as such forever. I can wear that as a badge of honor.  But I can only be proud of that if I am the type of doctor I now want to be.  I no longer want to be perfect or have all the answers—I do want to help people and believe this is part of my purpose.

Looking at me— at my faults and “imperfections”— is the way I’ve learned, and continue to learn, how to help others.  You don’t have to be addicted to drugs and alcohol to understand the idea of chasing a high, going for it at all costs, and getting there only to find that it’s entirely unsatisfying.  And while I can practice medicine and give back, my own program of recovery is apparent in the work I do. If I start trying to do all the work, don’t tend to my own self-care, or stop working as a member of a team, the community lets me know pretty darn quickly.  As we say, it takes a village.   

As I know today and continue to work to remind myself on a regular basis:  there is no such thing as perfect.  Defining “winning” by any one standard (i.e. how you do in school or what job you get) undermines the harmony, the complexity, the struggle, and the beauty of what I now define as really winning.  To clarify, I no longer see winning as the goal, but rather as living.  To really live, to me, is to do the right thing regularly, and repair and do T’Shuvah when I miss the mark.  It’s a stark contrast to the mere surviving I did in medical school and residency.

Hippocrates said, “Cure sometimes, relieve often, and comfort always.” Maimonides said, “May I never see in the patient anything but a fellow creature in pain.”  As these quotes have been passed down through the ages, it’s clear to me that Hippocrates and Maimonides knew a thing or two about the perils of perfectionism.  Yet, it seems to have been forgotten in the textbooks and curriculums of some of our most valued professional educations.  Perhaps it would’ve paid off to spend a little more time caring about Hebrew school, after all.