WordFind.

I'm a word junkie. For the better part of my life, I find myself latching onto fragments and pseudo-fragments that I instantly inhabit and just know will be with me for the rest of my life.

When I hear or read things that so deeply move me, I try my best to write them down - in lectures, meetings, movies, Spinning continuing ed rides (yes, right there on the bike... scribbling away; I actually have a 5-subject notebook mostly entirely full of thoughts and phrases that I use as coaching cues in my own classes). I've even been known to tell people during seemingly casual conversations that [whatever they just said] is going to be with me for a long, long time.

To be that moved by a mere string of words, to feel so deeply that something will remain with you forever, is a big deal. I've often wondered whether the sources of these words intended to have that much of an impact. My old boss, the source of words I thought would stay with me forever but faded long ago, absolutely did. He obsessed over making an impact -- and to some extent, he did... but not nearly as much as he thought he did. I have a major character in my life who often comes out with "lines" that dramatically impact my way of seeing the world on a pseudo-regular basis; sometimes I think he knows that but, unlike Former Boss, it's not contrived. One of my regular lecturers at school now aaaaaaaaabsolutely intends to make an impact through the specific words he uses -- and when he ever actually gets to making his point, I always *LOVE* what he says. He just takes 10 years to get there, and thus goes underappreciated by the masses. Failed intention. Intentionless success. A little bit of both.

This question of intention has prompted me, over time, to pay more attention to my own words. It's funny -- a lot of people in my "medical school life" (and to some extent, a lot of people in my non-medical school life) don't know the full extent of the somewhat ridiculous position that has unfolded for me over time. Having 400 people on a listserv who want to show up all over New York City to ride a stationary bike and hear you spout off about the "deeper meaning" of such a thing is actually insane. I didn't do anything to earn it; it just happened. It's the kind of thing that actually shouldn't exist. I know this. In theory, people shouldn't line up asking you questions about specific things you've said out loud in the throes of (cycling) passion. I know this. In theory, people shouldn't email you months later with the exact words you used about a given way of seeing the world. I know this, too. But it's been my life for the past two years. I don't talk about it even a fraction as much as I think about it (how do you even bring up something so CRAZY? How do you convey that you think IT'S a big deal, without misconveying that you think YOU'RE a big deal?). These relationships ARE big deal, to me, and a profound responsibility. There is a certain pressure associated with it - but not as much pressure as the rewards of knowing, with 100% confidence, that you can and ARE actually making an impact on another human being.

I don't have that kind of relationship with my new riders in Vermont -- not exactly, at least. I very much experience the "rush" of seeing, particularly in my 18-19 year old female regulars, the same look I get in my eyes when I interact with a pseudo-role model character. Is it enough to be contributing SOMETHING, even if for a moment? At first, it honestly wasn't. I had been spoiled by the suuuuuuuper-distorted set-up I had in New York, with dozens of people telling me crazy things about the exaggerated sense of importance of their 45 minutes with me a day (I'm allowed to call it crazy because 1) it is; 2) they know it, too; 3) I've related to a Spinning instructor that way myself). So, yes, crazy -- shouldn't exist. But did, and does no longer. Even without that, the past two weeks coming back to VT (after being so re-energized by the dynamic of my former life) have been REALLY rewarding. Those snapshots of "moments" of feeling like I was creating the energy I'm used to, structuring the specific experiences I intended, became enough. They are enough.

Over the weekend, I wasn't enough. A friend of mine, a friendship that came out of my Spinning classes no less, came to me with a difficult personal situation that represented an ongoing, thematic life challenge for her. She was vulnerable and in pain. She called up something specific that I said about self-empowerment during a ride when I was in NYC over my break, and asked how she could apply that to her situation. And I tanked. I just tanked.

While she said that she felt infinitely better after our chat, I felt like an infinite failure. Why? Because I knew that she didn't really hear me. I did not "wield my words with precision" (to borrow from one of my favorite life-altering fragments, from Jerome Groopman's "How Doctors Think") in a way that specifically met HOW she needed to hear it at that particular moment. Because of my inability to connect on the exact same wavelength of where she was RIGHT then, I did not structure a lasting moment for her. I did not inspire her to motivate herself towards change, to make a decision that she'd remember for the rest of her life. This friend was specifically, explicitly LOOKING for that from me right then. I had an opportunity, a moment, to say something precise that could help her to use her own mind clearly to tap into what she needed to think about, to prompt her to take a step back and identify what it was that she truly wanted -- all the stuff I talk about allllll friggin' day long -- and I blew it. I was generic and mediocre. I know I can't be a hero all the time, but I really wanted to be this time.

I think what went wrong here is that I was neither wearing my "coach" nor "doctor-to-be" hat, and I couldn't grab either one fast enough -- and when the question was I asked, I grabbed one of them and hurriedly put it on backwards and crooked. It was still on, I guess, but I wouldn't have wanted to pose for a photo with it.

This scenario will undoubtedly play out hundreds of times during my career as a physician. Selecting deliberate, precise words specifically directed to match the reception style on the other end. Often with wayyyyy higher stakes than I have to admit present themselves in a 45 minute Spinning class.

I'm seeing this play out with a family member now. This family member has declared that he is "cured" of his Crohn's disease (a lifelong auto-immune disease), and that he no longer has to be under the care of a doctor -- as per his surgeon who just removed half his colon. No. NO WAY. It's frustrating because I've spent 2.5 years in Crohn's disease research and have the unfortunate privilege of knowing a fair bit about it. A fair bit that makes this statement completely and utterly untrue. So either his surgeon is irresponsible... or my family member heard what he wanted to hear. Regardless of who is at fault, this is an absolute failure of communication. Imprecise words? Not connecting with the style in which the receiver listens? Not taking the time to verify a mutual understanding? All of the above?

All that matters are the words that people take with them when they walk out the door.

Today I got tearful in lecture (yes, again!). My course director scheduled a one-hour gap in lectures wherein he sat all 114 of us down and prompted us to sit and reflect about the course so far -- what we've learned (both content and process-wise), how it relates to REALLY what we're trying to accomplish, how it impacts the way we will one day care for patients. We were asked to write our thoughts down. Quiet reflection time... in medical school? It was a BRILLIANT perspective-resetting device, in the thick of this dense forest of "bugs and drugs" to memorize. "Something to climb for," as I would put it in a Spinning class. (As an aside, I actually did this a few months ago in one of my classes - gave people index cards when they walked in and asked them to write down what they wanted to accomplish that day. Prompting people to think about their goals is HUGELY motivational. I'm going to do it again with my Endurance ride on Friday.).

What did I write about, you might ask? About how, over the past 3 weeks of the course, I've learned HOW to be a liiiiiiiiiiiiiiiiiiiittle bit more precise. To start with a super-vague complaint ("I'm tired," "I'm pale") for which there could be 500000000 explanations -- and I've had to memorize a whole lot of stuff about those 5000000000 explanations, mind you -- and to gently chisel away at that bronto-burger of explanations through deliberate, methodical, precise questions and carefully selected tests. Do I know ANYTHING, in the big scheme of things? Not at ALL. But I surprisingly know... a lot. And being prompted to appreciate that is tremendously empowering and energizing to want to keep knowing more.

That's what I took with me when I walked out the door. And that's enough.