It feels important to recognize that I am sometimes miserable. Sometimes, people go into a tailspin of misery because they expect to not be miserable, and so there is then a second insult to the first problem. But there is a way out for me when I realize that being miserable during the week is part of it.

I get in to a string of feeling like I have no control. I get to clinic just in time in the morning and all of those tasks line up. And then maybe I have to drive to the hospital and work with a specialist. They may be kind enough, but it’s a somewhat superficial experience. On my end, I truly don’t want to be there, but feel compelled to pretend otherwise. There’s just this general untruth to it. I choose to avoid the complications that would come from frank honesty. And so I try to fit in. I think I am doing a fine job of it, but it takes a toll.

Someday, the goal is obviously to practice with integrity. This means I get to be myself in clinic. Myself is completely blocked out by the processes of the day, which take charge. I have to identify what the complaint is, which of the medical problems are relevant, to check on things like their health maintenance, their immunizations and screenings, and come up with a plan for the day. And then repeat again and again. It is too much. “I” back out. I recede into just getting the tasks done. I call the Spanish interpreter. I ask the questions, I order the meds, I check the boxes.

I had a session with my therapist today. I need to take better care of myself. I can. I get into becoming a victim instead of helping myself get out. I can be more in control of my energy rather than being so reactionary to the system. You know how these things work. Move your self. Get the work done. Take better care.

It feels very unlikely that I will be practicing clinical medicine after I finish residency. I can sense that this doesn’t make sense to some, but more importantly, I have been too unhappy for too long. It’s not a good fit for me. It’s unfortunately true that it doesn’t seem to be a good fit for almost anyone. That said, there are some who are still doing it. I want to learn what I can from them. But I don’t see myself filling those shoes.

I went into medicine to better understand the human condition. I am a poet. I am an over-sensitive artist type. This whole training process has been brutal on me and it is important to acknowledge that honestly. It is hard on anyone. It is hard on everyone. I’m not interested in playing the game of being the biggest victim.

I want patients to have good medical care. I don’t feel that I provide that. It means patience and good listening. But it also means confidence and medical knowledge. I have something of an error in how I process information. I don’t understand it, but it feels accurate to say that I have too much soul to work according to algorithms. A medical presentation to an attending is supposed to fit into a box, and I do not. I am supposed to click certain boxes saying I have reviewed the allergies and the medications and I do not. I am as overwhelmed by our shitty system as our patients are. I don’t believe they should be on statins or blood pressure pills, but I prescribe them. The whole thing feels meaningless. I am so bored of blood pressure. I don’t like anti-coagulation. I don’t like industrial primary care. I want to practice human medicine.

I want to play bass. I want to cry. I want to care about my patients and I want to live in a healthy community. Sometimes I feel like I am supposed to solve all of the world’s problems. That is not a healthy outlook. But I was so glad to hear the perspective of a Family Medicine hospitalist who finished his residency about 5 years ago say that he, like me was going through this spiritual process while he was completing his residency. He had this feeling that he was the only one “woke” to how awful the system is and how that at the time, on top of the tremendous load that is medical residency, this feeling added to the already overwhelming expectations that he put on himself. What a trip! How familiar?

I want patients to feel good. I want them to know about the benefits of a plant-based diet. I want to rant about of the over prescription of psychotropic pharmaceuticals. But perhaps that is a better realm for the people who have been in that fight personally? I can speak up, but I don’t need to go on a crusade against the institution of psychiatric medicine as an outsider with no skin in the game. It’s important, but it is not my life’s mission.

I do feel for the way our society lets the artists down.

I started residency as a kind of a 1000-day Vipassana (insight meditation) journey. This is what this feels like. It has been hard. I have been down. I have been mad, sad, angry. I continue one day at a time. Today came with its bruises. Tomorrow has more in store I am sure. I don’t do a meditation sit everyday, but in the last 2.5 years I have sat 463 times according to the insight timer. 43% of days. 110 hours and 22 minutes. I do get a little ego hit of pride from that. I remember telling a teacher at a free introductory meditation class that I wanted to be a meditator. Here I am I guess.

My sits don’t feel revolutionary. My mind wanders and I lose track of my breath. But despite my low opinion of how I do as a meditator, I do believe in meditation. I actually believe it is a kind of key to my worldview, an access point of sorts to the truth of how things work. How the mind works. We are all part of this ever-unfolding moment. There is no ego “I” self at the center of this identity that’s any different from the “I” that is at the center of everything. We can look at each other as brothers and sisters in this way and that’s it.

I want to teach people about meditation as a way to deal with suffering, not prescribe antidepressants. I don’t like the role of western physician. A western physician is supposed to give a PHQ-9 and then according to some guideline treat mental health concerns with medications.

Our system has been rearranged to serve the interests of the pharmaceutical companies and I feel my job, in the service of my patient’s best interest, is to say so. In my role as a physician working in the conventional system I get so lost in the day-to-day busyness that I lose sight of the overall rot.

On the weekends I am reading Deepak Chopra’s “Quantum Healing” and Lewis Mehl-Madrona’s “Narrative Medicine.” I like to keep up on the “Mad in America” website that regularly critiques modern psychiatry. I’m trying to do too much. I have a headache and I’m not sleeping well. I have notes to catch up on from clinic and assignments due this week.