Friday, June 30, 2017

Lessons I learned throughout my medical training

Today, I finished my medical training. Yay! This has got to be among the happiest days of my life. I started medical school 13 years ago and did two years of urology, two years of research, four years of radiology residency and one year of fellowship. Here are some of the lessons I learned along the way:

1.  My Family is my keystone. Throughout the trials and tribulations, my family was the rock that I stood on and that kept me from sinking. I was fortunate enough to be within driving distance to my family's home for most of my training. The hardest moments of my training were spent back at the safety and comfort of my family's home recovering.

2. Be in touch with yourself. Throughout the different phases of training, I had moments of elation and despair.  Medical training is hard and long. Understanding "why" you've decided to embark on the path is so incredibly important. There will be times when you want to cry, are desperate, tired, exhausted, and unhappy. It's during these dark moments, you realize who you are and why you're doing what you doing. When there is no good answer and there is no end in sight, then it's time to reconsider your path and redirect yourself to a different path that is more aligned with your values and priorities. Be okay with that and go with the flow.  This happened to me during urology and I was exhausted, tired and unhappy for a year leading up to when I decided to change specialty. The decision to switch specialty came at a huge cost to my personal relationships, but I did it. I don't think there is a "right" specialty for people and in retrospect, that experience "reset" my life and I had to start all over again. But, the decision led me to be more in touch with myself, my values and understanding of what I needed for myself to be happy.  I think only through these tough and raw experiences can you understand what your true values are.  For more insights on this, check out JK Rowling commencement speech.

3. Being a successful doctor means to learn how to study and never stop studying. The most important value physicians can contribute to the society is founded on our knowledge base.  During residency and fellowship, there is a lot of emphasis on research. My general surgery colleagues for example had two years of research during the their residency.  I've done a lot of research myself and published over 20 papers, but at the end of the day, the most important responsibility we have is to learn as much as we possibly can, stay updated with current breakthroughs and translate that knowledge to patient care. Research is a far, far, far second priority (a great JAMA article on "Shortening Medical Education") If you are a medical student or a resident and you're reading this, make sure you read the book "Make It Stick" and learn study strategies that are effective for med school and residency. Building our knowledge base is the most important job we have and one of the most important job we need to keep up throughout our lives.

4.  Never stop searching for mentors. The most successful moments during my education/training was when I had outstanding mentorship;  I can say that the low moments in my training was when I didn't have a mentor to guide me.  To be honest, I don't know how one searches for great mentors and in my experience, it has always been a lot of luck (or lack thereof). But, I can say with certainty that every successful venture was supported by a mentor.  But, I think there are different types of mentors for different phases of your life and training; sometimes, it's important to keep searching once your mentor-mentee relationship is no longer supporting the goals.  Failure to do the latter will come at a significant expense to your success, opportunity, etc.

5. Exercise. Exercise. Exercise. We all know the benefits of exercise. It's great for our mind, spirit, and body.  But, don't exercise too much either. I trained for a marathon this past year and was running 25-30 miles a week, compared to my usual 4-8 miles /week.  It was incredibly taxing and completely changed my schedule/routine. I ran 6am in the morning instead of the usual evening; I ran 2-3x farther than I did. After the marathon, the rigorous training stopped and my energy / flow stopped as well. It took 2-3 months to re-calibrate back to my regular 4-8 miles/week running schedule and those were the hardest 2-3 months of my training. Exercise keeps the flowing going and is important for being happy and being successful at whatever your pursuit is. My advice is to keep an exercise routine that you can stick to because exercise becomes one of the saving grace in your darkest moments.

6. Friends. It's like the saying goes "the Devil rests in idle hands." You have to put effort to keep up with your relationships with your friends, otherwise loneliness will take over and it's a downward spiral. I can be a socialite when I need to be but I'm talking about real, close friends who you can trust and call when you want to cry and who will call you to check up on you. These people are the next circle closest to you after your family in terms of being there for you to help you through the tough times. Family and Friends are God's gifts to us. Receive them with gratitude.

7.  "Change is the only thing that is for certain."  Everything passes with time.  Every experience (good or bad) has a purpose for us even if we don't know it at the time. Everything makes sense only in retrospect. Check out Steve Job commencement speech.  Being aware that everything will come to pass.

8.  To get perspective, think about who will be there with you when you die.  I moonlighted at a hospice early in my training and it was the most eye opening experience of my life; I saw so many people come to face and eventually accept and cope with death. When we are dying, I can tell you nobody gives a shit how many papers you've written, how much money you have, how much time you spent your life working, or any material thing. What matters is who is there with you, the relationships you shared, the values you lived up to, how you've helped people in the ways that you can, and the people you've helped and touched. It's that easy. Seriously. It's that easy. So, when I'm having a tough time making a decision or getting upset that something didn't go as planned or whatever, I think about my death bed. When you have the end in sight, it's easier to see the path to get there. So, I've decided to put people and values over my own success and advancement. It reminds me of the children's book story that I read to my daughter "Have you filled a bucket today?". You can only feel love and happiness when you make others feel loved and happy.  In the same way, you can only be free of sadness/disappointment and anger when you've relinquished these feelings towards others. This may be a less successful approach to achieve notoriety, fame and wealth, but I'd rather be happy/loved, unknown, poor rather than rich, famous and lonely. If you're in the situation or environment that will not be conducive to harboring good feelings for yourself and others, then it's time to remove yourself and change into an environment that will facilitate these goals because what matters the most will be very real when you're about to die.

9. Write.  If you don't want to be forgotten (nobody does) or want to leave a legacy (everyone does), you have to write.  We will never meet the 7 billion people in this world, but you can benefit tens to hundreds of thousands of people through your writing. I seriously mean it. I get no money or anything in return for blogging and sharing my experiences, but I've heard through friends of my colleagues who have benefited from my posts. Sharing your thoughts with the world through writing (or video or other forms of media) will leave an indelible mark and  positive impact to so many that you could not otherwise affect.  You can write about anything that interests you. But, everything you write is a unique story that will help you organize your thoughts and benefit those in a similar situation.  If you don't want to type, then I'd suggest you buy a dictation software like Dragon that will transcribe your words. I was inspired to start blogging after reading Nature's Science for All series about women in science and one of the articles advocated blogging to publicize our research, but now I have indirectly seen the impact of my content on the viewers and it's probably more rewarding than any peer review paper I've published.

10. Listen to your guts and let your subconscious guide you. My former residency program told us once that "you have let the people and surroundings guide you to what you might thrive in." He had mentored students and residents for nearly two decades and he noticed that some people would force themselves into a mold that they felt they wanted; in contrast, he argues that if people enjoy being around you, maybe you should consider management; or if you find teaching rewarding, then you can go into education, etc. But, it takes a lot of courage and personal insight to live this life and not just follow the path of perceived greatest prestige/ money/ fame.

11. It's not the song, it's the singer.  I was talking to one of my very thoughtful MSK attendings, Kambiz Motamedi, and he mentioned being a peer reviewer for abstracts submissions. He reviewed over 600 abstracts and made the decision to accept or reject a submission; what he told me was that the topics are usually the same (seriously, anatomy doesn't change) but he said it's how the individuals present the abstracts, their style, their tact and uniqueness which separate the accepted from the rejected pile. I think this is true about anything we do in life. The unique style and approach that we bring to the table is what keeps life interesting and how great things are discovered.

12. Time Off. I can't emphasize how important time off is for me. I was a workaholic. But this approach to life is counterproductive to our goals. A lot of research have shown that the break time and the transition between work, break, interruptions, vacation is when our best ideas come to us. The reason a workaholic life style is harmful is because our bodies are design with fixed energy and willpower; when we work all day, our energy and willpower get drained. If we don't make the time to recharge and repower our source of energy, then we just burn out.  I once sat next to Tony Atala  from Wakeforest at a luncheon during a conference and he told me that protecting my time is the most important thing I do for myself when I finish training. He told me that so many people become so busy and burdened with clinical work that they can never regain the protected time. So, protect your time off.  The most important part of our day is when we sleep because that's when memories are consolidated, and byproducts from our neurons are cleared; in the same way we should never cheat our sleep to study/work, we should not cheat time off in place of work because it does more damage than good.

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