Tag Archives: motivation

Just One Step

Attempting a new endeavor sometimes leaves me feeling like I’m standing in my hiking boots at the base of a slope, debating whether there are enough handholds to scramble up without falling and breaking my leg.  Or my neck.  Whether it’s writing papers, doing research, or starting a new phase of medical school, it’s often daunting to summon the internal energy needed to begin.

I’m beginning to realize, however, that my ability to gauge the energy required to take a particular action is not always so accurate.  I enjoy meeting goals, and I have some long-term ones in place as guiding stars for my life journey.  It’s like picking a distant mountain peak and saying, I am going to trek from here to there.  Doing so may keep me from getting completely off-course, but if I think that I need to have enough energy to make the 100-mile hike in a single shot, I’m not likely to ever get out the door.

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In reality, I would only need to have enough energy to make it to my first campsite.  I wouldn’t presume to have enough stamina to make it to the end without pausing, and if I felt beaten at the thought of doing so I wouldn’t blame myself.  But I certainly do that with less tangible journeys.  If need to start something and feel overwhelmed at the thought of carrying it to completion, I can respond to myself in any number of ways and they usually aren’t positive.  It’s something I’m trying to become more aware of, and perhaps this post is, in its own way, a part of sorting this out.

Being more realistic certainly would help.  If I realize that I only need enough internal power to get started–to create the ignition spark–it will help keep me keep the big picture in mind without feeling daunted by its implications.  One strategy I’ve used is committing to a first step that is so small, it would be ridiculous not to do it.  Need to write an email I’ve been putting off because it feels like too much to do?  Just log into my computer and open my inbox, and that is all.  No expectations beyond than that–if I get into my inbox, I’ve accomplished my goal.

By beginning with something small like that, I’m able to overcome the inertia of starting because I narrow my focus to what I need for the step right in front of me.  I’m no longer trying to bully myself into walking for miles; I’m just lifting one foot off the ground. I’m surprised each time I do this by how well it works–usually I end up getting far more accomplished than I had planned.

So far, I’ve applied this strategy mostly for writing-related things like papers or emails.  We all face more in life than emails, however.  I have a few landmark peaks in the distance, and the highest one would be realizing my dream to become a physician-writer.  That’s what I’m aiming for: to be someone who cares for the body without forgetting that it contains the human spirit.  It will be a lifelong journey, one that will hopefully include matching into residency, graduating from medical school, finishing my post-graduate training and finding my place in the world as an attending physician.  Right now, I’m just trying to figure out how I’m going to make it through clinics.  It feels overwhelming to think about right now, but I’m going to try taking the one–step approach to starting my rotations this April.

Review how to take a medical history.  One step.

Find one video to practice the eye movements in the neurological exam.  One step.

Watch the video.  One step.

Sign up to volunteer again at one of Stanford’s free clinics.  One step.

They’re little steps, and they don’t seem like much, but they’ll keep me from postponing everything until I feel ready.  Because, honestly, I’ll never feel completely ready.

And one day near the end of April, I’ll take a deep breath and remember to keep my head up.  And I’ll take one step that will carry my over the threshold into my clinical years.

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Halewright

One Test to rule them all, One Test to define them; One Test to bring them all and into knowledge bind them

Like Bilbo and Frodo did in their times, I am about to embark on an adventure beyond the borders of all I have known.  (Did I actually just compare medical school to the Shire?)  This morning (since this post has taken me past midnight to write), I’ll begin my two-month journey of studying for the USMLE Step 1–an eight-hour long exam which will test all the medical knowledge I’ve learned in the past two years of medical school.  To speak with a bit of poetic license, it is the exam which will determine my destiny.  It is the One Test to rule all tests, the score to end all scores, for the grade I receive on it will influence how desirable of an applicant I am when applying for residency in a few years.

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Thankfully, my future is (in reality) influenced by more than just the score I receive on this test.  Nevertheless, the Step 1 is a very important exam, and I’ll be devoting about 10 solid hours a day to studying for it.  Factor in time for meals, exercise, and the ebb and flow of natural life, and I’ll be starting my days around 6 AM and ending around 9 PM.  As intense as this will be, I’m excited about this block of time to study and really see how everything fits together.  I hope that I will be like a hawk soaring high above the landscape, taking in a panoramic view of everything that is going on so I can hone in on details and dive for deeper understanding.

I like to think of funny things like that.  It makes life more interesting to me. 🙂

Levity aside, it’s going to be an intense two months.  For me, a bright spot is that I’ll be studying with a very close friend, and we’ll be sharing the journey together.  As the old proverb says, “a sorrow shared is a sorrow halved; a joy shared is a joy doubled.”  I’m looking forward to teaming up with my friend to make deeper connections with the material as we grow into the doctors we dream of becoming.

That dream, however, is something I’ve been thinking about recently.

Very recently, for a few bleak weeks, I lost sight of who I wanted to be in medicine.  After nearly two years of studying and training, I felt that my path had led me into a seeping bank of fog.  I couldn’t see my way forward into the life-giving occupation I had imagined when I applied to medical school, and I began to feel increasingly lost.

For several agonizing days, I felt that I had lost my purpose.  After pushing myself in my studies for months while simultaneously struggling with the fact that life goes on even when you don’t feel like you have the reserves to deal with it, I was beginning to burn out.  It’s something that happens, and it’s a real thing.  I don’t think I burned out all the way, but reflecting on the past months, I see that I was beginning to.  I’m okay with admitting that because I know it happens to others too, and I hope that we can begin to dialogue about it more since doing so will help us, our colleagues and our future patients.  It will validate our own human experience.

It’s okay to be worn out sometimes.

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What helped me re-engage with my purpose was a recent encounter where I didn’t feel listened to.  It was a situation when I wanted the comfort of being heard, and I instead felt more like an avatar for my electronic medical record.  The interaction was relatively brief, but served as the wind to blow away the fog I had been muddling through.  I realized at a visceral level that, as a medical professional, I want to help my patients feel heard.  Even if they don’t always want to open up to me, I want each person to know they have had the opportunity to talk and be heard.

Yesterday, I watched a fantastic TED Talk by Dave Isay called “Everyone around you has a story the world needs to hear.”  Dave Isay is the founder of StoryCorps, which started as a recording booth at the Grand Central Terminal in New York to allow anyone to record an interview with another person.  In his talk, he discussed how empowering and validating it can be for people to tell their stories.

Of recording interviews as a radio broadcaster, he said “Over the next 15 years, I made many more radio documentaries, working to shine a light on people who are rarely heard from in the media. Over and over again, I’d see how this simple act of being interviewed could mean so much to people, particularly those who had been told that their stories didn’t matter. I could literally see people’s back straighten as they started to speak into the microphone.” (TED)

This was the other light that helped me begin reconnecting with my meaning in medicine.  I want something more than the technical skills and knowledge can give me; I want to be a healer through stories.  I want to be an artist who creates a space for people to speak themselves into existence.  Going back to the creation account in Genesis, words are what brought substance out of the void.  I think this is what can happen in our lives today when we pay attention to what people have to say–when we pay attention to their experience and their feelings and thoughts and what it means for them to be a human and a patient.

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I’m finding my way again, one step at a time.  So as I study the names of medications like ticlopidine and ticagrelor or diseases like loa loa and acute sclerosing glomerulonephritis, I’m also paving the way for stories to be told.

Since I love words and neologisms, here’s a word I’ve crafted to describe what I want to be:

Halewright (noun)

From Old English hǣlu-whyrta, corresponding to hale (health) + wright (builder, creator)

Someone who aids in bringing healing and wholeness to other humans through the act of listening to their stories.

And so the journey continues…

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Deliberate Practice

I’ve never really spent much time looking at the bricks inlaid on the path that runs past the Li Ka Shing Center, but yesterday morning I snapped pictures of the following words while on break between lectures.  I was trying to catch an impression that I wanted to write about without exactly knowing what it was, but today I think I know.

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It came together after reading from the Harvard Business Review.

I hadn’t realized how breathtakingly relevant pieces from this journal could be to my training in medicine. As part of my Managing Difficult Conversations class, however, I was reading through an article in the HBR this morning when the following sentences jumped off the page and into my lap like an oversized tabby cat:

“Not all practice makes perfect. You need a particular kind of practice—deliberate practice—to develop expertise. When most people practice, they focus on the things they already know how to do. Deliberate practice is different. It entails considerable, specific, and sustained efforts to do something you can’t do well—or even at all.”

This was particularly relevant because, just yesterday, I was mulling over how I am hesitant to do some parts of the physical exam when working with actual patients. The parts where I’m not yet confident of my skills.

Certain things I’ve practiced enough to feel mostly comfortable with—for example, placing the stethoscope in the four positions on the chest wall to listen to the heart. And some things are straightforward enough that they are no longer intimidating.  I am confident while feeling for the rush of blood through the carotid arteries, listening for bowel sounds, or examining the extremities for edema.

Other things leave me feeling like I’m approaching a forest with mist swirling about my feet. How exactly do I test strength and reflexes in a patient who is unable to leave the hospital bed?  Is that really the thyroid gland I’m feeling…or should I ask them to swallow one more time as I feel for the subtle slide of lobes beneath the skin? What if I forget to test one of the cranial nerves while doing the neurological exam?  What if I don’t feel something that is there, or if I think I feel something there that isn’t?

What if I mess up?

For me, our Practicum sessions this quarter have brought some of these anxieties to the forefront of my consciousness. In Practicum, we spend an afternoon in the hospital every other week, and during this time we each meet with an assigned patient to gather their history and perform parts of the physical exam. After the history and physical, we join our preceptor and present our patient’s case in (what is hopefully) a concise, organized manner. All this comes together to prepare us for when we start our clinical rotations, and it is an invaluable opportunity to gain actual experience in the hospital setting.

As I reflect on my own performance, however, I realize that my times of practice aren’t fully yielding the dividends I seek. This isn’t a fault of the sessions–Practicum gives me all the opportunities I need.  Since a good portion of my time is spent alone with my patient, I am the one who decides which questions to ask and which physical exam maneuvers to perform.  And as a student, I have the rare gift of time to do so.

But I have been drawn towards the things I already know how to do fairly well. I have the human love of discovery, but I also very much have the human love of competence. It’s uncomfortable pushing myself out onto the tight wire that spans the cliffs between what I am and what I can become.

As I read on, one other sentence in the HBR article caught my attention.  It especially stood out since we’ve been receiving coaching on how to improve the cohesiveness, clarity and delivery of our oral presentations in Practicum:

“Bear in mind that even Winston Churchill, one of the most charismatic figures of the twentieth century, practiced his oratory style in front of a mirror.”

It’s awkward to do so, perhaps, but this echoes what I’ve told about improving my presentation delivery by practicing out loud on my own.  More than any other time since starting medical school, I’m sensing that the way forward is through focused, intentional practice above and beyond what I would normally do in my sessions.  I need this deliberate practice–the sort of practice that drives me into the realms where I am not skilled, past all the whispering shadows of fears that would try to keep me out.

By embracing the discomfort of what I can’t do well, I will be in position to move forward in the way I need and want to.  I know who I am and who I have been; I am not one to back down in the face of challenges.  But somehow, my journey as a medical student is revealing vulnerabilities that have laid latent within my soul.

That’s okay, though.  As I talk with some of my classmates about these areas, I find that I’m not alone in how I feel.  We all have our own uncertainties, hopes, visions and vulnerabilities, and although on individual journeys, we’re still in this together.

I’m excited to see how far we’ll all have come a few years from now!  And since I’ve realized how to engage in deliberate practice, I’m not as afraid of falling short of my vision of who I want to be as a third- and fourth-year medical student.  I have a plan moving forward, and I believe I can actually get there.

I really do.

Opening the Window

Happy Winter!

It’s hard to believe that I’ve just finished my first full quarter of medical school. Winter break started last weekend, after a rather grueling week of final exams. Finals week began on December 9th with Developmental Biology and culminated on the 12th with a marathon through Anatomy, and I’m happy to say that I passed all my courses! The pass-fail system at Stanford is a beautiful thing.

And so here I am, in front of my laptop once again. After having been away from my blog for so long, I’ve felt a bit sheepish about coming back to it. Throughout the quarter, it has been hovering at the edges of my consciousness, surfacing weekly as one writing idea or another would come to mind. Each time, I would put it aside, waiting for a better moment…

For a day when I was less busy…

For a time when I had some splendid reflection to share…

For an afternoon when I felt more like writing…

Unfortunately, being a busy medical student with perfectionistic tendencies, such a moment has proven to be elusive (if not non-existent). For the past several weeks, I’ve been wondering how to pick up my blogging again with at least some measure of dignity and grace.

Scratch the dignity. I’m diving in.

Lately, I’ve been thinking about perspective. The themes of perspective and motivation surfaced in my Practice of Medicine course this quarter, and more recently, my mom and I have had some great discussions about perspective and life. It’s something that I was thinking about the other day while debating with myself the best way to begin blogging again. I was tempted to put writing off for a few more days (read: an indefinite amount of time) because the inertia of starting again seemed too strong. I felt rather defeated by the whole thing and, frankly, was lacking motivation.

If feelings could be expressed as scents, this one smelled of dust blanketing cloth-bound books on a forgotten shelf in a forgotten attic.

With a conscious shift of perspective, however, the bouquet of scents changes. A window is thrown open, letting a current of clear air fill the attic with the summer scents of citrus and fresh grass. Inhaling deeply, I ask myself, why now?

Why am I thinking about blogging now?

Why am I not waiting until later this week to think about it?

Since I’m thinking about it now, I realize, I must have some motivation to begin writing again soon. And with this change in perspective, I feel a little stronger—a bit more motivated and empowered to start again.

A few more things had to fall into place before I came to the point of writing tonight, but I’m beginning to appreciate more fully the power of perspective. That, and the power of encouragement and support from family and friends.

The dust begins to blow off of the books.