Sunday, June 9, 2013

Surviving, achieving and living

Well. It's been a while since my last post - shocking! (not)

So what have I survived since the last post? I officially finished all of my required clinical rotations (in med speak - I'm done with third year!). It's an odd time at Penn Med because this is the second semester of my third year, yet my "courses" now are equivalent to what 4th years take - the first 2 years are compressed to a year and a half = the clinical years get an extra 6 months.

I did a month of Radiation oncology (omg lazors), and a month of Ophthalmology (eye balls are awesome - seriously).

Took 2 months off to study for and take the USMLE (US Medical Licensing Exam) Step 1. The old saying is - you take 2 months of step 1, 2 weeks for step 2 and a #2 pencil for step 3. That saying is a slight exaggeration, but that's how it tends to go: the later tests are far more clinically focused - so you've probably seen it / taken care of a patient who had it.

Then came my sub I in Emergency Medicine. Sub I = Sub Internship. The first year of any residency is called / considered your intern year. A subi is a month where you show you're capable of filling the shoes of an intern when it comes to taking care of patients.

What have I achieved since the last post? I did well on Step 1 and I've decided to pursue Emergency medicine. A pretty big decision! Then again, if I've learned anything from my life - it's that I should be prepared to be surprised. I usually have a plan and a goal I'm working towards, but I almost always end up doing something radically different. So we'll see where this road leads.

And now? Now I'm living. I am still taking electives, but it isn't a crazy marathon sprint (yes, that's what third year is). I get to stop and smell the roses (less metaphorically put: visit friends outside of medical school, say hi to my parents in person for a change). It's frightening to realize that I'll be an MD in just under a year. It's also a scary personal realization that most of what I'll learn in medical school (like 90%) I've already learned. When I look back, there's no doubt that I've learned an immense amount of information. The reason I'm scared is because my 3 years of medical school have taught me how much more there is to learn. And there's a ton of it yet to learn...

Looking back at my third year, I started to carefully think about what the three words: surviving, achieving and living mean. Obviously they mean different things to different people. Asking a kid who goes to Princeton what his/her definition of surviving is will get you a different answer than someone from the war-torn Congo. Putting all of that aside, and throwing in my own personal philosophy into the mix, I think these are 3 completely different mind sets. But they get mixed up quite often - especially in the Asian / Jewish / immigrant culture.

I can't speak to the Jewish culture but I know from an Asian and immigrant background that survival was our foundation. Our parents (or our parents' parents) had to work their butts off just to get by. Some of them got lucky and ended up with the ability to give you way more opportunity than they (or anyone else) had.

And don't kid yourself. The world isn't fair. They got lucky.

There is something to be said for making your own luck. There's a saying that goes: "I don't know what can guarantee you success, but I know what can guarantee failure - and that's not trying". Ok, even that may not be true because some people are just so damn lucky that they don't fail despite not trying. But let's leave those people out for a minute.

Putting all of that together - our parents/family push us to try very hard. I am lucky enough to not be in the "survival" situation they were in. I don't have to worry about making enough money to put food on a plate. Or worry that we won't have electricity tomorrow. With the way medical costs are going, I may have to worry if I can pay for my medical care - but that's a digression for another day.

Our families take what they know (survival) and channel it into something that is more situation appropriate: achievement. If you aren't achieving, you've failed. And in the survival world, failure is not an option. Thus the push to achieve. All. The. Time. It's a pain in the butt, but it works: Asians and immigrants are increasing their presence in top schools.

But here's the problem with all of that: what about living? Many Asians and immigrants will tell you all they've seen their family do is work hard. They aren't sure if they've ever lived. Now, let's not start arguing about what it is to "live" - there are more opinions on that than every discussion above that I've shelved combined.

I think living is the opposite of achieving. Ever heard of delayed gratification? In the classic experiments, you'd get the rewards, even delayed, within a reasonable timeframe. Now - we are expected to delay gratification for years, or maybe even a decade (*cough* medical training *cough*). Where does it end? When do you get to live?

I think what people who are in my situation forget (and I'm in my situation because of dumb luck - more on that in a bit) is why we work so hard. Why our families worked so hard / push us so hard. It's so we can have what they didn't. So we can have a better life. Living. Sadly, I think people often miss the forest for the trees. Achievements are easy-to-measure milestones. We are quick to count off the number of trophies in a case or the number of extra letters after a person's name. We are quick to see the size of a house and the number of cars and do an approximate net worth calculation. What we aren't as quick to see is how well they've lived, what they've sacrificed to get here, and are they happy. These are very, very difficult things because they are not quantitative like the things I mentioned before.

So, what's my point? Don't lose the forest. I'm lucky enough (like many of my peers) to have the opportunity to live your life while trying to achieve - why? Because this isn't about survival for us. Not like it was for our immigrant/Asian parents. It isn't an OR condition - you CAN have both. It's about maintaining balance. Or so I tell myself.

Now, from this spawn 2 arguments:

1. Can you really achieve to your fullest potential if you are "wasting" some of your time / energy / whatever on something else (like this "living" I speak of)? If you take it as a zero-sum game, then probably not. You can't possibly give something 100% (or 110% if you are a "good Asian") if you're doing stuff like stopping and smelling the roses. If you take it from a perspective of self-actualization, then... maybe: the fact that you are living / doing things that directly make you happy can make you better/more efficient = your output per time unit invested improves.

2. What the hell leads to achieving anyway?

I'll probably make a blog post about both 1. and 2. at some point. But I will put in a small blurb about #2 - mainly because I said I would earlier.

I agree with Ben Bernanke's talk: for those of us lucky enough to be here and to have achieved this much - it's exactly that. Luck. I could've just as easily been born into a family that wouldn't have ever left the slums of India. Would I still have found my way to Cornell, Columbia and then University of Pennsylvania? Probably not. Is that to say my hard work didn't play any role in the outcome? No, that's silly too. But, more often than not, I tend to think that luck and just plain showing up are what lead to outcomes rather than your hard work (and keep in mind, any innate aptitudes you have are also innate to you because of luck). Even if hard work contributes only 5% to the overall scheme - I'm still going to work hard.

Why? Because that's the only thing I have control over. And I'm a control freak. Well, for the stuff I can control anyway. For the rest of it - meh. At least I know I tried!

- K Dawg out.