Monday, January 9, 2012

Walking the Tightrope

I'm sitting on my unmade bed looking about at my clothes EVERYWHERE and reflecting on the looming "To-do" list for the next week.  No where does it leave time for laundry, eating, getting my car fixed (which should have been done about six months ago) or even froyo with my friends.

While the list grows infinitely, there are friends unexpectedly getting sick, siblings celebrating their successes, and even unexpected deaths.  And darn it, that just doesn't fit in my schedule.

So who gets sliced from that list when the days become too short?

There's a saying that floats around medicine haphazardly, "You can't take care of someone else unless you take care of yourself." I think that's true in both the shallowest meaning and the deepest.  It sounds great in theory without paying attention to its implications for a healthy lifestyle, but then actually living turns that meaning into worthless scribble. However, when I dive into the meaning, I know there's truth.  Unfortunately, in my ordinary life I place those I appreciate the most only slightly higher than myself which is on the bottom of the totem pole.  While it is probably a common finding among many students, it is probably not good for the universe and patients if a generation of physicians consistently put themselves and their closest circle of friends and family on the bottom.

There's something to be said about sacrifice.  All medical students feel it.  You have to give up something for this profession.  And when I say something, I mean a minimum of 7 years of your life, not making money, and accumulating around 200 grand in debt.

I wrote earlier about how ordinary weirdos are the typical heroes, but we are brought up getting risk confused with sacrifice. How much do they overlap? You might have to risk an arm or a leg to move things along, but do you really have to give your arm willingly and with a big pearly smile?

The heroes we celebrate in our culture have sacrificed something, and while that is a good thing to motivate medical students into making that sacrifice worthy, it is not a per-requisite to becoming a hero. All physicians have sacrificed to get where are they are.  They didn't risk.  There wasn't a possibility of losing money or putting strain on relationships. That was a part of the job description. They went in and sacrificed willingly.  That intrinsic heroic drive is a trait found in myself and many of my peers that can drive us to either greatness or self-destruction.

If you are entering medical school, you are prepared for the sacrifice and willing to give up many things.  But when does it stop? If it starts with a lending hand, where does it end?  Where are the barriers? There might not be anything left if we don't take time to rejuvenate the parts we give away.  So what's the best way to rejuvenate everything we give? How do you create compassion when you feel like you've given it all away?  Well, my answer I live poorly by would be to ask for help and accept kindness from others.  Maybe kindness and goodness is just a universal life source that must be kept in balance with bad things, and when we run out we have to seek it elsewhere.  

Although simultaneously I disagree with that, and traveling has opened my eyes to compassion I never knew possible. Where I stayed in Nepal, there is a strong conviction that through meditation, awareness and love for yourself, you can actually generate more compassion to give away.  But, that's where it starts: real love and kindness to yourself, so that you can then give it away.  You can not keep it for yourself because that's just selfish and to keep that much power in yourself could actually become pathological.

We know doctors and all types of caretakers are better at their job when they lead their own happy and healthy lives, no matter what that may entail.  Maybe some physicians' happy and healthy lives means living at a hospital, and they have found balance.  But for the majority, happy, healthy and balanced lives include food, relationships, and social interaction: all the things many doctors hypocritically preach about to their patients (myself included).

While learning about posture and balance and what goes on in the brain and the body during a tight rope walk this past week, I decided to apply it to my own life.  When I add extra weight to myself and decide to carry something new, my body must adjust to keep me steady.   During medical school, I feel like I am walking on a tightrope consistently accumulating more and more bricks and information to carry.   But somehow, my mind and body adjust.  There is always more to give or more space for information, or is there? Can you choose for there to be more space?  Unfortunately, while going through this constant adjustment process,  the bricks I take for granted and think I can pick up again later get sacrificed and slip away.

Balancing between selfishness and selflessness in medical school is a huge mind game.  We were told our first day back to school to be selfish this year.  We need to put Boards ahead of other things so that we can be competitive, have a better shot at residency,  and ultimately take better care of patients. (Although, I wish there was a study done comparing board scores to patient care. I would LOVE to see some sort of correlation.)

But regardless, there is some truth to that.  We are supposed to be selfish in studying so that we ultimately provide the best care.  Therefore the reason to be temporarily selfish is to ultimately lead a life of selflessness.  But in the process of reaching that goal, we must be consumed with MY study time, MY test score, MY connections, MY whatever. ME, ME, ME, and sometimes that voice is so powerful, it makes us sick.

We are not wired to be consumed with ourselves.   We are supposed to be social and take care of each other, as that's the only way the species can survive.  As medical students only want to become great physicians to deliver the best patient care, we ought to be the epitome of the saying, "take care of yourself to better take care of others,"  because in fact, being so selfish, self-absorbed and isolating  can indeed manifest itself in real pathology.

For me, when I become sick with my own selfishness and anxiety, the only cure is genuine selflessness.  I know I need to get the mind off me and show up for someone else.  Simultaneously though, it's important to take time and take care of myself.  It's a delicate balance. Taking care and taking time for ourselves and our success while not becoming obsessed with our scores and studying is an unending adjustment process for the mind.

While learning to adjust and juggle all the bricks, I just hope that not too many important ones will slip as I walk the tightrope.

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