What I Learned During My First Year of Medical School

1. Expectations are everything, and there's a difference between "low expectations" and "no expectations."
My roommate often observes that I expect things to be "the best thing ever in the whole world" and am thus ALWAYS disappointed by the anticlimactic nature of EVERYTHING. I accept this as a premise: that everything is always at least SLIGHTLY sub-"best thing ever in the whole world," and by definition falls short of my expectations. I reject the approach of expecting little, and thus being pleasantly surprised when reality exceeds those low expectations; that's guaranteed but largely non-gratifying.

When we were in DC, my preceptor suggested this concept of flaneur -- wandering through one's experiences without interpreting them. Just taking it all in. No expectations, no interpretations. Just soaking it up, processing it a bit, tucking it away for another day. I so very much identified with this concept as an adaptive way to adjust to my new life, and it absolutely works for me. While I am consistently asking myself "Is this really my life?" (i.e., the baby lamb wandering around the dinner party; the pony trotting around across the road from the clinic; the guy who cuts his leg off with a chainsaw), I'm not distracted by the surprises and inconsistencies. I don't experience them as such. They just are.

2. "To care for a person, you must BE a person." Those nut jobs in the library at 3AM aren't happy.
I don't know many first-year medical students who hold a job, read for pleasure every night, sleep 7 hours, maintain two high-traffic blogs, and train for major endurance events. But I'm proud to be one of them.

My roommate, a med student in the class above mine, epitomizes life balance. She has been a tremendous influence on me, from the onset. I adopted a P = MD mentality within the second week of medical school (many of my classmates got there eventually but I started shootin' to pass from the very start). I was awkward and uncomfortable with it at first, guilty -- how could I NOT feel compelled to master everything that could ever possibly help me help someone whose life depended on it? Turns out, even if I tried, I still couldn't. A very wise classmate of my roommate observed to me during the second week of school (at the gym, symbol of life balance): "You're never going to be 'caught up.' If you wait to be caught up before you make time for you, you will never ever make time.' He was totally right. School is out for the summer and I'm STILL not caught up. But I'm happy. And I learned how to organize my thoughts, the things I encode and retrieve -- and how to look up things when I need them. I'll be re-learning those processes for the rest of my life.

3. Tapping into "pet" themes and concepts that empower and inspire me are important coping mechanisms.
Over the past 10 months, I've had several of such themes/concepts arise. Self-efficacy, of course. The patient/physician "partnership" construct (and its resultant rejection of the term "compliance" and related mindless paternalisms). "Inhabiting a person's existence." Those have been my Big 3 for the year. I think about them all the time, read what other people are publishing on them, plot how to weave them into my present and future daily existence, dream of how to understand and do and be better.

4. People actually don't expect you NOT to suck.
Who knew?

5. Processing the subtleties of your experiences while they're fresh gives them so much more "staying power."
This blog and my other are my #1 coping mechanism for navigating the challenges of my world. When I'm distressed, if I don't write about it, I distract myself to no end. I haven't written in a while, for example, and have been imbalanced, chaotic, and unproductive. If I process something meaningful, however, I learn from it and take it with me. It works.

6. My life is shaped by the characters I meet, and the words I choose to hear, process, and speak. I am in complete control over how much of that I attend to.
Last night, I heard a story from a wonderful woman whose teenage daughter had difficulty finding peers with whom to connect, finding her place in the world, until she haphazardly met traveling Eastern European musicians who enlightened her to a whole new culture -- and she's now traveling the world performing and studying and learning and growing and.... wow. All because of these completely random characters she happened to encounter. Great story, right?

I've been so fortunate to have so many formative "life characters" of my own, each of them playing a very specific role at a specific point in time. Sometimes I appreciate that in the moment, sometimes I appreciate it far later. But I'm always mindful of it, always curiously observing how that influence is going to evolve.

Last week, I went to a talk given by a Chicago surgeon who graduated from UVM 45 years ago. He offered some advice that, while not life-altering or paradigm-shifting by and large, seemed consistent with how I see the world. So after the talk, I approached him to ask him a question that had been on my mind and distracting me (about which I'd NOT been blogging -- see: #5).
I told him that, while I've been fortunate to meet many positive/enlightened influences, I am SO contemptuous and discouraged by anyone who speaks in patient-uncentered terms (i.e., "non-compliance") and that I wondered his thoughts on coping with exposure to that sort of negative energy. His reply? "Tell yourself it doesn't matter. They're not ready to see the world a different way. But you are. Go with it."

7. "Pursuit of Success" is qualitatively different than "Avoidance of Failure."
When I enter into an intimidating academic or clinical situation, I find myself thinking: 'Don't screw up.' That's absolutely NOT helpful. Even "It's ok. You won't screw this up.' isn't helpful.
'You will rock this,' 'You will do this,' 'You will be awesome at this' is really where that self-talk needs to be. But of course, see #4.

8. Even though I still know NOTHING in the big scheme of things, I know a RIDICULOUS amount of stuff. It's INSANE how much I know. (But I still know nothing.)
'Nough said.

9. Finding an equal/opposite force to balance the profound feeling of uselessness/incompetency with usefulness/mastery is absolutely key.
My coaching/cycling-blogging life affords me the opportunity to feel like a knowledgeable resource EVERY day. That balance is BEYOND important to me. It's why I invest so much time in that part of my life. As a first-year medical student, the ratio of 'things you know' to 'things you've never even heard of before' is BEYOND miniscule. It's a hard reference point: being 0% of an expert in "this thing" you've decided to do with the rest of your life. So tapping into the notion that spending hours-I-don't-really-have is essential to my view of myself in the world, that was pretty key.

10. For all my struggles to balance my "coaching" life with my "physician-in-training" life, they're the same damned thing. There's nothing to balance.
* Empowering people to identify their own values and goals
* Empowering people to make their own choices consistent with those values/goals
* Offering expertise and guidance towards the pursuit of preventive wellness and improvements to challenges

I've actually started planning training sessions that are based entirely on this concept. I'll write more about it on Spintastic soon. But I believe most firmly that what I'm doing in the Spinning studio is a direct reflection of how I'm going to try my darnedest to be with my patients.

If a Spinner stayed in the saddle when I coached my class to stand, would I call that person "non-compliant?" Obviously not; that would be ridiculous. (This argument spontaneously came to me, and it's the best one I've ever heard. I plan to make it repeatedly). Would I expect a Spinner to train at certain heart rates and buy expensive shoes/clothing... if I didn't take the time to educate him or her as to why I was recommending such a thing, and to provide that education in the context of his or her specific goals and values? Again, obviously not.

So why on earth would I approach medicine any differently?

I wouldn't.

There's a reason I've started cross-linking this blog with Spintastic. The themes that arise in both realms in my life are really mostly the same. Because I designed it that way.

If nothing else, this year has been about THAT. Carving out a very specific fusion of the way things should and should not be, just because I said so.

And with that, thus concludes my first year of medical school.