Who am I without my white coat?

Feb 3

Career transition, identity loss, and reconstruction

I heard the pop. The minute it happened, I knew I’d torn basically every ligament in my knee.

I knew this would be a career-ending injury.

Let’s back up.

The knee broke in January 2021, at the height of the pandemic. Three years before that, I’d been ranked the best ninja warrior athlete in my age range—in the entire nation.

Ninja warrior was my identity. Yes, I was a doctor and an academic. But where I really came alive was on the ninja course. Heck, I’d even changed my Instagram handle to ninjasurgeon.

But then a pandemic, a dissolving marriage, and toxic job deteriorated my ninja skills. As 2020 flipped over to 2021, my new year’s resolution was to get those skills back.

The problem was: I was nearing the end of my forties. Which meant that, although my deconditioned muscles remembered what to do, they were too weak to do it.

Also my ligaments had become porcelain.

Objectively, the fall that destroyed my knee wasn’t that bad. I fell less than three feet, from an obstacle I’d done hundreds of times before—an obstacle I was confident in; an obstacle that didn’t scare me (like most of them did).

But that evening, my body went one direction, my leg went the other

And late-forties porcelain ligaments aren’t designed for that.

I’m not kidding when I say that I tore everything in my knee. The MRI showed gale-force destruction: an ACL tear, an MCL tear, a fracture of the top part of my tibia, and an injury in the outer-back corner of the knee (I had no idea that was even a thing).

Four years later, the knee is mostly better. It’s never gotten back to what it used to be, and probably never will. Still, I can run (slowly), jump (hop, really), walk (so long as it’s not uphill), and I’ll never dare to ski again.

But this post isn’t about my knee.

It’s about the dark night of the psychological soul that followed.

For five years, ninja warrior had become more than a sport, more than a hobby. It had become an identity. And now that I could no longer compete in the sport…

Who was I now that I wasn’t a ninja?

My friend Georgina Pazcoguin is a soloist for the New York City Ballet. The last chapter of her book Swan Dive is titled “Dancers Die Twice”. In it, she writes:

When it’s my turn to stand onstage for the last time, what will it feel like? A loss of identity? Will my entire career flash in front of my eyes?…. This is all I’ve ever known. What will I do when I go home that night and fall asleep with the knowledge that I’ll never dance on that famous stage again?

Some of my magic will be lost.

(emphases mine)

In my coaching practice, I often work with healthcare providers considering a mid-career shift. And one of the very first things we have to address is the question, Who am I if I’m not a doctor?

Will some of my magic be lost?

For so many of my clients, the potential loss of identity emerges as one of the largest barriers to making a decision—even larger than financial or family considerations.

Doesn’t matter that getting out of their burnout will make their lives immeasurably better. The loss of identity still ranks among the top hurdles they have to overcome.

So, let’s get into the science of identity.

Why do some jobs make us who we are? And why is that sort of identity so difficult to shed?

Practice (alone) doesn’t make perfect

In their book, Peak, Anders Ericsson and Robert Pool dig into what practice looks like—how people do it, and how it can shape professional identity.

There are, according to Ericsson and Pool, three types of practice: naive practice, purposeful practice and deliberate practice.

The most basic version—naive practice—is the idea that simple repetition makes us better.

And yeah, true. It does.

Every med student remembers tying hundreds of thousands of knots on their first surgical rotation. I had literal cords of surgical suture dangling off every chair, table leg, light post. Any surface in my apartment that would admit a suture got tied up. Two-handed knots. One-handed with my left hand. One-handed with my right. Lights off. Lights on.

Simple, rote repetition. It makes us fast.

But naive practice only gets you so far. After all, knot-tying is only one part of what a surgeon does.

Purposeful practice takes the practice up a notch. In purposeful practice, repetition is coupled with a meta-evaluation. Purposeful practice is practice plus figuring out how effective your practice is. It’s practicing and gathering feedback on the practice—so that you can practice even better the next time. Smarter not harder, as the saying goes.

Finally, deliberate practice adds a defined target. Deliberate practice is purposeful practice, guided by imitating, achieving, and surpassing the best-possible performers in the arena. It’s practicing your chess moves, gathering feedback on how well your practice is working, all while trying to emulate, or surpass, Magnus Carlsen.

In other words, it’s understanding not just what Carlsen does to be so good at chess, but how and why he’s pulling it off.

And that brings us back to identity.

Becoming an expert requires not just time, not just thousands of hours of focused, repetitive practice. It also requires constant feedback, and a defined goal. In medicine, this process begins in medical school and continues beyond residency and fellowship. The rule is that a surgeon doesn’t reach her peak until 10–15 years after she’s finished her formal training.

There’s no way for a decades-long, intensive training not to demand a massive emotional investment. Deliberate practice doesn’t just build skills — it fundamentally reshapes how its practitioners think and view themselves.

Mental maps

There’s one more thing that sets experts apart.

Not only have they tied countless knots. Not only have they gotten laser focused on how they move their hands. Not only have they learned that rotating their wrist just one degree to the right can shave 20 seconds off their surgical time. Not only have they emulated and tried to surpass their role models

While doing all that, they’ve also built detailed mental representations of their domain.

“Detailed mental representations of their domains” looks, for doctors, like creating mental models of human anatomy, disease processes, and treatment protocols. Because these mental models allow them not only to understand their domain, but to teach the next generation and to explain the human body to the folks from completely different fields who come to them for treatment.

All this work takes time. It takes years of emotional energy. And, in the process, experts can’t help but build an emotional attachment to the work itself.

Building these mental models, engaging in deliberate practice, devoting the time to the deep integration necessary for a pursuit of perfection almost inevitably means that one’s sense of competence and worth becomes tied to what they do.

In other words, developing expertise changes not just what people do but how they process information and, as a result, who they think they are.

How we learned to love the status quo

To paraphrase Moneyball, we hate losing even more than we like winning.

This is called loss aversion (which I’ve written about in much more detail in prior blog posts, so I won’t belabor it here). Basically, loss terrifies us. We’re already a risk-averse species, but our inherent risk aversion becomes even stronger when we face potential loss.

And that makes us susceptible to something called the status quo bias.

Back in the late 1980s, Richard Zeckhauser and William Samuelson showed that, no matter what the choice is—and no matter what the better option might be—people tend to choose whatever they’re already doing.

Even if people are offered an option that’s unequivocally better than the thing they already have, they still prefer the status quo.

To show this, Zeckhauser and Samuelson ran a series of decision experiments in which they presented their participants with choices across all sorts of domains (think investment portfolios, health insurance, etc.)

For some participants, one of the options was something they were already doing. For the others, neither option was the status quo. And what the scientists found was that, no matter what the choice was, no matter how good or bad it was, participants selected it significantly more often when it was the status quo.

In other words, we’re not just creatures of habit — we’re creatures of inertia.

A psychological commitment to the status quo feels like it’ll protect us against regret (because, what if changing is worse?) and maintain our desire to be in control. The status quo feels like a “safe” choice, for no other reason than that we already know it intimately.

As Brianna Wiest writes, “Anything that is new, even if it is good, will feel uncomfortable until it is also familiar.”

And that’s how we get stuck.

So, who am I now that I’m no longer a ninja competitor? Who am I now that I don’t practice medicine in the US any more?

Well, fundamentally, I’m not a competitive ninja. I’m not a full-time doctor. Not in the way I used to be. Not in the way that brought me joy (in the case of the former) or burnout (in the case of the latter).

That’s never coming back. And that’s okay.

I’ve learned a few things from these transitions that I wish I knew before I made them—things I take with me to future transitions.

Identity archaeology

Every 6–12 months, I do a little identity dig.

What is it about what I’m doing right now that gives me identity?

What is it about the skills, the mental constructs, the investment that makes me “who I am”? What made me proud to be a ninja, proud to be a surgeon?

Was it just the white coat, just the ninja gym? Or is there something about the white coat and the competitions—some skill, some mental model—that makes me feel like that’s who I am. Because the former will disappear. It just doesn’t have to take the latter with it.

This dig always reveals the skills, practices, and habits that I can transfer to whatever I do next. Two examples:

What made me so proud of being a ninja? The sport is both excruciatingly physical and it’s inescapably mental. It forces you to stand 16 feet above a pool of water and jump further than you think your body can, just to try catch a spinning bar whose whole goal is to dump you into that water.

And the only way to move forward is to jump.

And that? Well that’s a transferable skill.

Taking the big risks, jumping off the platform—even if it lands you on the ortho’s operating table with cameras jammed into your knee—has served me very well.

Similarly, what makes me proud of being a surgeon? Among many things, it’s the absolute necessity of being calm. To quote the (horribly problematic and sexist) book, The House of God, “At a cardiac arrest, the first procedure is to take your own pulse.” Nobody benefits if the medical team is in the middle of their own freakout.

Again. A deeply transferable skill.

Your turn.

What makes you proud to be what you do?

When you spend years cultivating an identity, it can feel as if you only get to keep that identity if you keep doing the thing that got you there.

But it’s not true.

I’m going to end with a final quote from Brianna Wiest:

Your new life is going to cost you your old one. It’s going to cost you your comfort zone and your sense of direction. It’s going to cost you relationships and friends. It’s going to cost you being liked and understood. It doesn’t matter.

You are so much bigger than what you do.

→ Want more weekly content about making the hard decisions with confidence and clarity? Join my mailing list!

→ Ready to transform this insight into action? Get my free guide, “The Anatomy of a Good Decision,” where I break down the exact framework that helped me navigate my transition from surgery to decision science.

→ Are you a medical provider struggling with exhaustion, burnout, and indecision about how to craft a purposeful career? Check out my free webinar on the Solving for Why Navigation System here.

Mark Shrime https://markshrime.com