Thursday, December 31, 2009

2009: The Year of Commitment

Since meeting the love of my life, I write far less. After all, I have an alternative mechanism for reflecting and processing -- perhaps not achieving the same level of splicing my reality or deleting content from RAM as does the process of writing, but rewarding in different ways for different reasons. It's a balance: still a work in progress. But there is one rigid, inflexible, much-anticipated written ritual for which I *must* carve out time: my New Year's decree.

During the last week of each year since 2005, I open my electronic file of New Year's Resolution documents. I review each and every one of them, taking the time to re-inhabit where I "was" when I wrote them. What was important to me? What did I believe? What did I dream? How did I relate to the world around me? Who was I? What has endured, and what has changed? Then, I take stock of these previous goals in the context of the present: Did I achieve them? Did I fail? Why or why not? And does it matter, to the Present Me? And after reviewing and re-evaluating every single resolution I've ever set, I carve out an action plan for the year ahead -- informed by my previous values, achievements, failures, and lessons, transformed into the context of my present values.

On the eve of New Year's Eve 2009, I can reflect with confidence that I kept each and every one of this year's resolutions (for the second consecutive year, at that). They were informed, thoughtful, and behavior-oriented. I didn't aim to "be" a certain way; I aimed to "do." And at the time that I set out these "doing" aims, I had specific, step-by-step actions carved out to prepare and enable myself to do so. It was the best resolution-setting operation I'd ever undertaken, faciliated by preparing a "New Year's Empowerment" Spinning ride that proved to be the most [permission to be arrogant self-granted] creative and important contribution I've ever made as a coach.

Building on 2006 ("The Year of Change" - leaving my stimulating/rewarding career after appreciating how significantly it drained my creativity, self-advocacy, and ambition), 2007 ("The Year of Discovery" - dabbling in new experiences from which I abstracted no meaning until the year was over), and 2008 ("The Year of Putting it All Together"), I embarked upon 2009 with goals of establishing a sense of feeling "complete." Assembling the missing pieces, acquiring the opportunities and experiences I sought to learn from, and charging forward along an ever-evolving path. Along the way, I tapped into the metaphor of a red blood cell undergoing hematopoetic differentiation: influenced by "growth factors" along the way, maturing and developing in a certain direction, accelerating on its journey without possibility of going back. In effect, 2009 became "The Year of Commitment." (Only fitting that I would meet the love of my life two months from said year's conclusion, of course.)
In 2009, I carved out an existence that completely fused the values and experiences that were important to me as a physician-in-training, a coach, an athlete, a writer, a human being.

I learned how to apply my experiences in one realm of life to another, to find synchronicity and meaning and balance, and to connect with and inspire the same in other people.

I learned how to use my tools and resources to structure my experiences exactly as I need them.
I learned that by putting aside my perceived awkwardness and inadequacy and enduring but a moment (ok, a looooooong moment) of discomfort, I can and will achieve exactly what I want.

I learned how to critically evaluate how I measure up to my own standards, and when to re-evaluate those standards in the first place.

I learned how important it is to me to be "training for something," to be pursuing improvement - even for the satisfaction of improvement alone. I learned how critical it is to define "improvement" on a case-by-case basis.

I learned how to optimally learn from my experiences. Nothing is by accident. When I feel proud, or strong, or afraid, or incompetent, it's all for a reason. It's my job to identify that reason, internalize it, incorporate it into my processing of all future incoming stimuli, and to call myself out on it when I identify prospective challenges to upholding a given "life policy."

I learned how to splice and shape a story to tell myself, an edited version of reality that means more than its composite details.

And above all, I learned to experience myself as committed to a journey. A journey that evolves every day, a journey with no specific requirements other than to persist. I've ranged from blind optimism to epic doubt, to a (reasonably) quiet confidence that everything is exactly as it is "supposed" to be. And I've come to appreciate that, as harsh the reality of privilege that comes along with it, it's a pretty sweet journey indeed.

So now what?

2010 is the Year of Being Present on my journey.

What does it take to "be present?"

I will listen better, without anticipating or interrupting.
In my 2008 reflection document, I praised myself for becoming a better listener and dedicating myself to improvement to that end. I may be more perceptive now, I may ask more thoughtful questions - I may have a better sense for what I don't know and need to know in order to inhabit one's existence. But I'm not a better listener. I anticipate too much, think too much, track too much. Interrupt too much. In 2010, I will shut up and listen.

Since I anticipate interrupting myself every 30 seconds, I will establish a mechanism for re-focusing .
It's the same as I coach people to do in Spinning classes -- closing one's eyes, finding one's breath, and tapping into some detail -- any detail -- until the connection takes hold.

I will establish a reliable system for managing my commitments while protecting my RAM. RAM is reserved for medicine.
A predictable side effect of my 2009 resolution to "take action on new ideas within 24 hours of conception" (vs. sitting on them forever) is that I made a lot of internal commitments this year -- all of them meaningful, all of them rewarding. All of them time- and energy-consuming. Most of them exhausting. While I'm proud of myself for structuring a reality where I actually DO the things I think about, I need to be more mindful of my resources. I'm getting older: I have less energy, I need more sleep. I need more (as my boyfriend says) "nothing box" time. Instead, I consume all available RAM tracking these grandiose projects I start (and am committed to -- commitments are commitments, and entirely unbreakable no matter what). Since all available RAM is spent tracking work to do, there is no RAM available to actually DO the work. Hence my perpetual state of "pending." This is not to say that I get nothing done. I get more done in a given day than most people do in a month. But I have so many projects looming that inspire so much anxiety for no reason. If I would just DO them, they'd be complete. I already made time to devour a great book earlier this week: "Getting Things Done," by David Allen, which advocates a practice by which I lived in late 2006: keeping EVERY thought I had on a 8x14 legal pad, structured according to context and priority. I was far more productive, creative, and peaceful -- and I lost my keys far less frequently. I've already dumped my "pendings" of all realms of my life onto a legal pad, absolving my dorsolateral cortex from having any responsibility for any of it... until I actively seek it out. In 2010, I will protect my RAM and use it to be "present."

I will complete data analysis, write up, and publish my Psychological Effects of Heart Rate Training study.
'Nough said. The procrastination has reached levels of absurdity.

I will blog more.

This is a separate mechanism for "dumping" content from RAM. If I don't, I do not have the capacity to think the way I need to be able to think.

I will be more reasonable, realistic, and flexible in my self-negotiations.
Blog entries do not need to be novels. Data analysis for 226 subjects x 10 entirely open-ended questions does not need to be done in a single day. Articles do not need to be theses. I just need to DO things. The only way to enhance self-efficacy to DO things is to... DO things.

I will conquer new athletic exploits to build confidence and calmness.
This was one of the most important things I learned in 2009. So, must keep going. Legitimate transition to clipless pedals on my bike. First sprint triathlon in August 2010.

I will learn to appreciate that right now is "enough."
Commitment to continuous improvement is a great thing. That's why I have "Kaizen" tattooed on my back, after all. But here, now, this moment... by the end of 2010, I will find a way for complete satisfaction with the present to mutually coexist with the pursuit of something more.

Here we go.
2010: Best Year of My Life...

Wednesday, December 9, 2009

Too Quick to Dismiss.

"Don't blink if Shaquille O'Neal is on the Orlando Magic."
"See? He didn't blink. He's completely aware of what's going on."

A mother's desperate way of explaining her universe. The only way she could make sense of the fact that her first-born son lay before her in her living room, hooked up to a bunch of tubes and things that beep, after blowing off the back of his head in a kerosene explosion accident.

"Blink if you know we're here."
"Blink for us..."
30 seconds later, a random blink.
"See? He's right here with us. He's going to wake up any minute now."

She has been saying this for three years.

When I met this family on a house call over the summer that I made with my "med student hero," I felt physically ill from my inadequacy. What this poor soul was describing to me was, on its face, ridiculous. I'd never before seen how destructive hope could be, the desperate clinging to shards of nothingness. Nothingness that fueled a life of profound sadness, struggling, pain. Alcoholism. It was not my place to squash that hope. But when they asked me to reinforce that hope, I felt guilty and helpless. That wasn't my place either. I couldn't find a way to come up with the perfect response that neither squashed nor validated something I believed to have no scientific basis. (Fortunately, my colleague did, which I reflected on in the above-linked post).

In the five months that have transpired, we have discussed this family at the clinic time and time again. EVERYONE has experienced this as I have -- this sad, toxic hope that caused nothing but disaster for this family. EVERYONE has dismissed the mother's claims of all these "signs" of alertness, her attributions of brain stem reflexes to actual volitional movements. There was no QUESTION that these "signs" were completely random. EVERYONE was seeking the same balance that had eluded me. So when my preceptor invited me to accompany him and the clinic's neurologist to make another house call to this family, I was particularly interested in learning how these two REALLY smart, REALLY thoughtful physicians of whom I think the world would communicate with these parents. What could I learn from their magic?

We drove out in the snowstorm. They'd turned the wood stove, and left out pieces of stale cheese and crackers for us -- more food than I'd bet that any of them had eaten all day. I was humbled by their generosity. We exchanged small talk and then followed them into the living room. There, he lay - exactly as I'd left him five months ago.

Right away, she launched into her familiar routine. Basketball trivia. Blinks/no blinks. Mouth opening. Tongue protruding. All of it completely random.

"Wiggle your left pinky."
She reached for his hand. The neurologist encouraged her not to prompt the effort. Nothing.

Then, it moved. The left pinky.
I silently gasped.

"Wiggle your left index finger."
It moved. It really moved.

My preceptor's eyes started to bulge.

Just as we started to get caught up in reversing course on our assessment, the air was filled with more random reflexes. My doubt returned. As we started to leave, the father asked his son to wave goodbye.


Seriously. He picked up his left hand, and waved it. That's not a reflex.

We said goodbye and returned to my preceptor's truck. We sat there for a few minutes in silence.

"I always wrote them off...." my preceptor began. "Yeah, yeah, he blinks on command... right...."
He shook his head.

I was comforted by how mutually shocked we all were. These two people have seen INSANELY much -- and yet, they were just as unnerved as I was. This changed everything. This man was aware, and may have been aware for quite some time.

This also means that he can feel pain. Everything now was different.

My thoughts rewound back to a few weeks ago at clinic. My preceptor had asked me to go in and take a history from a new patient, with a goal of learning her entire life story in 10 minutes and coming back out to present to him before we went in to see her together. As if that were not unrealistic enough, this woman was ALL over the place. Probable schizotypal personality disorder -- seeing crazy patterns where they did not exist (as though I should talk!): her hand hurting every time she ate ice cream (due to the fat clogging her veins); her eye vessels bulging on command; her toe hurting every time she used a computer; her dire need to have all sorts of serum tumor markers checked because of a TV show she saw. And she was also certain that she was developing Alzheimer's disease (at the age of 35) because she kept losing her keys. I tried to get as much information as I could about her concerns -- founded or not, the things that were important to her needed to be important to us. I tried to reassure her about cognitive overload compromising the dorsolateral cortex (working memory), recommended a great book I thought she'd find interesting. She seemed to like that, and got back to talking about the ice cream clogging her veins.

At some point, I gave up. I went out to present to my preceptor. I began with the disclaimer that my history was absolutely useless, and that I had been inept at reigning in her tangential rantings. I prepared him for what he was about to experience. We returned to the exam room.

Within a few minutes, the woman launched into opening arguments for her Alzheimer's diagnosis case.
"Do you ever lose consciousness?" my preceptor asked her.

Oh my gosh. He was asking about seizures (i.e., a legit medical problem). I hadn't asked about any pertinent positives or negatives to support (or fail to support) a legit medical problem. It hadn't OCCURRED to me to do that. In the context of a medical interview, it actually hadn't occurred to me to ask medical questions. I was mortified. It hadn't occurred to me that this woman actually had anything wrong with her. I'd already written her off in my mind as a complete hypochondriac, which is NOT mutually exclusive to actually having a legit medical problem.

Really? *I* did that? For all my talk of inhabiting a person's existence, inhabiting their underlying fears and doubts and anxieties, REALLY?


Afterwards, I confessed my lapse to my preceptor. He laughed.
"Yeah, that happens...."

I don't want it to happen. That's not good enough. It's not okay.

But having experiences like this at this point in my training is important. Important reminders not to get sloppy. Not to discount, dismiss.

After all, I've now seen a man in a persistent vegetative state wave goodbye.