The Mid-Career Demon

Dr. Daaleman's wonderful essay is a journey through a time, both professional and personal, that awaits us all or, in the case of my cohort of physicians, a remembrance of times thankfully most of us survived. The beginning and end of careers are the source of most of the attention these days, but the great yawning middle is where we often go astray. No one leaves rock cairns as guideposts for people in their "middle" careers in part because the definition of "middle" has shifted a great deal over the past century. The Harvard longitudinal study of adult development that covered over 70 years showed that we continue to develop over an entire lifetime. It never stops. But that also means there might be more demons in our future.

Junior faculty get a pat on the back after wending their way through the maze of promotion and then, free to become what they have been striving to be, find that truly becoming is more daunting than the run up to it. Dr. Daaleman's noon day demon metaphor is wonderful and, whether we admit to it or not, the acedia he writes about so movingly is there for everyone. He just recognizes it for what it is and wrestles with it in a way that should inform generation after generation who will confront their own noonday demons. I wish that I had had Dr. Daaleman's essay on my desk when my own struggles came, which seemed to last so long and were so hard. I wish I had known.

William Carlos Williams, one of America's great literary figures, was a GP who practiced in the early 20th Century in industrial New Jersey. He wrote about his own struggle with the noonday demon. What saved him, just as what saved Dr. Daaleman and will save us if we are smart enough to recognize it, was to recommit to the work, believing that there was purpose and meaning to it, even if suffering and death were inevitable. The journey itself was important, regardless of the uncertainty of the destination. And Williams' way out of acedia was to let his patients help him. Daaleman tells about the patient who pulled him "into the space of her hope" Williams wrote in his autobiography, "the physician enjoys a wonderful opportunity actually to witness the words being born...Noone else is present but the speaker and ourselves, we have been the words' very parents. Nothing is more moving." Daaleman's patient says "we'll be aw'right" and leads him toward hope. He was right to listen. The work, the patients, and the words we are privileged to hear are, in the end, the hope.

Competing interests: None declared