LXXXIX. The Dark Side of Stoicism
Fate guides the man who's willing, drags the unwilling.
"First say to yourself what you would be; and then do what you have to do." — Epictetus
I'm always up before the sun splashes its light on the city. I lift or do calisthenics. I shower. I head to the hospital where the work starts before I'm fully awake and ends long after I should've gone home. My shift runs long. Sometimes twelve hours. Sometimes more. In between cases, I write. I jot down notes in corridors, between patients, after consultations, sometimes right before a procedure. I've gotten good at catching ideas before they disappear — like trapping steam in your hands. You'd think I'd be used to the groove by now. But truth is, most days, I don't want to do any of it. Not the work. Not the writing. Not the getting up before dawn. My body aches. My brain feels slow. My will drags everything forward by the collar.
My line of work can lead to burnout if you're not careful. So I still make time to nap. To read. To walk. At least 30 minutes a day. Not because I love to or because I heard some philosopher say walking a potent analgesic for the soul — but because I don't have a choice. The walk clears my head. It gives me enough energy to get through the rest of the day. It keeps me from sinking into that place where everything starts to feel pointless. People think it's extra work. It's not. It's what keeps me going. So I walk. I always walk.
Then comes surgery.
In the OR, the hours stretch. Your legs and spine tire, you feel like disowning them. You're hungry. You're tired. Then comes the night shift — your eyelids droop, your body slips into autopilot, and the only thing that brings you back, since fighting off sleep with willpower alone doesn't work — is the cut. The blood. The smell of cauterization. The perfection demanded in the moment. It jolts you back. You have to stay awake, sometimes lucid. Choosing to act right when you feel like shit is no small thing. You snap into focus because you have to. There's a person open on the table. One mistake, they lose their life. You're the one responsible.
And after all that — people.
Some days I want to lose my temper. A patient's rude. A colleague makes a careless comment. I feel the anger rise. But I hold it. I don't say what I burn to say. Other times, I don't feel like being kind or patient. I want to snap at people for their mistakes. I don't want to care. I want to stop caring just so I can breathe. But I do it anyway, because every human deserves it.
Yet, to say it's lonely is a cliche.
People expect more from you because you've shown you can handle more. So they pile it on. You're the strong one. You won't complain. You'll figure it out. You'll stay calm. And when you do, they don't think twice about what it costs you. You go home drained, and no one knows what you've been through. Even when they thank you, they don't really see you. They're not in the room with you at 3 AM when you're wondering if the effort is even worth it. They're not in your head the next morning when your alarm goes off and you feel sick at the thought of starting over. That loneliness is, I believe, a burden anyone intelligent and ambitious must carry.
I'm a very patient guy when it comes to endurance feats. Still, some mornings I want to quit. I'll stare into the mirror, toothbrush in hand, and think, What's the point? Be good? For what? Try harder? For who? In those days I hate it. All of it. I let myself sit in that muddy pile for a bit. But as I go about my day's tasks, the sulking wanes and what's left is simple, yet clear: I chose this. This life is mine — being a Stoic, a surgeon, a writer, a man, is what I am. This is the path I signed up for. It's not easy. It's not supposed to be. But I'd never trade it for something easier, I’d be lying to myself. I want a life that demands soul from me because I’m built for war. I want to live an interesting life.
"When a dog is tied to a cart, if it wants to follow, it is pulled and follows, making its spontaneous act coincide with necessity. But if the dog does not follow, it will be compelled in any case. So it is with men too: even if they don't want to, they will be compelled to follow what is destined." — Chrysippus
"Fate guides the man who's willing, drags the unwilling." — Cleanthes
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Previously,
Someone else said to "just handle your business". But I don't think that is actually Stoicism. Not exactly. Instead, what you describe sounds more real - implement coping mechanisms like your 30-minute walk. Take each day as it comes. Each patient as they come. Each challenge as it presents itself.
I might add to your routine that you must occasionally take a step back and appreciate yourself and appreciate what you've given your patients and co-workers.
And vis your co-workers, remind yourself that you are not alone, and needn't bear every single burden on your own.
As a fellow health care worker, *I* appreciate you and I'm grateful you are doing what you are doing.
Dear Doc,
Your message resonates deeply with me. It’s rare to encounter someone in the health professions who shares so many of my perspectives and experiences. As a clinical psychophysiologist and neurophysiologist, I also dedicate myself to teaching neuroscience-based coaching to support our patients’ recovery before, during, and after brain surgery.
This is the life I’ve chosen, and at 70, I find immense joy in continuing to work passionately every day. Thank you for sharing such an inspiring and insightful article.
Best regards,
Dr. Luis Gaviria