How to Have Your First Mental Breakdown in Four Easy Steps
I. Setting the Stage
Attention to detail is critical. Set your stage with the delicacy of one building a house made from slick, glossy casino cards. Here, we shall examine each one, its face value and color, how it might tumble down with all the rest.
Preparation begins early. Ideally, it starts with a mostly happy childhood, in a prim private school that reframes your every possible insufficiency as a reflection of your hideously patterned moral fiber, whether running too slowly at recess or placing second in the science bowl. A temperamental tendency towards depression is encouraged, and will turn any scraps of positive feedback into addictive, life-giving nourishment for your starved self-esteem. The complexes formed herein are not to be undervalued, as they will drive your direct and mostly reflexive evolution from teacher’s pet to top 2% to summa cum laude valedictorian. Collect your diploma. Enroll in medical school. Keep stacking the cards, one after another.
One year prior, almost to the day, schedule your standardized entrance exam for medical residency. It is important that you do not research this exam’s importance whatsoever beforehand, so that you will not begin reviewing until well after all of your other colleagues. Even this early on, you may begin to feel inklings of the breakdown. We recommend not to acknowledge them. The building pressure will make for a much more explosive finale.
Six months before this exam, begin joking with friends and family and coffeeshop strangers about how this exam will largely determine your medical specialty, and by extension, the next three to eight years of your life, and your professional contacts, and where you one day might find (or never find) a job, and, in essence, the entire rest of your life and your satisfaction therewith.
It will not be until three months later that the truth behind these jokes will land, the heavy, wet slap of a tombstone tipping over.
Begin studying in earnest. Reach and surpass your sustainable daily quota of review questions and, most of all, flashcards—watch them spill into your morning coffee, crash your date nights, even join you on the toilet, until you begin waking up in the middle of the night to the deafening crack of a factoid splitting down its center, Hypertensive emergencies are characterized by, demanding that you pair it with its second half before you can fall asleep again.
This is a good indication that you are prepared. Not for the exam. For the breakdown.
II. The Cast
A father with such passion for cars that he drives every vehicle like a race car, including the beaten-up 1992 Geo Tracker in which he taught you not only to drive, but to drive in his signature style.
A mother who will love you no matter how deeply you fail, and who has thus instilled within you an unintended yet insurmountable sense of duty to live up to that kind regard, which, being infinite, logically requires infinite achievement to merit.
Ancillary supports may include the silent, Gollum-eyed chorus of old teachers and friends who have been (you can only presume) closely examining how high you’ll rise before your inevitable fall.
Also recommended is at least one classmate that you know will get a better score than you no matter how much you study (as they have shared their scores with you after every medical-school exam with an almost voyeuristic eagerness). They will prove instrumental in subtly seeding you with the certainty that there are countless other students just like them, as effortlessly brilliant as you are hopelessly dedicated, yanking this standardized test’s average higher and sending you tumbling down the bell curve to land, breathless, on your back.
Most vital of all, you will need one person thoughtful enough to send you, on the morning of your breakdown, a simple supportive text.
Choose this person with care.
They will be the one who will set everything in motion.
III. Supplies
An alarm clock.
A backup alarm on your phone.
A subscription to the Headspace meditation app.
Four completed practice exams from the National Board of Medical Examiners, purchased at $60 each.
A winning smile.
Snacks.
More coffee than you think you need.
Performance-anxiety pills.
It is important that you remember all of these. Once you start your exam, you won’t be allowed to leave. Latecomers will not be allowed inside.
IV. Execution
Wake up to your phone’s backup alarm. Let the minor-keyed electric-guitar ringtone continue shredding as you scramble out of bed, snatch your actual alarm clock off your nightstand, and find that its battery has chosen this, of all days, to die.
Do not think of this as a bad omen.
Do not think of this as a bad omen.
Just follow the plan. Prepare more coffee than you think you need. Pack this and your snacks and your performance anxiety pills into an insulated bag. Listen to your daily Headspace meditation failing to soothe your twitching, jerking mind.
Most importantly, as you are about to walk through the door, check your phone one last time, and notice the surprise message from that one critical member of your cast wishing you good luck—a message that you will respond to, promptly, and which will leave you so newly motivated that you will walk out the door and, in your almost transcendent drive, leave behind that insulated bag containing all of your coffee, all of your snacks, all of your performance-anxiety pills.
Arrive at the test center thirty minutes early. Check in using your government-issued identification, and try not to get vertigo as the elderly proctor leads you through the entrance rituals: the turning in of the test permit, the turning out of the pockets, the turning over of the glasses for any hidden recording equipment. Take a deep breath. Enjoy it. It will be your last one for nine hours.
Because you will realize, as you’re forcing your locker door shut over your oversized backpack, that something is missing.
Your insulated bag.
Your coffee.
Your snacks.
All your performance anxiety pills for the nine-hour exam in this testing center that will not allow you to leave, or arrive late.
Here, you will imagine again that elaborate house of cards you’ve built; here, you will see it begin to wobble.
Explain the situation to the elderly test proctor. Use your winning smile. It must be absolutely prismatic. The kind that would make a 1980s gameshow host proud. As soon as you’ve walked calmly out of the building, and broken into a sprint towards your car, you may let the smile crumble away to reveal the ashen dread beneath it.
When you step into your car and turn on the engine, you will have a brief flashback of sitting inside a 1992 Geo Tracker. Use this to your advantage.
It is acceptable here to briefly black out. In fact, it is recommended. Come back to your senses halfway through the return journey, finding your forgotten belongings in the passenger seat beside you, and more coffee than you think you need in your hand. Guzzle this in its entirety while swerving through traffic back to the testing center, out of a notion that this might make up for lost time by helping you focus (and it will help you focus, in the way that a magnifying glass might focus light onto your eyeball as you look through it towards the sun, until the cornea begins to smolder, and the vitreous humor begins to boil).
Skid into the parking lot. Turn in and out and upside down for the check in. Accept the proctor’s terms and conditions that the testing center closes in eight hours at this point, not nine, and that you will not, will not make them stay late.
Sit down at your test station, and click the button labeled start exam.
Now comes the real use of your Headspace subscription. If timed properly, you will have been using it for just long enough that you can coach yourself through a brief mindfulness exercise while the exam loads, and just little enough that you will find absolutely no benefit from doing so.
Think back to those four practice exams that you took, each persistently placing you just below average and showing a 99.9% chance of passing if taken within the next two weeks. Reflect on how today’s situation represents something similar to a .01% chance.
Try to draw inspiration from your classmate, the overachiever. Succeed only in imagining the smile rippling onto their face, when the exam results return in eleven to eighteen business days, and you admit that you failed.
Put on the noise-cancelling headphones provided by the exam center. This will allow you to better listen to the whisper of the cards that you’ve so carefully stacked slipping across each other.
Attention to detail is critical. (CRITICAL. CRITICAL.)
This will determine residency professional contacts job life satisfaction.
Hypertensive emergencies are characterized by.
The final card will fall onto the foundation of just enough medical knowledge for you to note your symptoms (chest pain rapid heart rate excess sweating a sense of impeNDING DOOM) until some distant voice in your mind hisses the diagnosis (panic) as if down an empty hospital corridor, while you huddle on the tiled floor at the hallway’s opposite end, shaking in time with the echoes.