Chronic Active Adolescence

It was 1980. Michael was sitting in his dormitory room making the final summary sheet for 7 weeks of classroom notes. The notes he had scribbled in haste had been rewritten in a beautiful cursive and then exposed to the scrutiny of yellow and pink fluorescent highlighters. The summary sheet itself was coded in the ink of four different pens. The distilled facts that made it onto his final summary sheet held the key to a final grade of “A.” Michael knew that if he transposed this information onto his brain he would indeed perform heroically on the examination. He had perfected the process in 8 years of grade school, 4 years of high school, 4 years of college, and his first year of medical school.

His roommate, Kevin, snuck up behind him and slapped headphones blaring rock and roll onto Michael's ears. Kevin was wearing a towel and dripping the remnants of his shower on Michael's final summary sheet. Michael quickly saved the work from further defacement and shook the headphones off with a jerk of his head.

“Goin' to the party tonight, Ace? I heard Karin's gonna be there,” Kevin asked, dancing badly beside Michael's desk.

Michael smiled. He liked his identity of “the Ace.” Michael wasn't looking at Kevin. He spoke to a poster of Krebs' cycle that he had hanging over his desk.

“No, I'm not goin'. I've still got some studying to do. I haven't even started on my anatomy summary sheet yet.”

“Jeez, give it a rest, Mike. Everyone is takin' the night off.”

“Maybe some other time. Tell Karin I said ‘hi.’”

“Yeah … right, Mike. ‘Karin, Michael says hi.’ I'm sure she'll be impressed.”

Michael believed that Karin would be impressed. Impressed by his dedication, his focus, his mission, his martyrdom. Everyone else was. Throughout his schooling, everyone had told him so. He was the Ace.

Michael knew the difference between Kevin and himself-Kevin had chosen to keep one foot in the world outside of medical training. Kevin was not a true follower of Time Fragmentation Theory. Disciples of this theory found efficiency in overtly dividing their near future into digestible chunks of time for the purpose of focusing on the next big hurdle. Time might be fragmented into the number of days left before the big test, the end of the semester, or graduation. The individual thereby voluntarily placed his or her life on deferment for the purpose of clearing the next hurdle. Time Fragmentation Theory was delayed gratification for professionals. The true effect of this Time Fragmentation Theory was to suspend the individual's awareness that he or she was actually currently living a life. One day Michael would realize that Time Fragmentation Theory was a delusion. He would seek compensation for his lost time. He would feel victimized.

It was 1985. Michael had Christmas off. He needed the break from his residency. He complained half-heartedly that he shouldn't leave the hospital because he might miss some good cases. What an Ace, his colleagues beamed. Most of his family was home for Christmas. His mother remarked that he looked terrible. He hadn't had time to eat or exercise, he explained. If he wanted to land that fellowship, he had to make the grade. Michael's dad looked old. He seemed to have aged since Michael had gone away to college almost 10 years earlier. His little brother, Tom, and Tom's wife and daughter were also home for the holidays. Tom was a vice president at his company now. He owned a nice home, and he and his wife were active in the community. Tom and his wife played golf on weekends with friends from church. They had just gotten back from a vacation in Europe. Tom and Dad seemed to have a lot to talk about: raising a family, running a business, his mother's health. His mother's health? Why didn't he know about Mom's health? He was the doctor.

“Oh, we didn't want to worry you about that. How's school going, Ace?”

Michael escaped the discomfort of his parents' home to meet two of his buddies from high school for a drink. They had whole lives already: marriages, births, careers, travel, relationships, and responsibilities in the world.

“When are you going to finish school and get a job?” they asked.

Michael began to think about his prolonged sophomoric status. His teens and early twenties had been spent cramming for the big test. Now, in his late twenties, he still had someone else determining his schedule-when to report for rounds, when to go home for the evening. He had to live with supervision and evaluations, patients wanting to talk to the “real doctor,” nurses questioning his judgment, and attending physicians highlighting his inadequacies. Just a few more years now, he rationalized, and his apprenticeship would be over. When he got back from his Christmas break, he borrowed money to buy a new sports car and asked one of the ICU nurses for a date that Saturday night. She was married, she said incredulously, waving her ring finger. He ended up having to work late on Saturday anyway. His new car got a dent sitting in the parking lot. Someone would pay for this, he fumed. He began to feel victimized.

It was 1990. Michael was on staff. He had cleared his last hurdle, and his life was officially off deferment at the age of 32. Bring on adulthood and all of its rewards! He had a busy clinic and kept track of appointments, procedures, and patient data in his new electronic personal organizer. He had a new car and a new house. Michael finally made the kind of money he felt he earned. As the months passed, the car sat in the parking lot, where it collected rust while he spent his days and evenings in the clinic and the hospital. He hadn't made any new friends and he didn't have many old ones left. His father had died recently. He hadn't identified the perfect woman yet. He got a bad grade on his 6-month physician profile. He was an outlier on six of 12 indicators. Two nurses complained that he was arrogant and egotistical. Four patients reported that he was obnoxious and paternalistic. He had a fight with the semiretired former chief-of-staff in front of a patient. The former chief-of-staff reported that Michael was a problem.

They were all fools, Michael thought to himself as he circled the wagons, they were lucky to have a talented young physician like him on staff. He had been victimized! Over the coming months, his victimization gave rise to anger and frustration and finally to disillusionment. Michael wallowed in self-pity for a year or so, and then went to visit his old roommate, Kevin. Kevin sat behind a desk loaded with charts, regulations, practice guidelines, journals, correspondence, stale coffee, and half his lunch. Michael related his misfortune. Kevin understood completely; he had had the same affliction, but he had never given up his foothold in the world outside medical training.

“You're suffering from chronic active adolescence,” Kevin explained. “We've all been through the same thing. We flourished for years in a system where we based our identity on standardized examinations. We learned to thrive in the role of adolescent, and some of us even learned to put adult relationships and responsibilities on hold for over a decade in a curious attempt to focus on our training. When you finish your training, you're supposed to begin functioning in the world that you put on deferment sometime back in high school. The sad part is that you soon realize that the world wasn't really on hold at all, and then you feel victimized when people don't salute your perceived sacrifices. Frankly, nobody cares that you were the top of your class and …”

“Fine, so you're telling me to grow up,” Michael responded impatiently. “How will I know when I'm cured?”

“When you stop worrying about grades and start embracing relationships. When you stop dwelling on what you gave up to become a physician and start focusing on what you get back. When you feel humbled rather than victimized.”

• Copyright ©2004 by the American College of Physicians