Being true to our younger selves

My alarm beeped at 5:00 a.m., and I was instantly awake. I roused my sister, and we donned our jeans and rubber boots before heading outside in the dark. Gravel from our driveway crunched underfoot as we hurried to the barn, banged on the wall to encourage the rats to hide, and flung open the wooden door to retrieve the feed and hay for our mares. We sat on the steps waiting for them to finish their breakfast, anticipating the joys of our daily trail ride. The air was already warm and thick with humidity in the Mississippi summer, and if we didn’t get the horses on the trail with the sunrise, it would be too hot. Tack on, we mounted and sauntered down the road, taking an easy pace for the first hour through Mr. Buddy Crawford’s pastures to the beautiful old pine forrest trails. The mystical beauty of the morning and perfect harmony with my horse, Naomi, filled me with joy every day of the summer. As we emerged from the woods, a long straight stretch of unused cornfield made for the perfect runway, and my sister and I raced our horses across. Naomi responded to my voice command, “GO!” with unbridled enthusiasm, and the thrill of galloping across the flat grass course was like no other. At the end of the ride, I could tell she was just as happy as I was. This horse was my soul-mate; she came when I called, sensed my moods, and would follow me anywhere. She was easily spooked, but I knew all of her quirks. We returned to the barn and went about our day, watching the antics of our goats, dogs, and cats, and always looking for more adventure.

At this phase of life, around age 8-10 years old, I simply knew who I was, what I wanted, and what I liked. Shortly thereafter, around middle-school, my self-consciousness soared while I became thoroughly confused about what I liked and wanted. Unfortunately, that “phase” of life continued through high school and in some form through college, and young adult life. I made decent decisions for majors, friends, career, life-partner (ok an astonishingly fantastic decision on that one!), but I didn’t have that effortlessly pure, distilled sense of who I was. I also didn’t realize that this was the case, until I faced my own big monstrous burn-out during residency. This topic deserves it’s own post, which I will eventually write, but for now suffice it to say that it took months for me to work through the challenges associated with it, and when I was finally emerging from those doldrums I had a burning question constantly on my mind: What would my 10-year old self think of me now?

It was hardly a rhetorical question, and I had lots of answers. First of all, I would have been appalled at the lack of book-reading happening. As a child, I devoured stacks of fiction-book series. I read in my room, in the car, in the yard, in trees, at night, first thing in the morning, on the bus…I was a bookaholic. If I recall correctly, I was into several equestrian stories, maybe had just finished all the Boxcar Children, Baby-sitters Club, Chronicles of Narnia, and Saddle Club books. Anyway, at the point of my burn-out recovery in residency, i hadn’t read a novel since 4th year of medical school, when I read one chapter each night of War and Peace to help me fall asleep; it took me about a year to finish (short chapters) but I loved the ritual.

I also would have been perplexed as to why I didn’t write more. I always enjoyed journaling and writing stories, and even through high-school and college I nurtured the interest and skill in writing. I took AP English and was an English major in college; I wrote all the time. Even as a math (double) major, I wrote an honors thesis (on Non-Euclidean Geometry), which is just to say, I worked in writing at every opportunity. As a med student and resident, I never wrote anything except daily notes and H&Ps.

The next one was even more painful to admit to that little girl of my past…I had grown up into a woman who was too busy for a dog. This was a profoundly sad realization, and was decidedly the catalyst for springing me free of the burnout and depression because I made his resolution: “If I’m too busy for a dog, I’m just too damn busy and something has to give.” I decided then that this would be one of the barometers of my life to keep things in balance. And I adopted, and got adopted by, my soul-mate dog Ramble. (If you want some insight into how low I felt at this point in life, listen to the song, “Too weak to Ramble,” by Dr. Dog, which inspired his name.)

My first hike with Ramble, when the sun literally and figuratively came out for me.

Maybe one last big one would have been participating in humanitarian work and travel, essentially being connected to current events. I had picked cardiac surgery as a specialty and was pretty determined to not fall back on what I felt was a commitment to that field, but increasingly I felt that trauma surgery was so much more intricately connected to the community and current affairs, which I was very interested in. I did go on a trip with a cardiac surgery group (Novick Cardiac Alliance, which is a fantastic organization I will write more about in future posts) to Ukraine, and learned a lot there about delivering superb quality, highly advanced surgical care in a developing country, but I was much more interested in what was going on with the folks being bombed at the border than with the cardiac stuff. I hadn’t really made being an activitist in global health topics a priority with my time and efforts to that point; I was just trying to “get through” training.

Me in Kharkov, Ukraine, with a tiny patient in the ICU awaiting her procedure. We had to hold/bounce/jiggle her to keep sats up before surgery.

Ramble and I went for hikes every weekend that I was free from work that spring, summer, and fall. His influence on my life was profound, and taught me to be open to sharing my time and energy with the right people (and creatures). I also wrote a couple of articles for a local independent journalism group. I picked up some good books to read. I started the first Global Surgery Journal Club at Mayo Clinic in Rochester, and networked with some awesome surgeons and residents who had similar interests. I’ve never had a recurrence of burnout or depression. 

So many people go through similar growing pains in their early 30s, it’s almost a cliché. But the transformation was real, and was about taking back my life in small ways, and stopping that utter neglect of all the things that made me “Me.” But where am I going with this long,  long post? What’s it got to do with Indie Docs, or Global Medicine?

Learning about myself, what I genuinely like, how I truly want to spend my time, has been a challenge and has developed some skills of insight. It almost feels like a muscle that started out pretty weak those few years ago. It can be quite stressful to trust myself to step off the prescribed path of daily routine or academic medicine, and even more-so for choosing a really unusual career narrative.

Josh and I have discussed the subject, “What do we want our lives to look like in 5 years,” countless times, and we are still discovering the answer.

Fortunately, through her interview on the ChooseFI podcast, I discovered Jillian from Montana Money Adventures. I started working through her mentoring worksheets, and I was blown away by the insight they provided me. I asked her permission to use the worksheets as topics for discussion here, to which she has graciously agreed. So in upcoming posts and maybe on some podcast episodes, Josh and I will use her mentoring worksheets to answer the questions of how we are purposely designing our lives, engineering our time and finances, and thinking about the future in order to be true to our most quintessential goals (doing humanitarian medicine!)

I gave birth to a beautiful baby girl this past week. I’ve designed my year so that I get lots of time at home by taking a research position rather than an attending job. I’ll be doing some locums assignments as well to keep my skills sharp and gain experience, but doing this “off-year” was one decision I made that may have been different than what most surgeons would think is the right way to spend my first year out of training. With our unique circumstances, and how much fun I am having with my girls AND with stretching my skills as a researcher, and I’m secure in knowing that I made the best decision for us.

The ability to answer these simple questions of what we really want in life will be central to making sure we make the right decisions about what jobs to take this year, particularly in order to facilitate our bigger goals of making humanitarian medicine a major part of our lives. The decision could enable us to have the freedom to pursue many global surgery projects, or strap us to confining responsibilities.

There are trade-offs to every scenario, pros and cons to weigh, futures to consider (the girls’ in addition to ours), and plain old money questions. But all of those specifics take a back-seat to the simply being able to know and do what will make us happiest and give us the deepest sense of purpose.

With the help of some great mentors this year (stay tuned for that!), I am certain that we will find the right path.

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