Phoenix

What does it mean to have self-esteem? Parents think their children having enough of it will prevent them from doing stupid things to mess up their lives. Books are written on how to acquire or nuture it. But what is it, really? Who has it? What happens when you wake up and realize you don't have much of it?

Medical school is designed, much like fire academy, to show you your lowly place. That you know nothing, or that the work you do is so worthless it is always repeated by someone else. There is a never-ending parade of exams, all orchestrated to assess how much you don't know. Rounds are structured so that people ask you questions you can't answer, or they ask you harder or more questions until you can't answer, then they provide the answer to show you that you don't know enough. Occasionally you get lucky and get it right, but usually the question is set up so the asker can deliver the answer, like a joke. And virtually without exception, your intellectual emasculation is in the presence of witnesses. There's a name for this: pimping. Rotations are scheduled so that every month or two weeks you are sent to a different hospital or neighborhood clinic - sometimes every day for two weeks - with different people, hospital hallways, security codes, computer systems, equipment, storage, forms, at times you even have to switch your brain over to the predominant language of the new locale. Even the antibiotics used for an infection with the same bacteria might have different resistances depending on the institution or geographical area you are in, so you could find that what you knew last Friday at Hospital A is the wrong answer on Monday at Hospital B. Or that what works for adults, due to whatever random biochemical reason, doesn't work for kids.  I want to shout, same species! same species! all the time.

If you can imagine changing jobs every month or two weeks and having to learn a whole new set of skills under pimping supervisors who you can't tell where to go, you are on your way to imagining a med student's life.  To add insult to injury, you are paying for the uplifting experience of being everyone's bitch.  Or maybe someone else is paying for it, be it your spouse or your family or the bank, then you are not only everyone's bitch who pays to be mistreated, you are also everyone's bitch who goes into debt to be mistreated.  That certainly doesn't bolster confidence in your own intelligence.  Even the fire academy was only for three months, and I was paid $10/hr for my daily beatings.  It is a wonder to me that medical students ever smile.  

Some of us have incredibly supportive, nurturing, caring significant others who don't take advantage of our state of constant humiliation to make us feel worse.  Others maybe have friends or family outside of medicine who can provide perspective that outside life isn't quite as punishing - it may be to some degree, but not at the steady pace of Chinese water torture as in medicine.  And then there are those whose inner Phoenix gives them strength from within, that reminds them that they are intelligent, accomplished, rational, sensitive, caring, and good.  That the mental torture may be pretty bad at times, but can be survived as long as one doesn't lose the broader sense of one's self.

Maybe self-esteem is really a little firey bird in your soul that rises out of the ashes of your emotional beatings to remind you who you really are, when you are led to doubt your own perceptions of yourself.