A few years ago, I came across a profound quote by Seneca in Ryan Holiday’s The Daily Stoic:

“All the things which cause complaint or dread are like the taxes of life — things from which, my dear Lucilius, you should never hope for exemption or seek escape.”

This idea that we are faced with “taxes of life” we should willingly pay resonated deeply with me. It sparked a chain of thoughts: What are these taxes? What challenging experiences, pains, struggles, and mindset shifts are necessary for living a life of true depth and fulfillment?

My journey has involved reframing these negatives as positive and necessary components of growth and progress. Today, I’d like to share with you the ten taxes of life you must pay to live the life you truly want.

1. Periods of Loneliness: The Tax on Personal Transformation

When you embark on a journey of personal transformation, you’ll inevitably face periods of loneliness. For me, this was medical school. It was an isolating experience at times because I was so focused on just one type of study as opposed to learning about other areas of art, philosophy, and history I enjoyed in college.

As you change and grow, some people in your life might not understand or approve. You will likely lose friends, face criticism, or be called “crazy” or “lame.” This isolation can be challenging, but it’s a necessary part of the process.

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Remember: This loneliness is temporary. As you continue on your path, you’ll attract new, vibrant people who align with your evolving energy and values. Embrace this change – it’s the whole point of transformation.

It’s also worth noting that some of these feelings of loneliness stem from ourselves as we become people who move farther and farther away from who we used to be, dissociating from the versions that no longer serve us.

2. Stress and Anxiety: The Tax on Extreme Ambition

Those with extreme ambition often face heightened levels of stress and anxiety. Most of us in medicine and high achievers otherwise can relate. Ambition is a double-edged sword. It’s a powerful force for good when channeled correctly, but it can also amplify stress when progress seems slow or unclear. Right before a test, the fear of failure (FoF as I call it) can be both stimulating but also distracting.

We need to internalize that progress is rarely linear. Like the Chinese bamboo tree, which takes years to break through the ground, our efforts may seem fruitless for long periods before suddenly yielding dramatic results.

During these seemingly stagnant times, focus on direction rather than speed and the subtle signs of growth. And this growth will manifest in myriad forms, taking on unique shapes unknown even to you.

Sometimes, ambition must be nipped in the bud or pruned. There is only so much it can do, and instead of being pulled apart in several directions, it’s better to focus on one or two things at a time.

I’ve seen people set unrealistic goals out of an inflated sense of ambition, only to fail and spiral into depressive episodes because they’ve lost faith in their abilities. The whole time, it was an inability to plan and prioritize rather than any intrinsic factor that led to failure.

3. Boredom of Routine: The Tax on Long-Term Success

Contrary to popular belief, the lives of truly successful people often need to be more varied. The glamorous facade we see often masks a reality built on long periods of highly disciplined, repetitive routines.

For those of us who have a glimmer of ADHD, this can be challenging. Whether it’s the best surgeon or clinician I rounded with, many of them had dedicated their whole career to one sub-sub area of medicine for their success.

There is a certain solace in that, but it can be challenging in this era where commitment is harder than ever. In medicine, considering financial independence to retire early (FIRE), it is even more important to be steadfast. To not get caught up in trends of the day that do not impact your goals.

That does not necessarily mean you should not be educated and pay attention, but perhaps you should not engage in every trend since your journey to long-term success will differ.

You’ll struggle to achieve lasting success if you need constant novelty to stay motivated. Embrace the boredom that comes with consistent, focused effort. Remember: To shine in the light, you must first toil in the dark.

I knew someone from college who was brilliant in every way possible but couldn’t hold down boring desk jobs that would eventually lead to better horizons. So he kept gaining entry-level experiences in different fields but ultimately never specializing or climbing the ladder.

4. Hard Conversations: The Tax on Deep Relationships

Avoiding difficult conversations in relationships is like taking on debt. It will need to be repaid with interest in the future. Time alone doesn’t heal relationship issues; active communication and an open-minded approach to problem-solving do.

Your ability to build deep, loving bonds is directly proportional to your willingness to have these hard conversations. You will need to make minor repairs along the way to avoid major ones down the road.

My advice for people who find it difficult to hold these conversations is to value the people you love and sincerely commit to honoring their position in your life. Confiding in loved ones is a sign of trust and dedication to prove that you’re in it for the long run.

5. Imposter Syndrome: The Tax on Progress

Good things often happen when you put yourself in situations where you don’t belong. For so much of education and training, I had this feeling chase me up the walls.

There was always someone better, smarter, and harder working. At some point, I realized that it did not matter in the end since we all could and hopefully would be successful in our own ways.

However, that’s easy to forget when you’re in a bubble of such capable people. Imposter syndrome might push you to retreat to the safety of your current competencies, but it’s crucial to recognize this discomfort as a sign of growth.

Embrace the “Yet Mindset”:

– “I’m not good enough” becomes “I’m not good enough… yet.”

– “I don’t know how to do it” becomes “I don’t know how to do it… yet.”

– “I’m not capable of that” becomes “I’m not capable of that… yet.”

Remember, that feeling of uncertainty and fear is usually a sign you’re on the right path to growth. And a little discomfort is often an indicator of being on the right path. Our systems are designed to fear the unknown and associate learning new things with pain.

6. Misunderstanding: The Tax on Innovation

True innovation is often met with skepticism, ridicule, or outright dismissal. Consider Elon Musk’s experience with Charlie Munger, who listed all the reasons Tesla would fail.

Musk listened and acknowledged the potential accuracy of these predictions, but he persisted because he believed in their possible impact. While Elon has gone a bit crazy lately with the Twitter/X debacle, many people and ideas have been misunderstood.

If everyone immediately agrees with your innovative idea, it might not be as groundbreaking as you think. When I started training, there were journal articles about ending interventional neurology training since trials failed in 2011. Fast-forward a short four years, and the guidelines have changed radically.

In the process, many people went from being all but ostracized by neurology/neurosurgery colleagues to being on the right side of history. Many of these pioneers achieved FI just by pursuing their passions and innovation, too!

Enduring initial disbelief and misunderstanding is the price of admission for those who want to change the status quo.

7. Pain of Loss: The Tax on the Joy of Love

As a late mentor wisely taught me, sadness often sits right next to love. The pain of loss is inextricably linked to the joy of love – they come in the same package. If you try to avoid the former, you’ll never fully experience the latter.

Having seen many post-acute stroke patients pass, their families struggle too, which is, of course, expected. However, afterward, it can be an incredible burden if they cannot move forward.

Embrace the full spectrum of emotions that come with deep connections. The risk of loss is the price we pay for the privilege of love.

8. Failure: The Tax on Learning and Growth

Failure is an inevitable part of any meaningful journey. It’s not just a possibility; it’s a necessity for authentic learning and growth. Each failure provides valuable lessons and insights that success alone cannot teach.

Embrace failure as a teacher. Learn to analyze your missteps without self-judgment, extract the lessons, and use them to refine your approach. Remember, every successful person has a long list of failures behind them – it’s part of the process.

9. Discomfort: The Tax on Stepping Out of Your Comfort Zone

Growth happens at the edge of your comfort zone. To evolve and improve, you must regularly push yourself into uncomfortable or challenging situations.

This might mean public speaking when you’re shy, learning a new skill when you’re already proficient in another, or taking on leadership roles when you’re used to following. For us physicians, sometimes we get used to being part of the same old routine. It’s hard to move when settled in another city.

My father, a solo pediatrician, could have had a much easier career had he moved closer to an academic center or to an area friendlier to international doctors. However, the risk of moving was too great, and he did just fine, having entered partial retirement and exiting his practice recently!

Embrace discomfort as a sign that you’re expanding your boundaries. Over time, what once felt impossible will become your new routine, setting the stage for more significant challenges and growth.

10. Patience: The Tax on Meaningful Achievement

In our ‘insta-gratification’ culture, patience has become a rare virtue. Yet, any significant achievement – be it in careers, relationships, personal development, or creative pursuits – requires a substantial investment of time and consistent effort.

FIRE as a mindset also requires this type of steadfastness. Recently, I learned that Warren Buffet became much more successful due to patience and compound interest.

Cultivate patience by focusing on the process rather than the outcome. Celebrate small wins along the way, and remember that meaningful change and achievement often happen slowly, then all at once.

Some of The Keys to Mitigating Taxes on Life

The life you want lies on the other side of your ability and willingness to delay gratification – to do hard things, embrace the sucky stuff, and endure painful experiences. It’s on the other side of these taxes you need to pay:

• The periods of loneliness for your transformation
• The stress and anxiety about your ambition
• The boredom for your success
• The hard conversations for your deep relationships
• The imposter syndrome for your progress
• The misunderstanding for your innovation
• The loss for your love
• The failure for your learning
• The discomfort for your growth
• The patience for your achievement

When you embrace delayed gratification, willingly take on these challenges, and pay these taxes of life, you’ll find true depth and fulfillment on your journey. Remember, it’s not about avoiding these experiences but about recognizing them as necessary steps on the path to the life you truly desire.

Embrace the taxes, for they are the price of admission to a life well-lived.