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As a therapist, I have worked with medical students struggling with depression and anxiety, sometimes addiction but mostly desperate to save what is left of their failing relationships. They are torn by guilt and conflicting concerns that make them feel out of control. Medical school demands more than they can give, and yet they give, and give, and give until finally they are depleted. Ironically, this is when they need those relationships the most, but their loved ones have begun to withdraw and make do without them. Their loved ones have become accustomed to not being connected, and the medical student feels too guilty to draw them back in when they know until they are done, they cannot offer more.

A word that comes up often is “sacrifice.”

Merriam Webster’s dictionary defines sacrifice as “The act of giving up something that you want to keep especially in order to get or do something else or to help someone.”

Oxford English Dictionary defines sacrifice as “An act of giving up something valued for the sake of something else regarded as more important or worthy.”

It also defines sacrifice as “An act of slaughtering an animal or person or surrendering a possession as an offering to a deity.”

If we consider the first definition, we understand that need to be helpful to humanity, to do something worthwhile, to help someone as motivation to go to medical school. Medical students want to keep their relationships but are often forced to prioritize their studies, rotations, and finances in order to help other people. They sacrifice being present and engaged in the everyday lives of their families and relationships and focus on building relationships with new preceptors, clinics, hospitals, patients, and colleagues every 6 to 8 weeks. They make time to listen to the hardships and difficulties of strangers when their own loved ones have to find some way to deal with whatever is going on for them alone. In order to be helpful, medical students have to sacrifice the relationships that have been their support network, which leaves them feeling isolated in their pursuit for the greater good.

Let’s consider the second definition. The act of giving up something valued for something else that is more important or worthy. Unfortunately, we encounter a comparison that leaves the medical student’s relationships downgraded to “not as important.” This is how the important people in the medical student’s life begin to feel by the time they seek therapy. Mothers and fathers go several weeks without speaking to their children. Wives have to choose carefully what issues to bring up because their husband is already stressed and exhausted. Husbands have to find some way to be relevant without being in the way. Children cannot comprehend why mommy or daddy are hardly home or live miles away. Girlfriends and boyfriends begin to consider their “options.” Fiancés keep the ring hidden in the drawer because they are not sure if there will be a wedding.

The third definition makes the picture clearer. The medical student must bring something to the alter, an offering. The commitment and time it takes to complete medical school requires a slaughtering of what has, and still is valued in the life of the medical student – their relationships. “Sacrifice” comes up in therapy because medical students have had to give up their relationships to become doctors and at the end of it, if they can still say they have strong and healthy relationships, it will not be because they maintained them. It will be because their loved ones had to accept the role of sacrificial goat in order to be helpful to the medical student. Their loved ones had to live with being the offering the medical student placed repeatedly at feet of the almighty medical school.

Tapo Chimbganda is a psychotherapist.

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