(Letter to a friend with career problems)

I am sorry to hear you have been put into a difficult situation. Now it’s time to take stock and look for other opportunities available to you that you never considered before.

First some history. You continue to tell me how envious you are of my life. My life is good and I have prospered, but I did so by overcoming the exact kind of adversity you are facing. I started out in the bottom 1/4 of my high school graduating class and was let into college on probation because they had to take me as a State resident. I flunked out. Then proceeded to be thrown out of another college on disciplinary probation. Then flunked out again of a third and hit bottom with a D average and no job. My future was bleak. I got drafted and went where all such losers go, to war where I luckily survived but I learned from it. I came back and was the laughing stock of the Pre-Med community. First application to medical school was greeted by a round of guffaws. I got a mimeographed note thanking me for applying and no interview. I ultimately got in by a series of incredible happenstances documented elsewhere.

I fizzled out of a vicious pyramid surgical program with fifteen interns and five chiefs. I wasn’t a bad Intern, but I didn’t set the world on fire either. I also wasn’t Jewish with a vicious competitive streak in a city and a medical center with a very strong Jewish bias. I transferred to another surgical program and immediately found out they were a bunch of sociopaths. I should have known to avoid any program where there were three vacancies. I got crosswise with some very powerful people, some of whom tried to end my career. Mercifully I got in on the ground floor of Emergency Medicine in it’s infancy. First time applying to critical care fellowships I didn’t get accepted because of my EM background. Second time around I snuck in by the skin of my teeth here at Pitt because of an unexpected opening (someone dropped out) and I was immediately available. I got in crosswise with two of the attendings at the Pitt CCM fellowship and both of them tried their best to end my career. Safer intervened and took me for the second year. John Hoyt needed a fellow and I was the only one interested in going outside the system to private practice. Dumb luck and good timing.

This is a truncated list of my failures, and doesn’t include some I will never tell anyone about. If, following any one of these failures, I had given up and agreed that I didn’t have what it took, I would be asking if you wanted fries with that burger today. And there was a LOT of evidence that I didn’t have what it took. Everyone associated with me sure thought so. So, when you envy my life, remember I’m like the “overnight success” country singer who spent 20 previous years grubbing in bars. And let me tell you something profound. There have been moments in my life where I thought my life was over because I couldn’t make the grade. That the obstacles were too big to overcome and the path of least resistance was to just say die and agree with the prevailing opinion. In each and every one of these instances, a door opened that wasn’t there before. And when I went through that door, I found opportunity I never thought of before. And I went forward in a different direction, and I learned from mistakes, and I found things I never considered. Had I never failed at something, I would have stalled at that level. Failure forced me to look for other alternatives, and most of the time those alternatives turned out to serve me well.

Do you see a recurring thread in the above?

You should. That recurring thread is people who are successful became so not by being smart and witty, but by overcoming obstacles. The ability to overcome obstacles is not merely the ability to survive, it is the passport to prosperity, and many think it is improbable that true prosperity cannot be achieved without it, Paris Hilton excepted. Darwin criticizes me for my “get your shit together, fella” attitude, but in the end, that’s what it takes. And you do what it takes to get your shit together because if you can’t or won’t, your failures stay failures instead of opening doors. So, given that, it’s time to decide whether you are a survivor or a quitter.

If you are a quitter, then you sit down and cry and everyone cries with you and that’s the end of it. You just didn’t have it so it’s time to take whatever is offered to those who can’t quite get it. You live out the rest of your life treading the path of least resistance, hoping for the best deal available for those way down in the line.

If you are a survivor, then you get your act together and put it on the road. If you need psychiatric care, then get it. If it isn’t working, then keep rifling through psychiatrists till you get the one that works for you. If you need medication to make you functional, then you take it. You take stock, not of what you don’t have but of what you do have and make it work to the max for you. Some of those options I list below:

1. You have a family that depends on you. Children. You are not at liberty to ignore that no matter how bleak things look for you personally. Any decisions you make affect innocents.

2. So you are at “light duty” for eight years. That means you have more time and energy to put into other endeavors. You have more time to be with your family. You have a computer and you have access to the world. You have medical connections. You have a talent for writing and speaking at meetings. Use it. Call up everyone you can think of, including J.L. Vincent and tell them you now have a really great opportunity to do a lot of writing and educating. Call up all those Internet medical rags and tell them you want to be on their staff, won’t cost them a dime. You want to write all the time. How do you think Sanjay Gupta got all those gigs? Call up all the medical meeting promoters and tell them you want to speak on any subject they have at any meeting available. Start writing up manuscripts for journals. Get back in the game. That you temporarily have “light duty” in one portion of your career means you have more time to pursue other aspects of your career. Use it.

3. You profess to love CCM-L, so avail CCM-L of your writing and organizing talent and experience. Present a formal journal club every month. This will keep you reading the journals and keep yourself up and enable you to share that wealth with over a thousand connections in the global village, any of whom may someday be of value to you.

4. When you get out of stir, you still have a medical license don’t you?. You are at liberty to do anything you want. You will still be young and you can then present your extensive CV full of medical activities and go back to work somewhere.

Sure it takes some degree of talent and ability to succeed in life. You could never have gotten as far as you did without that. But sooner or later talent and ability stalls because of external circumstances that cannot be ameliorated by talent and ability. You then only go forward by blunt force.

I think you have what it takes to get back in the groove if you persist. The rest is up to you.

D. Crippen, MD