As an oncologist, I am no stranger to difficult situations, but the case of Mr. Smith was particularly heart-wrenching. Mr. Smith had been diagnosed with metastatic lung cancer and was being treated in the intensive care unit of the hospital. The sterile white walls and beeping machines were a stark contrast to the normally tough and stoic Mr. Smith I knew from our clinic visits. He was the kind of guy who seemed to take everything in stride, just like a character out of a Clint Eastwood movie.
But as I walked into his room that day, I was met with a scene I had never witnessed before. Mr. Smith was in tears, telling me about how he had missed his daughter’s award ceremony at school and how the thought of dying had finally hit him. His usually cheerful disposition was replaced with a deep sadness, and my heart went out to him.
“I can’t believe I missed it,” he said, shaking his head. “I always thought I’d be there for my girls, no matter what.”
I took a moment to sit down with Mr. Smith and listen to his concerns. I encouraged him to talk about his feelings and gave him the space to express his emotions. “It’s okay to feel sad, Mr. Smith,” I said. “It’s a tough situation, and it’s natural to feel like this.”
“I just can’t stop thinking about all the things I’m going to miss,” he said, tears welling up in his eyes. “I don’t want to leave my girls behind.”
“I understand,” I said. “It’s important to make decisions that are best for you and your family. And remember, you’re not alone. We’re here to support you every step of the way.”
As the conversation came to a close, I could see a visible change in Mr. Smith’s demeanor. The weight of his worries seemed to lift from his shoulders, and he sat up a little straighter in his hospital bed. The sadness in his eyes was still present, but there was a glimmer of hope and resolve there as well. He seemed more at peace, as if he had found some clarity in his difficult situation.
I left the room feeling grateful for the opportunity to be there for my patient and to make a difference in his life. The hospital can be a cold and intimidating place, but in that moment, I felt a sense of connection and purpose. I knew that I had done my best to support Mr. Smith through a difficult time, and that was all I could ask for. As I walked down the sterile hallway, I took a deep breath and reminded myself that this was why I became a doctor.
“The only way to change your life is to change your mindset. If you want to be successful, you can’t let your mind hold you back. You have to be willing to push through the pain and the fear and the doubts and the excuses. You have to embrace the suck and keep going. You have to take control of your thoughts and your actions and refuse to be a victim. You have to be a fighter, not a quitter.”
David Goggins
As a former gym rat, I never thought I would find myself bedridden and unable to exercise. But that’s exactly what happened after I ruptured my Achilles tendon. For weeks, I was unable to do any form of physical activity and I quickly began to lose my strength and fitness.
At first, I struggled with the victim mentality. I asked myself “why me?” and blamed everything else for my situation, including my injury, my work, and even my family. I felt helpless and frustrated, and I didn’t know how to move forward. Instead of trying to find solutions, I just sat around feeling sorry for myself and doing nothing.
To make matters worse, I started drinking alcohol to cope with my frustration and boredom. I spent hours watching TV and mindlessly scrolling through social media. As a result, I gained weight and became increasingly grumpy and irritable. I was unhappy and unfulfilled, and I didn’t know how to change my situation.
But instead of succumbing to this mindset and continuing on this downward spiral, I decided to take control of my situation. I knew that I needed to make a change.
One of the challenges I faced was that my ruptured Achilles tendon made it impossible for me to leave the house to go to the gym. But instead of letting this obstacle hold me back, I decided to explore other options for staying active at home. That’s when I discovered bodyweight training.
I began my calisthenics and bodyweight training routine with just 10 push-ups each day, and gradually increased the number of reps as I grew stronger. Over time, I was able to build up to a daily routine of at least 100 push-ups and 60 pull-ups.
But it wasn’t always easy to stick to this routine. I had to overcome numerous challenges and obstacles along the way. For one, I have a family and a full-time job, so finding the time to workout can be difficult. But I made it a priority, and I never missed a day, even on weekends. I would work out at 6am every morning, before the rest of the household woke up. If my kids woke up early, I would incorporate them into my workout, playing with them and getting them involved in my exercises. If I needed to take calls for work, I would do it while working out, multitasking to make the most of my time.
By prioritizing my health and fitness, I was able to reap numerous benefits. Not only did I regain my physical strength, but I also improved my mental clarity, focus, and discipline.
First and foremost, having a regular exercise routine helped me to overcome the victim mentality and take control of my life. By focusing on what I could do, rather than what I couldn’t, I was able to shift my mindset from one of helplessness to one of determination and resilience. This shift in mindset had a positive impact on other areas of my life, and I found myself becoming more disciplined and focused in general.
Another benefit of regular exercise was the positive impact it had on my overall health. By getting my heart rate up and increasing blood flow, I was able to reduce my risk of heart disease and other chronic illnesses. I also found that I had more energy throughout the day and was able to sleep better at night.
But perhaps the biggest benefit of regular exercise was the way it made me feel. I am more confident and self-assured, and I have a newfound appreciation for my body and its abilities. I feel strong, powerful, and capable of tackling any challenge that comes my way.
In short, regular exercise has been a game-changer for me. If you are struggling with the victim mentality, I highly recommend giving bodyweight training a try. By just starting and taking small steps, you can overcome this mindset and begin to take control of your life. The benefits will spill over into other areas of your life, and you will be amazed by the positive impact it can have on your overall happiness and health.
“You have power over your mind – not outside events. Realize this, and you will find strength.”
-Marcus Aurelius
Towards the end of my fellowship in hematology and medical oncology, I was anxious about not being able to find a job. I had applied to two places, but had not been offered a position at either of them. The burden of medical school debt, combined with the responsibility of providing for my family, including two small toddlers, weighed heavily on my mind. I found myself worrying constantly about the unknown and what the future might hold.
At first, I tried to control the situation by applying to every job I could find and even considering relocating to another state. But as the weeks went by and I still didn’t have any offers, I began to feel increasingly helpless and frustrated. I was consumed by thoughts of failure and the fear that I would never be able to provide for my family.
Eventually, I realized that I was letting my fear and anxiety control me. I decided to let go of the things I couldn’t control, such as the outcome of my job search, and focus on the things I could control, like my mindset and my determination to keep going. I started to see the job search as a challenge to be overcome, rather than a source of stress and anxiety.
I began to focus on my mindset, reminding myself that I was a skilled and knowledgeable oncologist with a lot to offer. I also started applying to more places and networking with other professionals in my field. As I continued to take action and stay determined, I gradually began to feel more in control of my situation.
One day, I received an offer for a job at a private practice group. It wasn’t my dream job, but it turned out to be the best career decision I ever made. I accepted the offer and began my new job with a sense of accomplishment and gratitude.
Looking back, I realized that I had let go of the things I couldn’t control and focused on the things I could. By accepting my situation and taking action, I was able to overcome my anxiety and find a job that provided for my family and allowed me to continue pursuing my passion for oncology.
Here are the crucial points to remember and apply in order to achieve your goals and live your best life:
Take control of your life by identifying the things you can and can’t control, and focusing your energy and efforts on the things you can control.
Make self-care a priority in your life, and take time to focus on your own well-being. This can help to support your personal growth and development.
Practice gratitude on a daily basis, and focus on the good in your life. This can help to shift your perspective and keep you moving forward with positivity and purpose.
In high school, I was a competitive tennis player, and I was determined to be the best. I would spend hours on the court every day, hitting balls and practicing my shots. But despite my hard work, I often struggled with injuries and burnout. I would go through periods of time where I was unable to play at all because of these issues.
One day, my coach suggested that I try a different approach. Instead of always trying to hit the ball as hard as I could, he suggested that I focus on consistency. “Mike,” he said, “it’s more important to consistently hit the ball in the right spot on a regular basis than it is to always try to hit winners. The last person to get the ball in wins the point.”
At first, I was skeptical. I didn’t think that this approach would be as effective as my previous training methods. But over time, I started to see the benefits. I was able to maintain my skills without getting injured or burned out. And I even won more matches. I realized that consistency was the key to my success, and that always trying to hit winners was actually holding me back.
So in the end, I learned that consistency is better than perfection. I was able to achieve my goals and improve my performance by focusing on consistency and playing smart, rather than always trying to hit the ball as hard as I could. It wasn’t always easy, and there were times when I still wanted to go for the big shots. But I learned that staying consistent was the key to success, and it helped me become a better player.
I learned that being consistent allowed me to consistently outperform my opponents and achieve my goals. I learned that being consistent allowed me to build my skills and confidence, and that it was the key to achieving success on and off the court.
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.”
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.”
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:
A Million Miles in a Thousand Years by Donald Miller
Hustle Harder, Hustle Smarter by Curtis “50 Cent” Jackson
A Million Miles in a Thousand Years by Donald Miller
How to Take Smart Notes by Sönke Ahrens
Steal Like an Artist by Austin Kleon
The 50th Law by 50 Cent & Robert Greene
Wherever You Go, There You Are by Jon Kabat-Zinn
Rich Doc Poor Doc Podcast #17: Business Building with Dr. Bonnie Koo
Greenlights by Matthew McConaughey
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!
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.
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.
Coconuts in Bien Hoa, Vietnam. Imagine a really big one of these in your belly. That’s probably how Pam felt. 5/12/16.
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.
Kari’s feet on a kayak in Halong Bay, Vietnam. Photo taken 5/16/16.
Several months ago, Gary came to my hospital complaining of weakness. Gary was 72 years old, so weakness was a pretty common complaint in his age population. While lying in bed, Gary told me that this morning he could not move his feet. Since then, the weakness has gotten progressively worse and traveled up both his legs. At presentation, Gary said that he could not even lift either of his arms or legs. I lifted up one of his legs, and let it go. The leg dropped like a dead weight. In addition, Gary said he recently got over a cold. Gary also told me he had a similar illness over ten years ago. He said at the time he was hospitalized for 3 weeks with over 10 days connected to a breathing machine. Essentially, what he had ten years ago was the same as what he had at presentation.
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