Category: Reflections on the Christian Life

The big screens lit up and the speakers boomed. The crowd cheered as the video played. By the end we were all excited. The freshmen were lined up with some upperclassmen holding them back. Then the upperclassmen released the freshmen and they stormed across the football field as they ran the “Baylor line.” 

It was a five years ago and I was in McLane Stadium at Baylor University. I had flown down to visit my daughter JJ. We had walked around the tailgating areas and had bought green (it was a green day) Baylor logo hats and shirts to wear. We were in the huge stadium and the “hype video” was a key part of the experience. We spent the rest of the day with our arms in the air doing the Baylor Sic ‘em. The weather wasn’t the greatest. It rained. Baylor didn’t win. But it didn’t seem to matter all that much. It was fun to be there and experience it and especially to do it with JJ.

The hype video was well done. It really got me excited about the game. I felt happy to be in the stadium and be a part of all of it.

It reminded me of a story that I had been told many years before. 

One of my teachers had worked for a large appliance store before he became a teacher. He told how each morning before the store opened they would get all the salespeople together. They would go through a “pep” talk – sort of the equivalent of a hype video. They would tell them how it was their duty to (a) sell, (b) sell and (c) sell some more. The more they sold the stronger the economy. That would then mean jobs and prosperity for our community and our country. He told me they would get them so hyped up that by the time of the doors would be opened he said he was ready to go. Every day he would be enthused and ready to convince anyone who came in to buy the latest and greatest electronics equipment. It was his noble and patriotic duty to do so.

When he told me the story, it made me understand that store better. Every time I had been to that store the salespersons had always been very eager to sell. I bought a big powerful stereo from that store. I loved it. It was strong enough that you could feel it as well as hear it.

It does, however, raise the question that confronts a lot of us: Do we have purpose in our lives?

A part of being human is a need to have a sense of purpose. We need to believe that what we are doing has meaning and value. To do less than that can lead to drudgery and eventually to burn out. “It’s time to make the donuts…” was the old commercial^[1]. At times any job can seem like that: a never-ending cycle of delivering a product or service. But we all want to go beyond that. We all have a need to find purpose and meaning in what we do. 

You can argue for or against the hype that the electronics store used. Honestly, it sounds ridiculous to me. But if that is your business, you likely will need to work through what you are doing. If it is just about doing something over and over again for no reason, you will not last. You will not be effective. If it is just about making money you may find a deepening hole in your soul that will eat at you. To last and be happy you will need to think through it to find a purpose or meaning.

I was unsettled. It is a long story but ultimately I had decided to leave my primary care internal medicine practice and go back to training and into a cardiology fellowship. My purpose had shifted. I couldn’t stay. In spite of the risk and loss of income I had to make a change. It was the right move for me.

In the time of that transition, I was at a dinner meeting and I ran into Mark. He was another internist that I had known for several years. “I thought about doing what you are doing,” he said to me as we put our coats on and walked toward our cars. “I admire you for it. I was really close to going back to fellowship myself at one point.” 

“Why didn’t you?” I asked him. 

“Growing up when I thought about wanting to be a doctor it was because I had a vision – a desire – to be “someone’s” doctor. In my mind it was the long standing and lifelong relationship that defined what it meant to me to be a doctor. I thought about specializing but realized that to do so would betray what my purpose in being a doctor was about.” 

It made sense to me. I was happy that he had figured it out. He was in primary care because that was where he found purpose and meaning. The reason he didn’t do a fellowship wasn’t because of a lack of ability or courage or drive. It was because it would have been wrong for him to betray his purpose. I was happy he saw his purpose.

It challenged me to think about my purpose. It was clear to me that there was something – or some things – that were driving me to do the fellowship and pushing me forward. The unsettled feeling was all about purpose. For me it may have gone further to even be a calling or a vocation.

How do we each find purpose and meaning in our lives? I have learned that it is a very individual thing. It also can shift and change throughout your life. 

It might not be at work. Some never find their purpose or meaning in their jobs. That is okay. Obviously throughout human existence there are times when just surviving is enough. Trying to find some deeper purpose or meaning in your work can often be a luxury. There are millions of people in the world who work to just survive. They still have purpose in their lives, but the content of their work may not be where it is. 

We all know people who do work to have the resources and time to find their purpose elsewhere.  For them their purpose is found in many different places. Family is a common driving purpose. Sometimes it is friends and the time invested in them as they pursue their favorite hobbies. Clearly faith and serving God is a big and driving purpose for many. Some do amazing things in their churches or other areas.  To them a demanding job might just distract or pull them away from their purpose. 

Some find meaning in the how rather than the what of what they do. For them their drive comes from doing whatever they do with quality and excellence. This is a common source of purpose early in a career. There is a real challenge and satisfaction in mastering an art, skill or field of specialty. In that phase of life, purpose and meaning is found in the effort of acquiring competence and eventually expertise.

There is something admirable about being an expert – or a craftsman – in whatever you do. I am convinced that a clerk at the gas station can have true purpose and meaning in their work if they are determined to do it well. The book, “The Fred Factor”^[2] is an excellent discussion about this type of thinking.  The subtitle explains the concept, “How passion in your work and life can turn the ordinary into the extraordinary.”

The point is I am convinced that the secret to sustainability in whatever you are doing is to find your purpose and drive in your life.

And now I pause.

Because it sometimes is easier said than done. Sometimes your purpose is crystal clear. Other times it shifts and changes. 

Sometimes you get cancer and it stops you in your tracks and confuses everything. Sometimes even though you recover from cancer surgery and treatment, you are left easily tired and not the same person as you were before. Sometimes you can no longer drive hard anymore. You find that you can no longer stay up late, working into the night, and then pop up in the early morning to continue to work for an hour or two before the clinical day starts. Sometimes you have a gym membership that you used to go to at 5:30 each morning that you still pay for but leave unused for months on end. Sometimes you get home at night and do not have the energy or desire or drive to answer the emails that accumulated during the day. Sometimes you have to figure out again what drives you – or what motivates you – or what is worthy of the energy that you do have.

I am not complaining. As I went through the cancer diagnosis and treatment, it occurred to me that I had no desire to continue with business as usual. I was eager to rethink what was important. It meant digging down into my person and my soul and my world to see what I wanted – or what I needed – to do. And even now, I continue to dig down and evaluate where I am and what I am doing. I would be disappointed if nothing changed. I would feel like I had wasted the trauma of having cancer (can’t I get something good out of this?)

What drives my hype video now?

Over these past three years since my diagnosis, I have been slowly figuring out some things. 

It is not about selling stereos. I don’t care about selling a product or making anyone profitable.

Some of it may have elements of what my friend Mark said. It has been a real honor to play the role as a heart failure cardiologist for the good of my patients and their families. In the past I would think in broad sweeps about systems of practice. Looking back now I realize that systems rise and fall and come and go. It is the patients, families, friends – the people – who have been helped that makes me really happy and satisfied. 

It doesn’t mean that improving systems and pushing to improve things doesn’t matter. I can remember the many times when I had a vision of ways that things could be so much better. In those settings, I was driven not to just endure the status quo but to work to make substantive changes. There is real value and honor in improving the systems. You can make things better not just for yourself but for everyone else as well. But the purpose is not just to have a shiny system to show off. No matter how wonderful and shiny the system is, it always tends to get rusty. The purpose is to have systems that work so that people get taken care of.  It still comes back to the people.

And so, the focus begins to return for me. I want to do whatever is necessary so that people are helped. Sometimes the best way for me to do that is to be a worker in the process. Maybe it is a time in life for me when the best thing for me to do is to “make the donuts.” But is there more?

I have found a desire to expand the reach of our specialty of advanced heart failure. It is for this reason that I have been pushing to have an increased role in developing outreach clinics. I want to see and help the patients that might not have been referred to us or might not have been willing to drive to Grand Rapids to see us.

What about beyond medicine?

It is odd to me the passion I have found for writing. I was never the student that was drawn to writing in college. I gravitated toward math and the sciences. But now it is a joy for me to pour out myself into these blogs. I hope that somehow maybe this writing could influence people in positive ways. 

I don’t know that I have it all figured out. I do know that there are things that I want to do. If one of them is to in some way help you – or push you – in a positive way then I am sincerely and deeply happy.

Please do not just exist. 

Don’t settle for just “making the donuts” for the sake of making donuts.

What motivates you? What is important to you? What do you care about? What do you wish you could change? Is there something that gets you excited or that can drive you? Even within what you currently do, is there purpose or meaning that you can find?

I can hear the hype video starting. The screen is large as the images start to appear. The speakers are powerful with deep base tones. The booming music is starting up. What is it saying for you?

For me it is:

• There are patients who need help and hope in the midst of their advanced heart disease.
• There are people who are suffering who need a kind and understanding physician to maybe make it just a little bit easier.
• There is a large community of healthcare workers who are getting lost and forgetting their purpose. They are burning out not because they can’t do the work. They are burning out because they are losing their purpose and meaning in the midst of the pressure of their work. They need to resist the forces and the stresses that threaten to make them just workers selling or delivering a product. They need to find again their purpose and meaning in what they do. There is so much good that the do. Can they see it or hear it again?

Can you hear the hype video now? It is playing loudly. I can – I will – get up in the morning and ignore how tired I feel and how my achy muscles are – and go to work. I can do it. I want to do it. It is worth it.

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^[1] A reference to a classic Dunkin Donuts commercial that depicts the owner getting up early every day to make the donuts fresh. https://www.youtube.com/watch?v=1AA1XDqK8tY

^[2] The Fred Factor, by Mark Sanborn, Penguin Random House LLC, 2004

He was flying his F/A-18 Hornet when it happened. His aircraft could fly at speeds up to 1,190 mph. It could climb from the ground to its maximum altitude of 50,000 feet in under a minute. It must have been an incredible experience to be in control of all of that power. He said he was cruising at normal speed admiring the beauty of flying when it happened. His legs went numb. He flew back to the base and took off his flight gear. The sensation didn’t go away. He went to see his flight surgeon. They examined him. They ordered tests. They didn’t find a cause. 

He was sent to The United States Naval Aerospace Medical Institute (NAMI). There he underwent additional tests. He was sent to see all of the different specialists at NAMI. I met him when he came to the psychiatry clinic. 

Each prospective flight surgeon gets training in all the aspects of flight medicine. One of the very important areas was psychiatry. I was a flight surgery student doing my rotation in psychiatry at the time.  

Our lead psychiatrist conducted a thorough interview with the aviator. We met to discuss and think about his case. Later all of the flight surgeons at NAMI met to review his case. This meeting is called a Special Board of Flight Surgeons(SBFS).^[1]  A SBFS involves all of the flight surgeons assigned to NAMI. Each medical specialty had a chance to examine the aviator and provide commentary as applicable. 

The meeting started with one of the doctors presenting the details of our patient’s case. The neurologist spoke next. He assured us that they could find no neurologic basis for his symptoms. In fact, his symptoms did not fit any sort of anatomic pattern that would make physiologic sense. It fell next to the psychiatrist to talk. He felt that the symptoms were because of a mismatch between the man’s true personality and what he was pretending to be. 

Isn’t that an interesting concept? Is it possible to create problems by pretending to be someone or something that you are not? That strikes a chord in many of us. We worry that maybe deep down we are just pretending.

The psychiatrist continued to talk. He spoke of the how the aviator felt the incredible pressure to take on a certain persona in order to fulfill his duties as a “top gun” type of jet naval aviator. The truth was, he wasn’t Tom Cruise. In trying to pretend he was, he had created such an intense psychologic stress that it was presenting itself as physical symptoms.  He had been able to do it for a period of time. He succeeded in flight training and in his initial tours of duty. Eventually however the disconnect had caught up with him. 

The psychiatrist finished his presentation by stating that he felt that the most descriptive diagnosis was, “Insufficient Narcissism.” 

Narcissism is defined as “the pursuit of gratification from vanity or egotistic admiration of one’s idealized self-image and attributes.^[2]

Narcissus was a figure in Greek mythology. The beautiful nymph Echo fell madly in love with Narcissus. Narcissus however refused her advances. Instead, he gazed at his own reflection in a pool of water and when he did, he fell in love with himself. Narcissus then “lay gazing enraptured into the pool, hour after hour” without moving. Eventually the unmoving Narcissus  was transformed into a flower (the narcissus). 

We all know people a bit like this. These persons carry themselves bigger than life. They have extreme confidence. They really value and like themselves. They don’t really listen to or pay attention to criticism from others.  Think Tom Cruise, Kim Kardashian, or Kanye West. As you do you will begin to get a picture.

Like Narcissus many of these persons can be both successful and at the same time cause tremendous damage to themselves and those around them. Pride is listed as the cardinal sin of the seven deadly sins^[3] for good reason. Pride can and does cause lots of problems. “Pride goes before destruction, and a haughty spirit before a fall.”^[4] “One’s pride will bring him low, but he who is lowly in spirit will obtain honor.”^[5] “For you say, I am rich, I have prospered, and I need nothing, not realizing that you are wretched, pitiable, poor, blind and naked.”^[6]  

Narcissism is generally bad. A diagnosis of insufficient narcissism was a bit audacious. Is that really a thing?

In our training we learned a lot about the psychology of a naval aviator. We learned about personality types that causes some to succeed while others would fail. We learned about the confidence that it takes to go flying at very high speeds even though you know that if you make one slight mistake you could crash and die. In flight training we talked about dying all the time. Before every flight we would brief about what could go wrong. By the end of their first tour of duty, most naval aviators have lost at least one colleague or friend. For them to go back and climb into their airplane and not just fly it, but push it very hard, takes a unique personality. They need to have a self confidence that causes them to believe that even though others have failed, they will not.

I have thought about this when I look at our political candidates. It must take a certain degree of narcissism to become a politician. They need to believe that they can succeed and win. They need to be able to ignore or not be harmed by the inevitable and continual opposition and criticism that they will face from their opponents. 

It creates the question, “Is there such a thing as a healthy narcissism?”

On the opposite end, we talk about the “imposter syndrome.” “Imposter syndrome is loosely defined as doubting your abilities and feeling like a fraud. It disproportionately affects high-achieving people, who find it difficult to accept their accomplishments. Many question whether they’re deserving of accolades.”^[7]

The idea is that some people who are very qualified and very successful still struggle to acknowledge the reality of their abilities. They often feel like they are “faking it.” 

The ideal state would of course be to have a realistic understanding of yourself including your abilities as well as your limitations. The truth is that this requires a delicate balance. You need to know your limitations and strengths, openly and honestly, but you should not be limited by them. You should be able to push forward with confidence. At times you should be able to push forward, pretending to be Tom Cruise complete with aviator glasses and a powerful motorcycle screaming at high speed toward the sunset.  It is not that you are being fake, but you’re smartly working through what you are able to do, and what you want to do and taking on just enough of a dose of narcissism to push to achieve your dreams.

In our training about the psychology of the naval aviator we discovered it is not just about training a bunch of narcissists. It is actually a lot more complex than that. We learned that most aviators put on some degree of a façade. They take on the persona of the overconfident never doubting jock. Inside however most are highly intelligent, intellectual, and often obsessive compulsives who have trained themselves for the role of an aviator. When they put on their flight suit, they also put on their persona of the super confident aviator.

It might help you to understand by thinking  of the opposite extreme. I think of a teenager who when talking to an adult apologizes in how they talk. They look down. They don’t really say what they are thinking. They are way too timid. They don’t have to be. They would do so much better if they just believed in themselves a little bit more. It would be so much better if they would greet you with a firm handshake, look you in the eye and naturally talk to you. 

I am not encouraging vanity. But I am wondering about the power of a little bit of appropriate confidence.

I’m not an athlete. But at one point in my life, I decided that it was okay to do things, even if I was not good at them. If I really wanted to do something, I was going to do it even if others could do it better. I am not a great golfer, but I still go golfing. I was never trained as a writer. But I enjoy writing my blog.

Do you want to paint? Then do it!

Do you want to write? Then do it!

Do you want to learn to sail? Then do it!
Do you want to learn to fly? Then do it!

Do you want to give the speech? Then do it with confidence!

Do you want to succeed at your career? Have you been trained? Then don’t apologize for it. Do it.

The SBFS concluded that our aviator patient needed time. They were going to keep him out of the cockpit and have him go through a series of counseling sessions. They didn’t know what the result would be. Perhaps he would be able to better understand himself, and then decide if he could or would be able to put on the aviator persona again. If he did he would need to do it by choice. It was possible that the persona would be too far of a reach for him, and his naval aviation career would be over.

I don’t know what happened. Honestly either would have been an acceptable outcome. He didn’t have to be something that he didn’t want to be. He could move on to other areas where he could be successful. On the other hand, he might have been able to come to terms with his subconscious struggle with “imposter syndrome.” If he did, hopefully he could take on the role of jet naval aviator again in a healthy way.

You don’t have to be something that you are not. But it is also okay to push yourself a bit to do and be the person that you want to be.  You don’t have to be the best at something in order to do it. Go ahead and try it. You might be better at it then you give yourself credit for.

Insufficient narcissism? Maybe that is or is not really a thing. Narcissism is generally bad. But appropriate confidence and taking on things even if you worry that others might be better at it? That is perfectly fine.

Go for it.

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^[1] https://www.med.navy.mil/sites/nmotc/nami/arwg/Documents/WaiverGuide/NMOTCINST_1301.1K_SBFS.pdf

^[2] https://en.wikipedia.org/wiki/Narcissism

^[3] https://en.wikipedia.org/wiki/Seven_deadly_sins

^[4] New International Version, Proverbs 16:18

^[5] New International Version, Proverbs 29:23

^[6] New International Version, Revelation 3:17

^[7] https://hbr.org/2021/02/stop-telling-women-they-have-imposter-syndrome