Dear Dr. Horton #1: Rudderless

Ever wish you could ask a wise, kind, approachable Student Affairs Dean something without having to admit the question was yours? Maybe you think it’s cringe-worthy; maybe you feel like you should know the answer already; maybe you think you will be judged; maybe you’re sure you are the only medical trainee on the planet ever to have felt this way, and you need confirmation now.

Enter Dear Dr. Horton, a new feature on the CMAJ Blog. Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment (rest assured, though — Student Affairs Deans in Canada are all really great people, and not only have they heard it all, but they take on these decidedly unglamorous, 24-hour call jobs because they really, really care about learners).

Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!


Dear Dr. Horton,

Medical school and residency have been all-consuming, and there is always more to do and learn. In rare moments where I can take a deep breath and contemplate, I no longer recognize myself.

I think the first step is to do something outside medicine that I enjoy — but to be honest, I’m not even sure what I like anymore! And that’s not even considering how difficult it is to commit to a regularly scheduled activity with frequent call and changing rotations...

Any suggestions?

Rudderless

Dear Rudderless,

One day, just at the start of my third year of residency, my base hospital was holding a barbecue. I didn’t need a barbecue. I needed a psychiatrist. As I was checking my new mailbox, I saw that a staff doctor I had worked with and liked was in his office doing some paperwork. He was a hip guy who rode his bike to work in all four seasons and had a copy of Siddhartha next to Harrison’s. Impulsively, I knocked on his open door. My expression must have belied everything I had been keeping to myself for the last several years, because he could see I wasn’t there to talk about this week’s New England Journal. “I’m thinking of quitting,” I managed to stammer, “or at least changing specialties.”

This kind soul, this mentor of mine… he immediately put aside everything on his desk as he leaned in and said, “Tell me more.”

What poured out? A torrent of self-doubt that I had been stifling since the first day of medical school. A flood of uncertainty and sadness. I talked about my specialty choice, and some of my grumbling doubts about whether the specialty and I could stay happily married for the next forty years. But I also talked about things I really loved before medicine… some of which I did exceptionally well. They weren’t medicine things. Gradually, all of those things had been nudged out by total exhaustion, the need to study whenever I wasn’t too tired to see straight, and — truthfully — a deep sense of futility. Why bother playing the piano once a month? Why bother signing up for a dance class I’d never be able to take? That kind of schedule would never allow me to excel, and what was the point of doing those things if I couldn’t excel?

To be honest, Rudderless... despite all evidence to the contrary from anyone else’s perspective, I also felt like a failure. I had secretly believed that I could, say, write a book during my residency, or submit articles to the New York Times, and run marathons, and pursue social justice for marginalized populations. In fact, some days it was all I could do to feed and dress myself — and frequently, I didn’t even manage to do those things particularly well.

My mentor told me some very important things that day, things that have stayed with me and that I have repeated over the years to countless tearful, younger versions of myself in the privacy of a Student Affairs Office and many other corners of the hospital.

The first thing he told me was that when he met me years ago, what was so memorable about me was that I was “different.” He pointed out that in trying to be like every other resident and in defining success in the way that was traditional at this big, wonderful (but also highly competitive) teaching hospital, I might have undersold what was best about me. He told me I needed to figure out what that was and get it back.

He also told me that if I could figure out what it was that I really needed, I would be able to find it in whatever I did. But it would never manifest until I knew what it was.

It wasn’t always easy after that, Rudderless, but I will tell you that the clouds parted just a bit that day... and some of it was that he had helped me identify that the person I was when I started medicine was worth chasing down.

The single biggest thing I realized I had to do after that conversation was readjust my expectations. Instead of beating myself up for not having been the one to write Bloodletting & Miraculous Cures, I started writing music: just a few minutes, every day. I used what I’ve since learned is sometimes called a “low benchmark strategy.” Instead of getting into a pattern of defeat where you plan to, say, knit a sweater for your nephew because you love knitting, fall asleep instead, then berate yourself for being a bad aunt and making nothing, which becomes one more narrative about how medicine has burnt through your life like a wildfire leaving no prisoners... instead, you say, “I’m knitting for five minutes tonight.”

Five minutes! What’s the point, right? But the thing is, there is a point. Because you get over the inertia of not knitting. When you are staring down the knitting, or the running, or the writing, or meditating, or whatever it is that your heart would really like you to do because you know it makes you feel better, part of what is triggering that crushing feeling of despondency is that you’re just so tired.  But sometimes, once we start things (and when we know that a goal is almost ridiculously attainable), we can find a way to inch forward. And what usually happens is after five minutes you’re in a zone, and you usually do more than five minutes, and you feel better, and you accomplished something even though it feels totally ridiculous to your over-achieving, sometimes unrealistic goal-setting self.

I guess what I’m saying, Rudderless, is that not all of our psychological obstacles are practical… sometimes, they are grounded in the fact while we can have it “all” in medicine, we definitely can’t have it all at once. But we can have a little bit of some things and a lot of others at the same time, and if we just stay connected to those other parts of our lives — using low benchmarks and overcoming the disdain that they aren’t concordant with our usual high-achieving factory settings — by connecting with something you love for a few minutes per day, you’ve watered the grass and you’ve kept that space alive, and in a few years it will be ready for more planting.

So, choose a thing — anything that you love that isn’t here in your life right now — and commit to a minimum of five minutes of it, every day (or most days, or whatever you can realistically do).

And test the water… find your own mentor: someone you can really talk to about your fears and doubts. Ask what worked for them, and keep asking until you find someone whose advice resonates as something that feels true. We don’t all share identical values and priorities, and apples shouldn’t always take the advice of oranges. Keep asking until you find that kind person who leans in and says to you, “Tell me more.” I promise you, they are out there.

Yours,

Dr. Horton

 


Dr. Jillian Horton is a graduate of McMaster Medical School and completed her residency and fellowship in general internal medicine at the University of Toronto in 2004. She was the Associate Dean of Undergraduate Student Affairs at the University of Manitoba from 2014–2018 and now directs programs in wellness and medical humanities at the Max Rady College of Medicine. She has won awards for mentorship, professionalism, and teaching at the undergraduate level. She is also a mother, musician, and writer. As an Associate Dean, she cared so much about undergraduate students because she never forgot what it felt like to be one of them.

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