By Luyi Kathy Zhang, MD

Long ago, in the BC (before COVID) era, I would chat up a local in a foreign country. Their usual response upon learning I was from the U.S. would be to seek clarification on aspects of American culture found most peculiar. There were your usual suspects — the Electoral College, imperial versus metric systems, and why we’re obsessed with the Kardashians — but the most common question was about our unabashed friendliness towards complete strangers.

“Americans ask each other ‘how are you?’” they remarked, mystified. “And you reply, ‘I’m good, how about yourself?” “You’re all so positive and optimistic!” they exclaimed.

But what about when we’re not?

As a palliative care doctor in NYC during the beginning of the pandemic, my typical greeting response of “I’m fine” was speedily replaced with “I’m hanging in there.” It seemed slightly less false (because who’s really “fine” amidst a global pandemic?), and soon it was the only response I heard throughout the hospital, as contagious as the airborne virus we were battling. The truth is I was quite literally falling apart, the furthest from “fine” I’d ever been in my entire life. I had lost all sense of self and purpose, swept up in the enormity of the suffering I witnessed every day at work, coupled with the spiraling anxiety that I couldn’t control the events of the world, much less my own emotions. I saw no way out, and the deeper I withdrew, the more I was trapped in a quarantine of my mind’s own making.

Sometimes the little white lie of being “fine” is easier than unloading your life troubles on some poor, unsuspecting stranger. Sure, a small, minuscule deviation from our own truth may not mean much at the moment. Perhaps we don’t even realize that we’re not as put together as we think we are (cue my go-to joke that denial is the name of an Egyptian river). But over time, the lies we tell ourselves are akin to little cracks in the glass window to our souls. These cracks grow and expand with each added insult and life pressure until a tipping point is reached, and the next fracture, whether mundane or catastrophic, causes the pane to shatter into a thousand little pieces. As innocent and routine as these mistruths feel, the soul keeps track.

After months of psychotherapy and introspection, I’ve landed on a new phrase, one that is kinder and gentler and allows for the possibility of simply being human.

On days when my world is upside down, my head is screwed on sideways, and the sum total of my calorie intake and bathroom breaks is a golden goose egg, I now say: “It sucks, and I’m doing what I can.”

It’s a deceptively simple yet highly effective sentence. It acknowledges that life isn’t peonies and butterflies and that in this very moment when I’m feeling pretty crummy, it sucks. The second half of the sentence offers up the compassion we don’t often give ourselves. We’re doing what we can with the resources that we have. It merely allows for the situation as is, without pretense or expectation.

Some days “doing what I can” is feeling on top of the world, going above and beyond for my patients the way I imagined as a preteen, and extracting joy from tiny things like how smoothly ink flows out of a really great pen. Others, it’s numbly watching Netflix all day in between bouts of uncontrollable sobbing on my bathroom floor, caught between the cold reality of the world and the frigid chill of the polished tiles below me.

And you know what? That’s OK.

I’m tired of pretending to be perfect because medicine and society expect, nay, demand that of physicians, especially women physicians. We’ve been indoctrinated in a culture of invincibility, where our mistakes are publicly highlighted beneath the glares of discerning colleagues and harsh hospital lighting alike. It’s no wonder that we fall apart at anything that dares to challenge our identity as infallible professionals who should know all the answers — because that is what the system has spent years having us believe. It is unhealthy and entirely unsustainable.

I love palliative care because it emphasizes self-care as the vehicle by which we deliver compassionate, whole-person care for our patients and ourselves. That starts with the words we say and the emotions we feel. Thus, I’ve started to allow myself to cry during emotional family meetings, to feel anger, pain, and anguish with my whole heart amid the pandemic rather than resorting to my usual coping mechanisms of intellectualization and plain old denial.

“It sucks, and I’m doing what I can.”

Language matters. What we say to ourselves matters. This phrase wasn’t the panacea that lifted me from the depths of despair, but it jump-started the process towards recovery because I finally acknowledged my feelings rather than pushing them aside because I expected myself to be “fine.”

So go ahead, give yourself permission, summon the compassion and grace you’d bestow on your best friend, and tell yourself, “This is the breadth of the human experience, and I’m only human.” There is immense beauty and strength in that vulnerability. I lied to myself for too long, couldn’t see the road ahead through the cracked glass until it, and I, in turn, shattered. Once those broken shards that obscured and distorted the path forward have been swept away, only then can the clarity of a stronger, more resilient soul begin to emerge.

I’m not back to normal, and it’s possible I may never get there. But each day, there are glimmers of hope that I might be closer to my true self than before — and that’s all I can ask for right now.

Luyi Kathy Zhang is a palliative care physician