I am taking the day off from practice to beat the deadline. In a final spasm of work, I have just completed and prepared for mailing my answer sheets for the final section of the formidable triennial self-assessment program offered by my professional society. For me and several thousand of my fellow internists, the nightmare from school days has come true once again: Turn in your exams, ready or not, time is up. I ought to feel nothing but satisfaction and relief, but having to use one of my precious vacation days for hard study has undermined my triumph and fueled my growing resentment of this exhausting ordeal.

Self-assessment has been an intellectually exhilarating process and an ego-deflating revelation of my deficiencies, particularly in human immunodeficiency virus disease, oncology, and genetics. Remembering both the brand and generic names of antibiotics is simply beyond my capacity. But what a feast for the mind it has been. The surprisingly low high-density lipoprotein levels found in my muscular weightlifting friend are a giveaway that he is taking anabolic steroids; no comfort can be found in drinking comfrey tea, because it may cause venoocclusive liver disease; the C-reactive protein test is a less cluttered indicator for acute phase reactants than is the sedimentation rate; and the ominous lymph node on my grandson's arm was probably caused by Rochalimaea henselae-the bacillus that causes bacillary angiomatosis in the patient with the acquired immunodeficiency syndrome-introduced by a scratch from a neighbor's cat. What's more, I have conquered allele angst, and I can now smile knowingly when the residents spout out terms like BOOP, C- or P-ANCA, and E. coli O157:H7. Truly, nothing so captivates the mind as new knowledge, but I find no balm in my intellectual Gilead, for the toll that self-assessment exacted from my personal life has been so great that I am thinking the unthinkable: Was it worth it?

Faced with obsolescence and hewing to my vision of the internist as a scholarly practitioner, I had no choice but to join my numerous fellow sufferers in this or some similar program. After several months of procrastination and with the complaining, rusty wheels in my brain clanking slowly into action, I plunged into this marathon project in February 1995 and emerged, dazed but alive, 5 months later. It took me about 240 hours of intense concentration-some 12 hours per week, or 2 hours per day, 6 days per week-to read and ponder the 1171 pages of densely written information and answer the 2031 related questions. Later, when I receive the results of the self-assessment, additional time will be required to work through the clinical problem-solving cases and study the discussions of the correct answers to the questions.

Because I was already practicing 55 hours per week (not including passive on-call time), I had to scratch and scheme to find the extra time, energy, and privacy required to complete this herculean task. While I continued to see the usual number of patients in the office, I carved out time for self-assessment by working faster. My preoccupation did not always go unnoticed. On one occasion, my nurse alter ego said that Mrs. Smith, whom I had seen that morning and who always tested my patience with her many repetitive complaints, had called back to say that she wasn't satisfied with her visit, that she felt rushed, that I had not really listened to her. "That is not true," I exploded. "She has no right to say that. I can tell you every one of her complaints. I have heard them all a hundred times." "Yes," said my nurse, "but you did not hear them today the way she wanted to be heard. At least, that's the way she feels, and that's what counts. I'm calling her to come back in; you be your old sweet self when she does."

I pared down even further the limited amount of time I ordinarily doled out to my family and to myself. Bolting down breakfast and trying not to wake my wife, I left home at dawn every morning. On the way to work, after assuring the suspicious campus police that I was not involved in a drug drop or assignation, I would try to squeeze in 20 minutes of reading while parked in a secluded corner of the university parking lot. After evening rounds at the hospital, I hid in the library from 6 to 7 p.m., skimping on my sacrosanct evening tete-a-tete with my wife. Sitting in our library, I tried to act as if everything were normal. She was not taken in. "I see you before me," she said, "but at times I feel that you're not here."

Nor did I spare my leisure time or friends. I slashed tennis matches to one or two sets and skipped the ritualistic aftergame communion with my fellow players over a cold beer. I abandoned altogether my heretofore erratic physical fitness program; as my mind swelled, my shanks shrunk. Feeling more and more trapped within myself and cut off from the day-to-day world, I made a deliberate attempt to escape from self-assessment, if only for a while, by accepting an invitation to go turkey hunting. But all was in vain. At the very moment when I should have been concentrating on the movements of a trophy bird stealing silently through the breaking mist after making his initial territorial gobble, my thoughts strayed to Borrelia burgdorferi, spotted fever, and rabid raccoons. "Why didn't you shoot?" my disappointed friend remonstrated. "I never had a good shot," I said, trying to hide my shame.

I was self-assessment's slave, and I savored its every word. Issues of The New York Times piled high in my library, and the latest Patrick O'Brian novel lay unread on my bedside table. Such was my distraction that, on one occasion, I arrived home too late to pull my visiting 2-year-old grandson in the brand new, just-delivered classic Janesville coaster wagon that I had so proudly ordered for him. "He sat outside waiting for you for over an hour," my daughter said. "We had to make him come in and eat his supper."

Later the same day, I have returned from the post office, self-assessment in the mail, my cerebral odyssey completed. The post office lobby smelled reassuringly of clean paper and mucilage, the clerks were friendly, and I had a pleasant conversation about the weather with some people in line whom I rarely see. Released from my glass bubble of thought, I feel the glow of everyday life and the reassurance of the palpable and concrete. Pleased and surprised to have me at home, my wife asked me to pot some verbenae. Eager to show that I am not an automaton but a person with feelings who cares for her, I embraced the task. Placing shards over the holes in the bottom of the pots to ensure drainage, I pressed in the warm black soil with my bare hands, bringing the dirt at the base of the plant up to 1 inch below the lip of the pots, thus providing a catchment for watering. The verbenae seem at home in their pots, their branches and purple blossoms spilling over the side in random effusion. My wife said, "Beautiful! This is the nicest thing you've done for me in a long time. You seem tired; why don't you just relax for a change and watch some Wimbledon tennis." Beyond all justification, I am forgiven.

How, then, shall I respond to my original question? Was participation in self-assessment worth it? Upon first completing the ordeal, the answer was, emphatically, "No, never again." Despite the deep pleasure and mental stimulation that I experienced while sitting at the Table with the brightest minds in the profession, the alienation and exhaustion I sustained were too high a price to pay; the ends did not justify the means. After a few weeks, however, I came to see that the fault lay not with the teaching program but with myself. I had tried to do too much in too short a time and had made no allowance for the care of those dear to me and of myself. I, not medicine, was the cruel taskmaster. What ostensibly had been a trial by self-assessment had, in fact, been a single-minded, insensitive trial by self, the terms of which were blind to the importance of the physician's life outside of medicine. I can only hope that, during the next round of self-assessment, I will have the grace and common sense to maintain a felicitous balance among my family, work, and play. Considering my compulsive, knowledge-obsessed, competitive nature-traits shared by many of my fellow physicians-this promises not to be easy. In my experience, the greatest challenge that physicians face is managing their own lives.