Resilience

Not so long ago, a couple of brilliant new medical students asked me how many notecards I do a day. “Doing a notecard” means quizzing yourself on its contents and making progress in remembering the information it contains so you can answer test questions on the topic. Talking about the number of notecards we do daily is typical shop talk in medical school—everyone is trying to figure out exactly how to learn the mountain of information that makes up medicine. Almost everyone decides early on in their medical school career that the only way to learn what we must learn is with notecards. But, what is the perfect number to do in a day?

I avoided answering those new medical students’ question about how many cards I do a day. I wanted to help but, it’s an unanswerable question. I am not a robot. If I were a robot, I’d do something like 500-1000 notecards a day. But that’s not how life works. Some nights I don’t sleep well. Some days I have meaningless meetings that take up the best study hours. I gotta eat. I gotta move my body. Some days, it’s just too sunny to stay glued to my desk. Sometimes I’m tired and I retain nothing. Sometimes I get bad news and I’m sad. Sometimes I’m sick. Sometimes I’m on fire and I cruise through notecards like a genius.

We talk a lot about resilience in medical school. Here are the typical discussion questions:

  • What is resilience?
  • Why is resilience important?
  • Can resilience be taught?
  • How does one become resilient?

Thinking about notecards led to me some answers. Here they are:

What is resilience? Why is resilience important?

Google defines resilience as “the capacity to recover quickly from difficulties; toughness.” With that definition, it’s obvious that when you’re doing very challenging things like learning medicine it helps to be resilient. Becoming a doctor is a long process and you’re guaranteed to make a lot of mistakes. The only way you’ll make it to the “end” is by becoming an expert in self pep-talks and getting up when you fall.  

Can resilience be taught?

I don’t think so. Not once, ever, has any class, piece of advice, or discussion made me better able to endure a hardship. Every hardship I’ve endured was because I decided to bear it. I had family and friends who supported me along the way, but the healing and “how to do better next time” was mine alone to formulate. But, while I don’t believe we can teach others resilience, I do believe that resilience is learned.

How does one become resilient?

We become resilient by being challenged. The folks who are most resilient are the ones who have endured the most hardship. That’s not to say all people who have faced many obstacles are resilient; it’s just to say that you can’t be resilient if you never face a challenge. If you’ve never failed or been hurt than you can’t know what it’s like to dust off the dirt from a fall and try again. Without challenge, you can’t learn how to adapt your plan as life unfolds new surprises.

This principle is the basis of the answer to the notecard question I was asked. How many notecards do I do a day? I have NEVER, not once, done as many notecards as I hoped to do in a day. Yet, I have passed all my classes comfortably. In fact, not only have I never completed as many notecards as I wanted to…when I started medical school, I didn’t use notecards. Not using notecards was a grave mistake. When I started using them my grades improved by about 5% and, for the first time in my medical career, I had time to exercise, sleep, and socialize a sustainable amount. I switched to notecards ¾ of the way through my first semester of medical school. I was terrible at making notecards. But, I gave them a fair trial because I knew how I was studying before notecards wasn’t working. I had two choice at that point: sink or swim. Swimming involves adaptability. I decided I would rather be an otter than a rock in the deluge that is medical knowledge.

Deciding to use notecards may seem trivial until you consider that I’ve bet around $100,000 (so far) on becoming a doctor. It seems trivial except when you consider that it took me 6 years (of work) from the time I decided I wanted to become a physician to the day I got to decide how to study my medical school material. It seems trivial until you realize that I still have at least 5 years, probably 8, and many licensing exams between me and practicing medicine. The stakes are high. I could have failed upon switching to using notecards. But, I thought it was worth a try and I knew I would fail if I kept up what I was doing.

This past exam (fast-forward to my second year of medical school) was the first time I finally studied all the notecards I’d made for an exam. It’s been a little less than a year since I starting using notecards to study. I’m way better at using notecards than when I started. But, my journey isn’t over. This spring I take the biggest exam of my life (my first board exam – a national exam everyone who becomes a doctor must pass). How well I do on that exam heavily influences what residencies I can apply to and, ultimately, what type of doctor I’m allowed to become. It’s scary. My daily notecard count is only one part of how I will prepare for that exam. The number of notecards I did daily last year, over the summer, and now is different. How many notecards I do today will be different from how many I do each day when I’m in the middle of studying for that looming board exam.

What challenges and failure come to show us is that things can be done in many ways. They also show us that we can only control ourselves. For example, I can’t change how much information I’m expected to know for an exam. I can decide how to learn the information. Resilience is not complaining about something that never could have been. It’s about deciding to make your dream reality. It’s about jumping into the flood, scared out of your mind, with a willingness to evolve until you get to where you’re meant to be.

Holding a Brain in Your Hands

My first semester of medical school I went to the anatomy lab 2, 3, 4, sometimes more times a week. Sometimes twice a day. In our anatomy lab we were split into groups and each assigned a cadaver for dissection. Cadavers are people who donated their bodies upon death to science, we call them “donors” in our lab. The 20 donors in our lab were once 20 people who had the vision to let us, 120 aspiring doctors, disassemble the human body so that we could intimately understand how it fits together.

The idea of cutting apart a human, even if they are dead, is disgusting to most people—including all of us who showed up to anatomy lab the first day. It never got easier to dissect my donor. I spent a little bit of each hour in lab wondering who my donor had been in life and if she had any idea what happens in an anatomy lab when she decided to donate her body. Yet, now that I’m done with anatomy lab and have had months to stew on my experiences there, I can’t imagine not dissecting a cadaver as part of my training to become a physician. Let me share one, relatively low on the gruesome scale, experience to illustrate how profoundly moving and informative it was to be able to explore a human body piece-by-piece.

Toward the end our months in the anatomy lab it was time to open the skull and see the brain of our donor. Weeks before that we had dissected the spine, opening up the vertebral column so we could see what the spinal cord looked like. Each week of lab leading up to the day we opened the skull was spent tracing nerves from the spinal cord and brain to each section of the body we had examined. Nerves look like strings, specifically they look like white, cotton strings soaked in oil. We spent many hours memorizing the names of those strings (the nerves) and their paths through the body.

So, on the day we finally got to open the skull we understood how the brain was connected to every muscle and structure in the body. We knew intellectually how they were connected but, also, physically how they were connected. Our hands had followed the course of many nerves until their routes were as familiar as the path of a zipper on a favorite jacket. We could imagine the journey of the nerves through the body without seeing them. Hence, we felt ready, excited, and nervous to meet the globe that controlled it all. We were ready to see the brain.

You can hold a brain in both your hands. It fits there comfortably. It weights about 3 pounds. In other words, it’s about the size and weight of an average cantaloupe. Such an unassuming structure for the burden it carries. It is our brain, in the end, that makes each of us who we are. It shapes our personality, our feelings, and our behavior. Without our brain we simply take up space. We can’t even breathe.

When I held our donor’s brain in my hands, I knew it would be the first and last time I held a human brain. I didn’t hold it for long, but I felt its weight. Its actual weight as gravity pulled down on it, but also the weight of the life it had traveled. Whoever my donor had been in life, it was the brain in my hands that had guided her. Every person has a brain something like the one I was holding. We each have our own globe of cheese, an organ science still doesn’t know much about, that pretty much decides everything in our lives. To think, I was holding the center of human nature in my hands. The feeling isn’t something I’ll forget.

Memory

When it doesn’t occur in an explosion, change often happens in such small increments that we don’t notice it happening. Medical school changed me in both ways. The start of school launched me into a new world of academia. I was pushed to study more efficiently and more than I ever had. I adapted to a new lifestyle. These changes were dramatic but expected. Starting a new job, which is how I view school, is usually that way. However, looking back at my first year of medical school (so far), I changed in unexpected ways that were not obvious in the moment.

Not so long ago I was learning brain anatomy. The topic was interesting and boring at the same time. The individual pieces of information were simple, however, woven together into pathways and functional groups these bits of the brain were quite complex and somewhat indeterminate. As I was considering several parts of the brain involved in forming memories, I found my mind wandering beyond the curriculum. Memory is an interesting thing.

My sister has always had a good memory. She can read a document 3 times and recite in perfectly; this worked well during her acting career. She always remembers things I’ve long forgotten from when we were kids. My memory has never been like hers. As a high school student, I thought that memory was an innate quality. I thought memory wasn’t something that could be trained and changed. I took that belief to college where I worked hard. I’ve always known that most things can be achieved if I work hard enough. Since college and until now, I haven’t thought too much about memory.

Medical school has made me reconsider memory. As I thought about the corticospinal pathway carrying motor signals from the brain and brainstem to the body and the anterolateral pathway carrying temperature and pain signals in a chain of neurons up to the brain, I realized that these things were complicated. But, they didn’t seem as complicated as they would have back in August when I started medical school.

These days, I find myself reading words I can’t pronounce and remembering them. I find myself reading dense documents about the presentation of a disease or the features of a drug and remembering more than I did when I read comparable materials in October.

As I was studying what parts of the brain are responsible for different aspects of memory—working, long-term, emotional—I realized that I have trained my memory since starting medical school. And, while my brain’s approach to remembering is still different from that of my sister’s, memory formation is dynamic. The brain is plastic just like the rest of life. Considering this, I’m curious to see how much my brain will change by the time I reach the end of medical school. Residency. And beyond. 

But, first, time to finish the last 4 weeks of my first year of medical school – hours that will be spent learning many aspects of the central nervous system beyond memory and brain structure.

Burnout

Alarm. Study. Class. Study. Eat. Study. Bed. Alarm. Study. Class. Workout. Study. Study. Bed. Alarm…Repeat. Repeat. Repeat. Sometime in the future substitute work for class and study.

My sister and I have a term for the life leading up to burnout. We call it living like a robot. It’s a life where work and/or school consumes you and sometimes you fit in sleep and things that make you happy. Most of the time in the robot life you simply work and wish you were sleeping.

The robot life is unavoidable sometimes if you have hard goals. I have always justified it by knowing when it will end. I’ve had several bouts of that life with years of rest between. Most of my undergrad I was a robot. My two years of post-bacc, pre-med studies plus all the work piled on top were some of the worst years I’ve known. Medical school is the first time I’ve not worked as I studied since middle school. It’s nice to have one job, just medical school. But, honestly, it’s still hard.

Medicine is cursed with a heavy dose of the robot life. This is partly because physicians have peoples’ lives in their hands, so expectations are high. It is partly because the type of people who become physicians are A types and have high personal goals. It is partly because health is ubiquitous and illness unavoidable. As humans, our ability to reach our full potential is partially determined by our health. If we are in pain or ill, we can’t do all the things we would if we felt well.

Medical school and then working as a doctor are challenging because the hours can be long. They’re also draining because the work is complicated and requires focus and lots of puzzling through piles of clues to find the best answer. The pressure is high because the puzzle directly impacts a human’s life. And depending on the gravity of the puzzle, the answer might impact a whole family.

Time and intellectual challenge aren’t all that makes medicine difficult. It’s a team sport, so office politics and business relationships come into play. But even teamwork isn’t the hardest part of medicine. Medicine is an emotional job. People who come to us as patients die. They lose function. They lose the ability to lead the lives they’ve always led. There are many happy outcomes, but not all patients’ stories end with joy. The sad outcomes add up as time goes on.

My time in healthcare as an EMT showed me that no individual patient impacted me unbearably. However, there are days when I feel the weight of all the patients I’ve helped. For example, I felt heavy after the last CODE I worked before I left the ED for medical school. A CODE is when you do CPR, shock, ventilate, and take other measures to try to revive a person whose heart has stopped.

That night I closed the curtain on a 30-something-year old with a wedding ring who hadn’t been identified yet. He was dead before he arrived, but we did CPR anyway. I was one of the last to leave his room. I never leave a dead patient before ensuring they’re presentable for family. CODEs are messy. If the family isn’t there to see us work, I see no need for them to experience the mess. I knew sometime in the night his partner would learn he was dead.

Tucking in that patient right before I ended my shift was hard. The death rested on top of the morning I walked into the ED to find teens on the phone crying. They, the teens, were calling their family to tell them their mother and uncle had died. Odd to have children deliver news most adults barely can. The sadness those teens felt added to the day I cleaned two CODEd patients back-to-back so they wouldn’t be bloody and dirty when their family arrived to say goodbye. After tucking in the second of these, I walked out of the room to find a visitor approaching. I interceded and joined her, but only upon entering the room did I realize she, the daughter, didn’t know her mother was already dead.

The sad endings add up. But, so do the good journeys and happy endings. The patients who turn our days around by sharing the most amazing stories or giving advice that is perfectly wise. Days in healthcare are brightened by visitors who show raw love toward someone stuck in a hospital bed. I’ve seen true love hiding in ED rooms on multiple occasions. It was working with old couples in the ED that showed me how I’d like to age.

It’s no surprise between the stress of the job and the rigor of the schedule that doctors and medical students burn out. However, knowing our challenges gives us the knowledge we need to persevere. Even within the field of medicine there are many decisions we can make to suit our goals. It begins with specialty and is followed by location and type of hospital. We have the information we need to know how a specialty, location, specific hospital, and extra projects we take on will impact our life or encroach on free time. We can decide, within the scope of meeting our obligations, when we wish to do extra and when we wish to do the minimum. Most importantly, we know that no state is permanent unless we let it be. 

I think at the root of avoiding burnout is being honest with ourselves and checking in with ourselves. There are stretches of school and work that must be survived. The robot life must be lived sometimes. But, amidst the madness we must decide when it will end. We can choose to rein things in when needed. We can choose to prioritize family or life outside work. Of course, to do this, we must know ourselves and what makes us happy. Once we know where we find happiness we can fight for it as fiercely as we fight for our patients. In the end, if we are not well, we can’t help anyone else at the level we can when we are in good health.

Today I’m Grateful

The past few months have a been a tornado. I’m 3 weeks out from finishing my first semester of medical school. What has “med school” meant for me so far? 4 hours or more of studying a day no matter how many hours I spend in class. Showering the formaldehyde smell out of my hair because I’ve spent hours in the cadaver lab dissecting or practicing structure identification. Discussing the ethics of assisted suicide, abortion, and patient consent. Considering how to evaluate research. Practicing physical exams and asking patients about their health.

But, even on days before an exam, when I’m exhausted and uncertain I know half of what I should, I’m excited to be doing what I do. I know how to feel a heartbeat through someone’s skin. I know how to watch a heart contracting using an ultrasound machine. I’ve held human hearts. I’ve explored their chambers and vessels. I know the path blood takes to and from the heart. I know what makes the heart beat. As the days pass, I know more and more about what makes human bodies function, how the body can break, and what we can do to fix it. For this intimate knowledge of life, I’m grateful.

These past weeks and months haven’t only been studying, despite how it feels at times. I’ve spent time with family. I’ve hiked many a mountain in both the sun, rain, light, and dark. I’ve eaten cake on mountain tops, carved jack-o-lanterns, and shared many a meal and snack with friends. I’ve walked up and down the hill from home to school while chatting with kindred spirits.

Friends new and old along with family aren’t all I’m grateful for this season. I also have a lovely home with a roommate with an eye for creating comfortable spaces where I can sip my mate peacefully. And, I have a partner who enjoys pie as much as I do. Helps keep life in order. Tells me my hair looks beautiful even when it’s greasy and fizzy (who knew hair could be both those things at the same time) and cooks me dinner so I can study.

I feel lucky this season. And, I’m grateful to have a few moments to soak in just how kind life can be. I hope your Thanksgiving is spent with people you care about or, at least, surrounded by tasty food. After all, the stomach feeds the heart. 

Marathon Goals

I remember the conversation I had with my best friend that sealed my desire to become a doctor. We were in our relatively new apartment, in the living room that was an extension of the kitchen. The city sun of Washington, DC filtered in the large windows and onto the bedraggled plants we had lined along the window sills. I’d been contemplating the idea of entering medicine for months. The thought came to me shortly after I started working in health communications. What I liked most about health communications was the medical research, knowledge of life, and opportunities to interact with people. I wanted to find a way to fill my days with those things rather than dabble in them. My friend worked in a primary care office, on the administrative side. She encouraged me as I talked about possibly switching careers. “You’d be a good doctor,” she said. Thus, began my marathon goal to become a doctor, a process I call “the doctorhood quest.”

That conversation was 5 years ago. Recently, what started as a thought became a real possibility. I’ve been accepted to medical school. There’s still the question of financing and survival, but with an acceptance to school, there is hope that the rest of the journey will fall into place. I will be a doctor.

Marathon goals. I’ve always been a planner and as a runner I prefer long distance. But, there is something uniquely challenging about making goals that will take over a decade to accomplish. There is no way to know the future, and absolutely no way to predict a future as distant as 10 years from now. But, somehow, the uncertainty and hidden challenges that the doctorhood quest presents have not deterred me. I reflected on the prospect of doctorhood during my years of Peace Corps service and, once back in the States, I started jumping through the hoops of medical school applications (I had no science background when I began). The long wait to medical school acceptance has only made me more excited to start my studies. The doctorhood quest isn’t even half over—medical school, residency, and board exams will be the longer leg of the journey. Yet, as I sit on an acceptance letter and wait to hear back from more schools, it’s thrilling that I’ve come this far.

People around me, to me or to others, often comment on how intelligent one must be to get into medical school. I usually remain silent, but smirk inwardly. I believe “smart” comes in many forms and not all are suited to medicine. I’m disinclined to suggest one person is smarter than another because life has shown me that humans have different gifts and society needs all of them to function. But, more specifically, my journey has shown me that medical school admittance has less to do with how smart someone is and more to do with how resilient they are. The doctorhood quest requires you to be gritty and determined. It demands that you jump up and try again each time you fall while tackling the perils of the road.

If resiliency and grit is the secret to pursuing marathon goals without losing hope, how does one get those? Experience and inward reflection are my guesses. We learn by doing and we expand our scope of understanding the more different experiences we have. Nothing proved this more to me than my years in Paraguay. I am not the same person I was when I first stepped off the plane in that hot, humid country. The people there showed me how they found happiness; they defined respect and God and love in ways completely different from any definition I’d ever encountered for those things; and, above all, they exposed me to foods, ways of life, and shared moments I could never have imagined.

Experience is the foundation for growth, but to truly grow one must reflect on those experiences. Paraguay, once again, taught me reflection. It is impossible to describe just how lonely and hard it can be to be the only one from your culture in a foreign place unless you’ve experienced it. Your world is turned upside-down and every definition and rule you ever thought was a given is no longer in play. Your default becomes mild confusion and curiosity about the new culture in which you have fallen. Most importantly, you are forced to examine how your culture does things and why. Once you start picking apart your host and native cultures, it’s an easy, logical jump to start evaluating and thinking about different aspects of your personal life—like your interactions, feelings, and activity choices. Once you build in time to reflect on experience you can start to shape your path more purposefully.

The secret to marathon goals is accepting you can’t know the future, but you can influence the present. The secret is celebrating small victories, making educated guesses about the best course of action today, and seeking out the people, places, and experiences that rejuvenate you when your hope falters. We do not achieve marathon goals alone (it takes many helpers) but it is only from within ourselves that we find the strength to withstand what’s hidden behind each bend in the road.

Raising the Boiling Point

When I tell my grandmother all the things I’m doing she usually says something like, “Just hearing about your activities makes me tired.” This comment always makes me wonder why we all have different thresholds of activity before we become overwhelmed or burnt out and disinterested.

Hypothesis

Interest is to productivity like salt is to water.

Water on its own boils at a certain temperature, but after dissolving salt in water the temperature at which it boils is higher. This is because the intermolecular forces between the molecules are stronger when salt and water are mixed than between water molecules alone. In other words, it requires more energy to boil a pot of salt water than it does a pot of fresh water because the little bits that make up salt water are more strongly pulled toward each other than the tiny bits that make up water are pulled together.

I believe interest acts like the salt when the water is productivity. If you dump some interest into your productivity pool, you’ll achieve a higher production rate than you would if you just do things without figuring out how they are interesting. I define interesting as something that is thought-provoking, relevant to my interaction with people, useful in the activities I do, and/or helpful in reaching my goals.

So what?

Productivity is not set in time nor does each person have their own unique productivity rate. We each have varying productivity depending on zillions of factors like time of day, enjoyableness of what we’re doing, and how many things we have on our mind. But, what I’ve found as I take each step on the doctorhood quest is that if I can convince myself (or already am) interested in something I can focus on it a lot longer and accomplish a lot more in less time than I can if I’m apathetic about it. I can cut the time it takes to do something sometimes by half if I can think of a way to find it interesting.

That’s what I did with first semester physics, specifically kinetics. At the time, I’d been battling squirrels. Squirrel rapscallions were decimating my garden, and though I truly hated those rascals, there was nothing I could or would do about it. I wasn’t going to kill them–I didn’t have the heart. However, kinetics equations such as those used to describe projectile motion gave me a tidy solution. Kinetics can be used to describe how far, fast, and high you throw something. I imagined (even though I’d never, ever actually throw a squirrel) that all my projectile equations related to chucking squirrels. The metaphorical “strike back” was enough to ease my anger over my garden crops being stolen by squirrel thieves and gave me the source of interest I needed to learn and excel in physics.

Side note: Once I got started, I didn’t need the squirrel metaphor…physics is actually pretty cool all on its own.

Test

I think it’s a powerful observation and a testament to the power of the mind that you can trick yourself into being interested in something and by doing so improve your ability to learn about that thing. If you can dig deep and find a fragment of something that sparks your imagination and curiosity even the hardest and most tedious of tasks goes more smoothly. Don’t be believe me? Next time you’re doing something that absolutely must be done even though you hate it, try to find something about the task that is interesting and worthwhile. Focus on that as you do the task. My guess is that you’ll find the whole process slightly more bearable and that you’ll also finish sooner than you normally would have. Challenge: Prove me wrong.

Springtime Rambling

My goodness how quickly time passes. It’s hard to believe that the last time I wrote was in the dead of a cold, dark winter—the hallmark of New England. I won’t bore you with the reasons why there was no time to write for so long, except to say that I know a great deal more about equilibrium, acid-base reactions, electromagnetism, circuits, batteries, optics, quantum mechanics, and special relativity than I did in February. Science.

Spring arrived in Vermont with the timidity of a mouse crossing a barren stretch—one step forward, three steps back. But, the soft, new leaves are starting to unroll; the grass needs to be cut, the flower gardens need weeding, and the fruit trees fill the air with soft scents. It’s the lilacs more than the tulips and daffodils that make me think the warm weather will stay a while.

The winter was long and cold. I dared not count the gray days that melted into rainy days between frost and flowers. It goes without saying that spring is a time of new beginnings and the return of the sun.

How I missed the sun! When I went on a walk today rays of golden light danced on the path between the yellow-new, pink fresh leaves. The spirals of young ferns lined the walkway and the damp mix of old leaves and new growth saturated the air. I paused on a bridge over where the river meets the lake. There in the flooded marsh lands a fish swam almost lazily in circles. It was over a foot long. A fin lined its back waving back and forth like a ruffle along its spine as it waved its tail. What a bold fish to be out in the open in eagle, kingfisher, and heron territory!

I’m sure you guessed, but the sun makes me think of Paraguay. I completed my one-year anniversary of my return to the States in April. This is my first full spring in Vermont in many years. And the humming of the frogs, bugs, and birds make me think that this coming year will not only be as productive as the last, but more hopeful.

It is a new beginning because I’m taking my learning out of the classroom. Not so long ago I started running as an EMT. I’m still quite a newbie, but I’ve learned that every patient is a puzzle, and that solving each puzzle is more thrilling than anything else I’ve yet encountered. To realize what I can do to help someone by looking at a few measures—for example breathing, pulse, and blood pressure—is far more interesting than piecing together the clues of a physics exam question.

I’ve been thinking these days about how much I’ve learned since last spring. This time last year, I could not have told you what a healthy blood pressure was or if 5 was basic or acidic on the pH scale. Today I know those things and a great deal more. But, for some reason, Plato’s Socrates and his comment about what makes one wise has been on my mind as I take my spring walks, a translation of which reads:

“I am wiser than this man, for neither of us appears to know anything great and good; but he fancies he knows something, although he knows nothing; whereas I, as I do not know anything, so I do not fancy I do. In this trifling particular, then, I appear to be wiser than he, because I do not fancy I know what I do not know.”

The more I learn about the human body and illness the more I realize how much I don’t know. And what I’ve come to see, now that the frost has cleared, is that the doctorhood quest will not end when I pass my last board exam. It’s a quest for knowledge and better understanding that will only end when I stop practicing medicine. And despite the weight of learning so much for so long, the length and breadth of my journey does not seem daunting. I know that even if there are stretches like a Vermont winter as I make my way, they will always be followed by spring. After spring comes summer. And summer is full of life.

Photo Credit: my father

 

The Doctorhood Quest

It seems timely to quote Carrie Fisher, who said:

Stay afraid, but do it anyway. What’s important is the action. You don’t have to wait to be confident. Just do it and eventually the confidence will follow.

That’s a decent summary of how I try to live. Going to Paraguay was a leap, but a longer jump is starting my quest to be a doctor. Becoming a doctor is a 7-year commitment at its least, and it’s looking more like 10 years for me. What a trip to start in my late 20s, don’t you think?

Can you imagine striving for 10 years even though there is a real possibility of losing your way at each turn?

I’m not sure if I can picture it. I’m not certain the path is clear to me, but I’m going for it anyway…because my end goal and vision are vivid. Fear and confidence. They go hand-in-hand. They balance each other. When one is strong, it is wise to foster the other.

I wonder every day if dedicating myself to becoming a doctor is what I should be doing right now. It’s not exactly doubt that makes me wonder, but more of a need for reflection. Ten years is a long time. It’s a little more than a third of my life so far. It might drive some people crazy constantly questioning themselves, but I’m comfortable with the uncertainty. You see, I’ve learned that doing things that initially make me uneasy usually yields the best outcomes.

It is easy to fall into a routine and a pattern. The path of least resistance is to continue along whatever path you’re on—Newton: an object in motion stays in motion along a straight line unless a force acts upon it. It is hard to stop and go and change direction. But, I like challenge. Sometimes I rest, but most often I act as my own force and alter my own direction.

I started the doctorhood quest back in May 2016. That’s when I took my first “real” science classes. But, I’ve known since 2014 that I’d be a doctor someday. Why such a delay? Life. The doctorhood quest is not about speed. It’s about endurance. I know I’ll reach the grail. I know that when I do, I will be happy to dedicate myself to medicine and improving the world in my small way. But the word for the doctorhood quest is “patience.” There are plenty of people who need healing today and there will be plenty tomorrow and the next day. Right now, I’m learning and doing the small things I can. When it’s my turn to heal, I’ll be ready.