One Year Away: My Journey Exchanging Time for Meaning in Life
“Life is what happens to us while we are making other plans.” — Allen Saunders
This is the story of reinventing my life during the COVID-19 pandemic. It is not the tale I expected to tell; rather, it’s about learning to let go of what might have been, to sit with what is. To the extent that it serves you, I invite you to read on — to relish in the delightful schadenfreude of things falling apart in someone else’s life, to decode my how-to guide for escaping the life you fought tooth-and-nail to achieve, or to try to understand how on earth an apparently sane person drops out of medical school and ends a five-year relationship all within six months.
Six months ago, I had a 20-year plan.
There were personal and professional goals for every year. There was a timeline with built-in flexibility. There was a clear path, with various alternative routes, all leading towards the same end.
The practice of individual long-range planning, though eyebrow-raising out of context, is a necessity for the typical M.D.-Ph.D. candidate. When highly competitive programs are evaluating you to receive half a million dollars of institutional investment over an eight year commitment, the steering committee needs to know that you know exactly how much is going to be expected of you, both during the program and afterwards in your residency, fellowship, early research career, mid-career, late career, and, well, “retirement.” (As COVID-19 reminds us all, doctors, and certainly physician-scientists, are rarely relieved of duties at any age.) Inevitably, there will be slight adjustments over time, but with a bit of luck, your basic outline for life will remain the same.
We all hope, with fingers crossed.
And yet, as every scientist knows, what works in theory seldom perfectly follows in practice. An underlying assumption in this admissions equation is that applicants have the omniscience to know what will nourish our souls before we don our personally embroidered white coats.
Of course, like the vast majority of my peers, I had volunteered in hospitals and clinics both domestically and abroad. I was privileged to apprentice with midwives in Madagascar and support survivors at Brigham and Women’s in the aftermath of the Boston Marathon bombings. I traveled the world to gain exposure to public health including at the World Health Organization in Switzerland and attempted to desensitize my vasovagal syncope (psychologically-induced faintness thinking about the circulatory system) at the Stanford Blood Center. I conducted research in the shiny laboratories of history’s most cited engineer and then worked as a research associate in the Silicon Valley biotechnology industry. I found joy in my interactions with patients from all walks of life, in my explorations of biochemical intricacies, and in my long, meditative hours pipetting and performing surgeries in the vivarium. No one would commit to the arduous process of M.D.-Ph.D. applications, let alone schooling, without reason to be highly confident of this career.
What I had not done, however, was work as a doctor or as a physician-scientist. I also had not trained as one. And the truth is that, for better or worse, when it comes to self-insight, we humans seem to learn primarily through trial and error.
We learn self-insight through trial and error, and primarily error.
Every scientist also knows that 99% of experiments fail (although this statistic is admittedly made up). Consequently, the process of self-development is one that involves acknowledging failure, evading the bias of sunk cost, and learning to adapt in real time.
At a certain point during my training, I became aware that the person I want to be does not align with the person that my medical school needed me to become. Expectedly, when you have a 20-year plan, a decade of dedicated efforts towards that end, and your identity all wrapped up in a neat little package of five post-nominal letters, admitting your own unhappiness is daunting. For a while, I kept hitting my head against the wall, thinking that maybe if I hit harder, I’d have a breakthrough.
This vain hope reminds me of these ominous lines from a poem, “Everything Changes,” by my college friend, the late Cote K. Laramie:
I’m made of un
-breakable steel
lasting eternally
only saying I die
Since the day I received the call of his suicide, that line break between “un” and “-breakable” has haunted me. Within that pregnant pause is a plea for help, one which he never shared directly. He revealed only his light, and yet, his darkness consumed him.
Because of Cote, I have striven to embody emotional transparency and authenticity with the people around me. I wear my heart on my sleeve, from time to time too effusively, and love freely, often without seeking love in return. I identify with others who have lost loved ones to suicide, who likewise experience this urgency to show up for everyone. We are the people who know that we never know who needs help. And yet, true radical honesty requires us to also show up for ourselves.
True radical honesty requires us to show up for ourselves.
During my M.D.-Ph.D. training, I did not show up for myself. I buried my head in the sand with my task lists and to-dos. I blocked my time with responsibilities to save myself from having to reflect, or to acknowledge what I knew to be true. I needed to survive, one more hour, or one more day, or one more four-week block.
When the COVID-19 pandemic hit, I was stopped, forcibly. Slowing down intensified the tsunami of my own unspoken darkness. For the first time, I had to acknowledge my misery. I cried all day and all night for two weeks straight, because I realized that I had lost hope.
For one, I had to come to terms with the reality that my five-year relationship was beyond depleted. I had given as much as I could and could not change any further for us both. Even as a medical student, I blinded myself to the signs of trauma-bonding. I was ashamed to acknowledge the volatility that had become psychologically dangerous. Our relationship had depth beyond its years. Together, we experienced joy, but also inordinate grief: unforgettable adventures, professional successes and failures, a first house, our little furred and feathered family, and the loss of a parent and grandparent. Nevertheless, I had to admit that there are times when unconditional love is incongruous with self-love.
Unconditional love risks being incongruous with self-love.
For another, I had to accept that I know no physician-scientist who I want to become. There are those who I greatly admire and respect, who have built in time for social justice, systemic change, and mentorship. Yet, this “free” time demands inordinate sacrifice. One person I know works both days, as an administrator, and nights, as a clinician. He gives up his sleep for his patients and medical trainees. Another works a reduced sixty-hour week in “retirement,” not including the time she volunteers working towards egality and serving the underserved.
And then there are the statistics: Half of female medical and graduate health students experience sexual harassment during training. In fact, female medical students are 220% more likely to experience unwanted crude behavior from faculty or staff compared to female students studying non-scientific fields. Physical violence by patients is also an accepted status quo, with 75% of all reported workplace assaults occurring in the setting of healthcare and social services (despite significant under-reporting therein).
Having already experienced more than a fair share of physical, sexual, and psychological violence in my life, these statistics fuel me and drive my impulse to incite change from within. There’s no justification for any health system propagating these social contagions, consciously or not: a toxic culture undermines the constitution of patients and providers alike, and the profitability and sustainability of the system as a whole. Mercifully, workplace culture is mutable with conscientious efforts by talented leaders—the kind to whose ranks I aspire.
Still, my optimism to join physician leadership specifically started to dwindle due to my female anatomy, given that 84 to 85% of medical department chairs and medical school deans are male. Faced with the rawness of it all, I had to ask myself if pursuing these degrees would efficiently support my higher ambitions, or only cause excess hurt.
There is heartbreak in change, but solace in reinvention.
There is enormous heartbreak in change, even change for the better, when the growing pains involve deconstructing our tightly-held identities in addition to our habits. And yet, there is a certain solace in changing everything at once, in personal life and career. I wiped my 20-year plan clean, erasing the traces of my imagined future, to review and rethink every dimension of my life.
My other favorite poem, “One Art” by Elizabeth Bishop, played on a loop in my head, strangely encouragingly:
The art of losing isn’t hard to master;
so many things seem filled with the intent
to be lost that their loss is no disaster.
Lose something every day. Accept the fluster
of lost door keys, the hour badly spent.
The art of losing isn’t hard to master.
Then practice losing farther, losing faster:
places, and names, and where it was you meant
to travel. None of these will bring disaster.
I held onto these lines: “Lose something every day… practice losing farther… faster.” And then I leapt.
Reinvention
How do we reinvent ourselves? How do we take the totality of our life experiences to recover the salient thread?
Søren Kierkegaard once said:
Life can only be understood backwards; but it must be lived forwards.
My view is that life is a very convoluted game of connect-the-dots. A quarter to half the way through, the picture isn’t easily discernible. What are our options? We have three: 1) We can look backwards at where we’ve been. We can ask where we’ve found joy and reflect on how we might increase that joy moving forward. 2) We can seek out other perspectives. We’re not alone in this world, and others, especially those who are farther along in the journey of connect-the-dots, might have unique insights into our own picture. 3) We can keep connecting dots. If nothing else, trying something, anything, will reveal more of the picture. I’ve connected my first 27 dots, and now it’s time for me to figure out what it all means.
(Spoil alert: The finished picture is at the bottom of this post.)
Step 1: Reflect on the path that led to the present.
Most if not all of my medical classmates would enthusiastically agree that I am a glutton for work. And, the truth is that, though I love working with patients, researching, and teaching, during an intensive program like medical school, how you spend your “free” time is extraordinarily telling.
Reflecting on my most joyous moments since matriculation, I realized what sustained me was not medicine. Rather, I found joy through other work, including:
- Leadership — Chairing a national committee for the American Medical Association student section; serving as a trustee for my local chapter of organized medicine; and, holding various other hefty leadership roles and responsibilities nationally and at my institution, including in medical student government.
- Advocacy and Social Justice — Lobbying at the state- and national-level for patient rights, gun control, environmental health, and affordable and accessible care; drafting resolutions defending and upholding rights for vulnerable people including refugee and imprisoned populations; and, volunteering in and coordinating free clinics serving the Native American, Spanish-speaking immigrant, and homeless communities.
- Community Engagement — Connecting personally with patients in free clinics beyond the typical fifteen minute clinical encounter; motivationally interviewing those same patients for smoking cessation and better nutritional decision-making; serving the community through volunteerism cooking, gardening, mentoring, and tutoring children; and, investing myself in difficult conversations on historical trauma including by my medical institution towards our greater community.
- Wellness — Uplifting my peers and our class social, emotional, mental, physical, academic, and financial health to the best of my ability as the medical class president; and, working to improve multiple dimensions of student wellness in an environment where, by survey results, two thirds of third years would qualify for clinical depression.
Admittedly I overdid these activities, but I also needed them. My extracurricular work supported my values in a way that felt essential to my very being. Consequently, I didn’t lose myself. I combat my own depression by finding meaning in my efforts. Yet, there is a finite amount of time and energy in graduate school, and I could not deny the enormity of my stress. I walked a tightrope, with scales heavily balanced between these roles keeping me alive and contributing to my burnout and breakdown.
We don’t have the luxury of time to lead an unfulfilling life.
Women are often told: “You can have it all, just not all at once.” The next logical questions is, then, what do I want to do most now? What is most central to my authentic self today? My answer was evident in my actions and priorities. Yet I stayed trapped in the cognitive bias of loss aversion. I had conflated my M.D.-Ph.D. status with my identity, and struggled with the psychological behemoth of letting that idea of myself go.
When faced with the task of reassessing commitments, the question becomes, ‘how does this bring me joy?’
This remained true despite the fact that, when I broke the M.D.-Ph.D. into its component parts, the misfit became blatant. I had never been interested in just a medical degree. My ideal clinical service would be four hours in a free clinic, at most twice per week. I wondered if working one day per week was sufficient reason to finish two more years of school. But, the clinical years would be depleting. I knew that while interacting with patients initially energizes me, by the end of a shift, my inner introvert drives me into an exhausted, borderline-depressed heap.
I had also lost sufficient passion to justify a doctorate. My scientific inquiries had, in a large part, been thwarted by the retirement of certain faculty, and my research aims had become, well, nebulous. Though I searched for other quality mentors and viable alternate projects, knowing I could easily and happily finish a Ph.D., I nevertheless began to wonder: to what end? Having witnessed the struggles of academia and industry, and sexism entering a field like biomedical engineering, I could not help but question my long-term intentions for pursing such an advanced degree. As in medicine, the time investment required to procure enough influence to work towards cultural change is significant. The benefits appeared no match for the sacrifices demanded.
There comes a point when the gains no longer justify the means. The balance is ours to decide.
There is professional security in trudging along a harrowing but well-established path. I wanted to run away from the inevitable, even as I began to mentally tack on future degrees: after the M.D.-Ph.D., maybe next is an M.P.H., then an M.B.A. Rather than trimming the fat, I was hoarding it. Even now, the part of me that isn’t downright gleeful to not have my housemate’s 12-hour shifts on the wards worries there may come a day when I regret not earning my M.D., or my Ph.D., or both. A part of me wonders if I will pursue one or another in the future.
But, the sentiment of Robert Frost, in “The Road Not Taken,” resonates:
Oh, I kept the first [road diverged] for another day!
Yet knowing how way leads on to way,
I doubted if I should ever come back.
Step 2: Seek outside perspectives.
Despite the abundance of evidence, I needed external validation, and a bird’s eye perspective. I needed to know that I wasn’t blindfolded and about to step off the edge of a cliff. At this point during the stay-at-home order, I needed to make calls.
I am deeply grateful to the incredible network of physicians who took me under their wings. Speaking with residents, attendings, scientists, and administrators from across the country allowed me to reflect on my direction and the dilemmas that keep me up at night. Together, we acknowledged the timeworn challenges I faced fighting for systemic change within my institution.
The best advice I heard on navigating our hierarchical and dated national healthcare system as a medical trainee was this: “Accept that nothing is going to change. The best you can do is keep your head down and safeguard your humanity until you finish your residency and have a few years of experience under your belt. That’s what you need to be taken seriously.”
We force our medical trainees to survive by giving up hope for necessary systemic change.
These words spoke directly to my heart: I could continue down this path, pretending, biding my time, and surviving having not lost myself. After a decade, or perhaps two, I could reemerge as my authentic self and potentially effect change. Or, I could escape now and try something, anything, else.
At this point, I reached out to career services to talk direction. I knew what had made me happy: working with people, working with communities, working to improve systems, and working to fight for justice. I also still found myself drawn to the medical sphere: I do not want to work with any people, with any community, for any system, or for any justice. I want to work with patients, providers, scientists, administrators, and stakeholders. I want to work to meet community health needs. I want to improve the healthcare system. I want to fight for patient rights, provider resiliency, and hospital sustainability.
I want to work with patients, providers, scientists, and stakeholders; to meet community health needs; to improve the healthcare system; to fight for patient rights, provider resiliency, and hospital sustainability.
I explored potential careers with these ambitions in mind and discovered health administration. Despite my school having a top-five nationally ranked M.H.A. program, and despite several of my colleagues pursuing this master’s degree, I had no idea that this degree existed as a direct line to healthcare leadership. For the first time I thought, huh, maybe I don’t need an M.D., Ph.D., M.B.A., and M.P.H.
Cautiously optimistic, I needed to check my fit for this path. After all, I had unwittingly misinformed myself about the life of the M.D.-Ph.D. I conducted a series of informational interviews with a variety of leaders in medicine and academia. What I found was incredible: whereas the M.D.’s I interviewed earlier had been drained and resigned, these M.H.A.’s were weirdly… happy, enthusiastic, satisfied, and thriving in the face of new challenges swept in by COVID-19. In fact, one interviewee was so excited about leading a new initiative at Stanford Medicine to address the pandemic that I ended up with a summer internship working with him.
But, how could I be sure? The final outside perspective I checked was my own, from four years ago. I reread my M.D.-Ph.D. application essays. To my great surprise, my answer was written all over those pages. It turns out that people are actually incredibly consistent. My driving force hadn’t changed, only my understanding of the steps needed to achieve these aims.
The mission hadn’t changed, only the path to get there.
(Ultimately, I stole a fair amount of material from my M.D.-Ph.D. applications to apply to the M.H.A.)
Step 3: Try something, anything.
I had discovered a better path: health leadership. And so I pivoted.
Applying to the M.H.A. felt strangely effortless. Whereas I had to stretch and squeeze to fit into the box of the perfect M.D.-Ph.D. candidate, my M.H.A. personal statement flowed naturally from my earliest proclivities in childhood:
I held my first leadership role from 2001 to 2002 as founder and CEO of the Nature Adventure Girls — or, NAG, for short. My eight-year-old self considered this a very clever pun for an organization formed to mobilize youth in educating and inspiring adults to donate to global humanitarian and environmental welfare efforts…
My letters of recommendation came easily, and quickly, from my outside endeavors during graduate training: one from the director of my board, one from another director in organized medicine, one from a national student leader, one coauthored by two associate deans, and the last from the dean of my medical school.
One letter from an M.D.-Ph.D. brought me to tears:
Her natural leadership and drive have been to create sustainable solutions, not only with hospital systems and medical management institutions, but also with the most important element of healthcare — the human element, its patients. I am not surprised about her organic pivot to pursue an MHA — it gives me confidence that we will have the necessary leadership to transform our national healthcare landscape in the years to come.
I didn’t have to wait long for the interview invitation, and the acceptance shortly followed. I felt like I had figured it out. I had sufficiently recharged, after navigating heartbreak in life and career, to succeed.
And yet…
When orientation rolled around in mid-August, our first dialogue on authentic leadership gave me pause when my program director said this:
This is not like other roles where you come to do a job. When you show up as a leader, you bring with you everything else in your life, for better or for worse.
I had recovered, but to the bare minimum threshold for academic success. I had taken enough time away only to stave off burnout and rekindle my inner fire. I had, in fact, never taken enough time to do more. Not after Cote’s suicide. Not after a college sexual assault. Not after the funeral of my then partner’s father.
I continued as a full-time student after the suicide. I permitted myself a three-month summer break with therapy after the rape. I started medical school two weeks after the funeral.
What would happen if I slowed down?
Would I asphyxiate?
Spontaneously combust?
Cytolyse?
Type A blood runs in my family. Specifically A+. And the fact that even my blood overachieves is about what the people who know me would expect.
The psychological need to exceed expectations has gotten me far in life. However, underlying this drive is a deeply ingrained fear that who I am, independently of what I do, is not enough. After all, I did spend most of my childhood trying to win the approval of my four years’ older brother. (I have it, by the way.)
Underlying the drive to wildly exceed expectations exists a deeply ingrained fear that who we are is not enough.
Therefore, intentionally not working, not performing, and not achieving professional success for a year is terrifying to me.
And I strongly believe in the merits of doing what terrifies me most. Fears reveal where we have the most to grow. Whatever path most terrifies is generally the one to take.
Fears reveal where we have the most to grow and how to pursue that growth.
There is also a reason that the Slow Movement has permeated our fast-paced, frantic society. There is value in eating mindfully (slow food), immersing ourselves in stories (slow reading), cherishing our journeys (slow travel), giving ourselves twice as much time as we think we need (slow work), building stronger, more meaningful relationships (slow love), and finding joy in the everyday mundane (slow life).
It is far too easy to evade self-growth when distracted by the time-suck of work, graduate school, and roles assumed to absorb the self. As with any athletic endeavor, attempting to strengthen our emotional capacity while short on time, energy, and focus will only lead to inconsistent performance, worse form, likelier injury, and lower enjoyment. By deferring from my studies for one year, and by creating space for intentional growth, there’s an opportunity to drastically improve technique.
The conversation that solidified my decision was with my new program director one evening after orientation. There’s a unique experience of joy, a sense of the universe exhaling in relief, when the person in charge of your professional development expresses a fundamental understanding of you. My program director shared this:
I have no doubt you will do incredibly well whenever you start, and I am so excited to have you join this program whether this year or next. I also know that your personal growth this year will translate to your career. Having a growth-mindset will make you a better, more empathetic boss... The reason our graduates are so successful is that we don’t just train the technical skills, but also interpersonal growth. Because of this, health systems can trust you immediately to lead a large team with a $5 million budget… You’ll learn more in this year working through pain to figure out who Zoe is than the students in this cohort will from coursework. CEO's embrace this kind of leadership — authentic, values-based leadership — and this isn’t something we want you to sweep under the rug. This is a moment for you to grow as a leader.
Her words resonated with my experience, and my heart swelled with the confidence to defer. And so I embarked on this year to recenter myself, or to do the bare minimum, as I’ve joked with my overextended family and friends on our shared journeys creating more sustainable lives. (Admittedly, our definition of bare minimum is arguably still too much). My official matriculation is thus with the next cohort of M.H.A. graduate students, one year from today.
Work through your pain to figure out who you are. Don’t sweep this under the rug. This is your moment to grow.
Time moves both quickly and slowly. In medical school, the few days into a new block consumed what felt like several months. A year felt like five. The last six months, however, melted into the time-space continuum like snow hitting warm asphalt, eliciting the question: What can anyone truly accomplish in only a year, a length of time that merely doubles the time I have already taken off? Happily, science’s answer is “a lot.”
One year away actually may be the ideal length of time to create space for intentional practices. New habits reach automaticity after 18 to 254 days of consistent practice, depending highly on the strain involved, which affords a year three months for contemplation and preparation and nine months for intentional change. I have the good fortune of time to sit with my intentions, ease into my practices, forgive myself, and reforgive myself, for my lapses, and try, try again.
There’s an energy in me when I think about this. Our minds interpret the physiological sensations from our body in context to assign emotions. A fluttering in the abdomen may be infatuation or a stomach bug. Uncontained energy may be nervousness or excitement. For now, I’m going with hope.
In the words of motivational speaker Trent Shelton:
Intentions
Authenticity demands the courage to be honest and transparent with others and the strength to face our true selves without the benefit of our seductive self-deceptions. We alone are capable of the introspection to live better aligned with our own values.
As stated by Susan David, Ph.D., on Eric Zimmer’s The One You Feed podcast:
During orientation, my colleagues and I arranged a collection of personal values that we individually heard, pulsating, through this heartbeat of who we want to be. Critically examining my actions against my principles, I was relieved to find that the values I hold most dear are also, by and large, those I practice well. These include justice, service, commitment, purpose, creativity, intimacy, compassion, forgiveness, nurturance, genuineness, honesty, risk, humor, hope, flexibility, mindfulness, and openness. Such alignment with my center brings me peace and harmony.
Certain others, however, illuminated discrepancies and weaknesses. And to face those internal conflicts that are most pressing to me, I am setting the following intentions for this year:
- To cultivate my autonomy and consistency — A medical student hears the phrase “irregularly irregular” and automatically thinks, “atrial fibrillation.” The description could also pertain to my first value-action discrepancy. To be clear, I am generally a superstar, and irregular in a way that still wows employers and professors years down the line. However, after personal tragedies and unhealthy work environments, I’ve been all over the map. I want to become “reliably reliable,” regardless of circumstance, and propose the following to myself: 1) reaffirming my personal boundaries to increase my emotional reserves, and 2) taking appropriate leaps of faith in myself. The former is often cited to reduce burnout. Every “no” to what is neither important nor urgent is a deposit into our emotional savings accounts. As for the former, to paraphrase Chip and Dan Heath, the greatest weakness of our rational mind is over-analyzing; the emotional mind is the one that zealously leaps into action to fearlessly tackle new challenges. My rational mind is very guilty as charged, and by spinning my wheels when I could be completing tasks, I waste precious mental resources. As stated by Voltaire, “perfection is the enemy of good enough.” Thus, this year, my intention is to lean into my gut-response, and only in the worst case scenario will I electrocute myself and burn my house down.
- To deepen my emotional reserves — My second value-action discrepancy builds on this concept of boundary-strengthening and incorporates intentionally seeking out and reflecting on physical and psychological discomforts to nurture my internal stability and emotional regulation, again in all scenarios. Interestingly, despite the sky-high rates of burnout and depression, medical professionals demonstrate better resilience than peers in other professions, and my personal history of trauma recovery would suggest I do too. However, resiliency is a critical skill-set of authentic leadership and being capable of rising to the occasion with high-quality decision-making in times of distress. Having recently experienced a series of unexpected tragedies in quick succession, I find a compelling argument in favor of the idiom, hope for the best and prepare for the worst.
- To invest in my networks and community — Despite apoplectic tales warning us that every man is for himself, there’s research to suggest that disaster actually brings people together, especially acutely. What’s more, as Mark Manson recently wrote, most people actually report benefiting from life’s traumas: “This is why trauma is weird. On the one hand, we wish it didn’t happen. It was horribly painful. On the other hand, we’re kind of glad it did. It made us who we are today. It made us stronger, more resilient, more grateful for everything we have.” Social distancing during the COVID-19 pandemic has been incredibly isolating for many communities. Medical training and relational codependency are isolating as well, though for other reasons. Whereas the stay-at-home order keeps us physically apart, chronic stress drains us of our resources to show up for others. For years, my resources to love, nurture, and invest in my friendships were very limited. The unexpected gift that this pandemic has given me is the opportunity to be more present and to become a better friend. Today, we know for a fact that everyone is lonely; therefore, calling an old acquaintance out of the blue has become socially acceptable. Or, perhaps, catching a flight across the country to hop on a two-week backpacking trip. Likewise, conversations with others through more formal relationships — volunteer encounters come to mind — have become more meaningful. I am my happiest talking one-on-one, heart-to-heart, with friends new and old and feel fortunate to have this time to foster these genuine connections. It’s an incredibly fulfilling experience to reconnect with people with whom I lost touch a decade ago, or a day ago, and to close the gap on those separations. We are all vulnerable sharing our mutual needs for support and yes, external validation. It’s also deeply gratifying, for me, to be let in. As I recently said to one friend, “One of my intentions for this year is to step up for the people in my life, and I’d love your help keeping me accountable to that. ❤” Teach me how to be there for you, and I will.
- To engage my perseverance — This intention is arguably superfluous. I have far more often erred by persevering too much than the inverse. Nonetheless, while acknowledging the need in my first intention to say “no” to what does not serve me, it is worth mentioning that courageously saying “yes” to what truly matters is still vitally important. Ultimately, there’s a latitude here to execute this year well or to fritter time with limited gains. With this fourth intention, I am prodding myself towards a greater return on investment.
- To challenge my own perceptions — When I step back from my thoughts during meditation to observe the chatter, I smile at the visualization of my mind as a distractible child. As adults, we’re prone to self-judgement when hyperfocus evades us (“Why can’t I remember this Anki flashcard? How haven’t I finished this project already?”); yet, we find both children and pets, living fully in the present moment, endearing. We observe the innocent carry on a safe but haphazard path, and once stuck, we smile knowingly and ask with warmth, “What are you going to do?” (To my cat, the next words out of my mouth are often then, with love, “Did you jump into a box that was too big and now you’re stuck? Did you not think that through? Is it hard?”) We give those in our care the opportunity to analyze a problem and attempt a few solutions, but before curiosity transitions into distress, we ask: “Do you need help?” We show up to give guidance before frustration overwhelms and undermines the learning process. Adults need this too. We are all on a journey. Animal behaviorists teach us that we are always training our pets, whether intentionally or not. Do you give your dog a treat after she does a trick? That’s intentional training. Do you feed your cat after he howls at 4 a.m.? That’s unintentional training. We are all capable of intentionally or unintentionally training ourselves, too, and we consequently progress to better align either with our superego or with our id. When we approach life with a growth-mindset, recognizing our characteristics are not immutable, it’s also easier to appreciate the potential risks of a skewed self-perception. To varying degrees, we all have one. We jump into boxes and get stuck. Whether we stay in those boxes, more and more entrenched, or we get out, however, depends on our resources, our knowledge, our natural inclinations, and the people in our lives who guide us before curiosity gives way to our own willful disengagement. Cultivating these nurturing relationships and, too, our receptiveness to external perspectives is significant for positive change in our personal lives. The stakes are all the higher and more consequential, however, with my professional career in mind. For health leadership, the pursuit of continually seeking feedback and resources for growth is on the scale of patient life-and-death, well-worthy of this fifth and final intention.
Practices
Early in my meditation training, my teacher shared with me: “Meditation is not a destination. That’s why we call it a practice.”
The second Noble Truth of Buddhism tells us that the root of all suffering is attachment — to desire, to aversion, and to ignorance. The desire, to reshape our emotional experience for greater happiness, peace, love, security, serenity, freedom, understanding, acceptance, care, connection, balance, satisfaction, fulfillment, confidence, strength of mind, and even self-actualization will only undermine our growth towards those ends. What we set out to achieve, we will not.
What we set out to attain, we will not. The journey, and the practice, is what leads to growth.
And yet, you may ask, do monks not seek enlightenment? Do we not seek personal growth in order to reach these elusive states? This is the paradox of goal-setting at first blush. We fail only when we strive to attain an end; we are guaranteed success when we strive to practice a discipline. The practice is the journey, and the journey continues every day we open our eyes and fill our airways with oxygen. (Sages, therefore, do not seek enlightenment.)
The Talmudic text tells us:
To illustrate this point, let’s imagine an elderly, loving couple sitting together, laughing, in deep communion with each other. An observer who feels lonely and bitter may see this pair through the lens of jealousy and resentment. They may say to themself, “Those people aren’t actually happy. They have to be faking it. They’d clearly betray each other in an instant if given the chance. Deep down, everyone is a liar and a cheat.”
Another observer, however, who is filled with self-love and love for others would view this scene through a different lens, seeing the couple’s interaction as confirmation of the love, hope, and potential there is in the world.
Both observers experience confirmation bias; however, only one suffers. The other experiences joy. A question worth considering is: which are you?
Two observers experience confirmation bias; one suffers and the other experiences joy.
Today, perhaps, you would be the observer who suffers, if not in this situation, in another. Fortunately, our mindsets are not fixed. We individually have the power to decide which observer we will be. Just as a tree will strengthen the roots that find water, the brain will strengthen the neuronal connections that are most active in our conscious and subconscious minds. The stories we tell ourselves can literally threaten or save our lives; yet most of our thoughts run without our conscious awareness. Therefore, changing our thought processes to strengthen the self-loving channels requires intentional practice in the conscious mind, to counteract the subconsciousness. We alone are empowered to do this work; no one can do it for us and we cannot do it for anyone else.
Personal growth also fits a logarithmic scale. This concept is central to Paulo Coelho’s The Alchemist, as translated by Alan Clarke:
In short, we benefit from beginner’s luck.
A logarithmic function accelerates rapidly at first. The universe conspires to help us with early growth. The initial challenge is in starting the practice, but the rewards are close to immediate. As the journey continues, we are tested for our patience and commitment. Our acceleration in personal growth slows. As we advance our skills, we hold ourselves to greater accountability. We work harder for more nuanced gains. We defy our limits like Olympic runner Eliud Kipchoge, shaving away 45 seconds from his marathon time to break the 2-hour threshold. However, by then, we have greater reserves to face these challenges along the noble path.
We start with the intention. The intention arises from our values and drives our practice. The practice grows into our habits, strengthening our neuronal connections. The neuronal connections increase our reserves, and this growth further fuels the practice.
I have set my intentions for my year away: to cultivate my autonomy and consistency, to deepen my emotional reserves, to invest in my networks and community, to engage my perseverance, and to challenge my own perceptions. My practices follow these intentions:
- Sustainable Self-Care —These are the practices to establish my daily schedule and habits: running, doing yoga, drinking water, eating healthily, cleaning, gardening, maintaining my home and finances, caring for my pets, meditating, and committing to a healthy sleep cycle.
- Intentional Reflection — These are the practices to nurture my personal development and humility: reflective writing, reading (at least one nonfiction book per week), podcast listening, solo backpacking (with silent meditation, facing loneliness), mindfulness training (including MBSR, RYS 500, and life coaching), and immersive living within an ashram (when social distancing restrictions are eased).
- Community Engagement — These are practices to counter my medical training isolation and strengthen my personal networks: clinical volunteering, social movement engagement and community service, class council and organized medicine leadership, tutoring and mentoring, language learning, and reconnecting with friends and family.
- Intensive Focus — These are practices to engage my mind to keep me mentally ready for graduate studies: independent study and online coursework, professional work, and academic research.
- Growth-Oriented Guidance — These are practices to engage others to correct my growth and steady me on the true path: psychotherapy, mentorship, and informational interviewing for feedback.
For updates on my journey throughout this year, please click ‘follow’ and check out these related posts:
