Saturday, September 12, 2009

"Own Your Awkward" -- not to mention your inadequacy, your anxiety, and your utter dread.

My current self-improvement project over the past few weeks has been to immerse myself in experiences that optimize my anxiety, discomfort, and outright dread. As I described last week, I am endeavoring to train myself to mindfully "accept" negative emotions without attempting to control them. Active acknowledgment; passive acceptance.

While the experiences I've been structuring for myself this week may seem quite drastic in the moment, they're actually quite subtle. In the true spirit of Kaizen, it's been the little things: Asking a question after class of an intimidating lecturer. Volunteering to interpret an EKG in front of 114 people (knowing full well that I would fail and embarrass myself). Accepting a task of injecting a screaming, kicking infant with a vaccine. Giving medical advice to a guy with heart disease about the proper way to use his nitroglycerine when he has chest pain. Asking my preceptor if I could accompany him, yet again, to the hospital late at night.

What these opportunities have in common: 1) I've not wanted to do them -- more specifically, I've wanted to NOT do them; 2) I anticipated that they would trigger my oh-so-familiar catecholemine surge, and its predictable consquences of physiological discomfort; 3) I recognized that exposing myself to situations that predictably inspire panic, to teach myself that it's not the end of the world to be uncomfortable -- with the expectation that, one day, it might be comfortable to be uncomfortable.

At the hospital on Wednesday night, I could NOT have been more awkward. I stuttered. I walked into things. I stood behind the nursing station while my preceptor checked labs on the computer, staring at the ground wishing that I weren't there looking like a moron. Stop. Who cares that you look like a moron? Just stand there and look stupid. You're gaining SOMETHING in this moment just by being there. So just be there.

I followed my preceptor across the hall to see our first patient. The room was dark. Before me lay a 42 year old woman who has been in and out of the hospital for the past 4 YEARS with uncontrollable vomiting and abdominal pain. Her moans slowed to heavy breaths as she nodded to answer my preceptor's questions. As she spoke, my eyes glossed over with warm tears. I froze. What are you doing? I'm frozen. I'm tearful. I'm awkward. I'm uncomfortable. I can't do anything to alleviate this woman's discomfort, or my discomfort. I suck at life. No you don't. Your task isn't to do anything; it's to stand there. So stand there. Why are you uncomfortable? I've never seen anyone in this much physical distress before. This is what you're going to do for a living -- see people in physical distress and try to help them. Remember? Right. So I then attempted to scan my brain systematically for the potential causes of this woman's discomfort. What's in the abdomen? Uhhhh... Really? Can you really not retrieve the organs located in the abdominal cavity? Uhhhh...

It occurred to me that there are some things that I'm not going to be able to accept. I was somewhat ok with the concept that my brain didn't work while in the presence of a crying, moaning person in pain. I could, in theory, ultimately remove myself from that setting and think outside of her presence. But what I could NOT accept was how poorly I was communicating. I expected that I should be able to say SOMETHING -- ANYTHING. And I couldn't. As my preceptor left the room, I turned to follow him. The pit of uselessness in my stomach made me want to crawl into the corner and cry.

Say something. Anything.

"I'm sorry you're in so much pain..." I started.
She moaned.
"Please help me.... please help me.... can't someone help m..." she trailed off.

I placed my hand over her wrist. People tell me all the time about how touch is comforting. I didn't necessarily believe that my touch would do anything - but I figured it was worth a shot. Maybe it did, maybe it didn't.

"We're going to do everything we can to get to the bottom of what's causing your pain."
"Please help me.... please....."
"We're going to try to figure out what's causing this, and help you get better..."

I could tell quite immediately that we could continue this inadequate cycle all night, and that the meek touch of my hand on her wrist and my empty commitments to diligence weren't going to achieve a blessed thing. Still, I allowed the cycle to continue a few more rounds, then capped it off with another "I'm sorry" and a goodbye. I have never felt so inadequate.

I returned to the nursing station where my preceptor was documenting his exam. I looked down at the floor, saying nothing.

When we left a few hours later, I stopped him at the door.

"Do you have any thoughts on how to prevent your brain from shutting down when you get emotionally affected? I found that I was so distressed in the room with that patient that I literally couldn't retrieve the contents of the abdominal cavity."

He smiled.
"That's how I've spent my whole life..."

We then had a fantastic discussion about preventing the limbic system from interfering with other higher-level cognitive pathways (he used the expression "going limbic," which I adored) and about my project of immersion in uncomfortable, distressing situations. He shared that this is exactly how he approaches his world: identify a weakness, and immerse entirely until it goes away.

I write this 30 minutes from heading out on the greatest physical challenge of my life. I am riding my bike 50 miles to the house across the road from the clinic (where I stayed for the summer), staying over, and riding 105 miles tomorrow. Century #2 -- just because. Just because I 1) don't want to do it -- more specifically, I want to NOT do it; 2) I know full well that it will inspire terrible, terrible feelings of panic during certain instances (I'm clipping in with both feet for the first time; I'm riding terrain I've never seen before; I'm riding by myself through areas where there are no people for hours); 3) I see it as an opportunity to practice EXACTLY what I've been talking and thinking and writing about all this time.

In my coaching life, I talk/write so much about identifying goals -- and more importantly, the REASON for these goals. I stress the importance of investing time at the front end to develop very clear, specific psychological fuel. That's why I'm writing about this ride BEFORE I do it, instead of after.

In theory, there is no good reason to do this ride -- except for MY reason. I see this, symbolically, as something that is going to represent conquering something that is important to me. I could try to talk myself out of my discomfort. Or I could just BE uncomfortable -- and keep going anyway. And when I've done it, I will remember it for the rest of my life. Every time I stand at the foot of a patient's bed and can't do anything to help him or her. Every time I fear that I've made a fool of myself. Every time I think I'm inadequate or incompetent or weak.

Completing this challenge isn't going to make me smarter or smoother, or a better doctor. It's just a structure, and an important structure. Conquering this is giving me a framework to expose myself to what scares the hell out of me, accept my anxiety, and do it anyway -- thus demonstrating, once and for all, that challenges can be conquered INDEPENDENT of negative emotions.

I have resources around me to make this (mostly) safe. My roommate has offered to come get me from "wherever," and I have resources around the halfway point. I'm doing the first 50 miles (the part of the trip I've never seen before) in sneakers. I have tools and physical fuel. My psychological fuel, of course, is a genuine belief that I will have an entirely different life outlook when I conquer this. I'm excited to KNOW that I've done this. I'm excited to talk about it in the Spinning class I'm teaching tomorrow night about triumphing over adversity.

I'm excited to be in an uncomfortable situation and remind myself that I did this, for the reasons that I did this.

So now, the only thing left is to DO this.

EDIT 9/13/09 4:10PM: I DID this. It was the most painful journey imaginable. But also the proudest.

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