Essence to Essence

Samuel Scharff1

1Johns Hopkins University School of Medicine, Baltimore, MD, USA
Address correspondence to:

Illustrations created and provided by the author (SS).


I have been warned more times than I can count that medical school will change me for the worse. That I will burn out in the face of mind-numbing paperwork, cynical co-workers, and an endless supply of unjust suffering. That healthcare’s culture of workaholic martyrdom will melt the ‘me’ right off of my bones. That I will become a sterile cog in a broken machine.

My response as I was entering medical school? “Pfffffffft.”

I mean, come on. I had handled difficulty before. How could medical school be any different? A part of me felt that my would-be “advisers” were underestimating my passion and talent. Or perhaps they were projecting their own regret onto my opportunity. Well, they didn’t know me. I was confident that while medical school would be a challenge, I would make it through with my soul intact. And truth be told, medical school began as I had imagined it: I was exploring a new city, learning constantly, and making a ton of friends. All was perfect…


…at least for a while. About six months into my first year, things began to feel out of place. At first, I figured I had caught a mild case of the existential fever others had warned me about before. Okay, I admitted. So I’m not a hotshot. The learning curve may have hit me like a brick wall. And I might not remember why I signed up for medical school in the first place. So it goes. But soon I was admitting that I might not remember the last time I drew anything. Or listened to music. And that I actually couldn’t think of anything I found enjoyable. And I might have lost my sense of taste. And I might not see a reason to go to class. Or to get out of bed. Or to live. But hey, whatever. I’d be fine. I couldn’t recognize myself in the mirror, but I’d be fine.


But I wasn’t fine.

My emotions stopped. My thoughts and movements stiffened to a halt. Death began to seem like a pleasant option compared to this total nullification. I realized all of this probably wasn’t what people were warning me about before I entered medical school. Something entirely different was happening – my brain had somehow broken. At some point it was explained to me that I had bipolar disorder. The diagnosis consumed me. Every thought, word, action, and relationship in my life now seemed best explained by my newfound insanity. I was sickness.


The day eventually came for me to return to medical school, and I felt beyond unprepared. How was an ill person in any position to heal another?

I would have to find out on the job, I guessed.

My physician mentor whisked me into the room with a fifty-something-year-old patient and his wife. The doctor began to list the man’s latest signs and symptoms: off-the-charts blood chemistries, cardiac arrhythmias, and possibly cancerous polyps in his irreparably scarred GI tract. The patient was entering the final spiral of chronic alcohol abuse. His wife received the news with grinding ambivalence. This visit might literally have been the hundredth time she and the physician have tried to stage an intervention for her husband. The patient stared emptily at the floor; his eyes glinting like the bottom of a whiskey bottle. Yet another conversation going nowhere.


As the wife and the physician spoke more and more, I learned how the patient’s life had been sucked dry by his affliction. Such a relatable emptiness! I felt a sudden stir within me, someone familiar choking back to life. And to my surprise, I began to speak. The patient turned his jaundiced eyes toward mine in reply. Our gazes locked, and before I knew what was happening, I was making an attempt to locate the person, the man in the bottle. I asked him questions about his frustration, disorientation, humiliation, and all those other messy emotions that come with a dislocated identity. Questions for him. Questions that alcoholism couldn’t answer.

And he responded. For a brief moment, we encountered one another. No medical student. No patient. No bipolar disorder. No substance abuse. No good. No bad. People.


The moment went as quickly as it came; the rest of the visit was pretty mundane. The doctor and I counseled the patient and his wife about different options for his ongoing clinical management. They thanked the doctor and me for our time, and left the room smiling. My instructor gave me some pointers, and we were on to the next case. Only as I left the hospital did the awe strike me.



As a medical student and future doctor, I expect to see a lot of people who never thought they would join the Imploded Identity Club.

My hope is that my personal hell has prepared me to find those moments to step out of the hospital’s indifferent chaos and be present with others as they are. Human essence encountering human essence.

For both their sake and my own.