Medicine as your Second Life: What happens when the game ends?

In 2003, Linden Lab, a company in San Francisco, released a multiplayer online game called Second Life. At its peak in 2013, it had 1,000,000 active players and as of 2017 had 800,000-900,000 active players. In January of 2008, players spent over 28 million hours actively engaged in game play, and around the same time, an average of 38,000 people were logged in on an average day.

A host of issues sprang up related to content, but many related to users spending more time involved in their virtual lives than they did engaged in their actual ones. The attraction of the game was that it allowed one to create a life they chose, a life they wish they had, for want of a better phrase.

Those who play the Second Life game create their own characters, known as avatars. In a wry twist, players are known as “residents” and, when engaged in play, one is said to be “in-world.”

See where I’m going with this?

Practicing medicine: Your Second Life

In 2021, there were nearly 145,000 residents actively training in the U.S. In 2020, there were more than 1 million actively practicing physicians. Medical school enrollment approached 95,000. That’s a lot of players. And in one way or another, they are all “in-world,” usually for more hours or days than they are not.

Medicine is our Second Life. Doctor [surname here] is our avatar. The number of hours we spend actively engaged in playing the game is staggering. But what happens when we unplug, have our plug pulled, or our career hard drive crashes due to an accident or a disability?

The idea of our professional personas as avatars is particularly intriguing. How many of us can separate our avatar from our actual self? How many of us simply remain our avatar even when we’re not in-world? How many of us simply can’t log off?

Late career and retirement raise all of these questions. When you’ve spent most of your waking life (as well as a lot of your sleeping one) being your avatar, who are you when the screen goes dark? What happens when your “credentials” no longer allow you to Sign In?

The challenges of leaving medicine

I’ve known colleagues who didn’t seem to have a persona outside of their professional one. They were Dr. X 24 hours a day, every day, every month, every year. They took journals with them to read on family vacations and called in from the exotic destinations where they had “escaped” to.

As the insidious reach of digital medicine and the Orwellian EMR has grown, the line between in-world and the real world has blurred even further. This makes, or will make, “leaving it all behind” all the more difficult.

Some describe retirement as shedding a skin – but when that happens in nature, the shedder still looks pretty much the same. If you have a true dual identity (doctor v. nondoctor), you’ve got a fighting chance.

I’ve had colleagues who haunted the hospital wards until the wee hours of the morning. Visiting patients just to check on them – often awakening the patient to make sure they knew how dedicated they were and how much they cared. They much preferred being in-world over the alternative.

They chose the Second Life over their First. Read the comments of people who became “addicted” to Second Life and see if you don’t spot the similarities.

 But why? Why would you spend twenty hours a day roaming the halls if you didn’t have to? Why would one choose their second life over their first?

The appeal of fulfillment

I think the answer is fulfillment. A hospital is a veritable Black Hole of need. The patients need you, the nurses need you, and the administrators (though they won’t admit it) need you. And when you meet that need, you are rewarded with love in return.

And who doesn’t want the love? It flows pretty freely at 3 a.m. and it feels better than an unhappy spouse or a teething child or a mouthy adolescent. Put on your white coat and you can be an emotional vampire, going room to room after sunset, slaking your thirst for validation. Dedication can be just another word for escape.

There are solutions. You can just keep working, returning again and again to that bottomless font of need and drinking your fill.

You can try to stay plugged in – going to dinner meetings, hanging about the office or the hospital or the doctor’s lounge telling war stories and basking in the experience and the camaraderie. You can loiter around the clubhouse for a long time after you’ve quit the game and they won’t ask you to leave.

Or …

Investing in your First Life

You can start reinvesting now in the value of your First Life. Before the plug comes out, the CPU fries and the screen goes black. Medicine is what we do. In retirement it is or will become what we did. If we allow it to become what we are to the exclusion of all else, then we’ve allowed something truly bad to happen to us.

If you’re young or in mid-career, look around at your senior colleagues and see if any of this makes sense. If you’re in late career or facing impending retirement, take stock of what lies ahead and not what you must leave behind.

I miss a lot of things about practicing – the mostly wonderful people I worked with, the teamwork, the pure satisfaction of doing good for others and the sense I spent my professional life improving the world. But I never look back or pine for the past.

I never wish I was operating again. I look at the phone every night before bed, ecstatic that it is not going to ring; overjoyed that no one is going to need me.

We all began this journey with a First Life – a real one. As we approach our professional endpoint and the sudden evaporation of our avatar into a million little pixels, the secret to future happiness and success lies in making sure that our First Life is still there. And that is something we can work on preserving throughout our careers.

I’ve been out for two-and-a half years as of this writing. Whenever someone asks, “Say, aren’t you the heart surgeon?” my now-practiced reply is, “I was the heart surgeon. But that was another life.”

After a long career of helping others, that’s what we all deserve – another life.

Next time: Disability and Unplanned Retirement: Do You Have a “Go-Bag” Packed?”

Related reading:

Retiring from medicine: The best of times or the worst of times?

This hobby helps me cope with my grueling medical training