What Being A Doctor Really Means?

It is always a challenge thinking about what course to take in college. I always tell people who do not know what direction to take to envision themselves in about ten years. Are you in an office? In…

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Irreplaceable

Perhaps you’ve heard this advice about creating job security: become irreplaceable. Strive to be so essential that the whole operation would grind to a halt without you. What about in a relationship? In a marriage? Does that create security?

How important is it to be irreplaceable?

I remember showing him how to cook eggs. We were college freshmen and I found his naiveté charming. Teaching him to recreate my simple homemade scrambled eggs made me feel worldly and competent, though I was anything but. He came back from winter break recounting how impressed his parents were by this measure of growth, this added sign of adulthood. I glowed inwardly with pride.

After graduating from college, we both embarked on new, exciting journeys. He landed a great job in the business world, where he excelled. I began a joint MD-PhD program to become a physician-scientist. We worked hard to distinguish ourselves in our chosen paths. Fast forwarding through the years, we helped each other grow in countless ways. Many times we learned together, side by side, improving and adding to a growing list of life skills. Moving in together, we delineated work by skill and preference: each of us specializing and finding our niche in the household. I was good at organizing and planning the shopping list. I cooked a lot. I enjoy cooking and more importantly, feeding the people I love. It was important and one of my central roles in — The Enterprise.

We were a functioning domestic unit — The Enterprise! — working together and supporting each other. Over time, our vague shared goals became more and more concrete. We married. We made an Excel workbook outlining, generally, the sort of life planning usually confined to dreams and gazing into your lover’s eyes. It was our dream — The Dream! — excel workbook, projecting far into the future: the first page a timeline and the second, a budget — The Budget — including retirement savings and big bucket-list trips.

One evening he asked me to sit down and review the Excel workbook with him, to think about when we might have another baby. It was a critical time in our lives. Both our careers were approaching a juncture of sorts. Many things were about to change at once. It was exciting and scary.

L had been born the previous fall, while I finished my graduate thesis. She was no longer an infant, but life was more intense than ever. Adjusting to the demands of our growing daughter and my new clinical schedule had been rocky. My mother moved in with us in our tiny apartment to take care of L when my maternity leave ended. Medical school began again in a rush akin to that after the gunshot at the beginning of a road race. In my memory those days are a delirious, adrenaline- and caffeine-fueled smear: a period characterized by my own extraordinary personal growth and, of course, the leaps and bounds of my daughter’s blossoming from a baby to a small person. It was full as to bursting. That is not to say it was without difficulty. Although I barely remember the difficulty of those days. In fact, I don’t even remember them as particularly difficult; as filled as they were for me with everything I loved and found exciting. I recall stretches of boredom and busywork when I longed to be home playing with L, and the associated oppressive guilt. I remember night wakings when my alarm was set for 4am. I kept my phone alarm tucked under my pillow so I could quickly silence it, pull on my scrubs in the dark, sneak past my daughter sleeping in her crib. I skulked to the kitchen to quietly pour a cup of coffee and grab my overnight oats without waking my mother asleep in the living room before rushing off to morning rounds. Those days I felt as though everyone was sleeping but my colleagues and I — my family sleeping as I left each morning, the city tucked away as I made my way to the hospital, my patients dozing as I came in to check on them. I was exhausted. Even then, I remember greeting my surgical student partner every morning and getting down to work, side by side as the world slept on around us. On slow(er) mornings we watched the sunrise over the East River from the call room window. She became one of my closest friends, and those mornings hold a special fondness of their own.

When did I even use the 11:50?

I remember trying to convince my daughter that flashcards could be a fun way for us to play… and failing. I remember rushing back home to make dinner late on a weeknight while simultaneously FaceTiming my best friend as she tried on her wedding dress. Even those memories give me a sense of overflowing fullness, and I find myself smiling at the extremity of those times. Such glorious intensity!

My partner didn’t share my enthusiasm for this period, even after the “worst of it” was past us. This attitude was reflected in our Excel workbook discussion about expanding our family more in the future. The timeline section had a new addition: a long block of “Internship” and “Residency”. He colored them both a bright red, and together they painted a long foreboding line. The unspoken statement highlighted in an angry red: this was when I was “out of commission”. This was when I wasn’t going to be around enough to help out, when my tasks would go unattended to and neglected. This was meant to be a sign of how important I was. I did so much around our tiny NYC apartment. I was an important part of The Enterprise! Those blocks would be times when our budget would be overburdened by nannies and daycares, takeout and maid services. Times when my partner couldn’t pursue his own dreams of more education, of making the big change in his career that would make him happier. The residency line was punctuated with brightly colored cells noting my passing birthdays, my ever-ticking biological clock. In contrast to my feelings about the time we were living (the glorious intensity!) our dream Excel workbook looked bleak and overstretched. It took some of the wind out of my sails, and I downshifted my enthusiasm to a small purr, reflecting the starkness of this contrast. All of that passing time, those waiting milestones were reduced to a black and white grid with my own personal career goals dashed across it like a giant scar. We changed the parameters of The Budget with different scenarios. We tweaked this and that based on living situations in different locales. Somehow, the number at the end never worked, and that thick line: “Residency” remained, a blight on The Dream.

I didn’t have to do a residency. I could choose to be a scientist solely, and not a physician-scientist. There were so many factors at play on both sides, so many variables to consider. I hemmed and hawed. I talked for hours with endlessly patient friends. I couldn’t decide. It was hard to let go of that vision of my own future, and the Excel workbook haunted me. It was our shared future, and if that residency line wasn’t there… He wanted to be supportive, or better yet, knew that not being supportive would be destructive to our relationship. If he asked me not to do a residency, I would resent him, he said. “No I wouldn’t!” I insisted. I stubbornly held out hope that we could figure out a way for me to do it all.

Time passed.

Everything deteriorated. It was difficult to keep up with all of my tasks, though I gamely tried in an effort to display how hard I was willing to work. I grocery shopped from my phone in between patients on rounds. I stayed up late preparing meals in advance for the week. If I forgot to bring a lunch for myself I ate those free peanut butter crackers we gave to patients in post-op. I knew where all the free lunches were. I barely spent a dime. I tried so hard to fit my life into The Budget. In the end, I couldn’t do enough. It wasn’t just the numbers, it was the strain. I couldn’t make up for the time. I chose not to do residency, but as I was finishing med school, every time I chose to be a dedicated medical student my choices were called into question. Why wouldn’t I just skip a day? I understood the subtext of the question (You’re not even going to be a doctor!). It was my last chance to be in a surgical suite on this side of the curtain. I wanted to take advantage. I wanted to live this relinquished dream as long as I could.

This perspective was a subliminal toxin. My work and my home life became invisibly antagonistic. The Venn diagram barely overlapped. Things had changed at home and I was walking on eggshells. It’s a separate story, really, a parallel process that contributed to the vicious cycle. My husband was depressed and unsatisfied with life. He walked around with a storm cloud over his eyes and a puddle at his feet. He was struggling. The problem was that dark cloud frequently transmuted into anger directed toward me. The dynamics of our relationship had shifted and I felt like a poorly performing employee, a selfish one at that. I was a failure. My husband was always angry with me. It felt like nothing I did was right. I lived in a constant fear of angering him. I was completely broken. I didn’t know how to banish that dark cloud and though I knew he was suffering, I was drowning in the rain. Many nights I felt like the cloud had completely taken over the man I had loved, the man I married. I rarely saw that man anymore. It was as though he had died or gone missing. Without knowing it, one day I had kissed him goodbye for the last time, and he had just walked away and not returned. Instead, an alien being had returned in his body. I was heartbroken, and I didn’t know how to save either of us. I started to only feel like myself at work, as though I could express myself in a way I was restricted from at home. As I left each evening and started my commute I shifted to a protectionist mindset. I started anticipating all of the needs I had to fulfill that evening, and all of the ways I could potentially fail so I could try and avoid them. It was the opposite of what I imagined most people feel, that tie-loosening feeling you get when you’re on your way home. I was buttoning up, getting ready for my night job. Everything was upside down and backward. I was at home at work and felt on the job at home. I was so determined to be better at home, as if I only did the right things and not mess up it would fix it all. The man I loved would come home to me.

One night I was distracted and got on the wrong train. When I heard the first announcement my stomach dropped and my pulse began to race. I would be late. He would be so angry. My mind raced through all the possibilities as I stood sweating, in a panic. How could I get a taxi and make it home without him knowing? Without paying for it on our joint credit card? Did I have enough cash? I never had enough cash. Maybe I could ask the driver to stop at an ATM on the way? Did I know anyone I could call?

Another evening I was rushing in the kitchen and I dropped the milk carton, spilling milk all over the linoleum. My first glance was to the clock on the stove. I found myself crying that evening, but not over milk. The absurdity of the immenseness of my relief to see I would have time to clean up before he got home had struck me and left a hard lump under my sternum.

One day daycare called. L had a fever. I was at lab when they called, my husband was luckily working from home and able to pick her up. When I got home, breathless from my quick walk from the train, he asked me what I would have done if he hadn’t been serendipitously at home to cover for me. Not — what would we have done? What would I have done. I, the normal child-picker-upper, that critical part of The Enterprise? I don’t know, I wondered. What would I have done?

If I was a single mom? …. Should I be thinking of myself as a single mom?

My real work became like a hobby. The place I could let my hair down. It was a selfish luxury. In the evenings at the dinner table, I rarely shared exciting things happening in the lab or on the wards. At best, they elicited passive indifference which left me feeling diminished; at worst, anger and distaste that left me feeling guilty. Once I was asked by a close friend to give the first journal club in his brand-new lab to establish the tone for the soon-to-be recurring weekly meeting. I would give a short presentation describing a recently published study for his bourgening group to discuss and critique. I was honored and excited to do it. I couldn’t hide my excitement sharing the news at the dinner table. “Why on earth would you say yes to that? Are they going to pay you extra?” well, no. The figurative balloons over my head popped and deflated. That’s not really how I get paid, and that’s certainly not how I view my work. My own Pollyanna perception of what I do all day has almost zero to do with money. Journal club is just a thing I do. I’m still hard-pressed to conceptualize its relation to me getting paid at all. Of course, preparing journal club meant I would have to work a bit at home beforehand. I resolved to start only after everyone else had fallen asleep and after I had finished all of my household tasks. I would not let this choice of mine impact him at all. I had survived with less sleep in the past. That night I cleaned the kitchen and lingered in the living room with the journal paper secreted next to me under a throw pillow. He never came out of the office where he was playing video games.

At the time I was too cowed and hurt to reflect on the underlying currents that generated his reactions. Perhaps they were new ways of expressing his own guilt in pushing me to give up medicine? True anger that I still wasn’t committed enough to choose the version of the future he had for our family over my own selfish wants? Jealousy that I still enjoyed the terribly difficult thing I was doing despite all the pushback, and he was searching for meaning in his own life?

In our last therapy sessions, my selfish choices were a recurring theme. I was choosing myself over “us”. I felt lost in “us”. Then again, I didn’t recognize him either. It was all a foreign landscape. At one point we conjured an image of a household somewhere as a thought experiment, one with more space, money, and a comfortable life. I saw that my husband imagined himself and L there. My own presence had a fuzzy outline. Where was I? Who was I in this scenario and what was I doing? How was I contributing? It was laid out for me: If you can’t be around to do your functions, you need to make enough money to replace them.

“This is my life too, this is what my career is, this is what I make.” I argued “What would you have me do instead?”

“Anything, I don’t care.”

The Budget demands if you won’t have time to cook dinner, we need to afford take out. If you can’t be around all the time, we need more childcare support. The Budget matters. We have to eat, pay rent. The Dream was The Budget, and I the wrench in the gear. I didn’t fit into The Dream anymore. The only thing that mattered was the household as a functioning entity, The Enterprise. That’s when I realized I was both replaceable and irreplaceable. My functions were essential. Critical, even. Irreplaceable. But I was replaceable. I was outside The Budget. I wasn’t really a part of The Enterprise. That’s how the workbook works. Oh, how clean that workbook would have looked with someone else plugged in. Someone with a better-paying job and better hours. She would have sparkled next to the picket fence.

I wasn’t a critical part of the dream. The Dream worked better without me.

So now it’s just me and L (half the time). I sometimes find myself at the end of a long day, sinking deep into my chair, gazing into a glass of whiskey and wondering what the people in my life would do without me. These days, the whiskey stare moments are different, how I think about my place in the lives around me. As before, I made breakfasts this morning, I packed lunches. I opened the lab, once there, I did things few others know how to do. On my way home, I stopped by the grocery store for milk, picked L up at daycare. After making dinner, I did the laundry and got ready to do it all again tomorrow.

Without me, it would grind to a halt. Is that supposed to feel good? F*#& that. It feels onerous. Everyone’s expectations. All day, every day. That is a heavy load to bear. I long to be considered “bonus”. I want to enrich your life. I don’t want to make it possible. I hope the answer to “What would you people do without me?” is “We’d get by, but we sure wouldn’t want to.” Something essential is simply needed, at least — wanted, certainly; but not necessarily desired.

How important is it to be irreplaceable?

I am happy to do things for people and I see that life would be harder without me. Yes, yes, thanks. You are welcome. Those are just completed tasks.

I’m single now, and dating. Being a good partner is valuable. I’m a great partner. I would make your life easier. It would make me happy to do so.

And yet, I hope that’s not why you pick me. I want you to choose me not because I am a fabulous cook (and you need to eat, after all). Many others are better. A pizza delivery man can take care of dinner (with his own flair, no doubt!). Some days if I’m busy I’ll toss together spaghetti and jarred tomato sauce, and I hope that is still ok. I may have made dinner, but our conversation over dinner is what really made dinner. I brought joy. That’s what makes getting up every morning and doing it all over again worth it. Not being essential, being extra.

Career can take away time from performing all of those essential functions and tasks. So much of who I am is wrapped up in the joy I get from being a scientist. I want to bring that home and share it with you. I want someone who doesn’t see that as a selfish thing. Or even if it is a selfish thing, it’s not a bad thing. Let me fill my cup so it can tip into yours when you need a boost. Let’s keep each other full to the brim or overflowing. I want someone who sees my wants and needs as an investment in maintaining what they really and truly value — me. I’ve learned that it’s not important to be functionally irreplaceable, but it is important to feel irreplaceable.

Dreams should be reserved for staring-into-each-other’s-eyes and budgets relegated to spreadsheets. Let’s not accidentally confuse one’s contribution to The Budget with his or her role in The Dream.

So… hand me some whiskey with that sly smile and bring your joy. I’ll bring mine.

Stuff has to get done, every single day. Let’s all chip in.

You bring you, because no one else can.

You are irreplaceable.

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