What Does Meaning Feel Like In Your Body?

I recently had the privilege again to meet with a group of bright, hard-working medical students.  Their college mentor, my friend and colleague, invited me to lead a discussion on meaning and stress.  She saw them, only starting their second year, already losing sleep and well-being over choosing a subspecialty (they do not have to declare until 2 years from now).  I recognize a similar anxious urgency in my own son, who applies to college this fall.  My friend and I wish for all of these young people to suffer less and really enjoy the journey of learning and integration, so we sat them down for a chat.  As usual, I learned at least as much from our conversation as the students did.

We discussed the Meaning to Stress Ratio, a framework I started using with patients years ago.  In essence, I posit that if your experience of meaning/personal fulfillment at work outweighs your experience of stress, then it is likely a sustainable situation.  We can afford to pay high amounts of stress if the work has enough intrinsic value to us.  Many students seem hesitant to choose certain specialties for fear of stress (hours, responsibility, risk), among other things.  Some are even prepared to forgo their true interests and passions, and commit to fields with better, lower stress ‘lifestyle’. 

My friend and I, sitting in the circle of students like a couple of Cub Scout den mothers, tried our best to reassure and encourage her students that they, like we who went before them, would figure out their true places in good time.  Our goal was to give them both moral support and some concrete tools to navigate the journey more lightly.

“What does meaning feel like in your body?” This question occurred to me while preparing for the session. I had never thought to ask it, to anyone, before now. For years I have asked patients where/how they feel stress in their bodies. The intent is to strengthen self-awareness and identify smoke alarms of sorts, so people can take steps to head off unhealthy consequences of excess stress and rebalance self-care practices. And though I ask patients about sources of meaning and personal fulfillment in work, I never wondered what meaning actually feels like, physically. How fascinating!

I thought to ask now because these students are still searching for meaning in their work (lives), while many of my patients have long since identified and pursued it.  If body signs of stress are smoke alarms, perhaps body signs of meaning are smoke signals.  They draw us in the direction of what needs us, and what we need.  Students reported sensations like ‘energized,’ ‘light,’ and ‘revved,’ and feelings of satisfaction, contentment, peace, and inspiration. They described being in flow.

In the end, we agreed on three practices for my future colleagues to develop as they find their rightful place in our profession.  I write this as a message to those students—Onward in solidarity:

Know your body signs.  Check in with yourself physically on a regular basis.  What body systems agitate and/or crash under stress?  How does this manifest in your behaviors and performance?  Your relationships?  When do you notice the opposite happening, what does that feel like, and could this be a sign of meaning?  Once you know your signs, what will you do when you notice them emerging?  How can you set your personal marathon course with pee stops and goo stations where you need them?  How do you feel at your highest and best, and what helps you get there?  How can you get more of that?

Maintain strong boundaries and observe.  There will never be a shortage of people, mostly older doctors, telling you why you should or should not choose this field or another.  They will project their own biases, disappointments, pride, and traumas onto you, ostensibly to help you, but I suspect it’s a version of self-soothing for them.  Do not let them enter your psyche; they may not have your best interests at heart.  Rather, look around for the people who exude joy at work.  Find the ones with whom everybody loves to work, the intense yet relaxed, the energized, light, satisfied, and peaceful ones.  Interrogate them about what makes them click at work, and see if it resonates with you.  Observe yourself in their presence—do you vibrate at the same frequency?  What does that tell you?

Cultivate relationships with those who/m: 1) you admire, 2) seem to balance meaning and stress well (then probe their practices), 3) sincerely care about you and your well-being, 4) will give you honest and loving feedback/reflections/observations about you/r attitude and impact, and 5) will stick with you through the hard times and hold you up—and whom you would support in kind.  These are the people who earnestly call you out and forth, who help your best self shine, sometimes through your own BS.

I’ll find a way to translate these principles for Son, as he writes his college essays. If only I could breathe peace and excitement into his lungs, and suck out the anxiety and pressure. For now I can at least be one of those loving mentors, standing by with Gatorade and cool towels when he swings by me this lap and the next, and the next.

Deep breaths, my friends.  Find your pit crew and trust the process.  You’ got this.

November 8:  My Students Make Me Better


NaBloPoMo 2019

Oh how I love my medical students!

Every other year I meet a new group of about 10 third year students, at the dawn of their clinical careers.  What a privilege!  I lead a monthly small group for a class called Personal Transition to the Profession.  I have written about this honor before, describing how

  1. My only job in this class is to love these students into the amazing doctors they are meant to be
  2. They help me see physician burnout from different perspectives
  3. Their experience of medical culture resonates with my own

Monthly group meetings are just enough to start to know any one person after two years, and then they disperse and I grieve the loss, just until my new group starts.  After ten years of stimulating conversations on professionalism and the humanity of medicine, I still feel anxious about my impact on these bright, insightful learners.  Did I do a good job?  Did I make a difference?  Did their time with me matter at all, or was it a monthly waste of time?

This June, I finally faced these questions head-on during a coaching call with Christine.  What are my strengths, what value do I bring?  How can I distill the central learning objective each month?  How can I connect more effectively?  We settled on some ideas for setting expectations and being more direct about goals and touchstones.  I instituted check-ins at the beginning of each meeting, something I should have started years ago.

This month’s topic was open; students were invited to write and discuss whatever was on their minds.  Blog posts and check-in comments resonated around words like exhaustion, sleep, and longing for connection.  So rather than delve into the content of their writing, I simply asked how I could help.  One student, ever honest and forthright, said, “let us go home and get to bed.”  The air felt heavy, almost forlorn… but not hopeless.  I found myself monologuing a few minutes about appreciative inquiry, and finally asked them, a little desperately, “What is the most loving thing someone has said to you this week?” and then, “or how have you felt loved this week?”

Slowly, small vignettes of connection, meaning, and hope emerged.  The student who wanted to get home to bed had received an email from a former preceptor, whose patient finally started and stayed on much needed antidepressant medication, which the doctor attributed to our student’s contact with the patient during his primary care rotation.  Another’s parents had driven into the city early in the morning to lend her their laptop after she had spilled water on hers.  Other students had connected with family members and friends, who expressed pride and encouragement.  Once again I was overcome with love for these young colleagues, and I could not help but tell them:  I have one job here, and that is to make sure you know you’re loved in your training.  I am not here to evaluate you.  You will all finish, you will all succeed.  In the time I have with you, my only objective is to hold you up in the process.  I made sure they all have my cell phone number.  I encouraged them to call me if they ever need anything.

Two students (and one’s wife) came to my house for dinner tonight.  It was supposed to be everybody, but I neglected to send a confirmation email so people weren’t quite sure if I meant my invitation last month (probably because I had planned for them to come over last month and then cancelled on them that week).  We ordered pizza and salad, I fried some potstickers, and we sat around the kitchen island with my kids, just talking.  We are all nerds.  We love to read, to learn.  S’s wife is a resident at my former hospital, and knows my friends there.  They have a book club there now, and this year’s theme is wellness.  She asked for suggestions, so I lent her my copy of My Grandfather’s Blessings.  She and S also borrowed our season one DVDs of The Big Bang Theory.

Our group will meet at a local restaurant after next month’s class.  We will plan (better) another evening meal at my house in the spring.  In the meantime, I will extend an invitation to each of them to come down if they ever need a break from school, a change of scenery, or just to feel a little extra love.  I have been where they are, and I remember how much I appreciated the empathy and compassion of my elders in the profession.  I still do.

How does this all make me better?  In medicine we talk all the time about the calling to care for patients.  But caring for one another, our colleagues and trainees, is equally important.  It keeps us and our souls whole, feeds us so we can keep doing the work.  My students recharge me, inspire me, and keep me young.  What an absolute honor to know them.

Culture of Medicine, Part I


NaBloPoMo 2018:  What I’m Learning

Recently I met with a group of medical trainees from different institutions, ranging from pre-med to senior resident.  The topic was leadership in medicine and culture.  My objective was to lead a discussion on how we see leadership, and to encourage physicians at all levels of training to see themselves as leaders, regardless of designated status.  I often invoke Benjamin Zander’s invitation to ‘lead from any chair.’

We started out discussing the current state of medical culture.  My summary of the labels, in the order we discussed them, follows here.  I strive to hold these observations with minimal judgment, and to practice radical acceptance.  This is simply the way things are, not good or bad, it just is.  That includes how we feel about it all, and that we want to change the parts we don’t like.  Tomorrow I will continue with Part II, characteristics of Culture of Wellness leaders.  For now I invite you, especially my friends in medicine and healthcare, to review the list dispassionately, objectively, from a distance.  See how it lands.  How do you feel reading this list?

  1. Intense
  2. High stakes—we hold people’s lives in our hands.
  3. Imbalanced. When asked to say more, this trainees explained, “It encourages a lack of balance—we are not supposed to mind the long hours.  Our priorities are skewed—we say patients first (but it feels like patients above all else, at any cost?).  There’s the paperwork, the burnout.  You can’t go home if the patient needs you (internal medicine), and in some fields there is no such thing as a shift.  It never ends. (surgery)”  These trainees felt no work-life balance.
  4. Resistant to change. It’s an attitude—“When I was your age…”  Anything different and new in terms of work hours, work load, etc. is deemed bad or inferior before it’s even considered.
  5. Hostile. Between staff members, between doctors and nurses, between doctors themselves, nurses themselves.  The trainees saw this as a key contributor to everybody’s burnout.
  6. Hierarchical—especially surgery (they pointed this out explicitly). For example, walking in the halls, there is an order in which people enter patient or operating rooms.  One student reported entering before her team, because she knew the patient, and making small talk.  Later, she reported, “the senior resident yelled at me, said to go in order, and do not talk to the patient.  In 2017.”  In the OR, when students cut sutures, they must always cut the attending’s suture first.  One medical student was admonished loudly in the OR for this.
  7. “You’re expected to know everything already, even though you’re supposed to be learning on the job.” Trainees agreed that they expect to have to prepare for each day at work.  But as trainees, they cannot always know how to prioritize information as they study in advance for what feels like daily examination.  And they are belittled and shamed for not reading their instructors’ minds and knowing exactly what the teacher is asking for (‘pimping’ the students, as it’s known).  “I never feel like enough.”

At this point you may suspect that I somehow planted the seeds of negativity in these trainees’ minds, goaded them on to blast our profession and everybody who had ever said something mean to them in the hospital.  I assure you I did not, and I marveled myself at how easily these labels flew onto the table.  I hurried to take notes.

Thankfully the vibe circled, as it often does.  One woman commented:

  1. “Family medicine seems actually anti-hierarchy.” Attendings, she observed, often defer to students, who usually know the patients the best, when discussing patient history and data.  Team members may all address one another by first names.  Another student piped in:
  2. Pediatrics is similar. Attendings cover for the team during signout, answering pages and signing orders—everybody pitches in.    On rounds students are allowed to be students—to make mistakes, to show gaps in knowledge.  And a resident pointed out:
  3. In anesthesia, team members take breaks, and she felt a sense of autonomy and support of residents—no shaming. “Maybe it’s the nature of the work,” she said, “it’s easier to tag team.”

Fascinating.  I was practically trembling with excitement—here were ten strangers, from different specialties and at various levels of training, men, women, people of diverse colors and cultures.  And we all had the same experience of our chosen profession, much of it negative.  Yet here we all were, committed and still excited to be doing this work—we all still hear the call.  Whatever keeps us going?  How do we get up every morning and come to work in this ‘toxic’ environment?

I’ll tell you tomorrow.