The ADHD Medical Student Chronicles: The Pandemic and Me
By: Yousef Hakimi
Tags: Pandemic Diaries, Medicine, Covid 19, Adhd, Medical School

In some ways, it’s actually been easier than I had initially anticipated. During undergrad, I was forced to memorise every enzyme involved in the Kreb’s Cycle and each step in purine and pyrimidine synthesis. You can imagine my shock and elation then when I found out that I wouldn’t have to remember the intricate details of any of this. Sure, a solid understanding of key steps would still be crucial, but if it meant not using as much brainpower thinking about the dephosphorylation of phosphoprotein phosphatase (yes that is a thing, unfortunately) then I was all for it. Of course in saying that, the occasional leniencies in the depth of biochemistry knowledge required did not really amount to much in the scheme of the overall volume of content and expectations medical students deal with.

In other words, you win some you lose some.

I’m saying all of this to elucidate how you can go into medical school fully aware that it’s ‘like drinking water from a fire hydrant’, and still feel like a husk of your former self only a few months in. You might recognize how time-consuming and demanding the course will be, and still feel like you’re drowning without a life jacket after a few weeks.

I truly believe nothing prepares you for medical school like starting medical school. No matter what sort of academic rigor you’re accustomed to, it is a completely foreign feeling for most — the realization that the knowledge you’re learning will directly contribute to saving someone’s life one day. It’s not something you experience (at least to the same extent) in virtually any other field of study. Of course, this hasn’t been the experience of all my peers though. Perhaps some of them simply aren’t letting on how tiresome the course truly is (these are who we call the gunners — we don’t like them here), but I also know my own set of personal circumstances contributed to the specific fatigue I was experiencing. Because while medical school is exceptionally difficult for anyone, I also happen to be diagnosed with ADHD.

Nothing prepares you for medical school like starting medical school.

I sometimes think there must be more doctors and medical students with ADHD, based purely on how much we tend to crave highly stimulating environments (what could be more adrenaline-inducing than a patient coding on an operating table in front of you?!) but I often imagine (partly in jest) the reason they’re not writing blog posts or vlogging their experiences on YouTube about it is because of how woeful we all are with time-management. For additional context, I once got ready for a 6 pm appointment at 11 am that was ten minutes away and was still late for said appointment. The biting reality, however, is that it’s more likely to be a result of the heavy stigma associated with the label of ADHD in the medical community. It doesn’t just feel like a diagnosis — when you’re pursuing a career as a physician, it can feel like a scandalous act of impropriety that you want to quash all evidence of, or risk being brandished with a scarlet “A” for as long as your peers know you. Even publishing this piece is incredibly daunting — up until now, I’ve been relatively selective with who knows about my diagnosis. This may come as a surprise to people who know me well enough that I won’t shut up about it, but I imagine most people reading this would not know I’ve lived with ADHD my entire life.

That might all sound very dramatic, even for people with ADHD, but in a profession where things are often quite literally life or death, whether someone’s judgment of you is ‘real’ or not is immaterial because every mistake you make still feels more scrutinized than it would if it were anyone else. But perhaps that’s the rejection sensitive dysphoria (RSD) of it all.

Unlike many other neurodivergent conditions, a diagnosis of ADHD comes along with specific labels like “lazy, impulsive, uncaring” — all of which actively undermine a doctor’s judgments, skills and capabilities. They certainly aren’t words that inspire confidence in your physician.

In spite of this, there’s stigma pertaining to all neurodivergent people when it comes to medicine; it’s a systemic issue that is evident in AHPRA’s mandatory reporting laws and the high rates of suicide in the profession. However, unlike many other neurodivergent conditions such as depression and anxiety (don’t you worry, I’m not entirely immune to these bad boys either), a diagnosis of ADHD comes along with specific labels like “lazy, impulsive, uncaring” — all of which actively undermine a doctor’s judgments, skills and capabilities. They certainly aren’t words that inspire confidence in your physician, or ones you’d want to be inscribed on your tombstone. To be a physician with autism spectrum disorder (ASD) and/or obsessive-compulsive disorder (OCD) doesn’t tend to fare very well in the medical community either.

So after one breakdown too many, you really begin to wonder whether medicine (or insert any career here if you otherwise relate) should even be your true calling in the first place. Not could, but should. I know I can do it — just like I think anyone can get through medical school if they have the will, drive, and passion (and a dash of stubbornness)… but was this the life I really wanted for myself? One where I will likely always be struggling? Always playing catch-up with others? I began to feel as if I loved medicine, but medicine didn’t love me back. What’s worse is that there’s no easily applicable “fix” to my issue either — amongst the worst aspects of my ADHD is the paradoxical way in which stress both overwhelms and fuels me. I require stress to perform at high levels, but it’s an emotionally and physically draining process that feels like an impossible cycle to break out of.

It’s also like I’m fighting a battle from two sides — on one hand, I recognize medical school is difficult for everyone and it can be an active process just trying to keep your head above water. On the other hand, my imposter syndrome has me so afraid that people inherently perceive me as less than capable because of my ADHD that I purposely sabotage myself with an inhuman number (even sans medical school or ADHD diagnosis) of jobs, research positions, and committee roles. This all makes sense to me in my head because if I fail, people can at least empathize that it must have been because of how much I was taking on. And if I don’t fail? Suddenly I’m aspirational. Suddenly I’m the blueprint for “success”. Or so I’ve told myself.

Insane. Unhinged. I’m very well aware.

A visual depiction of me after overwhelming myself with too many responsibilities. Yet again.

The global pandemic has felt like the tipping point for all of this, though. COVID-19 has undoubtedly affected everyone in unique, disparate ways but for myself, it’s internalized this idea that productivity and self-worth are one and the same. In other words, ‘grind culture’ got to me. I became obsessed with the idea of not being seen as mediocre, but the issue was that I was the only one able to define what ‘mediocrity’ was in the first place. Even still, my idea of mediocrity was continually shifting so that I was never in a position to feel comfortable for too long anyway.

I’m sure this sounds foreign to people who aren’t anxious overachievers, but you can blame the lack of dopamine transporters in my brain as well as the expectations I’ve been carrying on my shoulders my whole life from being a first-generation kid of immigrant parents. It was only a few months ago that I overworked myself so much that it physically manifested itself into Bell’s palsy. At least that’s one thing me and Angelina Jolie have in common.

So where does this all leave me? In light of a pandemic that is currently unchanging in predicament and a diagnosis that is lifelong, it seems as if I’ll be stuck living like this for the foreseeable future. While the process of writing this has been clarifying, my fear of failure and Type A personality is unlikely to let up entirely anytime soon. In fact, about a year ago I tried writing and publishing something very similar, which makes me fear this might all be a never-ending cycle even after I graduate. But, if you take anything away from this otherwise digressive (and admittedly whiny) piece, it’s to be kind to yourself. Always.

Ultimately, it does not matter whether you have ADHD (or not), or if you’re a medical student (or not). Becoming kinder to yourself and realizing that often there are limits to your capabilities (I’m sorry, but it’s true!), as well as being able to reflect on your accomplishments while acknowledging them for what they are is something we should all be working towards.

Of course, it’s not always so easy. I often have to actively remind myself to do it, but I’ve come to realise nothing is more important in a time of social isolation, where frequently all we have is ourselves and our thoughts. Maybe all I can do is try, but isn’t that pretty to think so?