I was once asked if medical school is an unhappy place. It is a good question, the kind that it takes someone outside of medicine to ask. It would never occur to me to wonder, maybe because I’m afraid to think too deeply about it, worried I will arrive at an answer I don’t like. But after being asked and finding that I didn’t have a good answer, I had to think about it.

The quick answer is no, medical school is not an unhappy place. But that’s not the complete story and a true answer will take more words than that.

Medical school is not an unhappy place, but it is often filled with emotions that are not pleasant. It’s an immensely intimidating place where what passes for average would anywhere else be extraordinary. There is always a part of you that wants to do the best — you had to be wired as such to even get to this point. As much as you try to bury it, it’s hard to shake the feeling that you’re still competing.

There is a lot of insecurity. None of us arrived here without an accumulation of sacrifices and more than a few emotional scars — the stories of which have been left in the past but not forgotten. I wonder sometimes if we would all make better, saner doctors if we had spent fewer hours with our books and more time lying in the sun, taking road trips with loud music playing and eating greasy food with friends late into the night. There’s a certain sanity, strength and wisdom that isn’t borne from good grades and a polished résumé, but from living life.

Medical school is both suffocating and lonely. Day after day I see patients with challenging life circumstances, their struggles quickly becoming a familiar pattern that overwhelms me for my inability to truly help. And after those long days in the hospital, I so often find myself lying on my bed, mind numb, body exhausted, feeling entirely alone in this singular experience.

It is wearing. The early mornings and the late nights take a slow toll, and the cost of sleep deprivation, chronic stress and a general lack of time is steep. After long stretches on harder rotations, I notice that my heart rate is constantly too fast, my mood always on edge, my mind racing at night even as I try to fall asleep — exhausted but somehow still wide awake. Sometimes I feel, seemingly inexplicably, sad. The phrase “frayed nerves” starts to make sense.

Most of all, it is terrifying. The prospect of learning enough to become a competent doctor seems constantly impossible, and the things we are called upon to do often take more bravery than it seems possible to muster. Patients place some of their greatest fears in the hands of their doctors — and now I stand among that team at the foot of the bed, hiding inside my white coat. How do I live up to that obligation? How can I shoulder the burden of someone else’s fears? Mine are enough.

So, no, medical school is not an unhappy place — but it’s also not always happy.

But I remind myself that for all the moments of deep frustration, fear and sadness, there are also those of inspiration, excitement and satisfaction. And, while it’s not always easy to see the happiness in the journey ahead, when I look back there’s a feeling that, in many ways, is more deeply affecting than happiness: Accomplishment.

It’s a long road ahead and the miles to go before I sleep seem always to stretch ahead far beyond the horizon. But the road behind is long as well. And that thought keeps me going in moments when happiness seems elusive: Look how much you’ve traveled already — look how far you’ve come.