The Sh*t Sandwich

“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.

On the Shoulders of Others

I had some original thoughts this week, my friends. A few were quite profound and moving. But I am too tired to expound on any of them in time to post. So I will share here the words of two of my favorite writers, as they express similar ideas eloquently and effectively.

The world is driven too much right now by cortisol and dopamine–threat and addiction, respectively, in a nutshell. We need more serotonin (joy, well-being, confidence), and especially more oxytocin (love, connection).

Watch Simon Sinek’s talk on EDSOC: Endorphins, Dopamine, Serotonin, Oxytocin, and Cortisol. He speaks in terms of companies; but expand the application to your own life–your family, your community, your school–any tribe in which you claim membership.

How do you lead, even without a designated title?

The anecdote below is attributed to Elizabeth Gilbert, as shared by my friend on Facebook. I have not vetted it, though it sounds like EG’s voice. If she is not the author, and you know who it is, please correct me. Regardless, I wholeheartedly endorse the sentiment.

What will you do differently when you claim you rightful place as ‘the light’?

Some years ago, I was stuck on a crosstown bus in New York City during rush hour. Traffic was barely moving. The bus was filled with cold, tired people who were deeply irritated with one another, with the world itself. Two men barked at each other about a shove that might or might not have been intentional. A pregnant woman got on, and nobody offered her a seat. Rage was in the air; no mercy would be found here.

But as the bus approached Seventh Avenue, the driver got on the intercom.”Folks,” he said, “I know you have had a rough day and you are frustrated. I can’t do anything about the weather or traffic, but here is what I can do. As each one of you gets off the bus, I will reach out my hand to you. As you walk by, drop your troubles into the palm of my hand, okay? Don’t take your problems home to your families tonight, just leave them with me. My route goes right by the Hudson River, and when I drive by there later, I will open the window and throw your troubles in the water.”

It was as if a spell had lifted. Everyone burst out laughing. Faces gleamed with surprised delight. People who had been pretending for the past hour not to notice each other’s existence were suddenly grinning at each other like, is this guy serious?Oh, he was serious.

At the next stop, just as promised, the driver reached out his hand, palm up, and waited. One by one, all the exiting commuters placed their hand just above his and mimed the gesture of dropping something into his palm. Some people laughed as they did this, some teared up but everyone did it. The driver repeated the same lovely ritual at the next stop, too. And the next. All the way to the river.

We live in a hard world, my friends. Sometimes it is extra difficult to be a human being. Sometimes you have a bad day. Sometimes you have a bad day that lasts for several years. You struggle and fail. You lose jobs, money, friends, faith, and love. You witness horrible events unfolding in the news, and you become fearful and withdrawn. There are times when everything seems cloaked in darkness. You long for the light but don’t know where to find it.

But what if you are the light? What if you are the very agent of illumination that a dark situation begs for?. That’s what this bus driver taught me, that anyone can be the light, at any moment. This guy wasn’t some big power player. He wasn’t a spiritual leader. He wasn’t some media-savvy influencer. He was a bus driver, one of society’s most invisible workers. But he possessed real power, and he used it beautifully for our benefit.

When life feels especially grim, or when I feel particularly powerless in the face of the world’s troubles, I think of this man and ask myself, What can I do, right now, to be the light? Of course, I can’t personally end all wars, or solve global warming, or transform vexing people into entirely different creatures. I definitely can’t control traffic. But I do have some influence on everyone I brush up against, even if we never speak or learn each other’s name.

No matter who you are, or where you are, or how mundane or tough your situation may seem, I believe you can illuminate your world. In fact, I believe this is the only way the world will ever be illuminated, one bright act of grace at a time, all the way to the river.

I’m slowly cultivating a friendship with a lovely couple in Appalachia, an hour at a time, once a month, over Zoom. Jay and I met in Ozan Varol‘s now defunct online Inner Circle. We three, Jay, Janet, and I, meet on video to exchange ideas and opinions from different positions on political, racial, national, and generational spectra. We agreed wholeheartedly today that bridging the world’s divides begins with conversations like ours, between engaged individuals, founded on mutual respect, curiosity, and patience. Healing Through Connection, indeed.

Onward, friends, ODOMOBaaT.

Decide When You Must

The lavender labyrinth at Cherry Point Farm and Market, Shelby, MI

NaBloPoMo 2021:  Do Good, Kid

“You don’t have to decide right now.”

These words usually cause me relief.  Maybe because I’m a procrastinator at heart?  And maybe because I just don’t like to be rushed into things, and for sure I do not like to be told what to do, no sir.  I will make up my mind when I am damn well good and ready, thank you very much.  Yes, that’s definitely part of it.  

But for many people, putting off decisions (or actions) incites anxiety, no?  Maybe you need a plan, and to feel secure that you know what will happen, where you’re heading?  I think this comes up a lot in medicine, when doctors and patients share decisions on plan of care.  Cancer screening and diagnostic testing protocols seem cookbook on the surface, but in order to make the best decisions for individuals in a large, complex system, we often need to think harder about what to do and when.

In the Knowledge Project podcast episode with Bill Ackman, he considers the utility of putting off decisions.  Just because you can make a decision now, does not mean you should.  Instead, assess and decide when you will need to make the decision.  The question to ask here, he says, is, “When will the risk picture change, and how?”  Basically, how much time from now until it’s do or die?  What factors should I monitor, and what are/will be my options now, compared to then?

What will we do with the information from any given diagnostic test? What are the possible/likely results, and how reliable will they be? Which results will answer our most important questions (what are those questions, anyway? What are our primary goals?), and which will provoke more questions, thus complicating the picture for no benefit? Screening and diagnostic tests are one way doors—once done, they cannot be undone. The information revealed, reliable or not, actionable or not, is now forever discoverable and requiring explanation. Many a wild goose chase are instigated based on benign, irrelevant, incidental findings from unwarranted and excess testing (my opinion). My minimalist bias stems from a deep aversion to wasting resources—time, energy, and access as importantly as dollars. In our quest for certainty, sometimes we get exactly the opposite.

That said, the suites of risk that matter most to you, me, or anyone else are both unique and overlapping, no?  Their weight and prioritization evolve in constant fluidity over time, and non-linearly, which I think we don’t attend to enough.  At the end of many elderly folks’ lives, they prioritize independence and quality of daily life now.  But their loved ones may prioritize safety now and longevity later.  Grandma may be willing to sacrifice months or years lived for staying in her house, and she might also change her mind multiple times before the actual end of life.  She may have a very different framework for deciding when/what/how to do things, compared to Son and Daughter-in-law.  You may be completely willing to risk finding colon cancer at a later, less treat/curable stage, because the intrinsic costs of the prep, sedation, or whatever else about the test are just that high for you.  Or you may be willing to have multiple breast biopsies, risking pain, bleeding, infection, scarring, and increasing likelihood of future abnormal mammogram findings, just so you can be assured every year that you do not have breast cancer now. 

As loving family members and conscientious healthcare teams, we must always negotiate for optimal outcomes, subjective as well as objective.  May we all approach ourselves and one another in respect, peace, love, and mutual support, and hold space when and where appropriate.