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Being human Medicine Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

The Hype Video: Purpose and Meaning that Drives What You Do

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.

So much fun watching the freshman class run the Baylor line!

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.


[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

Categories
Medicine Reflections on Life, Being Human, and Medicine

Pandemic Stress, Burnout, and Wisdom from a Young Me to an Older Me

I read a twitter post this week about a doctor leaving medicine. A lot of people seem disillusioned and discouraged. 

My mind went back to Dr. O.

I was 19 years old and thrilled to have a job in the emergency department (ED) at a small hospital near my parent’s home. They hired me as an ED technician. I would get patients from the waiting room, bring them to a bed in the treatment areas, get their vital signs, and take a brief history from them. I would also help do whatever they needed me to do.

I loved it. While college was SN1/SN2 reactions, derivatives/integrals, and memorization of botany classifications, this was real life. I was on the front lines. I got to talk to patients. I was able to touch them, hear their stories, and see their illnesses and injuries. It seemed there was a never-ending stream of interesting things that I saw. I started to gain story after story in my secret internal library. 

I made friends with the other people working there. While we were often very busy, other times the ED would be quiet. In those times I could talk and listen and learn from them. Even now I think of all of them as good friends though I have not seen them in over 35 years. 

I liked Dr. O, but he was tired and discouraged. He did his absolute best to talk me out of going to medical school. In the quiet times he would sit me down, “You don’t understand. If there is ANYTHING and I mean anything else that you like, do it instead.” “Do you like engineering, or computers? Do that. Do NOT go into medicine.” “You do not understand. Do not become a doctor.”

I don’t know all the details of his life. I don’t know why he was so discouraged. I tried to talk with him, but I was young, and he seemed to be talking from a position of experience and knowledge. I explained that I really loved what I was doing and that what I really wanted to do was medicine. I repeatedly tried to explain myself. But I was quiet and reserved and I don’t think I could communicate it very well. I know that he couldn’t or wouldn’t hear me. I was young and naïve, and he felt that I was making a mistake.

It was awful when I heard that he was gone. The story was that he set up a neat and clean anesthetic type setup for himself. He ended his life. Even now my stomach turns as I think about it. 

I don’t know all the details. Depression and death by suicide are always complicated. Depression is such a horrible illness. I am not going to try to explain away his life and experiences and what happened to him. I just don’t have enough information to do so.

But reading the twitter post this week and sensing discouragement in so many people, my mind went back to Dr. O and our dialogues in the ED.

I am about his age now. There are indeed days when it is easy to get discouraged. Sometimes I look at the long rounding list, another full day of clinic patients, or a huge Epic inbox and it is just drudgery and work. Back then it was paper charts. I can remember the stacks of them in front of Dr. O waiting for his dictations. He always seemed to get behind on his dictations. 

It is easy for me to get anxious at work. I hate getting behind. Today I looked at my list of patients. I saw one who was very complicated. I saw the name of another who has persistent symptoms despite my best efforts. I clicked to the Epic inbox. Already multiple patient calls and messages.

Sigh. A lot to do. Work.

It is tempting to envy the engineer, the banker, or the computer science person. “If there is ANYTHING else you are interested in…” His words echo back in my brain even now 35+ years later. 

It all seems to be worse now. 

COVID has created a lot of casualties. So many people have died. Beyond that so many people seem angry and not able to talk and understand each other. How odd that this battle that I thought might unify us has only served to divide people. Healthcare workers are burning out. People are leaving healthcare. Many are dreaming of being “engineers, or bankers, or…” I am hearing Dr. O’s voice on an increasingly frequent basis.

Young me (let’s label as YM or young Mike) calls out in my memory. Old me (let’s label as M for Mike or Me) and YM start to talk. M wants to be cynical, burned out, and envious of others. YM cries out, “I couldn’t help Dr O see it. I still feel it. M – will you hear me and understand?”

YM continues. “I just couldn’t understand it. Dr. O had so much that I wanted and dreamed of and yet he couldn’t see it or appreciate it. He made 20x what I made per hour. He had money and a nice car. He had knowledge. He would call out orders of labs, tests, and things that I had no idea what they were. He was smart. He would prescribe treatments. He would suture wounds. He had knowledge and he was able to use the knowledge to help people. He had people – real people – who needed his help, and every single day he was able to use science and his knowledge of science to help them. Many (most) of them (not all of them but many of them) were very appreciative.”

M begins to remember. YM has his attention now. 

YM continues, “It was so exciting to see the patients and all of their problems. I looked forward to every shift.  I was young and didn’t know very much. I couldn’t help as much as the RNs or Dr. O or the other doctors. They could do a lot more. But I could get the patients settled, get things for the doctors and nurses and help to hold or position or move the patients. I was happy to just be a part of it all.”

“It was so meaningful. It was real life. It was working on the front lines. It was not sitting in the background. I was a part of all of it. I loved it so much that I gave up every other Friday night and every other Sunday to be there for it. I got paid, but honestly, I didn’t do it for the money.”

M is now very interested. YM seems to possess some extraordinary wisdom. M seems to worry that he has forgotten it. M encourages YM to keep talking.

M: “Tell me more. Why did you not listen to Dr. O? Why were you so determined to go into medicine? If you could have a chance to talk to him again, what would you want to say?”

YM: “Medicine is so cool. It is just such an amazing combination of science and getting to use science and knowledge for good.”

M: “But people seem to not respect science anymore. Just look at the news and internet and the antivax movement.”

YM: “That is not really true. Look at your clinic schedule today. You have a full list of people who are eager for you to use science, your knowledge, and your experience to help them. Do you ever have patients tell you, ‘thank you’ or express gratitude?”

M: “Well, yes I do. But not everyone gets better. Look at my list today. I have got all of these patients to see. I worry that I won’t be able to help them. I worry about not keeping up. It is another full day in clinic with people bringing their problems to me and expecting me to have answers.”

YM: “I would LOVE that. Look at you. You really don’t get it do you? You have years of training and experience. You always seem to come up with ideas about what to do. I know you worry about it, but you do a great job. Your patients love you. I would absolutely love to live today in your shoes. I SO want to be you.”

M: “You are me – or you have gotten to be me. And you are right. I am not sure why I seem to forget. I do really enjoy what I do. I am going to give myself permission to really enjoy today at work. I am going to be sure to feel the excitement and the pleasure of using my training, my experience and science to truly help people.”

A pause.

M: “Thank you. This has been helpful. Can we talk again if or when I need it?”

YM: “Of course. Anytime. And thanks for listening.”

Another pause.

YM: “I wish I could have helped Dr. O to listen.”

M: “I think he had a lot more going on in his life than just his discouragement with medicine.”

YM: “You are probably right. But why is it that people so often only see what is missing rather than what is good?”

M: “You mean, seeing the partly empty cup rather than partly full cup?”

YM: “Yup. 1/10 empty rather than 9/10 full from what I can see.”

M (laughing): “I think you are right!”

I went to the office. I fell behind a few times. I walked out of an exam room half an hour behind. I clicked my Epic inbox. Six new patient calls, 2 patient messages, 8 result notes. It would have been easy to start getting frustrated. But this is who I am. This is what I do. This is my privilege. I kept going. For the next patient I had answers. It was gratifying to be able to help them. The one after that thanked me. She was feeling so much better.

It was a good day.