During my exam cram-induced nuttiness this week, I started to identify with a red blood cell.
I suppose I should explain: Hematopoetic stem cells start off with the potential to become ANY kind of blood cell; then, over time, they are exposed to various influences (i.e., chemical signals) to help it a) not die; and b) determine what kind of blood cell it's going to be. Now, as it continues down its given path, it becomes more and more committed to its final destination (i.e., less potential to become other things -- it has to be this kind of cell, no matter what, and it's going to be AWESOME at it. That's pretty much where I stop identifying. A red blood cell dies after 120 days; I've got way too many student loans for that to be the end of the road.
Hematopoeisis (see also: the process I just described) was the first lecture of "Attacks & Defenses," the course I finished yesterday: six weeks jam-packed with bugs, drugs, and the most stimulating and rewarding moments of medical school to date. Looking back, I cannot imagine a more fitting kickoff to set the tone for the course. One of my course director's explicit themes had been that of "practicing commitment" -- working from a broad-based differential diagnosis and then chiseling away at it in a deliberate, systematic way to figure out what's wrong; and upon making those decisions, based on evidence, to develop the confidence to hang your figurative hat on it. Committing to it. Owning it. Inhabiting it.
As an aside, I made this observation about the red blood cell "practicing commitment" as a reflection of the A&D theme to my course director. He was thoroughly amused that I'd given him credit for that sort of symbolic orchestration.
The past six weeks, for me, have been a period of major definition and re-definition. Coming off a refreshing and insightful 13-day trip to My Former Life, prompting a re-commitment to the things I decided were important, I suddenly found myself at this position of wide-open road -- where all of the things I'd say would "be" just... happened. Just because I said they'd happen, they'd happen. In the past six weeks alone, CRAZY things have happened: I launched my dream small group/personal cycling training program. I found really, really smart people to support my "pipe dream" heart rate monitor study. I connected with those insanely inspiring folks at The Health Center, my most idealized place on earth. I breathed a new life into my Spinning classes, and finally found a nice balance where I can coach here the way I coached in New York. I invested in my own training again, losing 10 lbs. and very much on track for my Century in a few months. I became a "real driver" (working definition = "not having panic attacks on the Interstate and being able to pull into a parking lot without crying"). I started making time to sleep, to cook, to date. To write.
And daaaaaaaaaamn, did I learn a lot.
The crazy thing is, I have a feeling that I'm actually going to remember most of what I learned in this course. It's still not rocket science; it's still volume. But the difference is that my brain finally figured out how to process and prioritize, and to store things usefully within an efficient framework. Too bad for those 1200 nerves and arteries and random holes in the head and neck; I just wasn't ready for them then. The other day during a practice clinical session with a standardized patient, I was shocked at how readily I had mild- to moderately intelligent thoughts and questions about the symptoms with which he was presenting. I felt the same way on the phone with my own grandmother today. It's surreal to actually KNOW stuff, even if it's a miniscule amount of stuff in the big scheme of things.
Just like that stem cell differentiating along its path, I'm exquisitely sensitive to the influences around me. As I accumulate more and more influences, both global and narrow in scope, I find myself latching onto specific things I decide I'm supposed to take away from my experiences. My advisor, for example -- a fantastically brilliant guy who makes the most astute, insightful observations about me even having only met me twice -- whose framework appears to be identifying the specific strategies my brain employs to get its job done. Being prompted to appreciate this, it occurs to me that I should pay closer attention to those strategies for optimal learning. Meta-learning: I dig it. Or, my course director, who so effectively imparted his "life approach" to think broadly and with sharply deliberate structure. Or, one of my closest friends who, despite months apart, is so damned good at abstracting general "life concept" themes from the minute details of my stories -- just like the key to success in A&D had been to abstract general themes about B cells and T cells and the duplicitous agents that test them.
Years ago, when most of my waking hours were spent at TFP, it was tricky to evaluate the relative meanings of the things that happened to me: everything was novel, everything was dramatic. There were no norms by which to measure anything against. I credit my former boss with so many of the adaptive coping mechanisms and skills I developed then, whether by good example or by necessity of avoidance. Why I detach so easily from the things that displease me. Why I'm so good at getting people excited about utterly unexciting things. But I also credit him with some of my worst habits: namely, getting so damned excited about so many things -- to the end of distracting myself from actually doing any of them. How many times did he speak of having "too many jealous masters," committing with both words and spirit to a gazillion different projects and causes, and following through with so few? How many people did he disappoint?
How guilty have I been, over time, of doing the same? Things I've really, really, REALLY cared about -- all the "best things ever"... until the next "best thing ever."
Not in 2009. 2009 is the year of committment. Committment to the specific passions I deem to be meaningful and compelling, actively carving out a clear path to get there. Rejection of the "noise" that distracts from them.
It has taken the better part of the past three years to no longer identify with the influences of TFP. I'm wired to be defined by my work, though, and have been so deeply fortunate that my life path has taken me where it has -- because my work as a coach is what most directly influences me now. Being prompted, or forced, to abstract my own take-home points, to structure experiences for other people to get them to arrive at the kinds of thoughtful questions they need to ask themselves, has been life-altering. Of all the talking I do about self-efficacy, nothing has more greatly contributed to my own than the experience of facilitating others' beliefs in their power to navigate the challenges of their own road.
I talk often about the dichotomy between coaching and training to be a physician -- how I struggle with compartmentalizing (take the two separate blogs, for example!), prioritizing where and how I invest my energy at different times. What has been interesting about the past six weeks, though, is that this is somehow ceased to be an issue. It's all the same.
We had a lecture last week on "Spirituality in Medicine," perfectly fitting after my experience last week shadowing the chaplain at the hospital. The epiphany I had during that lecture is thus:
Spirtuality IS self-efficacy. Empowerment, believing in one's self, appreciating one's place in the world and how to make sense of it all. The stuff I talk about all day long -- the concepts I try so hard to bring alive to my riders, the concepts I dream of bringing alive to my future patients. It's all the same. It's a commitment to one's self, to the things one holds important.
To being the best damned (blood cell) one can be, whichever path life's influences direct one to take.