On Pacing


DSCN0030 long distances there is a sense of panic and urgency that can sneak up at unexpected times. It is an insidious breathlessness that creeps up when you are not paying attention. Beginning with a slight feeling of discomfort and a desire to get to the finish line faster your pace picks up a small amount. You extend yourself just a little bit too far with each stride. This discomfort increases the desire for the end and the pace picks up a little bit faster and the strides become just a little bit longer. Twenty minutes of this slow acceleration with deteriorating form leads to a feeling of frantic breathlessness accompanied by a confusion as to how things went downhill so fast. The key at this point is to drop the pace, to focus on your breathing, even to walk at an aid station if needed. To recenter, recalibrate, refocus. Resetting the stride at this point, reaching a rhythm in your breathing, and recognizing how much farther you still have to go is essential to finishing, and finishing well.

The same can be said of many other aspects of life. Slow increases in stress or hours at work push us at a pace that we cannot maintain. We begin to lose the enthusiasm, the why, that is crucial. Weeks to months down the road, we end up burned out, gasping for breath, unsure if we want to continue or even if we can. The journey is no longer fun, and our pace keeps increasing at a frantic rate to try to get somewhere, anywhere a little bit faster so maybe all of this can stop.

In running you can use technology and intentional self-awareness to avoid the breathless panic. Watching for spikes in heart rate and paying attention to the rhythm of your breathing are essential. But it is not enough just to pay attention, you must also adjust. Slow your pace, enjoy the view, take in some fluids and nutrition. The same is true in life. You can track markers like work hours and do gut checks from time to time, but you also must be willing to change. To leave early and take a weekend off. To drop everything for a day or two. To take advantage of the slow times to regain your breath. To settle in for the long haul and make accommodations so that the long haul becomes a journey of joy instead of a painful slog.

After all the tortoise versus the hare is best understood not as advice for a day-long run but a lifelong pursuit.

What is your metric of success?



How do you judge if you are doing well or poorly? How do you know if you need to change something? How do you decide what the right course of action is? Is it the feedback from your boss? The surveys from customers? The smiles of patients? The profits that come in? The respect of those who are important to you? Most people, including myself, cannot provide a logical and concise answer to this. In reality for most of us the answer is probably yes… all of the above. We take surveys, feedback, smiles, profit, and respect, run those past the internal compass of who we are are and what we believe to be important, and then judge ourselves based on that.

The third year of medical school is the first clinical year. The first year in the clinic and thus the year at the bottom of the hierarchy. In medicine, as with many other fields, things can be right for two reasons: One, there could be empiric evidence supporting the fact, or Two, there is no empiric evidence but only the preference or dearly held belief of someone higher up the ladder. The point of education is to gain the first and disregard the second without damaging the tender egos above. Reading Ayn Rand (The Fountainhead and Atlas Shrugged) while in this environment is simultaneously amusing, ironic, and bewildering. Yet it also is centering. Although Rand’s ideas are not all correct, the radical juxtaposition of her ideals and modern medical education is enlightening. It highlights what aspect of the education that really matters, in this case excellence in evidence based medical practice and a deep personal enjoyment of the work, and what does not matter at all, in this case petty arguments,  myopic practitioners, and patients who refuse to take responsibility for their own health.

So whether the field be medicine, law, business, or any other field, slowly yet intentionally developing a base of empiric evidence and discovering a personal pleasure in the task is the most important method of judging success. Everything else, feedback, surveys, and profits are superfluous and peripheral if they do not align with first two.

A simple guide


Everyone is constantly offering their advice and their opinion about how you should act. And no matter how strongly stated, it is just that- their opinion. People can be displeased with you. Scratch that. People WILL be displeased with you. There’s no avoiding that. But very few people, far less than we imagine, can actually impact our lives in a significant and negative way if we do not let them. Reading biographies of successful people, they all had habits, opinions, and preferences, many of which do not align and often contradict. Elon Musk has mentioned on several occasions how rude Steve Jobs was to him when they met. Even beyond the obvious competition within the computer industry, the personal lives and habits of Steve Jobs and Bill Gates could not be farther apart. George Washington and Alexander Hamilton had a dramatic falling out after many years working together closely. Even Lewis and Clark strongly disagreed at points in their famous journey. Some people tell you to be deferential and mind your place, other urge you to be bold and to make your presence known. Some are all about book knowledge (most great people have been voracious readers), while others count on experiences to teach them all they need to know. People who have done well have opinions. People who have done poorly have opinions. People who have no idea what they are talking about still have opinions. Many people think your goal in life should be to become just like them. Others just assume that your goal has to be the same goal as theirs’.  

I realize the irony in prefacing my advice with an argument that we should discard many of the opinions of others. So instead, consider this as guidelines for myself, should I lose my way in the sea of voices:

Approach every new endeavor with curiosity, interested and ready to learn new things. Allow experiences to change you but hold tight to the core of who you are. Work hard with a tenacity and a resilience that few can match. Be humble with your head up and your shoulders back. And finally, be grateful for the opportunities and the people around you.

Confession and Gratitude


For every apology, for every confession, for every step of repentance, there must be an equal amount of gratitude and thanksgiving. With only confession the Christian recognizes the woeful inadequacies that drive us to the bottom of the pit. Without thankfulness for what He has done in our place we stay within the pit and slowly dig deeper without seeing reprieve or hope. With only thankfulness we are not able to fully articulate and celebrate that for which we should be grateful. Without confession for what we have done, we fail to see that on an hourly or minutely basis we willingly choose to jump back into the pit and cannot fully see to what extent we should be grateful. These two work together, linked to show us simultaneously our depravity and his grace so that we are neither crush beneath the weight of our failings nor inflated to subscribe to a hope in our self-sufficiency.

Virtual bubble


While the internet has connected us in many ways, it has also made it much easier for us to find and congregate with people who agree with our ideas and our opinions.  We carefully curate our social media feeds and populate them with people who are often very similar to ourselves. The social media companies suggest material, advertisements, and friends that they think best match us. And they certainly do not present us with people or ideas with which they think we will dislike and disagree. Often we don’t even see this when it is happening. Take the last election cycle. Many people were amazed that Trump won. Within many liberal, urban centers there was a sense of shock at the results of the election. In academia, which now is broadly notorious for the liberal skew, many people couldn’t name many friends or peers who would vote for Trump. Everyone’s feed from Twitter or Facebook is an extremely poor representation of the larger population on nearly every topic. Instead of promoting diversity of thought and diversity of opinion, some areas of the internet have enabled a paucity of thought and a clustering of yes men (or women) who congregate in the same virtual areas. Perhaps even worse, when we do encounter the ideas and opinions of people with whom we disagree online, this is a caricature of the whole person and the method of communication is starkly one dimensional without many rules, non-verbal cues, or incentives to be courteous and give the person the benefit of the doubt. I still have yet to meet someone who got in a battle over Twitter or Facebook and who was won over through the sound reasoning and convincing rhetoric of the other side.

So find friends, online or offline who disagree with you. In the words of Thomas Jefferson, “I never considered a difference of opinion in politics, in religion, in philosophy, as a cause for withdrawing from a friend.” As much of our lives now involve some aspect of internet based technology, so the bubble we are has enclosed this space as well. In a digital age that pushes us away from people unlike ourselves, this becomes a task in which we must be constantly intentional. Both offline and online engaging with real people with ideas and beliefs different from ourselves is not an accident. It must become a habit critical to our growth and our identity as citizens of the global community.

Drifting a river or overcoming enemies


We all have people we agree with, books that we love, and schools of thought that we endorse. When you read a book or hear a speaker and agree, it is empowering and encouraging- you want to do it again. I recently read a book by Jocko Willink titled Disciple Equals Freedom.  I was all about the ideas, the drive, the motivation. There was a book, perhaps the polar opposite of Jocko’s book called Blue Like Jazz written by Donald Miller a number of years ago. Blue Like Jazz is a book that meanders its way through the story of the author through the different adventures and experiences he had over several decades. Donald’s approach to life could be summarized as going with the flow and slowly drifting down the river of life enjoying the feeling of the light breeze. Jocko’s approach is better summarized as mental toughness and meticulous planning are key (As a former SEAL, I think he mostly means in enabling you to kill all your enemies…but there are parallels to less intense things as well). People are wired differently. People who are all about intensity and discipline love Jocko’s book. People who enjoy the experience and the journey are all about Donald’s book. However this is probably opposite from what these people need to hear. Those who are drifting down the river, beer in hand, would benefit the most from the discipline and planning of Jocko. Whereas those who love the grind in their home gym and overcoming challenges would benefit from being dumped in a slow flowing river with no cell service next to Donald. The sad part is that we often skip the books that would benefit us the most and even when we do read them, we forget to take to heart the parts that would be most valuable to us because they don’t agree with our current way of thinking. So read an author you don’t see eye to eye with. Or read a book that’s not right up your alley. Ask yourself what you can take away to become a better person. After all, you can always go back to working out and plotting ways to overcome your enemies another day. And the river will still be flowing and the beer will still be there for you to come back to.


The long haul


Things in the zeitgeist are not the things with which you should be primarily concerned. There will always be another hot topic, another cause of public outrage, another new theory to consider. This is certainly not to say that the things in the popular discourse aren’t important. They certainly are. But, the zeitgeist is fickle and pet topics fleeting. If you have found the cause or topic you are passionate about, stick with it, while it is popular, and perhaps more importantly, even when no one else is talking about it. Be an independent thinker. Do not be bullied by the moods of the masses. The numbers take years to change whereas the twitter feed is constantly shifting. The problems and causes that were popular years ago, are often just as much a problem today as they were then. The problems today will continue to be a problem even when they are not trending on social media anymore. Pick a cause where you don’t care about the tide of popular opinion. If that is immigration, awesome. If it is healthcare reform, great. If it is a rare disease, fantastic. If it is accessible education, good. If it is addiction assistance, sweet. But if your list of causes mirrors that of the news feed or the top tweets reevaluate. Public campaigns come and go, but the real problems last much longer and the solutions require years and decades. We need reformers and advocates in each area who are dedicated to the long haul, to doing whatever it takes, with no regard to whether it is popular. This is how you win a war, change the culture, and make a difference.

Are we happy?




We have become a culture concerned with happiness. If you are not happy with your job you are encouraged to look for a new one. If you are not happy with your relationships you are encouraged to move on. If you are not happy with your home, your car, or any number of things you are encouraged to change them in order to become more happy. Advertisements are based on the idea that some new product will make you happier, assuming of course that everyone’s goal is to be just a little bit happier.

And happiness is certainly a good thing. If you are consistently making decisions that make you less and less happy you should probably change some things. Yet the problem is that constantly checking the barometer of internal happiness is a self-defeating exercise. The more we are concerned with our happiness, the less happy we often become. “Am I unhappy?” followed by “how could I become a little more happy” becomes our obsession. And with no clear end goal, this becomes an ultramarathon we cannot win. Imagine running a marathon. Every 10 seconds or so contemplating “Are my legs tired or hurting?” Of course the answer is going to be yes at some point. And constantly thinking about that pain is going to amplify the perception of the discomfort.

One area of our lives in which this problem has become prominent is in romantic relationships. The search for a future partner has become, in many ways, like looking for a new television or car. The argument in favor being that, because we can often get a superior television or car by comparative shopping, the same should be true for a partner or spouse. On the surface this seems like a great plan. However, consider what you do with your new television or car. You’re happy with it for a bit but as you use it consistently you ask yourself if it is better and you are happier. You notice that the blue-green ratio of the screen is off, and that it doesn’t quite fill out the space that you were hoping it would. You realize the seat heaters only warm your butt and not the lower back like you were hoping they would. Worst of all you start to hear a squeak in the dashboard. Asking these questions you forget about all of the things that are great and begin making a list of things you will make sure the next television or car has. With a television or car this system is less than ideal but clearly not disastrous.

However, t is disastrous in our relationships to constantly be thinking “Is this making me happy? What do I dislike about this person?” Now occasionally sitting down and discussing your relationship is good, but constant contemplation of happiness and unhappiness is toxic. Unlike the car or the television, building something great together is the goal, not momentary happiness. Unlike a car or television you are not looking for someone to replace after a few years with a newer model. You are looking for a partner, a friend, and someone to build something great with. And incidentally, true happiness is often found in this, and not in the frenetic search for someone to please you in the moment.

On Selecting a Mentor


Irving Weissman, a Professor at Stanford, member of the National Academy of Sciences, and a prolific scientist specializing in stem cell biology, had lunch with a handful of students following one of his seminars. As we were talking, he asked what we thought the most important criteria for selecting a mentor should be. Trajectory of past trainees was the answer. This is the simple litmus test everyone should consider when looking for a mentor and is applicable across fields.

Having completed my PhD I realize how fortunate I was to have a good mentor. Yet I recognize I stumbled into that more by luck than by methodical planning. Had you asked me what the most important criteria for selecting a mentor was five years ago I probably would have replied with a non-specific combination of adjectives from Mad Libs such as “smart, well-funded, collaborative” or perhaps the worst “nice”. Not that these things are not important. You certainly do not want a mentor who is the opposite of these “dumb, unfunded, solitary, and mean”. However, these criteria do not generally differentiate between mentor. The trajectory of previous trainees tells you how invested the mentor is into propelling you into a career, how well they know how to train (teaching is as important as being a content expert in this regard), and if they have the resources to help trainees complete their training.

Let’s revisit the “nice” criteria for a moment. You are picking a mentor who will function as a coach. You want someone who invests in you, speaks truth, motivates, sees your weaknesses, and pushes you harder than you think you can be pushed. Training is precisely that. Training. If you were in boot camp you don’t want a cheerleader, you want an experienced instructor. If you hope to be an world class athlete you don’t want someone who hands out water breaks and foot rubs. You want to be made excellent. In the boxing ring or the octagon you don’t want a yes man (or woman) but someone ruthlessly pushing you to become better. Now nice people are important as well. Find faculty to meet with occasionally who are nice and who don’t always push you. Find fellow trainees who are your friends regardless of how you are performing. These are the people in the stands, those rooting you on. They are nice! Always encouraging even when you are playing the game poorly or losing. But down on the field, pick a coach who knows the stakes and makes you perform at your best. One final note, sometimes “nice” is simply a mask for indifference. If you make it through training without frustrating your mentor and without your mentor frustrating you, this is less than ideal although it may feel better. My PhD mentor and I ruined each other’s weekend or evening every few months which is part of the cost of working hard together on something you both care about. If your mentor is “nice” when you are inefficient and ineffectual and is complacent about you working towards something great, this is indifference and is one of the most toxic things in a mentor-mentee relationship.

When picking a mentor, pick one who has a proven record as an invested coach and effective instructor.

One at a time




One at a time.

One day at a time. One run at a time. One mile at a time. One step at a time. Any task can overwhelm even the most talented, competent, and prepared individual if they try to do everything, all at once.

In a long distance race, thinking about every mile while standing at the start line is terrifying. Even more, standing at the edge of the water before a triathlon thinking about the swim, then the hours on the bike, then the many miles of running. Mentally, it is the stress of doing all three disciplines at the same time.

Occupations can be the same way. To become a physician or scientist many stages of training are required. If you want to do medicine and research, the problem is further compounded. Undergraduate education takes 4 years, a PhD or MD take around 4 years (or combined 7-9 years). Then comes at least 3 years of residency, often followed by 1-3 years of fellowship, and for the research minded, a 3-4 year post doctoral fellowship. It’s like graduating from your undergraduate work and realizing you have to repeat kindergarten through 12th grade all over again. Just writing all that down in one place is enough to elevate the stress levels. No one could finish that training by waking up every morning and counting down the days (The count at the end of undergraduate work would be something like 6,200 days left). Planning ahead but also taking each challenge as they come, not mentally all at once, is essential.

The same can be said for other life events. Launching into a responsible adulthood does not mean buying a car, getting a mortgage on a house, finding your life companion, starting a retirement account, and getting a salaried job all at once. It means gradually progressing towards the long term goal of independence.

So whether in a race, an occupation, or life in general, it is important to take the next step without fighting every battle and taking on every future challenge all at once.

“Do not worry about tomorrow, for tomorrow will worry about itself. Each day has enough trouble of its own.” (Matthew 6:34)

This however, is often easier said than done.