How a Slate Journalist Became a Psychiatrist

Collective wisdom.
May 28 2013 6:45 AM

Shrink Dreams

How a Slate journalist became a psychiatrist.

(Continued from Page 1)

After several years in social work, I was nearing 30. As an undergraduate, I hadn’t completed any of the science courses needed to apply to medical school. Completing them on a part-time basis at the local university would take several years at best. So I had to do a “post-baccalaureate” pre-med program, essentially going back to college full-time for a year. I then had to apply to med school, which would take another year, assuming I got in on my first attempt. Then four years of med school, followed by four years of residency. I would be close to 40, and more than $200,000 in debt, when I finally started to practice on my own.

I chose to do my post-baccalaureate year at Bennington College in Vermont, a tiny (its undergrad population is around 700), rural school, with an even tinier post-baccalaureate program (five or six students a year) and a good track record of getting its graduates into medical school. The small class size appealed to me, as I didn’t want to spend my “post-bac” year getting lost in a sea of ambitious pre-meds clawing to stay ahead of the grading curve.

But studying at a residential liberal arts college at my age—I was at least five years older than my post-bac classmates and 10 years older than the undergraduates—was an odd experience, to say the least. I lived off-campus, but there wasn’t much going on in little Bennington, and Boston and New York City were both more than three hours away. The first weekend of the fall semester I went to campus to socialize. I found myself in a 10-by-10 cinderblock dorm room sipping wine from a red plastic cup amid a dozen or so undergrads. Suddenly there was a knock on the door. The music stopped, someone said, “Security! Hide your wine, hide your wine!” and people began to stash the alcohol in the closet and the cups under the beds. These Bennington students were a hip and well-dressed bunch, but they were still underage. This theme of being older than my peers (and occasionally older than my mentors) followed me throughout my medical and psychiatric training. It was a bit unsettling at first, but in the long run it is a useful exercise in humility to recognize that just because someone is younger than you doesn’t mean he doesn’t have more experience and knowledge, that he doesn’t have something to teach you.

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After a year of chemistry, physics, calculus, and biology, I spent a summer studying for the MCAT, drove back to Seattle, and was accepted at the University of Washington School of Medicine. For me, medical school was largely what I expected—intense and grueling, yet eye-opening and formative. I spent semesters watching hundreds of PowerPoint slides a day, cramming my head full of facts; then weeks on surgery rotations, watching trauma victims get stitched back together, or in pediatric clinics, doing routine well-baby checks; and, ultimately, years absorbing the intricacies of knowing which attending physicians to please or how this type of patient expressed his illness differently from that one. It was exhausting. Although I’m glad I did it, I don’t think I could do it again.

Being a “nontraditional” student—the moniker applied to older med students who have had another career—could be construed as a burden. It’s harder to take a high-stakes multiple-choice science exam every week if you’ve spent your academic life primarily as a writer in the liberal arts, and it’s also harder to do overnight call in your 30s than it is in your 20s.

But being nontraditional gave me a crucial perspective. It is common, for instance, for first-year med students to grumble about how cursed their life is for having to spend so many hours studying, or for third-year students on their clinical clerkships to bemoan their peon status in the chain of command. These students are typically 25 years old and have either never held a job or served for one year as a research assistant after graduating college.

I, on the other hand, had recently left a position where I spent a sizable portion of my time doing paperwork for doctors because my time was not considered as valuable as theirs, where I made $25,000 a year without much hope of earning more, and where I almost never had the opportunity to be formally supervised or to improve my skills. I knew, in other words, that working your ass off in medical school is qualitatively different from working your ass off in a dead-end job. I also knew that being at the bottom of the physician hierarchy is not the same as being at the bottom of the health care hierarchy. The second lieutenant doesn’t spend much time bitching about orders if he was once an enlisted man; he’s just happy he’s an officer.

I’m now about to enter my final year of psychiatric residency at Mount Sinai Hospital in New York City. One thing I can say about the training of psychiatrists is that it is highly inefficient. I estimate that 80 percent of what I learned in pre-med classes and medical school I never use, and never will use, in the practice of psychiatry. But the 20 percent that is useful is crucial. First, because it allows me to think about my patients’ problems in a medical and biological, not just in a psychological, way. And just as important, because it allows me to prescribe medicine safely and effectively. Psychotropic medication may not be appropriate for many patients, but for others it is a vital part of the healing process, and sometimes it can be lifesaving.

My career change has become part of my life story. Like many parts of a life story, it’s something one can grow weary of—or, at least, weary of rehashing at cocktail parties. But it is something I’m awfully proud of. I had many advantages over other career changers. I didn’t have a family to support. I had the ability to borrow money with a decent chance of paying it back. I was young and had energy. Even so, it was a huge sacrifice.

Before you make a similar sacrifice, I would advise a few things. First, know exactly what you’re getting into. For example, don’t go to law school with the vague notion that “it will sharpen my analytical abilities” or “maybe I’ll get involved in politics.” Go because you want to be a lawyer, because representing clients is in your blood, because you dig argument and discovery. Go because you’ve worked in a firm and seen what lawyers do on a daily basis. Once you have a true sense of what the job requires, you can assess whether you have the stomach for its less-elevated aspects. People may gravitate to law school because they like the idea of justice, but to be a successful lawyer, you need to be comfortable with conflict.

Second, do something you not only enjoy doing and have an interest in, but that you think you may have some talent for, by dint of innate ability or life experience. A lot of folks like being around kids, but a successful teacher is likely to have a proven ability to both inspire them and channel their chaotic impulses in productive ways. He knows he has the personality to both motivate students and enforce class discipline—a delicate balancing act that many find impossible. And he has the drive to seek out training that will enhance his ability to improve kids’ lives.

At the start of my career transition, I was interested in the workings of the mind and the brain, but I also knew, from my experiences in life and as a social worker, that I could tolerate and effectively work with the sadness, anxiety, and anger that patients bring into the clinic with them day after day. I also knew I had the drive to complete a long course of medical training, because I truly believed that I could best serve my patients by considering their problems from both psychological and biological perspectives and by offering them both psychotherapy and medication. To be able to use those skills to help patients is something that I find very rewarding, and that has made the past 10 years of my life well worth it.

This month, Slate is sharing stories of people who started over—like budget wonk Ina Garten, better known as the Barefoot Contessa—in our "Second Acts" Hive. We want to hear your tales, too. Please go here to submit your story about starting over.

Michael Brus, a former Slate assistant editor, is a psychiatrist in private practice in New York City. He is on the clinical faculty of the Icahn School of Medicine at Mount Sinai.