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Picking Up the Pieces

Thomasrobey72x721Thomas Robey -- Some people write to understand or explain the world around them. Others use the pen as a vehicle to better understand themselves. The fact that one in ten Americans has tried their hand at blogging speaks to the appeal that the written word has in clarifying the mind. For me, my private journals, my personal blog and this column (in order of clarity) offer an outlet that is as important to me as a refreshing stroll at day's end.

Imagine how shocked I was to discover my eyes welling up and my fingers trembling as I wrote an email to my clerkship director about the struggles I described yesterday. Email as therapy?!?!?!??? What began as a simple request for advice on oral presentation skills evolved into a soul-bearing reflection.

By now you're thinking, "What's wrong with this guy?" I mean, really: get over it! In the grand scheme of things, what is a single blown presentation? But it wasn't just that. I had noticed myself getting grumpy, withdrawn, looking forward to the end of my shifts, cutting corners... and when this sort of thing happens, you can bet that you're the last person to see it.

To get to the bottom of all of this, we have to back up a week. Eight days before my bombed presentation, I learned that my grandfather had died. He was a great man, and his life was long. His passing was not fully unexpected, but news like this never comes easily. I mourned his passing that day, but I was also post-call. So I went to sleep at 6 PM and woke up the next morning ready for the wards.

The memorial was scheduled for three weeks after his passing, which happened to be the day of my medicine final. When my family heard about this, they reassured me over and again that the last thing Pappy would have wanted was for me to interrupt my studies to fly across the country for his service. I comfortably chose to stay home to finish the clerkship and take the exam. But in the end, this was the wrong decision.

It only took a week for my personal situation to negatively affect my functioning. I initially blamed this on fatigue incurred from a tough call schedule at a busy county hospital in a course I wanted to excel in. In retrospect, this conclusion was corrupted by the blinders I donned when I decided to delay mourning my grandfather's passing until "after the test."

Medicine is a career of delayed gratification. It takes, at a minimum, a decade to finish formal training as a doctor. There's always something to be sacrificed in the name of medical education. Hobbies. Exercise. Sleep. Friends. Family. We all struggle to maintain balanced lives, and many succeed to one degree or another. But as the end of my formal education approaches, it is clear that the training is just beginning. As such, there will always be something from the medical career demanding attention.

This brings us back to a third year medical student perched before a computer in the Team D workroom, tapping out a short note that brought tears to his eyes. Only then did it become clear to me why the previous week had been so miserable. Sure, I was sleep deprived; sure, I had encountered some stumbling blocks; sure, I was worried about my grade. What I realized while writing that email was that I had an unaddressed deep need to mourn my grandfather's death.

When I met with the clerkship director later, we didn't even mention oral presentation skills. The next day, I arranged to fly to Pappy's memorial service. As important as the medicine clerkship was to me, and as inconvenient as it would be to make up an eight-hour exam, a memorial for a dear loved one held no match. Fortunately, I will not have the option of regretting my choice.

It's strange to say, but the most important thing I learned on my internal medicine clerkship wasn't in any text. I learned to stop compartmentalizing work and family, so that critical needs in one would always trump the other. I am thankful for a mentor who helped me see what I was doing to myself by blindly committing to career. In experiencing loss, and addressing it, I have a new understanding of the proverb, "Physician, heal thyself."

April 25, 2008 in Thomas Robey | Permalink


hello thomas. i liked your post and as a prospective medical student i have a question. what are you willing to sacrifice for our chosen profession. medicine is after all a 'profession'. are you willing to pause for a bit to experience life. are you willing to spend time to 'heal' yourself. i personally feel that even though i am going be a part of an extraordinary profession i must exercise 'self care'.
soon i will be in front of the interview panel and they will ask me the question " Mr... how will you handle the workload. how commited are you to this profession?

now i ask myself. does committment mean the sacrifice of my emotional and personal needs to serve the patient? how far do i sacrifice what i enjoy in my life. family to me is the cornerstone of what i am today. it defines me. it makes me happy and energises me every time. i dont want to make a choice between family and medicine. i am not sure i even have to?
what do yout think?

Posted by: gabbi | Apr 25, 2008 5:47:25 PM

Your questions are very good and reveal an understanding of the conflict inherent in a career in medicine. For some, medicine offers more than just a profession. Healing offers deep meaning to caregivers' lives. Medicine is a muse to a good number of artists and writers. Providing care teaches us about ourselves and about the human world we live in.

You certainly need not choose between medicine and family. It is however often necessary to maintain a tighter balance between your career and personal life when the hours are longer and stranger than in most other professions.

The questions you ask are really geared toward finding balance. I feel personally that I have a rather balanced life and wish to continue that. It is very important for all of us to find time to heal ourselves - no matter what we do. To bring in another idea, I think there is a good reason that sabbath, rest and meditation play such a prominent role in most world religions, and have for millenia.

As long as you know what is your the foundation, by all means, live (ans study!) in a way that nurtures that base!

Posted by: Thomas Robey | Apr 27, 2008 8:42:14 PM

hi Thomas.i read your reply and i think it does clarify my question.
i have a strong desire to care for the sick. i believe that is what gives me a real sense of purpose. a career as a doctor will enrich me and as you said help me understand myself better.however, there is no reason why i cannot do other things that make me feel good. i guess it is all a balancing act where you need to know your priorities. One must also be ready to sacrifice some things in life to acheive their goals. "you gain some and you lose some".
i personally feel that variety in life is very invigorating and it positively impacts on the all that one does. im not sure how much time i will have left outside work to engage in such activities but i am sure that whatever time i have i will put to good use.

once again thanks for your point of view Thomas. much appreciated.

Posted by: gabbi | Apr 28, 2008 1:24:38 PM

Enjoyed your post(s), Thomas. I'm a third-year student myself, taking some time off for health reasons (I have hereditary chronic pancreatitis, which means a lot of pain a lot of the time, and it sucks.) It didn't hit me until this year how hard medical school really is, and how much sacrifice it requires when compared to almost all other careers. For me, it's been an uphill battle mentally, physically, and emotionally. I am constantly beating myself up over something that I did wrong or could have done better, and worrying about what will happen the next time. My relationships and mental and physical health have suffered. They tell me it's worth it. I hope "they" are right!

Posted by: Kim | Apr 29, 2008 7:25:38 PM

thanks for your post, thomas. it brought tears to my eyes. glad you went. i went to my uncle's funeral during 2nd year. it was a pain in the ass to fly all day friday and again on monday and screwed with my exams, but i'm really glad i went.

Posted by: Katie | Apr 29, 2008 7:46:10 PM

You are so right, you don't have to live with regret the rest of your life by not missing your grandfather's memorial. When I was a medical student, I had both my father pass away and my grandmother. I gave up time to be with each just prior to their death, and those memories are priceless. I was an older medical student, already a grandmother, and had a lot of life experiences to draw on. You're doing a good job, and this is just another in a long experience of learning life's important lessons.

I really enjoy reading these posts from you students, keep up the good work!

Posted by: Suzy | Apr 30, 2008 9:16:08 PM

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