The "Shoulds" and "Should Nots" of Awkwardness.

It might be said that my protocol for interacting with my environment is a tad rigid.
Perceive stimulus --> evaluate stimulus --> decide how stimulus "should" be --> rationalize/negotiate/strategize cognitive construct to make stimulus match intention. Translated as: "Reality is the way I say it is."

Most of the time, this serves me well. I decided I "should" be able to ride 100 miles on my bike -- so I rode 107 (just a few miles shy of the Canadian border) and am primed to ride 110 in 3 weeks. I decided I "should" be able to do a study on an obscure concept about which nobody admits to thinking about except me (even though it changes lives, and the potential to be applied to EVERYTHING), so I launched a survey that collected 230 responses from around the world. I decided I "should" be able to leg-press twice my body weight -- and, as of a week ago, I can. I decided I "should" be training at my fantasy clinic that I discovered in an obscure magazine article before I even interviewed for medical school -- so I, well, am. I decided I "should" spend tonight writing about my psychological strife instead of studying, despite having also spent the past 2 hours coaching people on a bike. Reality is the way I say it is, after all.

Yet. when I decide that I "should" be able to get through stressful life experiences without anxiety or any negative emotions -- any emotions at all, even -- this intention is not only unsuccessful but it's absurd. When I experience a response that departs from my intention, I expend a TON of energy to shut it down and control it -- forcing reality, in some way, to be as malleable as it is in 90% of my life circumstances.

So for the last few weeks, I've been trying to drop the word "should" from my vocabulary. As adaptive as it has been for some of the examples I've cited, its destructiveness has been way more profound. I "should" be useful at all times at the clinic, so as not to be perceived as a mooch off their energy and resources. I "should" feel more comfortable performing every single clinical examination I know about. I "should" sleep more, study more. Consternate less.

Instead, I've been making an effort to "accept" reality as it is -- not in spite of my intentions exactly; just independent of them. I'm not very good at this process. I "accept" that part, at least.

Last night, I was at the clinic really late seeing patients with my preceptor. Around 10PM, he announced that he had to go admit one of his patients to the hospital through the ED. I asked if I could accompany him. (See: creating opportunities). I told him that I had no legit hospital experience and that it made me anxious, and that I "should" get over this by exposing myself to it. He supported this plan. I think he's amused by my ready professions of what makes me anxious and what I intend to do about it. I think he's also quite perceptive about what makes me anxious. When I don't have a useful structure with which to organize incoming stimuli and/or I lack confidence about my abilities or decisions, these patterns quite predictably set me off. So he spent a half hour teaching me how to organize a hospital admissions note. He's so awesome.

So, 11:30PM. EVERYTHING about my arrival was awkward. It took me 5 attempts to park straight. I caught my stethescope in my car door. Upon entering the ED, I felt the wave of "awkward, useless, why am I here?!" wash over me. Yes, that wave. I timidly avoided interacting with human beings until my preceptor introduced me, lest I be faulted for draining attentional or oxygen resources me.

'I "should" not feel this way,' I thought. This is a great opportunity, and you are ruining it by being ridiculous. Stop it.

Then I remembered Operation: Acceptance.

Yes, I am anxious. Yes, I am awkward. It's ok to be awkward. This is the first time you're in this situation. You're fine.

My preceptor pulled up a CT scan of the patient we were here to see. 72 year old man with Stage 4 esophageal cancer -- which even a 2nd-year medical student knows is a really dismal thing. Though I often can't tell a heart from an intestine on CT, I knew exactly what I was looking at -- and it was bad. His esophagus had become completely obstructed by the tumor. Part of me felt confident that I knew what I was seeing; part of me felt guilty for possessing this knowledge.

We went in to see the patient. His frail, bony legs stuck out beneath his hospital gown. His sunken face looked up with indifference. "I can't keep food down, Doc. It comes right up."

That was the "real life" translation of what I had just seen on the computer screen. It aligned perfectly. I stood there, possessing knowledge that explained this man's world -- defined it, scripted it towards an ending that I could anticipate far more clearly than he could.

I gave myself permission to freeze and mindfully observe how I felt about this moment, a preview of so many moments just like it that are to come. Observing each sensation, without interpreting it. I was awkward and useless -- and whether that "should" have been or not was irrelevant. I was training to be right there in that moment -- that heavy, painful moment -- accepting every aspect of my reality.

And in that moment, reality was ok.