Featured, Preclinical
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The Dragon: On Coming to Understand My Mental Health During Medical School

This piece is part of in-Training Mental Health Week.

Editor’s note: The author’s identity has been withheld by the Editorial Board due to the sensitive nature of the article.

During our psychiatry block, I learned how the aching sadness within me curls through my brain. It begins in the thalamus, amygdala, and hippocampus — three points that sit like stars in my body’s sky. They form connections, signals of GABA and glutamate and acetylcholine that guide my emotional trajectory, ending on a network of neurons that disseminate the news: I am lonely, I am worthless, I am not worth improving. These feelings, which sear through my internal monologue like a blaze on an oil spill, are too strong, too urgent, to just be biology. No, those simple and straight lines, short connections from one region to another, etch out an image, a constellation informed by the vastness of mythology. A sleeping dragon, guarding my contentment as if it were gold. Like the calves I’ve strengthened trying to chase it away, he has become resolute and strong. When I get near, he stirs. He gets angry and screams at me, telling me everything I don’t deserve and never will. He breathes fire, and shimmering in his flames are images of all the things I will never be.

Once upon a time, I thought I’d conquered him. I thought I came to a place where my queerness mattered less than I thought it did, that the pigment of my skin didn’t color my interactions, that the way my body curved through space didn’t render me invisible, that these threads of my experience didn’t congeal to leave me feeling homeless. Despite what that dragon told me, despite the memories he kept whispering in my ear — the time my mother told me my sexual orientation was her worst nightmare, the night my cousins insisted there was no place in their culture or their family for a faggot, the moment I realized no one would try to make it better for someone chubby, gay and dark-skinned — I deserved happiness. I was worthy of love, friendship, and companionship.

For a while, I could believe it. The family that told me they’d never accept me started to signal otherwise — a softening in the South Asian diaspora’s rigid heteronormativity. The gay culture that demanded thinness and whiteness I could never offer started to matter less and less. These two worlds, worlds that failed me and abandoned me when they themselves promised to celebrate me and my truth, didn’t matter. I convinced myself I could celebrate and nurture myself, and revel in the truth of some inner goodness — an inborn right to be happy. And, for a brief, fleeting time, I could. I had succeeded in pushing back the beast. The gold was mine. I slayed the dragon.

Feelings of worthlessness, however, run deep. Like desert ruins covered in and preserved by inches of sand, the dragon, wounded but alive, had simply retreated underground. He let himself be hidden by the euphoric gusts of getting into medical school, of completing my senior thesis, of tangibly feeling a bright future for myself. He waited for those months of biochemistry, microbiology, physiology — chemical pathways and pathologies I could never know well enough to be above average — to remind me of my place. He fed on my test anxiety, my frustration at each lecture I struggled to grasp, my disappointment in barely-passing exam scores. He reawakened.

He threw tantrums when I didn’t do his bidding. He threatened to destroy the wall I’ve erected between my private and public selves, so that the only thing people would see is the person I am when I’m not performing. Mornings spent crying on a couch, unable to move as I let myself linger over each faux pas I made and wrong answer I gave. Hyperventilations in the library that forced me to ride out the storm in my car. Frantic texts to friends both old and new asking them what it was about me that drove people away, sent not because I thought they could comfort me but because I felt I would burst if these questions gnawed inside me.

To keep him at bay, I started running. The few miles I could barely squeak out during undergrad gave way to five miles, and then 10, and then the finish line at my first half-marathon. Running is discrete. Though the end is not easily reached, it is always within sight. The endorphins released when I make it, and the threat of self-loathing if I do not, drove me to put one foot in front of the other, over and over and over. To an extent, I carried that logic into my lectures. One slide after another, over and over and over as the dragon, only barely audible, grumbles in the background. I make it to the exam. I pass it. I start over on Monday.

In the years I’ve spent trying to understand my feelings — and in the firsthand accounts I read before attempting this essay — I’ve come across one phrase over and over: “the floor fell out beneath me.” I don’t identify with it. Yes, it aptly describes the spiral, and conveys a sense of the lows our darkest emotional states can take us. However, it is too optimistic. It assumes we’ve built a foundation to stand on, that the ground level is our norm. My recrudescence felt, and still feels, like a homecoming — as if a windstorm had swept the sand from those barely-covered ruins to reveal my throne. My birthright is to sit there and waste away, gazing upon my wasteland as the dragon stands by my side, whispering his truths into my ear. These emotions would never go away. It’s not that this place was comfortable, but it was certainly easier. It was, at the very least, habit.

Though it would be easy to blame my emotional state on medical school, to do so would be a disservice to my emotional truth. Paths worth pursuing are rarely simple, and do not leave us feeling good about ourselves. We must find nourishment and enrichment within ourselves, on our own time. While I don’t believe I am capable of that (and I often prove myself right), I am not alone in that failure. Self-care is a skill that eludes more than those struggling with depression, anxiety, and insecurity. The emphasis researchers and medical schools have placed on improving their students’ mental health is proof enough of this.

However, if I could go back and change one thing about my medical career, it would have been to wait before I started. One year, two years, maybe more, to focus on restoring and reconstructing myself as someone defined by the limitless potential of what I can give my loved ones and the world around me. This project of restoration and transformation is difficult with exams every three weeks and my first round of board exams looming in the distance behind them. Instead, I remain an amalgam of the injustices I’ve internalized and the negative thoughts about myself I very much believe — constrained by a paradigmatic understanding of the ways I am not, and will never be, enough for those who choose to invest their time and effort in me.

Without this time to restore myself, I simply balance my workload — lectures, preceptorships, research — with the sinkhole in my stomach that drags and distorts even my most pleasant memories. I wake up, convinced I am alone, and work my way through a section of First Aid before I drive to school. There, I talk to, joke with, eat lunch with, and debate with friends I suspect do not like me because I feel unworthy of being liked; people I am afraid will disappear the moment they see just how deeply broken I am.

While reasoning out my emotional truths — in understanding them as an entity both separate but intertwined with my rational self — I have come to understand, in the most visceral way, why people believe in God. How wonderful it must be to feel unconditional love, untainted by the whims of human nature. To be aware of your brokenness, and to not feel that it will push others away. I wish I was capable of that faith.

Instead, when it gets particularly bad, I run. I put one foot in front of the other, over and over and over. I let the miles pass under my feet the way I let the endless slides pass under my eyes. I tell myself this jog, this block of exams, this current stretch of feeling so terribly alone, is something I can make it through. That I can push through them, and keep on going until they’re simply remnants of my past — feelings as familiar as legends, but as distant as the stars in the sky. I always hope that will be enough. It never is.