The Map of Reality is Not Reality: Guidelines and Melanoma

How often do you use GPS to get somewhere? I use it all the time. Whether it be going to the hospital, dropping off my son at daycare, and even going back home, I have GPS on. Using GPS is useful. If there is traffic on the route, GPS will reroute me to a better route. If I am lost, I can easily get home with a few touches on my phone.

Relying on a map can lead to a variety of problems. The map can be wrong, missing information, or can be interpreted incorrectly. Maps should be treated as a guide, not the rule.

Map is not the territory

In 1931, mathematician Alfred Korzybski popularized the idea that the map is not the territory. Basically, the description of something is not something itself. Abstraction is not reality.

Alfred Korzybski poses three downfalls to using maps.

  1. Maps can be incorrect without our realization.
  2. Maps are a reduction of reality by necessity, and this reduction can lose viable information.
  3. Maps require interpretation, which in turn can generate errors through misinterpretation.

A map is a representation of a territory. We use maps all the time. Whether it be physical maps or Google maps, maps are useful in getting from point A to point B. However, maps are not perfect representations of reality. Maps should be served as a guide, but if something in reality does not appear on the map, we should trust reality. With this mental model in mind, I successfully treated and continue to treat one of my longest living patients with active cancer.

Beyond the guidelines: Treating melanoma in a Jehovah’s Witness

An elderly male with past medical history of advanced melanoma presented as a follow-up in my clinic. He is a known patient of mine who was initially found to have melanoma of his right axilla (armpit) several years ago. At the time he had no sites of metastatic disease. The standard treatment for him would have been surgery followed by immunotherapy. However, his melanoma was almost 10cm in size which would have been a big surgery. Further, he was a Jehovah’s Witness. Jehovah’s Witnesses believe that Christians should not receive blood transfusions, even from themselves.

Since the surgery would have been extensive requiring blood transfusions, I presented the case to our multidisciplinary tumor board. We reviewed the guidelines and decided to treat with radiation first followed by immunotherapy. With radiation, he would not require blood transfusions. Immunotherapy was successfully given to patients with melanoma after surgery, but there is a paucity of data on radiation only. There are no guidelines to support this approach, however based on clinical experience and reasoning, this approach was the best option.

At the follow-up, he is doing well. He has been on immunotherapy ever since his radiation treatment with no sites of recurrence. In fact, the melanoma has been stable and decreasing in size. His quality of life returned back to baseline and is enjoying life.

Guidelines are like maps. Every patient is different so there is no one size fits all type of treatments. Religion is not a factor mentioned in the guidelines for treating melanoma, however it is a huge factor for patients in real life. If the guidelines contained nuances for every religion and personal belief out there, the guidelines would be too large for any clinical benefit.

Better decision making requires a firm grasp on reality

By remembering that the map is not the territory, we can make better decisions. Maps don’t strictly apply to geographic areas but to guidelines for life as well. By staying footed in reality, we will make better decisions. If reality and the map contain a discordance, follow reality. Remember who created the map as their perspective may not necessarily coincide with ours. And there is plenty in reality not seen in the map.

If I strictly followed guidelines for my patient, I would have likely recommended no treatment. He would have passed a long time ago. Instead, by following reality, he is alive today.

I read 60+ books in a year, you can too!

Warren Buffet, the greatest investor of modern times, was once asked how to read more. He held up a stack of papers and said, “Read 500 pages like this every week. That’s how knowledge builds up, like compound interest.”

Everyone knows that we should read more. The question is how?

In 2020, I read over 60 books. I did this while working as a medical doctor during the ongoing COVID-19 pandemic and raising two little boys. So when people tell me they don’t have time read, I interpret it as they don’t choose to read. Super productive people like Elon Musk have only 24 hours a day, and so do you. Need some help? Here are some tips that helped me read more.

Develop a love for reading

In order to read more, you need to actually like reading. So to develop a love for reading or for anything else, just do it. Start with the small stuff. It can be even the “junk” that people tell you to avoid reading. Angel investor Naval Ravikant says “There’s no such thing as junk. Just read it all. Eventually, you’ll guide yourself to the things that you should and want to be reading.” For me, when I don’t feel like reading heavy nonfiction, I turn to fantasy. Currently, I’m working through Brandon Sanderson’s epic fantasy series Stormlight Archive. Call me a nerd, but like the Immortal Words that the Knights Radiant lived by, I live by too: “Life before death. Strength before weakness. Journey before destination.”

Quit more books

In elementary school, we were taught to finish what we read. There were deadlines to finish books. In the real world, no one is keeping tab. As long as you get one new idea from a book you’re reading, I think that’s enough. Even if the idea is that the book isn’t any good, then it should be even more reason to put the book down and move to something else. James Joyce, author of Ulysses, put it best, ““Life is too short to read a bad book.”

Read several books at the same time

To read more, you need to read more books. Don’t be afraid of reading multiple books at once. Read one book at a time, but feel free to switch to different books when you get bored. Bill Gates, Microsoft founder and avid reader, carries with him a bag of several books he’s currently reading at any given time. Reading more books at the same time brings multiple benefits: you’ll finish more books and never get bored.

Allocate time for reading

Time is the most valuable and precious resource we own. In order to read more, you need to allocate more time to it. Don’t have time? Make a routine. One method is to schedule time for reading. Try scheduling at least one hour of your time to read. Write it down in your calendar. If one hour is too long, try at least 15 minutes.

“When you don’t have much time, a routine helps you make the little time you have count. When you have all the time in the world, a routine helps you make sure you don’t waste it.”

Austin Kleon, author of Steal like an Artist

Make reading a habit

James Clear, author for Atomic Habits, describes creating a habit into four steps:

“How to Create a Good Habit

The 1st law (Cue): Make it obvious.

The 2nd law (Craving): Make it attractive.

The 3rd law (Response): Make it easy.

The 4th law (Reward): Make it satisfying.”

To make reading obvious, reduce the friction to reading books. I know having a tidy place is the priority for some people. It is for me. I was brought up and taught to always put things back to where they belong. My fiancé on the other hand leaves things out everywhere. At first it drove me nuts, but then I realized by leaving my books out everywhere, I was more likely to pick it up and read it if I saw it. So some mess is ok, as long as it’s conscious mess. Besides, life is supposed to be a little messy, so I’ve learned to live with the mess.

To make reading attractive, Clear recommends temptation bundling. Take a daily habit and pair a habit (reading) you want to do with it. For example, when I wake up I reach for my phone to turn off the alarm. With my phone on, I open the Kindle app and just start reading whatever I was reading last night for a few minutes.

To make reading easier, Clear describes the “2 minute rule.” Start with a smaller, mini task that takes less than two minutes to complete. This can be picking up the book and opening it and reading at least one page. Even if it’s one page, that will be better than none. If it’s a book you like, it will be more than one page.

For your reward, you can keep a book list and cross things out as you read them. For me, I kept a numbered list of books I finished on my Notes app on my iPhone. Seeing the numbers increase gave me enough dopamine rush to keep going.

Bonus: Speed reading

There’s a lot of debate on whether speed reading works. Personally, I think some techniques make more sense than others. Here are two techniques that I use and seem to work for me.

Tracing

How many times have you reached the end of the paragraph and wondered what you just read? Hopefully, it’s not this post! That is called regression, and one method to prevent that from happening is called tracing.

Tracing is simply taking a pointer like your finger or pen to run across the text. The point of tracing is not to go as fast as you can. Tracing prevents regression. For me, tracing keeps me focused on the page at hand instead of drifting to the next page or elsewhere. For paper books, I use a pen and glide the pen over the words as I go along. For the kindle, I hover my finger above the text. Tim Ferris, author of Four Hour Workweek, does a great job of explaining this method here.

Minimize subvocalization

Remember when you were little and had to read in front of the class out loud? I do and still hate it. Unfortunately that’s how we all learned how to read. Subvocalization is your inner voice speaking the words you read in your head. Many studies have shown that eliminating subvocalization won’t increase your reading speed, but minimizing it may.

The average reading speed is about 150-250 words per minute (wpm). And the average talking speed is exactly the same. Minimizing subvocalization can increase your reading speed to 450-700 wpm!

So how do we minimize subvocalization? Try being a visual reader. When we read, we extract ideas from the words written down. Sounds abstract, but a concrete example would be to think of a “STOP” sign. When you are driving and see the “STOP” sign, do you you say the word “stop” in your head? If you’re like most people, you understand the combination of those letters means stop. So, you stop your car (hopefully) when you see the “STOP” sign. This is similar to being a visual reader. When you look at the words, try to take in the meaning of what’s written instead of saying it to yourself in your head. This skill will take practice, but I guarantee it will be a useful tool for you and your reading endeavors.

Now read more

To read more you need to develop a love for reading, quit books quicker, read several books at once, schedule time for reading, and make reading a habit. Speed reading is up for debate, but tracing and minimizing subvocalization will help you read faster and more efficiently. Remember, reading is for fun and learning. So, now go have fun and learn something!

Have any other tips on reading? Let me know what you think!

Fastest Way to Get Out of a Funk: Negative Visualization

What’s the worst thing that can happen?

Some days are harder than others. For me, it would be rainy days. The rain made me feel trapped inside the house. I didn’t like feeling wet so I’d avoid going outside. Being stuck inside made me think of all the things I was missing in life: the super successful job, the huge house, the Tesla. It became a vicious cycle of victim mentality and self-criticism. Being so negative reminded me of something I read on Stoicism and the practice of negative visualization.

What is negative visualization?

Negative visualization is a practice where you think about what your life would be like without your loved ones or possessions. Sounds simple at first, but the exercise is quite profound.

By practicing negative visualization, we enjoy every moment as if it were our last. The Stoics recommended that we imagine losing our most valuable people and possessions. We must imagine our loved ones dying, our house burning down, or losing our job. By doing this, we learn to appreciate our loved ones, house, and job more than we normally would.

The final step that many Stoics believed would be imaging our own death. By contemplating our own death, we discover what really matters.

Don’t believe me? Amazon CEO Jeff Bezos had a similar practice called “regret minimization framework.” Bezos imagined himself at 80 and whether or not he regretted trying this decision. Also, former Apple founder Steve Jobs once said, “Remembering that I’ll be dead soon is the most important tool I’ve ever encountered to help me make the big choices in life.”

Practicing negative visualization is essentially thinking with the end in mind. By thinking of the end, we are able steer our lives towards the end result we want.

How to do negative visualization?

Practicing negative visualization is really quite easy. The main method is to ask what if. “What if my loved ones died suddenly? What if my car was stolen? What if I lost my job?”

Negative visualization does not have to be just the big things. We can find value in the small things as well. Tired of your iPhone because it’s not the newest one out there. Try imagining what if you didn’t have a phone at all. Now you can value your current phone and all the wonders that it can do like call, text, surf the web, and watch anime.

3 lessons I learned from practicing negative visualization

If every time is the last time, then make every time the best time.

Practice every goodbye as the last goodbye. When I say goodbye to Kari (my fiancé) before work, I imagine that might be the last time I see her. By thinking that in my head, I am refocused on the moment. Thinking that this may be the last goodbye, I hold on to her a little bit longer and stare into her eyes with more precision. What normally would be a pat on the back and peck, becomes an intense embrace and kiss.

When I am alone with my sons, instead of waiting for time to pass by, I imagine that this might be the last time I played with them. All of a sudden, dancing with them becomes more fun than annoying. Letting them ride me like a horse doesn’t cause as much back pain. I get to enjoy their presence instead of being annoyed by it.

Keep in mind, the Stoics focused more on actions rather than words. I do not tell Kari or my sons that I’m thinking of their death, I only think and act with it in my mind. Otherwise, I don’t think they would take me thinking of their death the right way.

By contemplating that everything is only temporary, we are forced to realize that this might be the last time. So if it is the last time, might as well make it the best time.

To be happy is to desire what we already have.

By imagining the loss of everything we own, everything we own becomes much more valuable in our eyes. The other day, I dreaded waking up early to walk our rescue dog, Coral. It was freezing and the sun was not out yet. I just wanted to spend a few more minutes in bed. While in bed, I imagined what if Coral died later today and this might be the last time I walk her. Like with Kari and my sons, walking Coral became a blessing rather than a chore.

I thought the same thing to when I was stuck in California traffic the other day. All around me I saw Teslas, BMW’s, Lambo’s zoom past me as I was driving my mom’s Toyota Camry. I sure longed for the nicer car, but then I reminded myself, what if I couldn’t drive anymore? What if I had to take the public transportation to get where I was going? Not to hate on public transportation, but it’s essentially nonexistent where I live. Driving became fun and I was glad I could.

Negative visualization is not resignation.

Although we are pretending that we might be living our last day, this isn’t meant to change what we do. The point, the Stoics believed, was to change how we thought about what we do. Instead of giving up on everything or making dumb decisions a la “YOLO” (You Only Live Once), we should still continue our daily lives and remember to appreciate today. So don’t go spend your life savings because you might die tomorrow. Instead, continue to save for your goals and appreciate that you are able to do such things because you might die tomorrow.

Conclusion

Life can feel hard. Life can feel mundane. Life can feel unfulfilling. By practicing negative visualization, we can learn to appreciate the now and make the best of today. So practice saying your goodbyes as if it were your last goodbye, make every time the best time, and feel blessed with what you have. For me, what if it was that last time it rained? Wouldn’t I miss it? I sure would, so I put on my rain coat and took the boys outside.

Want to learn more about negative visualization? Check out this awesome book, A Guide to the Good Life, by William B. Irvine.

What if this was the last time you read this blog? What would you comment?

Mind Games

Over this past year, I had a lot of time for introspection. My third year of fellowship was split into 70% research time and 30% clinic time. The pandemic compounded the social distancing by turning all of my research meetings into virtual Zoom meetings. Basically, I spent nearly all my time at home. Since I was left to myself a lot, I did a lot of thinking.

Life is a single player game. People’s greatest problem in the modern era is that they cannot sit in a room by themselves for 30 minutes. I learned that the hard way.

Sitting by myself is hard because I always had the need to do something or be somewhere. Several years of medical training always kept me busy with exams and papers and the like. With what seemed like more time on my hands, I found time to sit and think. I soon realized that my mind literally acted like a monkey. The monkey was running around throwing poop everywhere and making a mess.

People can speak up to 4000 words to themselves every minute. These are the words of the monkey mind. Sometimes the words are positive (I can do this), sometimes are negative (Ugh, I can’t do this), or just nonsense (Baby Shark doo doo doo doo doo). The quality of the words matter. I needed better quality. I stepped up and talked to myself.

The most important conversations are the ones you have with yourself.

Win the game with two steps.

Pay attention.

In order to change is to be aware of a need to change. By not being aware of your mind, you can easily succumb to the powerful emotions and be enslaved by them. If you can observe your thoughts without forcing change, you often times can find both pain and happiness at the same time.

Pay attention to things that you can control. The things you control are internal, like your thoughts. Things you cannot control are external like health, wealth, and pleasure. Epictetus, a Stoic philosopher, describes this as your sphere of control. “Externals are not in my power; will is in my power.” Your will is your thoughts, and your thoughts you can control. Being aware of your thoughts is the key to freedom from the monkey mind.

Talk to yourself as a friend would.

Good friends are compassionate friends. Since the most important conversations are the ones you have with yourself, might as well make yourself your best friend. Self-compassion works. Research has shown that self-compassion increases happiness, positive outlook, and motivation and decreases anxiety, depression, and negative introspection.

Showing compassion is listening. How do you like it when you are venting to a friend and all they do is interrupt you with what you should do and how to fix the problem? I sure hate that. Especially, when I need to vent. So you must do the same with yourself. Pay attention and listen to what’s going on. Give yourself space with no judgement. Allow the situation to boil over.

Everything needs nourishment to survive. You need to eat, right? So, does negative thinking. Let the negativity run its course. As long as you don’t feed the thoughts, they will die of starvation. Just like after letting friends dump their suffering, just let yourself dump your suffering. You can speak to yourself nicely and gently. Motivational lies won’t work here. What works is validation. Validate yourself. Tell yourself “Yeah that sucks!” or “Wow, I see where you’re coming from.” You just need to know that someone is listening. That someone is you.

Life is a mind game

“Every day is like a blank page: When you’re finished filling it, you can save it, you can crumple it up, or you can slide it into the recycling bin and let it be. Only time will tell you what it was worth.”

Austin Kleon, Keep Going

Life is a mind game. The only player that matters is yourself. To win, you need to do two steps. First, pay attention. Pay attention to your thoughts, feelings, and actions. Second, practice self-compassion. Be honest with yourself. Talk as your best friend would. Best friends are there for listening.

Negative thoughts will always happen. You can’t or shouldn’t avoid that. Instead, you must accept that they do happen and realize you have the tools to help yourself when they do happen.

I needed to hear that.

What does your monkey mind say about that? Mine is still singing “Baby Shark doo doo doo doo doo.”

DAD Guidelines

“To me, fatherhood meant a man had made it in life.”

Matthew McConaughey, Greenlights
Being a dad is hard, but I still recommend it!

As a father, I made it! I’ve got two young happy boys (Zac (2.5 year old) and Archer (1 year old)). Ok what do I do next? The thing is that most people don’t tell you what to do after you made it.

What I can tell you is that being a dad is by far the hardest thing I’ve ever done. They cry, pee, poop, eat, sleep, need to be held, and need your attention. Sometimes in that order, sometimes randomized, and sometimes all at the same time! Plus, they don’t even help pay for rent.

Being a dad tops medical school, residency, and fellowship. You are literally on call 24/7. You are expected to give 100% effort, all the time.

In medicine, I’m used to having guidelines on how to treat different diseases. Care for the most common diseases usually have national guidelines that everyone goes by. You have pneumonia, I know exactly what to do. Heart attack, American College of Cardiology has got me covered. Even cancer, (my specialty) had guidelines on what chemotherapy to give. That’s why they call it the standard of care.

There are no guidelines on how to raise kids

I needed help. I did not have many friends who were parents. Online google searches would just confuse me. I’d often get sucked into the clickbait without any substance. I wanted substance, so I needed a book. Since no one goes to the library anymore, I did the next best thing – Amazon!

I typed into the Amazon search bar, “parent books.”

I came across this gem, The Montessori Toddler by Simone Davies.

To say that this was one of the most influential books I’ve read is an understatement.

What is the Montessori method?

Dr. Maria Montessori, an Italian physician from the 1900s, developed a philosophy of education on teaching children called The Montessori Method.

Dr. Montessori’s method challenged the traditional method of teaching

Traditional education involves teachers directly teaching children. This included primary instruction and external discipline. Children are passive learners through primary instruction. External discipline included reprimands from the teacher and the dreaded timeout.

Montessori method placed more emphasis on the child. Children are cultivated with the desire to learn. They are encouraged to ask questions. Environment plays a big role in developing internal discipline. Changing the environment promotes self discipline. Creating things such as yes spaces and worlds for kids to explore are roles for the adult teacher.

The thinking of the Montessori Method excited me

Instead of doing all the work, I can make my kids do the work. I can sit back and enjoy my kids grow to be the wonderful people they are.

So, if you’re like me and need some help on raising your kids, here are my favorite tips from The Montessori Toddler

Teach the basics, first

Show by example. Show first, talk later. It’s better to show new actions like drawing slowly without saying anything. Toddlers are still trying to process thoughts, so overwhelming actions and words may be too much. An acronym I read in The Montessori Toddler was “SHOW.” “SHOW” stands for Slow Hands, Omit Words. So keep it slow and quiet.

Have age-appropriate expectations and be prepared

I would take blank sheets of paper and draw with Zac. He’s a toddler and is still learning to draw. So I would draw only lines and squiggles. The thought is if we show them something too difficult like drawing a car or house, they might not even try at all. Of note, I can’t even draw a car or house.

Cultivate the desire to learn instead of dumping facts

When Zac started talking more, I’d always ask him to tell me about what he sees. I’d keep asking him why he liked certain things. The point is to encourage curiosity. With enough questions, he learns to question everything – even his dad.

Toddlers are always testing you, so keep limits consistent

Use positive language instead of negative language. Give information. Say “Yes, you can do this” instead telling your kids “No, you can’t.” Kids learn from you. So if your kids are saying no a lot, you need to adjust your language. So instead of saying “Zac, stop pushing your baby brother!” say “Zac, we are gentle with babies.”

Change the environment, not the child

If your kids love climbing on furniture (or you), create obstacle courses for the kids to climb. Sometimes, I would be sitting in the living room and Archer and Zac would just climb me for no reason. By creating a pillow fort, I was able to rest in peace as they played in the fort. I forgot how much I loved making pillow forts as a kid until I made a fort for my kids.

Use one word commands

Using one word commands allow kids time to process ideas . My favorite command is “Shoes!” Every time before we go out Zac has a habit of sprinting out the house. By yelling “Shoes!” he stops and puts his shoes on. Sometimes the most simple idea is the best idea.

Always ask the kids to help out

Kids love to be part of the family. So why deny them? At the supermarket, Zac, Archer and I chase their mother around as she picks out groceries. Once we catch her, she hands them a grocery item. Then the kids would throw the groceries in our cart. Every time they make it in, I’d comment with “goal!” or “slam dunk!” It makes grocery shopping fun, although we are quite loud!

Be present

Toddlers are focused on the moment. They are present all the time. By spending time with them, we learn how to be present. So the best gift we can give them is to be present with them as well. I practice this by focusing on my breath while Zac and Archer are climbing on me. Breath in. Breath out. Repeat.

Summary

These were my favorite tips from The Montessori Toddler. Remember, they are still kids so we need to show them how to do things at the easiest level. Teach less. Cultivate their desire to learn. Keep limits consistent. Creatively change the environment for fun. Kids love being part of the family, so let them be. Always be present with them. And most importantly, kids need time with you.

“A French journalist who was writing a piece about my book Trust Me, I’m Lying once told me that love is best spelled T-I-M-E. I don’t think I’ve heard anything truer or more important in my role as a husband or father.”

Ryan Holiday, 33 Things I Stole From People Smarter Than Me

Spending time, any time, is better than no time. Leave work at work and be home with your kids. Take them to the grocery. Go out for a walk. Or even just let them follow you around the house. Kids grow up faster than you think, so make the most of it now before it’s too late.

What do you think? Do you have any other Montessori tips to share?

Writing, again

Stories are good when the characters face their fears

“I wanted it to be an easy story. But nobody really remembers easy stories. Characters have to face their greatest fears with courage. That’s what makes a story good.” [1]

What I was doing over the past 5 years

My last post was in 2016. Since then I finished my residency in internal medicine. In 2021, will be finishing my fellowship in hematology/oncology. I also got engaged. I had two boys. I moved 4 times in one year. To say I was busy was an understatement.

Over time, I forgot about writing.

And as time went on, I became more and more afraid of writing again. I wanted to write, but never made the time to. Time went on. I developed an uneasiness with writing. I couldn’t place my finger on what was causing it. 

After much contemplation, I realized it was my fear of failure.

Failure sucks, but it’s highly recommended.

“Many people dream of success. To me, success can be achieved only through repeated [[failure]] and introspection,” Honda said. “In fact, success represents 1 percent of your work, which results only from the 99 percent that is called failure.” [2]

People fail all the time. In fact, that’s how all progress is made. Science is just a result of countless failed experiments to prove a theory. What was I afraid about? 

I was afraid of people judging and criticizing this blog.

Make stuff for yourself

“Writing a story isn’t about making your peaceful fantasies come true. The whole point of the story is the character arc. You didn’t think joy could change a person, did you? Joy is what you feel when the conflict is over. But it’s conflict that changes a person.” [3]

Conflict turned out to be important. Conflict is what drives innovation. When there is a problem people find solutions. I was afraid that my writing would suck. But that’s just part of failing. To get to your best work you need to work through projects. Some might be great and most will fail.  So what was my next step? Getting started. Through writing and sharing my thoughts I can grow.

‘Dweck shows convincingly that the most reliable predictor for long-term success is having a “growth mindset.” To actively seek and welcome feedback, be it positive or negative, is one of the most important factors for success (and happiness) in the long run.’

‘Embracing a growth mindset means to get pleasure out of changing for the better (which is mostly inwardly rewarding) instead of getting pleasure in being praised (which is outwardly rewarding).’ [4]

I needed feedback. The best way to get feedback to ask someone to review your work. More reviews, the better. And what’s the best way of getting more reviewers? Sharing online.

My next question was what do I write about? What’s the hottest topic now? What’s trending? Should I write for others? Is that true to me?

In Steal Like an Artist, Austin Kleon beautifully captures this message

“The manifesto is this: Draw the art you want to see, start the business you want to run, play the music you want to hear, write the books you want to read, build the products you want to use—do the work you want to see done” [5]

I needed to make stuff for myself.

“Your life must be a progression towards ownership—first mentally of your independence, and then physically of your work, owning what you produce.” [6]

Why Write?

“IF THE POINT of life is the same as the point of a story, the point of life is character transformation.” [1]

After all that, why should I be writing anyways? Life has been great. I’m practicing medicine, raising a wonderful family, dating/romancing my beautiful fiancé. What else could I want?

Writing is knowledge

“Writing is not what follows research, learning or studying, it is the medium of all this work” [6] 

By writing we are able to communicate with the world and ourselves our thoughts and ideas. Sharing our ideas is important. Ideas need a space to mingle. Through writing we can give ideas a place to come together and that’s how creativity happens.

“the best-researched and most successful learning method is elaboration. Elaboration is nothing more than connecting information to other information in a meaningful way.” [4]

Writing ideas make ideas come to life 

“Writing those ideas down protects you against that idea getting lost. Once it’s on paper or your computer file, it’s there forever. Staring you back in the face whenever you look at it. Whether or not you act on it is still up to you, but at least you won’t forget it. Once you have it down on paper, you’re setting yourself up to make something valuable happen” [6].

Writing translates thoughts onto paper

Thoughts lead to feelings which lead to actions. Through writing again, I can write my thoughts down. The thoughts are frozen, and therefore are malleable. Changing my thoughts will give me more control of my feelings and my actions.

The only things you control are your mind, body, and time

Writing helps me to control my thoughts. Thoughts are like waves on the ocean. Writing is like surfing those waves. Writing lets us catch our thoughts, watch our thoughts, and swim in our thoughts.

“One way to envision how mindfulness works is to think of your mind as the surface of a lake or of the ocean. There are always waves on the water. Sometimes they are big, sometimes they are small, and sometimes they are almost imperceptible. The water’s waves are churned up by winds, which come and go and vary in direction and intensity, just as do the winds of stress and change in our lives, which stir up waves in our minds” [7].

‘The spirit of mindfulness practice was nicely captured in a poster of a seventy-ish yogi, Swami Satchitananda, in full white beard and flowing robes atop a surfboard riding the waves off a Hawaiian beach. The caption read: “You can’t stop the waves, but you can learn to surf”’ [7].

Write to reflect and forget

I write to reflect. On Rich Doc Poor Doc with Dr. Bonnie Koo [8], Dr. Koo discovered through journaling on how to be a watcher of her own thoughts. I write down new ideas as they occur to me throughout the day. At the end of the day, or even in the future, I review my ideas. This helps me iron out the good ones. I throw out the bad ones (or edit them).

I write to forget. In Greenlights, Matthew McConaughey wrote “I never wrote things down to remember; I always wrote things down so I could forget” [9]. I do the same. For one, I can write down any events I perceive negatively at the time. I forget about the event. I forget about my perception of the event. I am able to review the event later. Any negativity I still I have, I release the energy into words

Writing clears my short term memory cache. George A. Miller famously claimed that our short term memories can hold at most 7 items of memory, plus or minus 2 [10]. By writing down my thoughts, I can safely store the short term memories there, and make room for other short term memories and thus more memories. By creating more memories, life will be more memorable. A memorable life is a good life.

“A good movie has memorable scenes, and so does a good life” [1].

References:

  1. A Million Miles in a Thousand Years by Donald Miller
  2. Hustle Harder, Hustle Smarter by Curtis “50 Cent” Jackson
  3. A Million Miles in a Thousand Years by Donald Miller
  4. How to Take Smart Notes by Sönke Ahrens
  5. Steal Like an Artist by Austin Kleon
  6. The 50th Law by 50 Cent & Robert Greene
  7. Wherever You Go, There You Are by Jon Kabat-Zinn
  8. Rich Doc Poor Doc Podcast #17: Business Building with Dr. Bonnie Koo
  9. Greenlights by Matthew McConaughey
  10. The magical number seven, plus or minus two: Some limits on our capacity for processing information. Miller, George A., 1994

Thanks for making it through! What will you write about? Share in the comments below!

A Swollen Arm, Radical Mastectomy, And Becoming A Doctor: How To Overcome Failure

Holly, a 68-year-old woman, came in with a red, hot, and swollen left arm. On presentation, her left arm was at least twice the size of her right arm. She’s a thin lady, so the contrast was remarkable. She told me that the arm blew up 2 days ago. Her left arm felt extremely hot. She chronically gets arm swelling because she had a mastectomy of her left breast about 5 years ago. This type of swelling is a common side effect of the surgery. Lymphatic ducts in the arm cannot drain the fluid correctly, thus congesting and blowing up the arm like a water balloon. Ever since the surgery, Holly tells me that her arm keeps on swelling up, but never this big. Normally she goes through her physical therapy very religiously; she never misses a session. She’s frustrated that her arm is infected, but she states she’s not going to let this stop her.

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Beach Ball Abdomens, The Ars Moriendi, And Why I Want To Be An Oncologist

Pam was a 62-year-old female with pancreatic cancer who first came in due to abdominal pain and distension. She said she was diagnosed with pancreatic cancer this past January and was going through chemotherapy. She was admitted to the hospital because her abdomen was the size of a beach ball. Several family members were with her at bedside. Although Pam looked weak, she was laughing and making jokes with her family. In fact, she jokingly remarked “Doctor, I look like I’m pregnant!”  I asked her if her husband knows. She asked me, “Know about what?” I pointed to her stomach and said, “the baby.” She broke a smile and the other family members in the room sheepishly chuckled. I told her we were going to run some tests and figure out what’s going on.

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Coconuts in Bien Hoa, Vietnam. Imagine a really big one of these in your belly. That’s probably how Pam felt. 5/12/16.

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Crohn’s Disease, Poop In The Urine, And The Reclining Buddha: How To Sell Yourself To Yourself

The nurse comes into my office with a grim look on her face.  She tells me that my next patient threw up in the exam room. The nurse adds that the patient has severe abdominal pain. I save my note, get up from my desk, and briskly walk to see the patient. In the room, I see a light-skinned African-American 29-year-old female embracing her stomach and crouched over. Her name is Rae.

Rae’s afro was bobbing up and down due to the pain. She’s crying and wincing while clutching her stomach. I ask her what’s wrong. Rae tells me for the past month she’s noticed increasing amount of feces in the urine. I ask her how does she know it’s feces. She tells me that it’s brown and it smells.

I rush the history and physical. I tell the nurse to give her some pain medication and to straight catheterize her. When the nurse catheterized the patient, 100 millilitres of brown, fecal matter mixed with urine came out. I call the hospital and admit the patient. She had surgery the same day. The patient had an acute flare up of Crohn’s disease.

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A Flood and Fiesta For The Common Good: How Family Might Save U.S. Healthcare And You

Over the past three weeks I have been traveling throughout Asia including Vietnam and Philippines. I don’t speak any of the languages, but it didn’t take much to see the culture of community and family.

On one particular day in Biên Hòa, a suburban area one hour away from Saigon, a storm flooded the street. As I stood at the doorstep of the place I was staying at, I watched cars and motorcycles trudging across the high water. I looked at the stores around my area and saw people helping each other put their belongings away, move their scooters inside, and even push cars through the torrent. There was hardly any hesitation in any of their actions – a firsthand example of working for the common good.

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Flood one hour away from Saigon, Vietnam. 5/12/16

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