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When to Say “No”: Yes, It Gets Messy


Four years. I had gone four years without crying in a faculty member’s or an advisor’s office. And there I was, sobbing all over myself, as I tried to explain the situation. A couple of days prior, I received a terse email from the training director, saying I needed to come in to meet with her. She was not happy with my most recent feat as a doctoral student.

The week beforehand, all of the students in my program received an email with the semester schedule for the mandatory monthly meetings, which were designed for students to check-in with one another regarding our work at the clinical sites off campus. When I saw the date of the meeting, my heart sunk. I was scheduled to drive up to Maine with my partner and some of my friends to run and volunteer for a marathon. Not only had I been training over the past few months to run the race, but I was running it in memory of a friend who had taken her life the previous spring — I had even raised money for the American Foundation for Suicide Prevention along the way. It was the first marathon she had ever run. For me, it was an act of personal growth, self-discipline, grief and closure — and it was a commitment I was not willing to let go.

I took a deep breath, reminding myself that I couldn’t always be the “good doc student,” and that I, too, had a life — a personal life, with priorities. Right? The plans and reservations were secured, the miles on the pavement were complete and the money was raised. To miss this would be like quitting a doctoral program when I was more than halfway done with it. I stared at the screen. I hit “reply.” I kept it short, thinking of what my fiancé always told me: “You don’t have to explain yourself away all of the time — you can’t make it, and that’s fine.” In fact, I had recently noticed all of my “I’m sorry, but…” and other submissive buffers I included in emails, statements and interactions with faculty and peers. I wanted to get away from that. I wanted to be more assertive, and stand my ground. So, I said I could not make it, and I did not apologize.

It turns out, I should have. The training director emailed me back immediately and requested that I schedule a meeting with her to talk about my inability to make a mandatory commitment. So there I was in her office before the three-hour class I had with her, convinced I would remain calm, cool and collected while I articulately plead my case. Wait, not plead, but while I advocated for myself as I explained again that I would not be able to make it. I remained calm for a few minutes, but the dam cracked the minute I said Angela’s name and the reason behind the marathon. I could not miss it. I was not a bad student. But, I could not miss this trip.

The director was quiet as she looked at me — the kind of quiet where you start to imagine all of the worst-case-scenario words and phrases. And then, she said, “I wish you would have told me.” This was the reason she was so displeased? My email came off as flippant and she didn’t believe I understood or valued the importance of the meeting. By bringing me into her office, she was reminding me that she was the alpha dog and that it was my job to nod my head in agreement until graduation. I walked out with my tail between my legs, her “permission” to go on the trip, and a newly assigned paper to write on the topic of the meeting we just had.

Was this a victory? No. A relief? Not that, either. I walked away with guilt, confusion and a nice big mystery bag of other emotions. Still, today, this meeting and those feelings resonate with me. As a new graduate reflecting back on this experience, I still wonder what the “right” decision would have been. The line between personal and professional is incredibly vague, as is the boundary between healthy self-care and hard work. Last week, when meeting with the medical students on campus for our monthly wellness dinner, the topic of saying “yes” versus saying “no” came up. We realized we did not have an answer, and may not ever get one. Decisions such as this likely depend on a number of factors: the commitment, the work load, the attending physician or the resident, how much time you have for lunch that day and how much energy you have to swim against the current, and the culture of medical school.

Drinks with friends, or understanding one more aspect of the endocrine system? A trip to see your girlfriend for the weekend, or an opportunity to go grocery shopping and actually catch up on laundry? Perhaps there’s never a right answer or a right way. Perhaps it may not get easier. But, steps toward self-awareness and taking a good, hard look in the mirror will help you along the way.

Next time you have a “yes” versus “no” predicament, step back a moment and ask yourself what will matter more to you and what will affect you more five years from now. Even 10 years from now. Then, move forward and own that decision. Skipping something important? First, you may want to do what I didn’t, by respecting your place in the hierarchy and recognizing that this next event is, of course, an incredibly valuable commitment and learning opportunity that you really do wish you did not have to miss. Then, provide just enough information to let the alpha dog know that despite the importance, your event is an important personal “life” issue that has to take the front seat for once. Sometimes, the decision will swing toward work. Other times, it will swing toward life. As long as you can manage to balance that pendulum and allow it to work both ways, you will not cause too much destruction on either end of the spectrum. And, that is the ultimate goal in the end. Get out alive and well, with those two beautiful letters behind your name.

Are you willing to share your experiences as a medical student regarding your own stress, health and well-being? All U.S. medical students are invited to contribute to Dr. Ayala’s newly launched national study. Research on these issues is important, and is typically done in a piecemeal manner by looking at only one component of stress, health or wellness. Help her fill in the pieces and build a representative sample of medical students by filling out the survey.

Erin Ayala Erin Ayala (2 Posts)

Guest Writer

Albany Medical College

Erin Ayala, PhD is a clinical faculty fellow in the Department of Psychiatry at Albany Medical College. She conducts research on health and wellness, does clinical work with medical students, and facilitates wellness initiatives and workshops at the college. When she’s not working, she’s training for triathlons, playing with her 2 dogs, and thinking of new ideas for personal hobbies and projects she may or may not actually finish.

  • Diane Brackett

    “You don’t have to explain yourself away all of the time”

    That’s so true. I received similar advice one time, and I think of it quite often. I’ve found myself writing out long explanations (in emails) and then I shorten it because I realize I don’t need to give away every last detail — that I have a right not to.

    • Erin Ayala

      Yes, Diane, I still struggle with this! The longer those emails and explanations get, the more guilty we can feel–and that’s the last thing we need when trying to advocate for ourselves and prioritize work-life balance.