Sigh. (Again). I'm 6 weeks into my third year of medical school (i.e., inpatient rotations), living in a new city away from my home, my Spinner, my indoor cycling classes, and the life I've very deliberately carved out for myself. I wake up at 5AM, spend all day til after dark at the hospital, where I am treated to some of the gloomiest, most depressing scenes and stories, and feel absolutely helpless in contributing anything to the lives of the very very sick, very very lonely people who have very little choice in allowing me to learn from them. I do my best to stay out of the way of the medical team I follow around, who reward me by "pimping" me (asking me questions in front of a huge group of doctors, often for purposes of fulfilling a rite of passage under the guise of "teaching") on various topics. At night, I come home, "dump" a version of my crazy day to my boyfriend (4 hours away, back home in Burlington) by telephone while I eat frozen food, read for a few hours about arbitrary, self-selected vague medical concepts I think might potentially help me with the next day's "pimping," then sleep for a few hours, snuggled up with a heating pad for my aching neck that's been weighed down for 14 hours with my overloaded white coat and stethescope.
My usual coping mechanisms for navigating the challenges of my day seem not to apply here. I'm not blogging (occasionally, I splatter collections of inarticulate, partially processed stories onto my "life blog") -- not blogging meaningfully, at least. I'm not regularly exercising. I'm not reading anything that inspires me. I'm not "creating" anything - an experience, an example. I'm flat.
But there are moments that make all of "this" worth-it -- subtle moments that lend perspective, purpose, and meaning. A patient dying of renal failure tearfully telling me that I made her life better. Another patient getting out of bed for the first time in 3 weeks. An email from my mentor back in Vermont, validating the concerns and reflections I've shared about how cold and callous inpatient medicine turns out to be. A Facebook Wall post from someone who reads this blog, telling me that some verbose rant or another had somehow contributed to their ability to communicate with and guide other human beings. Traveling back to Vermont to co-lead a 6-hour charity endurance ride to benefit the Special Olympics, sharing the honor with Master Instructors who have mentored me (including Jennifer Sage, flying all the way out from Colorado -- no way!) I VERY regrettably cannot make time to write about this life-altering experience (at least for a few months til I get my first break) - but Jennifer wrote about it on ICI: click to read.
It's these moments where I remember that, only weeks ago, I was adaptive, fulfilled, and happy.
Why? I had an epiphany as to why. And, finally, I was motivated to write.
I used the word "exercise" above. I very rarely use that word. When I expend physical activity, I refer to it as "training." I am always training. I always have an overarching goal for which I am "in training": whether it be to prepare physically/mentally for my next Century ride, to increase my lactate threshold to x bpm, to lower my resting heart rate, to be able to climb x hill at y heart rate, to be a more "automated" breather, etc. etc. For every given training session, I have specific objectives to achieve these goals: specific heart rate parameters, a specific plan, and specific issues on which to focus with specific reasons for doing so (i.e., "today I am going to focus exclusively on perfecting my wrist alignment -- because when I ride outside, I re-injure my old wrist ligament injury even when I'm not grossly leaning on the handlebars"). When I get uncomfortable or tired or discouraged or otherwise tempted to quit, I remind myself of my goals.
I've written ad nauseum about the importance of "training for something," and of encouraging my riders to identify what their "something" is. When I train people, I educate them and empower them to make choices consistent with their values -- with their "something." They always know "why they're riding," because they set out with specific goals and priorities from the onset. It means something to them.
On my first rotation, nephrology, I didn't show up with any specific goals. I showed up "ready to learn how to become a doctor." That's kind-of like showing up to the gym "to exercise." I would never DO that. Armed with my uber-specific goals and sub-goals, not to mention my heart rate monitor, I'd have WAY more purpose than that -- merely walking into a gym. Why was I not approaching my career the same way? Had I had specific objectives and strategies, perhaps my days would have at least had the illusion of greater structure and purpose. When a patient on my service died every few days, maybe I could have remembered what I'd identified as my reason for being there. Maybe not. But maybe.
Last week, I started my psychiatry rotation. I'm on the dementia unit, which is truly as sad as end stage renal disease. I'll write on my other blog eventually about the important differences between these experiences -- but the one noteworthy for now is that I started with specific goals: 5 things about psychiatry that I wanted to see, understand and internalize to best enable me to serve people in primary care (I'm going into Family Medicine). I thoughtfully developed them, ran them by my mentor back in VT (a family doc), and hit the ground running.
This changed everything. I show up every day with purpose, move through my day with a specific agenda -- and in the process of so doing, actually end up being more useful to both my team and the patients for whom we care. It's still a largely discouraging experience being surrounded by so much brute hopelessness. But in defining a purpose, it's easier to restructure one's attitude and outlook. Having a specific goal allows one to experience those "moments" that make it all worth-it, moments one chooses to create and structure. I'm finally training for something, something of which I can remind myself every time it gets tough. And when I've learned what I've set out to experience, I won't merely feel like I "survived." I'll feel like I actually accomplished something.
As on the bike, as in life... as per usual.
*UPDATE* Psychological Effects of Heart Rate Monitor Use Study
12/21/2010: Preliminary results were reported at Indoor Cycle Instructor in October 2010. Manuscript in preparation. Once published, results will be made available on this site and at ICI.