To be relieved from a deception . . . to be relieved from a misapprehension of the true state of affairs . . . to be relieved from a faulty perception of an external object . . . to be relieved from a figment of the imagination – what word/s did these definitions bring to mind?
I heard guesses this week I have heard every time I have used this didactic riddle – e.g., to understand or see clearly, . . . to be enlightened, educated, rescued from naiveté, . . . to have elucidated, explained, illuminated, . . . to have one’s eyes opened.
The answer (which I have yet to hear) : to be disillusioned.
Surprised? No doubt, because we invariably use the word ‘disillusioned’ with a burdened meaning – i.e., to be utterly deflated, crushed, disappointed, discouraged. Listen to these samples from my conversations with medical students and physicians over the past 25 years. They speak for many of us -- non-physicians as well as physicians. Do you identify?
An anxious junior pre-med student disclosed: “I have shadowed a number of physicians – private and academic – this past year and did not find one physician I would like to be around.”
A frustrated medical student, near the end of her first year, recalled: “We had the ‘keep your balance, protect your relationships’ orientation talk from the dean on Day One. And one of the medical school’s ethicists reminded us the same day to ‘nurture your interior life’. Day Two blew by all that. After the first round of tests, reality set in. Getting decent grades means 80-100 hours of study every week. What’s left for relationships? or for my ‘interior life’? The grades for my first set of tests reassured me. I can do this. But at what price? I guess the dean and the ethicist will recycle their platitudes to the next class of new students. Where is the dean? Where are the ethicists? Obviously not near enough to our experience to speak with understanding and integrity. I feel betrayed.”
A third-year medical student speaking with her attending early in her oncology ro
A weary second-year resident, during a lunch conversation, admitted: “By the third year of medical school, I realized being a physician is not what I had envisioned. Being with patients and making a difference in their lives 90% of the time would be great. Even 70%. But 40% or less? I feel stuck. What else can I do? It’s hard to quit after having invested so many years. I am not in medicine for the money. There are much faster and easier ways to that goal. My college friends are making buckets full of money while I am sacrificing my 20s and amassing an enormous debt. I am frightened by the ways I have changed. Fatigue has darkened my mood and shaken my plans. My family/friends do not understand how tired I am. Will these changes reverse after residency?”
A physician in her late-40s reflected: “I remember quite clearly my first day in medical school. The dean did not mince his words. ‘Medicine must be your husband, your wife, your children, your family, your life. If you cannot make this commitment, get out now.’ I fought to keep hold of the grand ideas that brought me into medicine. I fought against the dean’s angle on medicine. And twenty-five years later, I am disillusioned about my profession, burned out, cynical. The medical school, residency, and practice settings have worn me down.”
Such grim dispositions are too widespread among us to be ignored.
To be disillusioned is to be moved closer to the realities we face, a painful but inevitable/necessary experience for maturing into a professional. However, to be disillusioned is also to suffer a devastating blow to motivation, purpose, courage, resiliency. How we respond to both consequences of being disillusioned feeds deeply into how invested we remain in the ethical dimensions of patient care.
