I find it interesting that my mind is unable to remodel the emotional trajectory of my life through at least the last 10-15 years. I remember being someone who was a perfectionist, inordinably hard on myself, always thinking that I was a failure, that I wasn’t good enough, that I wasn’t smart enough, that I’d never succeed. I recognize that a lot of this was in response to a mother who was excruciatingly demanding, who couldn’t stand things being done in any other way than her own, and who would just do things for me instead letting me do things my own way.

The humorous upshot of this is that I have never really learned to take care of myself. Granted, my Y chromosome already sets me up for a disadvantage, but I am generally oblivious to the squalor that I live with. I am awful at picking up after myself. (This is not to say that I’m dirty—I like taking baths and staying clean—but I am fretfully disorganized, and, well, messy.)

But in retrospect, I think this contributed to my attitude of learned helplessness. What’s the point of trying if they won’t let me do it my way?

The other thing that I think of is this crushing sense of, I don’t know, duty. There is this Filipino concept of utang na loob, which doesn’t translate well literally, but which figuratively means a debt that can never be repaid. I know I sound like a whiny brat, but I recognize that I am extraordinarily blessed. I basically had three sets of parents growing up, because my aunt and my uncle on my mom’s side never had kids. And, I suppose, like all Filipino parents have of their kids, they had extremely high expectations for me.

But what I want to get at is how I got to where I am now. The detailed mechanism of my path to, I don’t know, enlightenment, for lack of a better term.

I realize that, by definition, utang na loob can’t ever be called even, but when I finally graduated from med school and matched at my first choice residency, I made peace with myself. I’ve at last achieved this one goal that has chased me down since childhood, this single purpose for which I have lived my life since as far as I can remember. Up until that moment, I felt like my life was completely out of my hands, that other people had made plans for me, and that I was constrained by utang na loob to play them out. I felt trapped by my own warped sense of honor—in the last few years I knew at least intellectually that I could just say fuck you all and take off—I don’t know—into the frozen wilds of Alaska, or the anomie-ridden urban organism known as New York City, or the jungles of Central America. Jump completely off the track, and burn out like a firecracker, going out with a bang. I spent hours fantasizing about this, making insane plans of partying like a rock star until the money ran out and the credit cards were all maxed out, and I’d either go into hiding or off myself.

Instead, I chose the life laid out before me. Luckily, I actually like what I’ve gotten myself into. Otherwise I’d be royally screwed.

But some time two years ago, I made peace with myself somehow. I can’t find it in my past blog entries, how exactly I came to that feeling of serenity, how I came to the conclusion that I’m done, as far as those plans were concerned. That from here on out, I’m living out my own dreams and schemes, and if they don’t like it, they’ll have to deal with it.

The whole sense of learned helplessness, though, I really haven’t figured out yet. I mean, I’ve figured out exactly how it exerts its destructive force on my life, from my simple vice of procrastination, to how I refuse to take control of a situation and how I always let someone else handle it, to how I can sit for hours and days and weeks and months and years utterly miserable for no good reason and just dwell in it, swim in my own psychiatric filth, wallow in major depression.

If I could choose the one thing about me that I could get rid of, it would be my propensity for depression. It’s kind of ridiculous how many cumulative years of my life I’ve spent living underneath this black, ominous cloud, how much time I’ve spent in onerous turmoil, how much time I’ve wasted just feeling awful, with no way of getting out of it. It is probably a blessing that I did decide to go into medicine, because I doubt I would’ve even recognized this insiduous force in my life if I hadn’t been forced to study it. It may sound bizarre to all you lucky ones who have never experienced it, and it may sound quite trite to anyone who has dealt with depression, but I found it wonderfully liberating to realize that I have a diagnosis. That there is a disease process occurring, and it’s not just all my fault, and that I can be helped, at least to a degree.

I suppose I have a long way to go, though. It’s been two years in this place and I haven’t yet found myself a psychiatrist (which is characteristic, since I am the king of all procrastination.) While I haven’t felt suicidal in a long time, I realize that it’s probably pretty dangerous not to have a professional in my corner. I’m not going to win this fight on my own, not with an enemy like this, not when I’m my own worst enemy.

But I would like to learn how I disabused myself of my perfectionist tendencies. I used to be one of those nerdy kids who everyone would hate because I would strive to screw up the curve. I had the potential of becoming what they call a gunner in medical school. Sure, it’s easy to explain because I kind of crashed and burned during the end of my undergrad years, and then didn’t get into med school three years in a row, but if anything, all that did was reinforce my sense of inadequacy, fed the fuel of my perfectionism. This actually translated itself into a lot of displaced anger. For at least the last three years of medical school, if I wasn’t depressed, I was full of rage and anger. I’ve never hated so many people with such depth and detail before, I’ve never wanted to kick the crap out of so many people in my life, and I’ve never come so close to actually doing it, until those last few years. And I especially hate that time for turning me into that kind of person: hateful and filled with displaced rage.

Now part of the improvement is that I rarely work with such odious people as I was used to in medical school. Most people I meet are happy, friendly, and conscientious. They try to do the right thing, for the most part. Now I’m not saying I’m surrounded by saints and angels, but the sense of rancor just isn’t there. I don’t know if it’s simply the fact that I’m older, and I just don’t care any more.

And it’s not the recklessness of rage that I’m feeling anymore. I think I’ve come to grips with some Taoist principles, or maybe at least that Alcoholics Anonymous prayer: God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference.

I guess a lot it, though, was this past year, for which, despite how horrific parts of it were, I am grateful for. For once, I have survived something that has been kind of harrowing and have not felt drained of life. It all started with my dad having a heart attack, a plaque rupture right into the left anterior descending coronary artery, the one they nickname the widowmaker. He went into congestive heart failure, and I remember the sense of panic and raw fear that corroded my soul. I can’t even remember how awful I felt, those days are just these bled-out memories. I remember the sequence of events, but I can’t remember exactly how I felt, I can’t re-create that emotion. And thankfully, he did well, and continues to do well, but it was kind of mind-shattering, that someone I’ve almost never seen sick before, that someone who has spent a greater portion of his life taking care of sick people, was sitting in the ICU with his O₂ sats dropping despite increasing oxygen, and with his chest pain worsening despite maximal medical therapy. I remember that awful moment, when I was at my dad’s bedside with my brother, and I saw this defocused look come over my dad’s face, this bleary-eyed look where he couldn’t really see us, where he wasn’t really awake, and even though I had only finished my intern year at the time, I knew that look. It was the kind of look that makes clinicians go “oh shit,” the kind of look that makes some people go look for the defibrillator and some pads, or at other times, makes you look for family members so you can clarify resuscitation orders, and I remember how much it hurt to have to hold that feeling stoppered inside myself, not wanting to tell anyone exactly how I felt. I had to just kind of stand there pretending not to be worried so I wouldn’t freak out my brother, and while my mom has been in nursing for longer than I’ve been alive and probably knows that look too well, I didn’t want to tell her either.

That was just the prelude.

There is one memory that, even now, when I think about it, it makes me teary eyed. There was an 18 month old kid in hematology/oncology who had some weird tumor taking up almost all the space in his chest, so that he was constantly short of breath, and he was too unstable to try another round of palliative chemotherapy, and in any case, his parents didn’t want him to suffer any more. So it was up to me to make him comfort care and start the morphine and Ativan drip. And I remember working through the night, without a blink of sleep, not feeling a goddamn thing, until the morning broke and I got out of that ward, and the tears just started leaking out of my eyes and I didn’t have any strength to stop them. I cried all the way home until I fell asleep in exhaustion. Even as I write this, I think of that kid, and my eyes blur a little bit.

I know for a fact that there wasn’t one goddamn thing I could’ve done to keep that kid from dying, that he was as good as dead when I met him, but it still hurts even now, for complex reasons that I don’t even want to think about right now.

Then it kind of got worse. Because even when it’s the 20th time you watch someone die, even when you think you’re emotionally detached, when you’ve come to grips with the idea that all you need to think about are the numbers, and code status, even when you resolve to yourself that you don’t really give a flying fuck, even when you accept the fact that you have no idea what you’re doing and they’re all going to die anyway, when you’ve balled up your ego into a tiny wad to hide in the corner of your fraying soul, trying to protect yourself from that sick, squishy feeling clutching at your entrails when family members are weeping all around you, looking at you for some smidgen of hope, and you know that you are completely empty-handed and even when you refuse to apologize for it, even when you learn to shrug at how inadequate you are, even then, Death knows exactly where to hurt you. I came to a point where the scope of repeated tragedy was so beyond my petty personal concerns, that I didn’t even have time to worry about how stupid and inadequate I was. Even when I’d get yelled at for doing something wrong, it just failed to register. Death ran circles around me. All the little fiddling I did with people’s medication, all the small heroics I tried my hand at, did nothing in the long run (except for one perhaps miraculous case for which I did nothing but make a few phone calls and gape like a moonstruck imbecile.) I like to think that maybe, just maybe, in the short run, that what I did mattered, that maybe at least a few people will remember some of the trivial kindnesses that I could muster, bedraggled and sleep-deprived as I was. All I could do was try and give some minute comfort. I’m not certain that I even succeeded at that, but all I can say is that I tried.

In the face of all that, my stupid little insecurities and shortcomings don’t mean diddly-squat. I am what I am, and I try to muddle through each day and try to learn something about what it means to be a physician, and perhaps even to learn something about what it means to be a human being, but all my petty concerns are pretty much buzzing annoyances that bite my brain once in a while before I swat them away.

All I can do is tend my own garden, my own little patch of the universe. All I can really say (at least when it comes to my work) is that I tried and am still trying. (Because clearly in my life, there are still some things that I am way too chickenshit to take a chance on.)

I am trying to learn to embrace the universe with open arms, and trying to learn to stay in the sunlight whenever I can. Everything else that comes my way is, I suppose, just icing on the cake.

(Update 2006 Jun 12: I corrected utang ng loob* to utang na loob. Thanks, Issa!)