If you look at the posts on this site, you’ll notice a glaring gap between the month of August and the month of October. Maybe you’ve wondered why. Maybe you attributed it to the inconsistencies and waxing, waning enthusiasm of a new blogger.
Fear is, in fact, what happened.
I’m currently the last year of my fellowship. That’s 2 years of college, 4 years of medical school, 7 years of on-the-job training: over a decade spent preparing for a profession that I’m about to officially, independently embark on. If anything, I am over-prepared. I should be impatiently chomping at the bit. I should be eager to move on.
I was – am – terrified.
All those years of education were helpful in preparing me for the medical challenges that I would face. I don’t know everything, but I know how to begin, how to analyze a dynamic situation, and how to proceed. No matter the emergency, my body and brain would likely start to automatically respond in the correct manner.
But it didn’t prepare me for the other challenges that a career in medicine brings. There were jobs to look for. (Where should I look? Was I starting too early? Or too late?). There were research projects. (Would they be finished in time? Would I want to do research as part of my career?). There were financial purchases. (How would I pay off my student loans? Was disability insurance even necessary?). There was a glaring lack of future skills necessary to run a medical practice (How does one bill for procedures? How do you hire good staff? What equipment would I need to request?).
So while one of my co-fellows was comfortable in the security of a job offer, and the other began her job search with great clarity of goals in mind, I spent the first part of the year feeling overwhelmed, slightly out of step with the expectations and reality of the last year of training. I was paralyzed. Whenever I would start to mention my doubts, the same platitudes would come my way: “You’ll do fine.” “Don’t be ridiculous.” “Everyone gets a job.” I felt alone in my fear.
This is the thing that they never tell you: you will never be fully prepared. You will be scared.
It may happen when you encounter an unexpected complication during surgery, whether emergent, rapid bleeding or dense scar tissue. It may happen when you encounter a sick patient whose symptoms don’t match any diagnosis you know. It may happen when you have been on call five weekends in a row, each more exhausting and draining than the rest. It may happen when you’re trying to figure out the next step in your career.
In fact, fear may stay with you always.
We think of fear as something to be feared itself, and perhaps that’s wrong. After all, it was hardwired into our beings, an emotional advantage that helped our ancestors stay alive.
Fear clarifies the realities of our situation. We see exactly what is happening right now, what obstacles we will face, what circumstances are working in our favor.
It heightens our awareness, giving us clarity of mind. It gives us insight into what we have and what we lack.
It keeps us grounded in the present, not focused on daydreams of the future or successes and failures of the past. We are occupied with the problems of the here and now.
Fear in medicine is particularly a powerful thing: it keeps us humble, keeps us curious, keep us learning.
If we can keep our fear from evolving into anxiety or paralysis, that fear can be our friend.
This is what I’ve learned in my struggle to befriend fear:
It is okay to be afraid.
It is not okay to be afraid of fear, to avoid and deny and refuse to face the situations that inspire fear.
Sometimes you need to take a breath. Or two. Or three.
Sometimes you need to take the stress out of other aspects of your life in the meantime, whether that means taking time to exercise, or ordering take out, or taking time to meditate and pray.
Sometimes you need to process your situation internally, whether through a moment alone in a supply closet, or alone with your thoughts on a couch with a glass of wine, or through paper and pen.
Sometimes you need a friend who can break down the situation logically, balancing your true strengths with your weaknesses, the difficult with the good. A friend who can tell the truth kindly but firmly, without resorting to easy and pat answers.
And sometimes – in time – that fear will turn into curiosity, and action, and growth, and adventure and possibilities instead.
In a critically acclaimed episode of the BBC series Doctor Who, a time-travelling Clara (played by Jenna Coleman) comforts the frightened young version of our hero, the Doctor, with an extraordinary monologue:
“I know you’re afraid, but being afraid is all right. Because didn’t anyone ever tell you? Fear is a super power. Fear can make you faster, and cleverer, and stronger and one day… you’re going to be very afraid indeed. But that’s OK, because if you’re very wise and very strong, fear doesn’t have to make you cruel or cowardly. Fear can make you kind.
It doesn’t matter if there is nothing under the bed or in the dark, so long as you know it’s OK to be afraid of it…You’re always going to be afraid, even you learn to hide it. Fear is like a companion, a constant companion — always there. But that’s OK, because fear can bring us together. Fear can bring you home…Fear makes companions of us all.”
We will never shake off fear. And perhaps we shouldn’t try.
For fear can be itself a powerful weapon, not used against us but for us – if we learn to wield it properly.