am i good enough?

I live in constant fear of not being enough.

Smart enough. Successful enough. Nice enough. Pretty enough. Good enough at karaoke. Every dumb thing you can think of.

This is what makes your 20s difficult. On the one hand, we see people who are able to create amazing things, smart people who build enormous value in the world. We see the Facebooks, the Googles, the 30-under-30 lists that set off a mental ticking clock in my head, reminding me to hurry. That my time might be running out. 

“Tonight I am worrying that other people have greatness and there is a finite amount of greatness and it is slipping out of my hands. Also, it is embarrassing to admit to wanting greatness knowing there is a risk I might not achieve it.” - Penelope Trunk

This is an incredibly hard post to write. I’m anxious about being imperfect, which makes me anxious about being anxious. But my anxiety has stopped me from writing perfect and glossy posts about snowboarding and design strategy, technical diligence, serendipitous space. So I’m trying to be vulnerable. Imperfect.

Some days the anxiety eats you alive. Stops you from running in the rain at 6 AM. Stops you from returning a phone call. From going to wine bars with friends on Friday nights because you’re curled up in the fetal position listening to Jack’s Mannequin. Right now, my anxiety is like that. 

I have an unbelievable amount of self-doubt at the moment. I live in constant fear that the scope of my ambitions so completely outweighs the scope of my abilities.

Last year I was named to the Council of Outstanding Young Engineering Alumni. Placed on organizational “High Potentials” lists. Invited to speak about success, leadership, and women in technology at half a dozen conferences. And last Tuesday my nomination to the Board of Trustees for the Georgia Tech Alumni Association was announced, making me (as my friends like to remind me) one of the youngest trustees, maybe ever.

We all have our own insecurities. 

I’ve learned that the last thing I should do when I get anxious is shut down. And the first thing I usually do when I get anxious, is shut down.

So I push. I push in ways that aren’t easy, or comfortable. I push myself to publish posts, when the last thing I want to do is share any part of my soul. I push myself to learn to snowboard, when I could be perfectly comfortable, perfectly safe, perfectly good at skiing. Push myself to share my thoughts – all of them, the mundane, the hopeful, the anxious, the silly - with two friends on an obscure social network, at the risk that they’ll see all my insecurities and think less of me for it. And then I deactivate my Path account because there’s only so much pushing I can take.


Thanks for responding to this, Elli.

I push myself to remember that it’s ok to have insecurities. Even if other people think you shouldn’t.

Elli reminds me all the time that if we were perfect at what we are chasing, that we aren’t chasing the right things. 

He came to see me last week. After taking Step II of the USMLE, three weeks before graduating from one of the best medical schools in the world, before moving to Philadelphia, after an 8 hour test. He sat on the couch in the living room at 1:20 in the morning and reminded me, in a still, small, voice, that I’m only 25. That the world still lies ahead. That I am enough.

“We are the daughters of feminists who said ‘you can be anything’ and we heard ‘you have to be everything.’ “ – Courtney Martin (stolen from Kontrary)

My ambitions have always been greater than I can justify. To write world-class content. To develop technology that saves millions of lives. To empower billions of people out of poverty, out of hopelessness, and into a situation that preserves their dignity, that removes shackles, that brings people along. I don’t know that I have the ability to do it. I don’t know that I’ll ever get there. But I’m trying. 

A still, small voice.

You are enough.

the conflict of hurting to heal

Elli was in town this weekend (he hates it when I call him that, but some habits die hard). I’ve been meaning to share his post for quite some time, but haven’t found the right words to introduce it. I remember it often when I’m in the hospital. Sometimes I get the thrill of seeing my designs and devices on patients, but I’m often immediately brought back down by the realization that to see my success is to see their suffering. Elli’s words are humanizing - a reminder of the “conflict of hurting to heal.”

Having a thug contest at Cypress Street. The Lou is no match for A-town.
Current location:Third Floor Carrels
Current mood: thankful
Current music:Pandora
Sport

In the past two days, I’ve had a lecture/case study and read about ALL. This reminded me of my first patient, our anatomy cadaver. Although we couldn’t help him in any way, I certainly hope that all he taught us will help countless patients during my career. I wrote this about him for the Cadaver Memorial Service at the end of our first year.
For Sport
We have been told that our patients will be our greatest teachers, and we will always remember him as our first patient and surely one of our greatest teachers.
The bulletin board called him, “African American male, age 20, acute lymphoblastic leukemia.” We found that we wanted to know him better than that. We started by looking at his face. Some of us needed to see his face the first week, so we pulled back the cloth and stood in silence, taking in his features. Others just saw the contours through a freshly wetted cloth at the end of the day. Either way, he became more than a body to us, he was a person, and as we pulled him apart piece by piece we felt the conflict of hurting to heal, of having to harm and invade our patients to try to make them better. With him the conflict was even more poignant as we harmed a man we could never heal. On the day we began to dissect his face, one of our group members cried. The rest, though stoic, understood why she was crying. We called him Sport. It took some time for this nickname to catch on. We first spoke of him in hushed tones, with no name at all. We came to know him too well for him to not have a name, so we gave him one. Eventually, we found that the nickname Sport fit him much better than anything else we could have thought to call him, short of his real name. I hope he would not consider it irreverent that we called him by this nickname. It was not given out of callousness or even convenience, but it was more like the way you sometimes find that you and your friends no longer call each other by name, but rather by nicknames that just fit after spending long quality hours together. Sport became a friend after long hours together, and he deserved a friend’s name.
Had he been a real patient in the hospital, there were many times we would have called him a “Difficult Patient,” or even “Noncompliant.” Our note in his chart might have read, “Patient is uncooperative with the week’s prescribed regimen of completing pages 53-67 in Grant’s Dissector.” We struggled with his 20-year old connective tissue and with the fat and lymph tissue that coated and invaded his body during the course of his disease. We left last almost every day and stayed late on other days, and we still never seemed to finish a dissection. Even TAs and professors seemed to occasionally leave our table in frustration in search of an easier dissection with clearer structures. And yet, we toiled on. Our struggle was rewarded when we discovered beautiful structures not yet broken down by long years of life. We became more confident in our dissection technique. We felt that we would be prepared if we ever operated on a young body. Through our “noncompliant” patient, we learned to work hard for our patients, and we learned that the extra time and effort will pay off in the end.
We all wondered what led a 20 year old man to give his body to be clumsily dissected by untrained, awkward hands. We talked about it often as we went about the business of anatomy lab. For other tables, the conversation may have been similar as they pondered whether or not they would give their body after death. Still, I imagine the thrust of the conversation was significantly different…as other tables wondered whether they would be willing to give their bodies after a long life like so many of the cadavers, we wondered whether we would be willing to give our bodies now. As one of our group exclaimed on the first day, “he could have been on Facebook.” That really hit home for me. I hope we would have been facebook friends, but instead of checking his status updates, we were exploring his innermost parts. We did not know him during his all-too-brief life or during the illness that unfairly shortened his days. I wish we could have known why he gave his body…what his hopes were for the future doctors who were with his body during its last few months as a body. We speculated that maybe he wanted to give something back to the medical field that we hoped had treated him skillfully and compassionately. Maybe he was just young and rebellious and wanted something extraordinary done with his remains. Maybe after such a short life, this was a chance for him to have a legacy carried on in time by the four of us who so benefited from his gift. We will probably never know who he was, what he was like, or why he gave his body. Our great hope, Sport, is that we will become the kinds of doctors that will make whatever reason you had completely worth it.
Thanks friend, and godspeed.

tug of war & thoughts on 3rd year of medical school

An incredible post from an incredible friend.

Current location:Barnes Hospital/St. Louis Children’sCurrent mood:AllCurrent music:DMB: Christmas Song
Tug of War

I’ve never been more nervous or more excited about what’s going to happen from day to day. I’m blessed to be on the path to the greatest profession I could possibly imagine.

The first time a patient calls you “Doctor,” it’s really cool and really scary. I am not, in fact, a doctor yet, but it’s fun to pretend.

I make sure to correct them immediately. I make it a point to introduce myself as “Eli, the MEDICAL STUDENT.” I emphasize that I cannot prescribe drugs, order tests, or make any decisions regarding their care. I likely have never encountered their particular problem before. This is, in fact, the first time I have ever sutured, or used an Ultrasound machine, or done paracentesis. Beneath the facade of calm and confidence that I attempt to put up whenever I stroll through the hospital in my short white coat, I guess the trembling of the foot-long needle I am about to stick into your abdomen must have given me away. The real doctors will be in to see you when I’m finished talking to you. I will be allowed maybe three minutes to tell them everything that we’ve talked about for the last thirty minutes to an hour, and then they will need all of five minutes to figure out what’s wrong with you and how to make it better. No, I don’t know how they do this. Yes, they are very good at what they do. You are in very good hands here…that much I do know.

Here’s what I can offer you. I can get you a blanket. I will listen to whatever you want to tell me. I will even pass something along to the doctor if you think it’s really important. I cannot guarantee that the doctor will think it’s important; sometimes they will and sometimes they won’t. But, I will be happy to tell them whatever it is that you forgot to tell them earlier. I will talk to your family. I have time to be polite, to talk about things outside the hospital, and to try to distract you from all the madness around you in this place. I am good at getting glasses of water, and sometimes I know where they keep the food trays. I have to check with the doctor before I let you eat, though. I don’t know how to make that thing stop beeping, but I can find a nurse who does know. I can make sure your arm is really numb before I suture for the first time, and I promise somebody will check my work and do it all over again if it’s not up to par. I will be back in just a few minutes to make sure your pain/nausea/cough/chest pain/bleeding/withdrawals/delusions are better. If you need anything in the meantime, please let me know, I’ll be at the station out in the hall.

I have been in third year of medical school, and thus an official part of the hospital, for three months. It’s a much sadder place than I ever thought. Before, I always thought of hospitals as places where people come to get better, as hopeful places. And they are that too, if they weren’t hopeful and if people didn’t get better, then being a doctor would be about the worst thing ever. But the sad thing is, people rarely get all the way better. One of the most hopeful things I have seen is seeing an acutely psychotic or depressed patient emerge as a functional, interactive human being again. One of the most troublesome things is seeing that person back on the floor or in the emergency room a month later. It’s really cool to see a patient walk out of the emergency room when they came in on a stretcher in severe pain, but that victory is dampened when you realize they’ve been in with the same pain every month for years, or if you know they’re leaving now because it’s time for them to get another fix or start having withdrawals. Learning to be a good doctor is learning to not get taken advantage of and to not be disillusioned. It’s learning that not all real problems have real explanations. It’s learning a lot of stuff about a lot of stuff, and knowing how it all fits together, and knowing that in a second because you don’t have time to look it up. It’s learning how to give somebody bad news without crushing their will to fight, and it’s learning how to know the worst possible outcome, the worst probable outcome, and not losing your will to fight. At least, I think it’s all of those things, but I’m only three months in, and I’m pretty sure it takes a helluva long time to learn how to be a good doctor.

I haven’t seen a patient die yet; I don’t know what I will do when it happens. I have come to see a patient and found an empty room. I followed two kiddos in comas during my two weeks on pediatric neurology. One of them came in the night before I started; she was the first room my team visited. The other guy came later in the week. Both kids had a lot of problems, neither was a “normal” kiddo outside of the hospital, and both had very little interaction with anyone around them. Parents love those kiddos just as much as any “normal” kid. One set of parents hung on every word we said, wanted to know what we thought, made sure to be there every time the team came in. The other set of parents wanted nothing to do with the doctors on my team, didn’t care what we thought because they didn’t believe us anyway, and would have preferred different doctors. Somehow I managed to connect with both sets of parents…I think it was my bow tie. I told one of the moms that I was rotating onto a different service and wouldn’t be taking care of her kid anymore; she told me there was no rule against visiting. My friends on the service after me told me that the other dad, the one who really didn’t like doctors, asked if the “bow tie guy” was going to be coming back. Unfortunately I got busy and distracted with adult neuro, and I didn’t make it back to visit for two weeks. I went back on the first day of my Emergency Medicine rotation because I had an afternoon off. I rounded the corner of the PICU, expecting to see the dad arguing with a doctor or hovering over his son like always, mom sitting in the corner convinced of a miracle and unwilling to accept any talk of anything less. The room was empty. The kiddo died early that morning. I went and saw my other kiddo down the hall. I read her chart; she had gotten a little better in some respects, and worse in others. Her mom wasn’t there, so I just went in briefly and then left. The next morning I got a text from my friend on the service….”Eli, I just wanted you to know that your kiddo died this morning. Her lungs had gotten really bad, and the only way to fix them was surgery. Her mom had promised her no more surgeries, so they withdrew care.”

There are a lot of ups and downs in the hospital. They don’t equal out, but they don’t have to. Sometimes you just do all that you can, and that has to be enough. It has to be. And emotions, emotions are completely messed up. You try, usually without complete success, to stay focused on your patient, to keep compassion as your primary emotion, but so often incredulity or stress win out. And you can’t be really happy about every happy thing, or really sad about every sad thing, because there’s another happy or sad thing coming, and there’s not enough time to sort it all out. So here’s what you do, if you’re lucky. You try to put the patient first. You try not to look dumb in front of residents and attendings. You try to do both of those things at the same time (which is hard, because when the attending asks about something you forgot to ask or check, you have to say “I don’t know,” and go back and do it because it’s best for the patient, but it makes you look really clueless). And you play a delicate tug of war between your brain and your heart. If they balance out just right, you can get your brain to not think about things too much as long as your heart doesn’t feel about things too much, and hopefully neither one falls into the pit in the middle when you’re not paying attention.

Sometimes your eyes get wet, or you go on a really long run, or you spend a night angry or lonely or worried or scared. Sometimes you have no fingernails left to chew. Sometimes you whistle in the shower, and sometimes you smile at strangers. Sometimes you cry at something on TV, or read websites like givesmehope.net, or drink one or five too many beers. Sometimes you just really want an Oreo Blizzard. Sometimes you just really need a warm body next to you. Sometimes your dreams wake you up three times a night. Sometimes you lose hours in the deepest sleep you’ve ever had. Sometimes Paul wrote an epistle directly to you. Sometimes you just can’t go to church because it seems too easy and too good to be true. Sometimes you just really, really hope God knows what he’s doing. Sometimes you know deep down that of course He knows what he’s doing, but you wish it were more like what you wanted him to do. Sometimes you just don’t know how to say what you’re feeling.

And you usually pretend that none of this is because of the empty rooms.
Inspiring. I have goosebumps.

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