The “in-between” has never something I’ve embraced. It has been nearly a year since I last treated a patient, and I find myself still in a state of being “in-between”.
At the risk of sounding reductive about the complex interpersonal dynamics within the practice where I was recently employed, I would sum it up as a situation in which the business of medicine got in the way of the practice of medicine. Both aspects are important, but in this practice, the balance seemed disproportionately skewed, from my perspective.
When I was first recruited, it appeared that this partnership would be a great mutual fit – a prime opportunity to build creative collaborations that would make a meaningful difference in the lives of the patients we served. In hindsight, there were some early clues, albeit subtle, that the personalities and priorities involved in this particular practice – including my own – would likely result in an incompatible union.
Nonetheless, I was determined that I was going to make this arrangement work. I started by using the same tools which had been effective for previous challenges in my life: Identify the underlying issue. Approach it directly. Find common ground. When these strategies failed, I went to my default: Work harder. Make concessions. Put my personal life on hold until any issues in question were fully addressed and resolved. Point out my own faults before anyone else has a chance to. I took on extra projects. I worked nights and weekends. I reasoned that it was only a matter of time before the value I was bringing would be recognized. It was an all-consuming endeavor. I was exhausted.
In retrospect, I brought much of this on myself by failing to see that sometimes the better part of valor is taking one’s self out of a situation and cutting one’s losses, i.e. quitting, which is something I wish I had done within the first couple of months. But who wants to be “a quitter”? I certainly had no desire for this moniker. Instead, my ego and I managed to stay on board for over a year, during which time I had allowed the dynamics within the practice to erode my self-confidence and my sense of purpose.
Ultimately, the practice and I parted ways. I immediately felt that a monumental burden had been lifted. I felt as if I were in a fog of pink cotton candy weightlessness. I felt peaceful for the first time in ages. The confectionary cloud did not last long though. Within a week, shadows of uncertainty darkened the horizon and a sense of impending doom started creeping in.
I struggled to impose order and structure on my shapeless days. I had been so focused on “proving my worth” at the last position, that I had not allowed myself the time or space to methodically explore other opportunities. Now, I found myself frantically trying to ascertain what I should do next. What was the next chapter of my life supposed to look like? What would people think of my leaving one job without having another one lined up? How did it reflect on me as a physician – no, as a person – that I wouldn’t just do whatever it took and “tough it out”, in service of a higher purpose?
Yes, it was a painful situation, but relatively minuscule on the global scale of human suffering. I could always find a job within another practice, but how would I ensure that I wouldn’t inadvertently fall into this type of dynamic again? Maybe that’s just the current reality of the medical machine, I speculated, and I simply need to accept this. Besides, it is a privilege to have people entrust us with their health. Wasn’t I being ungrateful by not wholeheartedly espousing the belief that this privilege is worth any sacrifice? I had believed it once before. However, I could not seem to intellectualize my way out of this fog of self-doubt, or navigate myself out of the sea of inertia, and back to chartered waters where I could find my bearings and make a cogent decision about next steps.
Initially, I had given myself three months to “figure things out”. However, the more I explored potential career options, both clinical and nonclinical, the more overwhelmed I felt. I gave myself another month. Then another. But when does “taking a break to figure things out” turn into an exercise being idle and spinning one’s wheels?
After several months of R&R (Reflection & Rumination), I became listless. I wish I could say I had an epiphany, but I haven’t – not yet anyhow. I recently accepted a non-clinical position which I think will be a reasonable fit for the time being, and it is a good opportunity to round out my skill set, but it is not the culmination of all that I’d hoped for in my next position.
My natural inclination would have been to pass on this job offer, and continue searching, not resting until I had found or created a role that would leverage my degree, my experiences, my interests, and my desire to connect with people in a meaningful and genuine manner. Then, and only then, would I share any useful lessons learned during the course of my journey. This plan seems absurdly grandiose now.
I have learned a lot this past year, and for this I am truly grateful. The life lesson of “know when to cut your losses and move on” is an important one, but at the moment, it seems like an inadequate return on investment for the challenges of the past year. A greater lesson for me is the fact that there is far more “in-between” in life than I would like. I have become increasingly willing to accept this inconvenient truth, albeit begrudgingly at times.
People naturally gravitate towards “before and after” pictures or some other incarnation of a successfully completed journey. We seek this out. The “in-between” seems less compelling and not exactly inspirational. Yet this is where we spend much of our lives. So, perhaps it would be beneficial to another person for me to share this “in-between” stage of my journey, rather than wait until things are buttoned-up and tidy before I offer my distillation of Things I’ve Learned Along the Way… because I think we are always, in some form or another, “in-between” …at least I know I am.
Maycie Elchoufi, MD is an Internist and Obesity Medicine specialist.