On Mediocrity
This story is drawn from real experiences. Protecting my patients’ confidentiality is of utmost importance to me; names, details, and timelines have been changed to honor their privacy, and any similarities to actual persons or events are purely coincidental. The emotional truth remains intact.
I am not the smartest doctor. I’m not even close. I’ve met doctors with brains so impressive that I walk away questioning the decision I made some fifty years ago to become a physician. Often they went to far more impressive medical schools than I did. They were members of mysterious societies with Greek names. After tests, talking with them was an exercise in heart-sinking reality as they rattled off with near-perfect memory, nearly every question on the test, many of which you then learn you got wrong. I’m not going to lie, it can suck being around them.
Let me be clear, they’re not assholes…well, most aren’t. They’re generally lovely people, with ginormous brains. They are usually giving and not at all cutthroat. Most don’t need to be. They, through a combination of hard work, discipline, and a ridiculously efficient brain, just plug along and do exceptionally well at almost everything. I wanted to be one of them so badly
My journey was fairly typical for a medical student. In high school and even college, I knocked it out of the park academically. I was a salutatorian in my small high school—my mom still holds that I was robbed of valedictorian—and was, generally, a superstar. College was similar. Classes came very easily to me, and it was there that my love of science really flourished. But more than that, it’s where I developed a deep love of writing and the arts. College made me explore areas foreign to me, and I found great joy in those spaces. I finished college, having completed the honors program, won academic awards in the field of biology, and graduated summa cum laude. I had already been accepted to medical school; I was ready, baby.
For a time, I held my own. I regularly ranked in the top 10 of the anonymized ranking list of freshmen students. Life was moving along pretty much as I’d imagined it. But the days wore on. The volume of information continued at a pace unrealistic for mere mortals. I moved into classes for which college had not really prepared me. Slowly, I saw my ranking drop. Nothing I tried changed that slow, depressing descent into the morass of the middle.
During my third year of medical school and during my clinical rotations with a cratered confidence, I dropped out. A feeling of not being enough for the responsibility of patient lives had been slowly growing, mostly superimposed on the same graph plotting my realization that I wasn’t nearly as smart as I thought I was. I felt continuously embarrassed publicly by unkind attendings, seemingly looking for weakness. I stressed about patients constantly, and if one died, I fully and completely knew in my heart that it was me, Christopher Dael MS3, who had killed her.
I just wasn’t smart enough.
On realizing this, I knew there was only one course of action. I went to the dean’s office, and from a bowed head said, “I need to quit.”
Our dean was one of my favorite people in all of medical school. He was fun, and brilliant, and kind, and, as it turns out, completely oblivious to my existence.
“What was your name again?”
It’s okay, I was part of a very big class, but it did sting a little. Once he had my name, he looked me up on the computer to see how I was doing in classes and rotations.
“You’re doing pretty well. Usually, I hear this from students who are really struggling.”
“I am struggling! I go to the hospital every day, terrified I won’t know something and will hurt someone. I’m constantly ashamed that I can’t answer questions that everyone else seems to know. I live in fear every single day of my life. I just don’t think I’m cut out for this.”
He paused and took me in for a bit. “Let’s do this. Why don’t you take a break?”
“You can’t give me a big enough break. I need a forever break.”
I think he smiled a bit, “Let’s start with a month. Come back to see me, and if you need another month, I’ll give you another month.”
I agreed and left, confident that medical school was over for me. And in an instant, I had no stress, no terror at the thought of humiliation, or worse, killing someone. It was an amazing feeling to have the crushing weight of all that responsibility and self-doubt suddenly lifted from my shoulders.
But a few days in, amid all the heady joy and freedom, a niggling sense of loss began to emerge. I was missing the process of figuring out what was hurting people, what was making them sick. I missed the patients themselves, too. I missed learning about the veteran of WWII sitting on the bed, more interested in telling me about his buddies in the trenches than how the tumor had taken the vision in his left eye. I missed the 63-year-old woman who, in spite of her failing liver, was so excited to be released from the hospital in time for her daughter’s wedding. I missed sharing moments of utter exhaustion with my classmates and laughing together at the bed-head that comes from two hours of nearly useless sleep. I missed it all.
I took my month, but it became one of reflection and self-examination. I realized a few things. I’m never going to be the smartest guy in the room. I will continue to get questions wrong when put on the spot by relentless attending physicians. I won’t be able to divine their personal niche areas of interest, or figure out, “What the hell are you even asking me?” But mainly, I realized I still very much wanted to be a doctor.
I went back to the dean at one month on the dot and, as I’m sure he suspected I would, asked to resume my studies. He was very happy but had one requirement. He wanted me to see one of the most respected faculty members in the department of psychiatry. My heart sank. What might a psychiatrist uncover deep within the murky confines of my mind?
We talked for about an hour. I told him my story, from start to finish. He listened, he asked questions, mainly about what I was feeling in those moments, and what I was feeling now. But he wanted to know so much more. What did I hate about medicine so far? What excited me? Where did I see myself within this great tradition of healers? They were big, meaty questions. And I loved it.
A few weeks later, the letter, which had been sent to the dean, was forwarded to me. I desperately wish I still had it, but I’ll never forget what it said.
“Christopher cares deeply about his patients and bears heavily the responsibilities that come with that. Sometimes these feelings can overwhelm him, much as they have for nearly every physician who came before him, and for those yet to come. But I believe it is this deep and genuine caring he feels for the people in his charge that will make him an outstanding physician, and one we will be proud to have representing this school of medicine for years to come.”
So deep in the grips of self-doubt, no part of me felt I might actually become something extraordinary in medicine. That was for those special few at the top rungs. I was aiming for pleasantly, benignly competent. But here, in a few thoughtful words immortalized in a letter, this old psychiatrist, and the dean before him, gave me an incredible gift, a way forward.
I returned to my training as a third-year medical student, but with a new sense of purpose. I embraced my limitations and crafted a strategy around them. I decided in that moment to focus all my energy on a truly deep understanding of human physiology. I spent all my energies trying to learn and understand how it all should work in this crazy amalgam of mostly water and carbon. I kept asking myself, “What does good look like?” I studied human physiology with a passion. I couldn’t do what the best and brightest around me could. I couldn’t know all the minutiae, so I accepted that I wasn’t always going to look good on rounds; I might even be mocked a bit. But something good started to happen. As my understanding of how the human body should function grew, I began to have increased confidence in speaking up when, by extension, it wasn’t behaving properly. I started to trust what I knew about the body, and speak up when I observed something askew.
This simple plan to focus on what my brain could handle, but always in the context of how the information applied to actual human patients, transformed my medical school experience and clinical rotations. I started to do better. Over time, attending physicians began using phrases like “insightful” and “good mind for medicine” in their evaluations at the end of rotations. I started doing better on exams as well, scoring some of the highest grades I’d ever achieved on standardized tests.
There are great benefits to brilliance, and I’ll always covet that gift. But there is a benefit in working from a place of disadvantage, too. To those of us without the unimaginable capacity to absorb and retain. When forced to do something very hard from within the confines of inescapable limitations, a purity of focus can develop, and from that, something very special in its own right. I spent a career aware of outliers but not obsessed with them. I focused instead on developing a keen, well-honed sense of when something didn’t make sense in the story, the physical exam, or the labs and studies, and I trusted that feeling, even if I didn’t fully understand why. It’s a subtle-sounding shift, but a giant leap psychologically, to take something that doesn’t make sense, and rather than assume the mystery lies in some fault in your knowledge, to instead confidently endeavor to figure out WHY it doesn’t make sense.
I made it through all of that, because a kind dean of students, and an old psychiatrist recognized that something special can be hewn from even the most mundane looking stones. The work may be harder, the approach different, but it may be all the more special because of it.
As I look back on a long career, I’m happy and proud of the work I’ve done and the people I’ve helped. And while it would have been nice to have rare gifts, I wouldn’t trade my journey for anyone else’s. The view I have from the middle of the pack, of a life fighting tooth and nail to become excellent, is pretty special.