“I have realized that I really enjoy learning about ***, but I don’t necessarily like studying it and being tested on it.”

And there it is. My mama pride swells at this concise, distilled insight of self-awareness that Son shared with me, about 6 weeks into college. So you really like ***. How much might you be willing to work/tolerate/sacrifice to stick with it? Will you keep *** as a hobby/interest, or can you see yourself making a career out of it? No rush to figure it out! And how cool to know there is a distinction to make?

How much are we willing to give for something we really want? Are we willing to eat the particular flavor of shit sandwich (a la Mark Manson–check out his blog and books!) that’s inevitably served on the path to our goal?

Sometimes we don’t even have to know what we want; clarity about what we don’t want–shit sandwiches we will not eat–is enough to set us on the right path for each of us. Some shit sandwiches I have rejected:

Three Dimentional Calculus and Vector Analysis: Freshman year in college, one problem on the final exam of this class took up 8 pages in the exam book. And why did I have to know it? How did the reasoning help me in life? No more math for me, thank you. I left engineering the following quarter.

Physical Chemistry: Having already gotten a C in physics (which happens when you fail the second midterm because you start dating your husband), empowered with an aversion to math, and knowing already that life is too short for this kind of suffering, I rejected chemistry and embraced biology as a major.

5:30am Rounds: General surgery, my first ever clinical rotation. My intern, the wonderful Gopal Kowdley whom I love to this day, looked at me and said, “You’re tempted, I can tell.” But OMG surgery–the egos, the bombast, the misogyny–AND getting up in the dark every day, forever? Nope.

Lifelong call: I love reading echocardiograms–ultrasounds of the heart, beating in real time. Second year of residency is when internists apply for subspecialty fellowships. That year my cardiology fellow stood right next to me at 10pm, monitoring a dying patient in the cardiac ICU. He had a little girl at home who missed her dad. Later that year, the attending cardiologist, my amazing teacher, sat across from me at the nurses station, in the middle of the night, reviewing the EKG of a lady with a likely heart attack. He had grandchildren already. He had to get up in the dark–in the middle of the night. No cardiology fellowship for me!

I live in Chicago when my home is Colorado. Wut? But Husband is from here, we trained here, and we both found jobs here that fulfill us and allow us to make a difference in people’s lives. WINNER! Love makes us do crazy things, like eat this. huge. shit sandwich. Without hesitation, no matter how it tastes. Every day. For 20+ years.

Through the long hallways of my career, at each door has stood a waiter offering some shit sandwich for me to taste in order to get through. I closed some doors, and walked through others. I wrote last month that I regret none of the work thresholds I’ve crossed to date. Since the beginning, nothing has been be-all, end-all. If I hadn’t gotten into med school the first time I’d have decided to try again or try something else. I committed to finish an internal medicine residency and pay back my student loans; those doors swung heavily one way. Other than that, I have always had the privilege of myriad opportunities to use my skills and credentials in new and interesting ways if I wanted to–generalists are needed everywhere. But the older I get, the more selective I am about what shit sandwiches I’m willing to eat. I think that’s normal.

As Liz Gilbert interprets Manson in her book, Big Magic: “So the question is not so much ‘What are you passionate about?’ The question is ‘What are you passionate enough about that you can endure the most disagreeable aspects of the work?’”

So ONWARD, I say to Son. Keep learning about yourself and the world. Try out different things, taste a little of everything as long as you’re sure it’s not toxic. Carve out your space. I am confident you will find your favorite flavor of shit sandwich.