Everyone is a visionary

Photo: Greg Rakozy

Everyone is a visionary. Everyone has a vision, an image of who they are, of their place in the world. However, it is up to each individual whether their visions are grand or small, whether they aspire to new heights or prefer to remain within the safety of the known. Throughout history, the greatest people of each generation were defined by their ability to see a picture of the future that no one else could see and their ceaseless drive to make that picture into a reality. Every individual must have a picture of who they envision themselves to be in the future and what they envision the future to be like around them. Without such a vision, without this fixed point, present strivings are turned to meaningless motion within a sea of ambivalence.

Visions are dynamic, far from static depictions of two dimensional images at a single point in time. Each vision should be ever changing as the collective knowledge is ever changing and the outer reaches of human understanding are constantly expanding. Visions should change as new opportunities present themselves. Serendipitous occurrences should be taken advantage of with great enthusiasm. Thus changes in vision entail a retooling of the vision, not the loss of vision. 

Everyone is a visionary, many just have weak visions. Many fail to construct a compelling picture of who they see themselves to be in the future and an even poorer visions of the world they see surrounding them. Even more difficult, many fail to maintain that vision amidst the plethora of swirling distractions clamoring for their attention.

Clarify your vision, refine your vision. Be intentional about building a greater vision, and once it is build tirelessly strive towards that vision. 

Everyone is a visionary. 

Advocates

Photo by Brecht Denali

Ask anyone to name the most important people in their lives, those who have made the biggest impact on who they are as a person, on how they have grown over the years, and you will invariably get a list of teachers, coaches, parents, siblings, friends, employers, and the like. The unifying attribute amongst the most important people is that each role entails a staunch advocate, an unwavering supporter. Whether a teacher, coach, parent, mentor, older sibling or simply a good friend, each one takes on the role of an advocate. Cheering from the sidelines, pushing and prodding when one has all but given up. 

The classic role of an advocate is that of one who takes up the cause of another, who petitions on another’s behalf. It is the one who battles and wars for the benefit of another, who will not be silent or stand by when outside forces attempt to trample them underfoot. These are the lawyers who entreat on behalf of their clients, the loyal friends who look for ways to bolster one another up. These are the competitors who make one another better, mutually advocating for one another to achieve a higher goal. 

The outstanding advocates in our lives advocate not only on our behalf to others, but on our behalf to ourselves. These are the parents who consistently demonstrate uncompromising standards combined with unconditional love. These are the coaches who exhort towards excellence from the sidelines. These are the friends who say “I always knew” when success is achieved. These are the teachers who stay after hours to challenge their students, the free thinking pastors denying both culture and denomination in a quest for truth, meandering though the way may be.  

When we give up on ourselves, they remind us of our worth, our value, how far we have come, and the prize which lays at the finish line. When we overextend ourselves, they speak caution and calm, reminding us that a long journey is ahead. When we lose our way they are our compass. When we forget all that surrounds us, they are our map. 

The best people are advocates. The best part of a person advocates on behalf of another. Who are we advocating for? For whom have we come alongside to push a heavy cart and lighten their burden. For whom are we cheering for, willing on to success? Who knows that we are in their corner no matter what, there to prop them up, encourage them, and bolster them as they get back into the fight. Do we advocate on their behalf to others, and just as important, to themselves as well? 

In gratitude for the advocates who are in our corner, looking towards being ever better advocates for others in the future. 

Clarity and Energy

Photo by Anton Lecock

During an interview Satya Nadella, CEO of Microsoft, was asked what trait he looked for in new hires. Contemplating the question, he responded, 

“Do they create clarity? Do they create energy”  

Energy and clarity, two characteristics that are invaluable not only within the workplace but in all areas of life. 

Not only is the presence of energy and clarity inestimably valuable, but the presence of the reciprocal attribute is correspondingly inestimably detrimental. Apathy is contagious derailing even the best laid plans and strategies. Likewise confusion takes abundant energy and converts it to worthless drivel. To have only one is worthless at best and harmful at worst. Energy with confusion is mania. Clarity without energy is static. Start-ups often have an abundance of energy, a plethora of enthusiasm but lack the clarity needed to win in the long run. Likewise, ideas in academia often stagnate as there is great clarity to a project but little urgency within institutions known for tenure and long-winded discussions. 

Both energy and clarity are essential. Proverbs emphasizes this in contrasting stereotypes of the youth and the elder in chapter 20 verse 29. “The glory of young men is their strength, but the splendor of old men is their gray hair (ESV).”  During ones youth, energy is abundant. The struggle during youth is containing this abundant energy. The common encouragement for the young is to sit back, to think, to contemplate. Get a group of young people together and there will be plenty of energy with little trajectory. Conversely, the gray hair to which the Proverb refers, speaks to the experience and wisdom which comes from many years spent walking the earth. The common struggle for the elderly is to get going, to muster up the energy to get moving, to get things done. Energy and clarity are required at all ages, yet there is a proclivity to different ends of the spectrum at different ages. 

The first question must always be aimed inward. Am I someone who generates energy? Am I someone who generates clarity? Most importantly, are there areas where I am weighing the energy down through complaining and indifference? Are there areas where I am creating confusion through using too many words or perhaps because the plan remains unorganized in my own head? 

The second question is then aimed outward. Who around me embodies both of these things- bringing both clarity and energy to every situation. Conversely who around me embodies apathy and confusion? In what ways can we bolster the former and sequester the latter? The longstanding success of every endeavor depends on the combination of these two. With energy short term gains may be realized as energy is contagious. But clarity is required to build a long term trajectory, an organization that is capable of withstanding a changing environment. 

Proverbs 29:18 reads, “Without vision the people perish (KJV)” . Without clarity everything is lost. Proverbs 6: 10-11 emphasizes the importance of energy. “A little sleep, a little slumber, a little folding of the hands to rest– and poverty will come on you like a bandit and scarcity like an armed man (NIV).” Both energy and clarity are required in tandem.

Do I bring energy?
Do I bring clarity?

Guarding fire

Guard carefully the fire that burns inside you. Remember how feeble the flame was at first, how it quivered in the frigid air, how the slightest breeze threatened to extinguish it. Remember how you nursed it along, with bits of the choice fuel, using your body to protect it from the winds. Remember the feeling when it sprang to life and grew of its own accord, when the flame multiplied into a robust fire.

Do not take for granted the comfort of the flames, the warmth it provides for it can always be taken away at any time. Left untended, even for a short while, the flame, once robust and seemingly invincible, may slowly fade and die. Without fuel, without air, the flame will go out, returning your world to darkness and cold. 

Guard your fire with your life, for it gives your days meaning and your movements purpose. Guard your fire for it is your life, for without it your days are meaningless and your movements void. There are those all around who’s fire has gone out. Empty shells who continue on an uncontemplated trajectory simply because they know not what else to do, who trudge on because a body in motion will stay in motion and there is no force, no will, no fire to direct them in a different path. 

Guard your fire well, tend it with all your might and you will be kept warm on the coldest days and your vision clear through the darkest nights. Stoke your fire and fuel it well and it will light the fires of those around you. The fire that burns within you will provide the spark, the energy to activate a fire in your neighbor. 

Guard your fire well. 

Tend your fire with care.

Again

Repetition is the basis of excellence. Do it until you get it right. Keep doing it until you cannot do it wrong.

Repetition is where learning starts. As toddlers and children, repetition is how memory is built, muscles are developed into functional units, and how language is learned. The importance of repetition extends all the way to the masters and experts within a field. Malcolm Gladwell emphasizes this in the book “Outliers” where the 10,000 rule is noted; the idea that at least 10,000 hours is required to master a field or discipline. In many cases, the hours are likely significantly more. How much time is 10,000 hours? How many repetitions is that? How many iterations, are held within those 10,000+ hours? Striving towards mastery one assumes that extra effort, beyond the 9-to-5 is being exerted, with time in the evenings or on the weekends devoted to ones craft. At 60 hours a week, for 48 weeks a year, the 10,000 mark is reached in just under 4 years. Incidentally this is approximately the amount of time for an undergraduate or graduate degree. 

There are disparate reactions to this. The first is surprise at how long this is, the second surprise at how brief. If mastery is accomplished in significantly less than 10,000 it is likely a field in which mastery is not highly valuable. The emphasis here is that this is MASTERY, not merely competence. Whether medicine, computer programming, law, or any number of other tasks, basic competency can be achieved at or below 10,000 hours. Yet to be a true master, to be exploring the fringe of the known and the unknown, requires enormous repetition. 

Many attending physicians have incredible stories. Many have lived through many eras of medicine- some before HIV drugs were discovered, others when cancer therapies were still in their infancy. Even decades after a particular patient, they can envision specific patients, specific disease manifestations, or other interesting aspects in the case. Often they even remember the family of the patient. These repetitions, achieved over decades, not hours or years, are where true mastery is developed. 

Often repetition feels monotonous, like the background drone of an airplane. When it goes on for long enough there may even be a sense of futility, a sense of repetition without improvement or purpose. Perhaps there is a sense of numbness, perhaps even a loss of purpose for brief periods along the way. Yet it is in these repetitions that true mastery, expertise, is developed. Anyone can do something once. A blind squirrel will eventually find a nut. Only a master performs Every. Single. Time. 

Do it until you get it right. Keep doing it until you cannot do it wrong.

This is the basis of excellence.

Sleep on it

Waiting is the hardest part. Waiting 24 hours can feel like an eternity. In a fast paced world where responses via email, text, or social media are expected around the clock, pausing, contemplating, and allowing the situation to settle is one of the most difficult things to do. There is a pressure, a tension nagging in the back of the mind, a compression within the chest compelling a response- any kind of response. 

Alarms for one patient in the intensive care unit were going off. The patient was incredibly ill and had many drips and machines supporting multiple organ systems together attempting to correct  the radical imbalances which he had developed. With multiple alarms sounding and staff members nervously moving around the room, the temptation was to go into the room, become overwhelmed by how ill the patient was, panic, and make a large number of changes to the drips, ventilator settings, and other machines in hopes that something would change. After making one change to the ventilator, with alarms still going off, the attending simply said, “Let the patient settle”. The team walked out of the room and allowed the patient to settle, while intermittently checking back in throughout the day to ensure that the changes were ameliorating, not exacerbating his overall condition. An important change was made and the patient required time to equilibrate to this new adjustment. Valuable information could be obtained from observing the patient’s response to the change. That said, no information would be gained if many changes were made simultaneously as it would remain entirely unclear what changes resulted in improvement and which changes resulted in decline. 

There is often the feeling that something must be done, more often that multiple things must be done all at once. There is a pressure to act. Whether it is an email, a phone call, something we read in the news, or an in person meeting, there is a pressure to generate a prompt response. There are many times when this first response is not the correct response, and can do much to worsen a situation, even more than doing nothing at all. Instead of the reflexual flail making a deliberate change and then allowing time to settle is often the only way to make meaningful forward progress.

In basketball there is the principle of letting the game come to you. The default is often to feel the tension and importance of the game and then to begin to attempt to push. This results in forced plays, turnovers, poor shot selection, and a frenetic sense of anxiety amongst teammates- the opposite of a flow state. Letting the game come to you means waiting for the open shots, practicing the fundamentals while looking for opportunities, slips by your opponent. Letting the game come to you means biding your time, observing the court, and then acting deliberately when the time is right. 

Constant reaction is replaced with deliberate action. 
Variable emotion is replaced by intentional motion.
Haphazard flailing is replaced by purposeful work. Let it settle. 

Sleep on it. 
Wait. 
Your time will come. 

Breadth and depth

Jack of all trades, master of none is the unfortunate default state. The beauty of specialization is that one can get better products and services for less time invested. Complete ignorance is discouraged as a cursory knowledge of what exists is required for productivity and establishing oneself within a relevant context. Furthermore, knowing the place or the people to whom one would go for help, to learn more on any given topic,  is of course hugely beneficial. It is difficult to collaborate on a project or to seek help with a particular problem or question if one is unsure what technology exists and is available. One pitfall after realizing that something exists is the perceived need to become competent in a particular piece of technology or a particular skill. Exerting excess time and energy to gain unnecessary competence unfortunately negates the benefits of specialization and either decreases the quality of the product or service or increases the time and price at which the result is achieved. One may have a working knowledge of computer programming which may aid in communication, project design, and the selection of the team with which one works, however one would be foolish to spend one’s time attempting to learn, then perfect and implement the coding themselves. 

Success in the near future depends on the ability to identify opportunities and then work well with other team members from different backgrounds in order to achieve the goal. Being able to communicate well with members of other fields in order to harness the unique expertise and perspective from each individual field is vital. The list of hospital tasks in which a physician does not have expertise far outstretches the list of tasks for which a physician does have competency. For example, swallow evaluations, starting parenteral nutrition, determining the range of mobility and assist devices which would most benefit a patient, and compounding specific medications for administration are all outside the physician’s wheelhouse. And that is okay. Recently on rounds in the ICU the team outnumbered the patients by a significant margin. The rounding team was about 15 strong- enough to start a couple of basketball teams. The goal of any member of the team is not to become proficient in all the tasks and all the aspects of patient care, but rather to have expertise within their one area with enough knowledge and appreciation of the other aspects that they are able to work amicably and synergistically with all other members. Dietitians are not asked to interpret EKGs, start central lines, or declare patient’s deceased. Physician’s are not asked to perform swallow evaluations or conduct strengthening exercises although are certainly expected to recognize the general theory and importance of each discipline and identify patients who would benefit from such interventions. The goal is not to do the every job- that is simply wasteful redundancy. The goal then is to be able to understand the overarching principles of each job to enable teamwork and enhance productivity. Ultimately, the competency goal must be “Works with all trades, Master of one”. 

S2.14 Choosing to stay

A common refrain heard in medicine is “I should have done ________” or “I should quit practicing medicine and do _________.” The sentiment is well taken. The hours are long, the years of training are substantial, and often the job description and responsibilities have grown while the benefits and perks have decreased or stayed the same. However in many ways this sentiment also rings hollow. There is always the opportunity to change jobs, to move to consulting, to work in research, or to just do something else altogether. If one truly believes that they should have done something else or truly wants to quit medicine to do something else, they can easily walk away and into a myriad of other opportunities, different fields where a 9-to-5 schedule and weekends off are standard and where one does not encounter people dying on a daily basis.

Yet overwhelmingly, physicians choose to stay. They choose to stay because it is a calling, not a career. They stay because there is a camaraderie among healthcare workers not found in the 9-to-5. They stay because medicine is unique amongst the other careers in the diversity of encounters, in the interesting problems, and the even more interesting individuals you meet along the way. The frustrations with the job and the healthcare system are because physicians care, because constantly correcting the imperfections in the system matters, because for all of the flaws, there is no better career or calling in the world.

S2.13 What If There Was Silence

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What if on the last car ride before the end, the last moments at the bedside, the last roll down the hallway there was only silence. What if there was no scramble to get things in order, no panicked attempt to remember everything that must be done. What if there was no hurried goodbyes compressing everything that should have been said over decades into a handful of minutes. What if there were no desperate attempts at reconciliation, no last minute need for apology or the appreciation that should have been voiced long before. What if there was silence. 

Silence because everything that should be said, that wanted to be said, that needed to be said had already been said. Silence because every expression of gratitude had been made, every appreciation made known. Silence because every implicit  affection had been made explicitly known. Silence because every grudge had been released, any anger extinguished. Silence because every question had been asked, every concern given voice. Silence because every future plan had been made every detail worked out. Silence because every “one more thing” had been taken care of. 

What if instead of the frantic phone calls, the hustle to get things ready, to cram everything into the final few minutes, there was peace. Instead of doing there was only being. Instead of words there was only presence. What if there was silence, and the silence was enough. What if there was silence, and the silence was perfect. What if there was silence.

S2.12 Be Like The Firefighter

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The critical, title job of a firefighter is to fight fires. Thanks to many improvements in building codes, preventative measures, technology, and awareness, the number of fires has dramatically decreased. Thus the role of the firefighter in the community has expanded to become that of a first-responder to a variety of situations including motor vehicle accidents, paramedic response, and other rescue operations. While not performing these duties or training to perform these duties, there is often a significant amount of downtime at the fire station during which they must be on the premises but are otherwise free to engage in the activity of their choice. Cooking, cleaning, working out, playing games, and watching movies are often among the options. However chatting around the dining area is also one of the preferred past times. 

Sitting around the fire station table talking with a number of firefighters I was pleased to find a high diversity of opinions and world views as well as a genuine curiosity and desire to learn more. The extra down time at the station meant that many were well read or studied on many subjects from science to religion to sports. One Sunday I talked with a firefighter who was an atheist who was interested in many topics in science from origins to gene editing to the impact of diet on health. Later that day I spent several hours talking about conspiracy theories with another firefighter, a friend of the first, who believed the earth was flat. Each of these “debates” were friendly, curious, genuine, and colloquial. As the firefighters live in close quarters for extended periods of time in a sometimes stressful environment, they have learned the art of pleasant discourse and courteous disagreement without any of the acrimony and vitriol that has seemed to permeate our culture otherwise. 

While stating your point and making an argument it was completely acceptable to disagree but personal jabs were discouraged and the zingers that would normally make the highlight reels on YouTube were out of place. Everyone was attentive to the interpersonal drama as well as the sparring of knowledge. Importantly, no one cut off the discussion or stormed out (unless there was an emergency of course… then you went to the call and picked up wherever you left off several hours later). This is the type of discussion, and disagreement, that we should all be building towards. The type where you can disagree but will not walk out. Where you care more deeply about the relationship than the win. Where your understanding of truth is important; as is being able to clearly understand the other person’s understanding as well. Consider how your arguments would be different if you knew you were going to be fighting fires, cutting apart cars, eating, sleeping, and laughing with that person across from you for days at a time. Be like the fireman. Discuss and dispute like the fireman. Be relational like the firefighter.