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Becoming a doctor wasn’t just the American dream—it was the family dream. Our great-grandparents emigrated from Russia and barely scraped by. Our grandmother was a secretary, and our grandfather worked in a factory, but it wasn’t enough to support five children, so he worked a second job delivering milk. Before his kids were teenagers, he had taught them to drive the milk truck so they could finish their 4:00 a.m. delivery cycle before the school day and workday started. When none of their children went on to med school (or milk delivery), my grandparents hoped our generation would bring the prestige of a Dr. Grant to the family.

The first seven grandchildren didn’t become doctors. I was the eighth, and I worked multiple jobs to pay for college and to keep my options open. They were proud when I ended up getting my doctorate in psychology, but they still hoped for a real doctor. For the ninth grandchild, Ryan, who arrived four years after me, an M.D. was practically preordained.

Ryan checked all the right boxes: along with being precocious, he had a strong work ethic. He set his sights on becoming a neurosurgeon. He was passionate about the potential to help people and ready to persist in the face of whatever obstacles would come into his path.

When Ryan was looking at colleges, he came to visit me. As we started talking about majors, he expressed a flicker of doubt about the premed track and asked if he should study economics instead. There’s a term in psychology that captures Ryan’s personality: blirtatiousness. Yep, that’s an actual research concept, derived from the combination of blurting and flirting. When “blirters” meet people, their responses tend to be fast and effusive. They typically score high in extraversion and impulsiveness—and low in shyness and neuroticism. Ryan could push himself to study for long hours, but it drained him. Drawn to something more active and social, he toyed with the idea of squeezing in an economics major along with premed, but abandoned that idea when he got to college. Gotta stay on track.

Ryan sailed through the premed curriculum and became a teaching assistant for undergrads while he was still an undergrad himself. When he showed up at exam review sessions and saw how stressed the students were, he refused to start covering the material until they stood up and danced. When he was accepted to an Ivy League medical school, he asked me if he should do a joint M.D.–M.B.A. program. He hadn’t lost his interest in business, but he was afraid to divide his attention. Gotta stay on track.

In his last year of med school, Ryan dutifully applied to neurosurgery residencies. It takes a focused brain to slice into the brain of another human. He wasn’t sure if he was cut out for it—or if the career would leave any space for him to have a life. He wondered if he should start a health-care company instead, but when he was admitted to Yale, he opted for the residency. Gotta stay on track.

Partway through his residency, the grueling hours and the intense focus began to take their toll, and Ryan burned out. He felt that if he died that very day, no one in the system would really care or even notice. He regularly suffered from the heartache of losing patients and the headache of dealing with abusive attending surgeons, and there was no end in sight. Although it was his childhood dream and our grandparents’ dream, his work left little time for anything else. The sheer exhaustion left him questioning whether he should quit.

Ryan decided that he couldn’t give up. He had gone too far to change course, so he finished the seven-year neurosurgery residency. When he submitted the paperwork for his credentials, the hospital denied him because he had placed the dates on his résumé on the right instead of the left. He was so fed up with the system that, out of principle, he refused to move them. After winning that battle with bureaucracy, he added another feather to his cap, doing an eighth year of a fellowship in complex, minimally invasive spinal surgery.

Today Ryan is a neurosurgeon at a major medical center. In his midthirties, he’s still in debt from student loans more than a decade after graduating from med school. Even though he enjoys helping people and caring for patients, the long hours and red tape undercut his enthusiasm. He tells me that if he could do it over, he would have gone a different route. I’ve often wondered what it would have taken to convince him to rethink his chosen line of work—and what he truly wanted out of a career.

We all have notions of who we want to be and how we hope to lead our lives. They’re not limited to careers; from an early age, we develop ideas about where we’ll live, which school we’ll attend, what kind of person we’ll marry, and how many kids we’ll have. These images can inspire us to set bolder goals and guide us toward a path to achieve them. The danger of these plans is that they can give us tunnel vision, blinding us to alternative possibilities. We don’t know how time and circumstances will change what we want and even who we want to be, and locking our life GPS onto a single target can give us the right directions to the wrong destination.

GOING INTO FORECLOSURE

When we dedicate ourselves to a plan and it isn’t going as we hoped, our first instinct isn’t usually to rethink it. Instead, we tend to double down and sink more resources in the plan. This pattern is called escalation of commitment. Evidence shows that entrepreneurs persist with failing strategies when they should pivot, NBA general managers and coaches keep investing in new contracts and more playing time for draft busts, and politicians continue sending soldiers to wars that didn’t need to be fought in the first place. Sunk costs are a

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