When Medicine Doesn’t Turn Out the Way You Planned | Ep35

Michael Hersh, MD

[00:00:00] 

You can do everything right and still not get what you wanted. You can work hard, plan carefully, make sacrifices, delay gratification, and still end up somewhere you did not expect. Not because you failed, not because you didn't want it badly enough, but because life didn't follow the plan you had in your head.

There's a moment when you realize the future you were working toward isn't gonna happen, and most physicians don't talk about that. We don't talk about what it's like to keep functioning while something quietly falls apart in the background. Instead, we push harder, or we go silent, or we pretend like it doesn't matter because letting go feels dangerous.

Like you're giving up ground, like you're admitting defeat. And instead of giving ourselves time to register [00:01:00] what didn't happen, we spend years arguing with the way things actually turned out. And when you skip that step, you don't just lose the past. You lose access to what comes next.

Well, hey everyone, and welcome back to the Better Physician Life Podcast. Thank you so much for being here. So today we're talking about something that's pretty personal for me, and it happens to be something that comes up all the time for physicians. We dream, we plan, we make sacrifices.

We orient ourselves around the future we're working toward, and sometimes, despite all of that, things don't work out the way we thought. The residency you wanted doesn't work out, or you get the fellowship you wanted, but it's a thousand miles from the people and the life, you know. Or you get [00:02:00] exactly what you wanted, but someone important to you ends up somewhere else.

Sometimes something happens, and in that moment, you just know the life you are planning for isn't gonna happen. There's no confusion there. This isn't about perspective, but there is a loss, and most physicians don't pause long enough to let that register. We move straight into the next step: adapting and making it work.

On the surface, that looks like resilience, but when you don't allow yourself to register, what just ended, your attention stays anchored to what should have been, and when that happens, it becomes really hard to see what's actually in front of you. For me, that moment was very clear. It was Match Day 2003.

I [00:03:00] still remember exactly where I was when I opened my envelope, and I remember knowing immediately that the future I was counting on wasn't gonna happen. I was supposed to end up in New York. That wasn't just where I wanted to train. It was where my entire life was supposed to be. My family, my friends, everything familiar, everything I imagined adulthood would look like, and in one moment, that future was gone.

There was no confusion about it, no waiting to see how I felt later. I knew right away that the life I had been planning wasn't gonna happen. It was a terrible day. I looked around at my medical school classmates. Some were ecstatic about their futures. Others not so much. There was a heaviness in the room as [00:04:00] everyone took stock of what they were getting and what they weren't.

And what happened next is what most physicians do. We adapted. For me, that meant telling myself I’d make the best of it. This was temporary; this wasn't really my life yet. I was still in training. I'd get back to New York as soon as I possibly could. And so I moved forward quickly, too quickly. I didn't give myself any time to register what I had lost.

I didn't talk about my disappointment. I didn't sit with it. I just focused on functioning. Getting through residency, doing well, keeping my head down, and getting back to New York. And for a while, it worked. I loved my residency program. I made really close friends. I was progressing. I was building a career and becoming the doctor I [00:05:00] truly wanted to be.

But internally, I was still oriented toward a future that no longer existed. I treated where I was like a placeholder, like real life would start later once I got back to where I was supposed to be. And the problem with that is that while you're waiting for a different life to begin, you don't actually fully inhabit the one you're actually living.

That was the cost of skipping the grief distance, distance from the people around me. Distance from the opportunities in front of me, distance from the life that was slowly taking shape anyway. What I didn't realize and couldn't see at the time was that many of the best things in my life now are a direct result of Match Day 2003.

But I couldn't see any [00:06:00] of that yet, because until I stopped arguing with how things turned out, there was no room to see what else might be possible, and I didn't know it at the time, but that way of living stayed with me for years. I kept telling myself I was being practical, that I was doing what I needed to do, that this was just a temporary chapter.

I'd be back in New York before I knew it. And because of that, I never really questioned the plan. I just assumed it was still intact. I just kept building toward that earlier version of my life. Strangely enough, the thing that finally helped me see, it had nothing to do with medicine. It happened after fellowship when I ultimately moved to Chicago.

You see, for a long time, I thought Chicago was called the Second City because it was second to New York. I [00:07:00] know, I know. But honestly, how many of you thought the exact same thing. As a Native New Yorker, that explanation made perfect sense to me, so I never dug deeper. But the truth is, that's not actually where the name "Second City" comes from.

The Chicago we know today exists because the first version of the city, the original version, burned down. The great Chicago fire of 1871 destroyed most of it. What came after wasn't a return to what the city had been. The city was rebuilt with an entirely different structure that included alleys and a very intuitive street grid.

If you know an address, you know exactly how to get where you're going. Different priorities from the original city and a design that was meant to last. One of the few remaining remnants from the [00:08:00] first city is the Chicago Water Tower. You see it on Michigan Avenue, and it is surrounded by all of the skyscrapers that came later, a piece of the original city right in the middle of everything that replaced it.

When I finally understood that, it changed how I saw my own life. For a long time, I wasn't trying to rebuild anything. I was still chasing the original plan as if it were somehow still possible, even though on some level I knew it wasn't. The first version of my life was gone. Not because it was a bad plan or because it didn't matter, but because you can't recreate something after it's already burned down.

What you do instead is build what comes next. The problem was, as long as I kept chasing what no longer existed, I couldn't really see what was already taking shape. [00:09:00] My attention was split. Part of me was still oriented toward New York, toward getting back, toward proving something, and part of me was living a different life entirely.

One that I wasn't fully committed to because I didn't think this was where my life was really happening. And when your attention is divided like that, you don't fully show up. Once I finally let go of the chase, I didn't lose ambition. I didn't lower the bar, I just stopped organizing my life around something that wasn't even possible anymore. And that changed everything.

I was where I was. I made decisions from there and I could finally see what this life was actually offering. Once I stopped organizing my life around getting back to New York, something else became possible. I started investing where I actually was. I allowed [00:10:00] myself to date and to build relationships, and I also let myself imagine a new future.

Eventually, I met my wife. We built a family and created a life that I could not possibly have planned or pictured on Match Day 2003. And the hardest part of that whole process wasn't the original disappointment. It was letting go of the story that I was supposed to be somewhere else. That's the part I see most physicians struggle with.

We're very good at holding on. We're disciplined and persistent and committed, and those traits get us through training. They get us through hard seasons, but sometimes the thing that once helped move us forward becomes the thing that keeps us stuck because when you cling to a version of the future that no longer exists, you're [00:11:00] arguing with reality.

And that argument is exhausting. You compare what is to what should have been, you measure your current life against a future that never fully arrived, and without realizing it, you make the present. You like a compromise. I see this all the time in doctors. The job that was supposed to feel different by now, the role that didn't turn out the way you thought.

The location, the schedule, the career arc. It looks fine on paper, but it just doesn't feel quite right. Most of the time, the issue isn't that something is wrong; it's that an older version of the plan is still running the show, and that's the part that matters. Before anything new can take shape. There has to be some recognition of what didn't.

It's not about analysis or blame or [00:12:00] rewriting history, just a willingness to let the old version stop running in the background. Most physicians never do that. We move straight to adaptation, to making the best of it. We tell ourselves we should be grateful, or that it could have been worse, and none of that is wrong.

But when you never pause long enough to acknowledge that something ended. Your attention stays divided. Part of you is still oriented toward a future that never arrived, and part of you is trying to build something else at the same time, and that's an exhausting place to live. Okay. Up to this point, I've been talking about what happens, the pattern, the cost of it, but the question most physicians get stuck on is, okay, I get it. Now what? 

This is where the work actually is. Not in changing your life or making a big decision, [00:13:00] but in how you relate to what didn't happen. So what does that look like in practice for physicians? It starts with something we're not very good at, letting ourselves register the loss. Again, not analyzing it, not reframing it, just acknowledging that a future we were working toward, it didn't happen.

A role you expected to have, a place you thought you'd end up, a version of your life that made sense for a long time. That loss doesn't go away because you adapted. It doesn't disappear because things turned out fine. It just goes unacknowledged. And when that happens, it keeps pulling your attention backward.

The practical work here is naming that loss and allowing it to be real without turning it into a problem that needs to be solved. This does the heavy lifting. It reminds you that future isn't possible anymore and that the life you [00:14:00] built since then is real.

You don't have to minimize what was lost to appreciate what you've gained. You don't necessarily have to be grateful to accept what's no longer available. Both can exist. When you let yourself see that a little more clearly, the arguing with reality begins to lighten up. You are no longer trying to get back to a life that ended.

You are orienting yourself to the one you are actually in. That's not forgetting the past. It's letting it take its proper place. And from there, the possibilities in front of you become easier to see. Not because you forced optimism, but because your attention is finally where you are. This is something you can work on deliberately, not by forcing change, but by choosing where you place your attention.

For a lot of physicians, that work fits best in the transitions of the day. The drive [00:15:00] in the drive home, that's when the old plan tends to resurface. When your mind goes back to how you thought things would turn out, or runs ahead to what still hasn't happened yet. And that's why I built the 5-Minute Commute Reset for Physicians, just a place to slow down for a few minutes.

So you're not trying to figure this out on your own five minutes in a part of your day that already exists. A chance to notice what you're still carrying after work ends to name what's no longer possible and what still is, and to remember what you've already built. And you can grab it for free at betterphysicianlife.com/commute-reset .

And of course, I'll tag it in the show notes. So let's come back to where we started. Sometimes you don't get what you wanted, and that hurts. But that doesn't mean the dream was pointless, and it doesn't mean the effort was [00:16:00] wasted. Those plans still shaped you. They gave you direction and purpose and helped get you to where you are now.

But at some point, holding onto them costs more than letting go, and sometimes the real work is deciding what you're ready to stop chasing so you can see what's actually possible now. That's not giving up. It's choosing to live the life that's right in front of you.

Thank you so much for listening today, and I'll see you next time on the Better Physician Life Podcast.