After my surgery rotation, I was in a very bad place. I felt like two months of grueling work hours and relentless studying were wiped away in an instant by a bad test score. That single number somehow mattered more to me than every positive comment I had received from my patients, colleagues, residents, and attendings. I felt like I had put my heart and soul into that rotation, constantly studying and working every day, returning home exhausted, but grimly determined to try again tomorrow.

When I got my test results, I didn’t believe I deserved a better grade just because I worked hard. But it was that deep down; I knew I had tried and found myself wanting. Although I passed the rotation, it felt like a failure all the same.

In the following weeks, I don’t believe that I met the requirements for clinical depression — the five out of nine symptoms over a two-week period that every medical student remembers through the SIGECAPS mnemonic. However, as I told myself that I wasn’t depressed, I had an indelible feeling that something was wrong — something that wrapped around me squeezing out every drop of happiness and self-worth I possessed.

Sometimes, I felt a vague sense of unease and guilt that presented itself when I tried to take a break from studying. More commonly, it was the thought that I wasn’t good enough to become a doctor.

I didn’t realize this initially, but the way I was feeling was not an isolated event — it was the culmination of two and a half years of constant pressure on myself to succeed and often learn at the cost of skipped meals, sleepless nights and delayed gratification.

Many future medical students are perceived as the smartest people in the room. When you finally get to medical school, you realize this illusion no longer applies. For the first time in many of our lives, failure becomes a true possibility, and the same ambition and drive to succeed that brought us to medical school can become the inner voice that never stops criticizing us.

This may surprise many of my friends and family who are not in medicine, but I found myself understanding the reason why physicians have the highest suicide rate of any profession in America — twice that of the national average. I believe that many doctors die from suicide because of the relentless pressure we put on ourselves and what we call “burnout,” which should often be more appropriately described as depression.

I never had a golden epiphany to rescue me from my dark mood and put me back on the righteous path. My next psychiatry rotation allowed me to have a much better quality of life with more sleep, exercise and free time. The lifestyle changes alone probably helped my mental state more than any profound revelations.

In retrospect, it seems bizarre that I spent most of my day thinking about how to make my patients feel better while not doing the same for myself. Thankfully, studying psychiatry re-introduced the concepts of mental health hygiene, and some of the material began to take hold unconsciously. One of my attendings always recommended a book to his patients, Feeling Good by Dr. David Burns.

Saying this book changed my life is an understatement; I have half a dozen friends and family members who own a copy of this book because of my recommendation. The book addressed my negative thoughts and refuted them one by one, all while providing helpful exercises that I continue to employ.

For those who don’t read Feeling Good, I offer my high-yield takeaway: You cannot base your happiness on your academic success, job, romantic relationships or any other external factors. One of the most difficult lessons that I’ve ever had to learn is that it’s OK not to be the best.

Life is more than a progression of exams to ace and accomplishments to the checklist. I‘ve had to go back and re-evaluate how I defined success by trying to embrace new experiences rather than punish myself for not always meeting my impossible personal standards.

I believe I was able to take a brief look into the abyss, the depression that threatens us all. I write as if this was a singular journey with an ending, but I realize how this is a daily struggle to re-align my thoughts and banish negative thinking. Some days are better than others. If what I have said resonates at all with you, just know that you are not alone. You are magnificent and brilliant, and the sooner you can say those words to yourself and believe them, the happier you will be.

Evan Schauer is a medical student. This article originally appeared in Baylor College of Medicine’s Progress Notes.

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