Many of us spend life chasing what we want but remain confused on what we need.
Perhaps we dream about the time we (finally) say what we think.
Someday I will say, “Sir, you eat too much.”
Even to suggest such a vicious thought betrays an unconscious heartlessness. (Call the college!)
Imagine charting only useful clinical data: AOM, Rx Amox. Nothing more. Delete 300 words about all you did not find – all you considered but did not do.
How long could you hide your rebellion? A day? A week or more?
To sleep, perchance to dream…
Walter Mitty – The Movie
In a character-defining scene, Walter sits on a bench waiting for the train. The elevated platform stands several stories above street level.
Walter chats on his cellphone with Todd Maher of eHarmony, an online dating service. Walter loves Cheryl, a co-worker, and wants to leave her a ‘wink’ online.
Todd looks at Walter’s profile. It is blank. Walter must tell about himself: What he has done? Where he has travelled?
But Walter hasn’t travelled or done anything special. He just goes to work.
“Have you done anything, noteworthy? … or mentionable?” Todd asks.
Walter freezes. The phone slips from his ear.
A distressed dog barks inside a nearby building. Something is wrong and Walter must find out.
Walter starts running past all the businesspeople on the platform. He picks up speed and leaps over the railing, arms outstretched. Flying through the air, Walter falls several stories and crashes through a window in a low-rise next to the train.
People scream and race out the entrance.
Walter sprints out with Chips, Cheryl’s three-legged Chihuahua.
Cheryl jogs up in slow motion, dishevelled and distressed. She stares at the camera, oblivious to the carnage and debris.
“I heard barking. Thought I smelled gas,” Walter says, as Cheryl reaches for Chips.
“I hope it’s okay,” Walter says and pulls something from his jacket. “I engineered a prosthesis for Chips, while I was sprinting down the stairwell. A little hip-joint assembly with a drop-ring lock and an anterior pelvic band.”
In slow motion, Cheryl responds, “God, you’re note-worthy.”
“I just live by the ABCs,” Walter says. “Adventurous. Brave. Creative.”
“Hey, my man,” Todd’s voice comes through. “My man! Are you still there?”
Walter returns to reality. He has missed the train and starts running to work.
If you have not seen it, go watch the movie. (Clip attached below.)
Needs vs Wants
My daughter took scrip-writing in New Zealand. (She even hung out at Weta – Avatar, Lord of the Rings, etc.)
During Walter Mitty, she said, “Here’s where we define his character. He thinks he wants Cheryl, but he needs self-confidence.”
Walter embarks on a quest, which seems built on his desire to impress Cheryl. But he isn’t seeking Cheryl. He needs something more and gets … watch the movie to find out.
Why do we work?
Docs enter training to fix things. Twenty years in, we find that we can only fix a few things, and often not very well.
What were we looking for?
Respect? Security? Understanding? Some bizarre certification of a strange intelligence?
Movie characters often confuse needs and wants. We do too. We think we want the guy or girl, but we need something deeper.
Not only do we misunderstand what we need, the thing we need tends to change depending on our stage of life. What seemed crucial at twenty might be irrelevant at thirty-five. We need courage at twenty, humility at fifty, and for the opposite reasons.
Career Arcs
Most professionals change careers every five years. Experience births excellence. Analysts become managers and managers CEOs. A would-be CEO stuck as an analyst breeds resentment and frustration.
Docs used to define their own career arc. They would get a general training. Pick up extra skills. Chase interesting clinical topics. Then they would spend decades pruning off varied and abundant branches of interest. They faded into a mature career focussed on what they do best — things they love and would do for free.
Government killed that tree.
Planners cannot tolerate anything so wild and diversified as an apple tree figuring out what fruit to bear. An apple tree must bear mature apples from the start and do so until cast into the brush pile.
We cannot tolerate individuality, exploration, or diversity. The tree must pay its debt to society. It must bear fruit. We supplied the fertilizer. It should be grateful to bear.
What Are You Good At?
In the numb silence that follows a clinic,
After you’ve seen the last patient;
The dread of undone charting looms:
Filling trenches designed by bureaucrats –
Proof that you cared for patients long gone,
Ask yourself,
What do I want?
What do I need?
What am I good at?
Am I good at writing charts?
Or am I good at caring?
Am I good at following protocols?
Or am I good at solving problems?
A Lesson From Walter Mitty
What do you truly need?
If you sense what you need, what must you do to find it? What resources will it require?
Time and money are excuses, not reasons to delay. You will never have enough of either.
Now leap over the railing.
“Why do we work?” – A great question. Is it because we “must work” at something? Roof over our heads and food on the table type of thing. As docs, those basic needs are met fairly quickly and there’s a lot more pocket change left over at the end of the day to ponder about.
Is it for altruism ?– do we want to help our patients ? Do many of us even care about the pieces of silver as long as we feel we’ve done good with our time on this plane ?
Many of us are feeling burnout of late. We are dissatisfied in some way about our work and lives and feel uncomfortable and exhausted. Just as there are career arcs, there are also life arcs. The idealism and liberal ideas of youth undergo metamorphosis to more conservative and practical thoughts as one’s journey continues.
Ultimately, work is a means to an end, and one must define what that end point is. The target though continues to move and evolve and one must be prepared to adapt to new end points depending on your position in your arc. Burnout may be from the inability to recognize that your goal posts have moved.
Many of us despise wasting time and resources, but in essence, we are wasting a good chunk of our lives working with zero satisfaction rather than doing something that would enrich our lives and experiences. Maybe as the game continues to be played, we all need to look at where the goal posts really are, and rethink our play towards them.
Great comments, Rob, as always.
I like your notion of a life arc. It makes sense of varied experience. You raise the point about the luxury of being able to ponder life. If we were starving or hiding under pieces of tin at night, we would not have bandwidth to ponder. Given the luxury to ponder, we ask painful questions, or we avoid the questions by filling our lives with sound and fury.
You also juxtaposed our innate disgust at wasted time and resources against the sense of our own wasted professional energy/skills/talent/desire (I took the liberty to expand “our lives”). I think your insight adds another layer to understanding burnout in knowledge workers.
Your comments have sparked something…must go and ponder them some more! (As I go about my work…)
Thanks again
Thanks again Shawn for inspirational musings and, as always, exceptional writing.
I realized after stepping down from ER chief and then Chief of Staff, that I’m best In the trenches teaching the young ones the lay of the battlefield that is the ER. And I love it! I’m where I am supposed to be doing, as you say, what I do best and I have enjoyed the process of getting here just as much.
I have been to the top of the mountain and I’m happy to be slowly walking down the other side.
See you at base camp my friend.
Oh well said, Ozzy!
This is a really attractive turn on the pruning back of one’s career idea. I am impressed that you have noticed your enjoyment of the process itself. Very cool. Maybe you need to package THAT process into your teaching. Many people can teach the nuts and bolts of clinical care. Only you can teach/share the process of up and down the mountain, as you said.
Excellent. Thanks for posting it!
Cheers
Our true needs are basic, food, water…then we have the requirement for clothing and shelter….then we have Maslow’s pyramidal hierarchy of needs …after the base of food, water warmth and rest we have safety and security needs…then belonging and intimate relationship needs, friends…then esteem needs with prestige and accomplishment needs…then self actualization needs at the apex, the achievement of one’s full potential and creative needs.
Wants are infinite.
Wants ( desires) and needs ( essential requirements for survival) are not black and white…there is a blurred continuum where many needs are not really needs at all…one thinks of computers, wifi and smart phones which are perceived as being essential needs by the moderns but are not.
When one clearly know what one wants, when one have specific goals in mind, in particular when they harmonize then one has a tremendous advantage over those who don’t have the foggiest idea of what they want.
On my part it was easy…as a refugee , a child, I had nothing, no money, no family structure other than my mother…no support system other than my mother , we had to part company so that both of us could climb different ladders…she went from being a house keeper to become a teacher in London , England…myself to med school in Wales.
When one is at the bottom of the pyramid one’s vision is quite clear…the vision of the silverspooned lying on soft pillows sucking on Bon bons is not always as clear…for my part I imagined myself in a little put put boat with a 2 stroke 3.5 hp outboard engine surrounded by magnificent 600hp power boats and luxury yatchs …I had a chart and the stars to guide me , many of the other larger ,more capable, more powerful vessels , drifted aimlessly bumping into each other…one had to weave amongst them …keeping out of the wake of the few power boats who knew what they wanted , knew how to get it and were rushing full speed to get there.
Poverty has its advantages.
One lesson I learned in life was to envy no one ( “envy no one until you know the mode of his death”) , emulate the successful and learn from other people’s mistakes…when you know what you want and get it be satisfied, enjoy it , treasure it, remembering that it all could be taken from you in the blink of an eye as it was taken away from each of the two generations of my family that preceded me.
Andris,
Your writing and wisdom just get better and better. I loved the “envy no one until you know the mode of his death.” (I had forgotten this…remind me who said it?) You wove together envy with the deceitfulness of wealth; the essential ephemeral nature of something we spend so many hours pursuing just to make a living.
Great points about poverty. I thought we were quite well-to-do, when I was growing up. Looking back, I realize that we were lower middle-class, if that. But I doubt we were as poor as you describe. Having said that, I know how to live on very little, and I am sure I could do so again. A good splitting maul and a pile of firewood offers more pleasure, fulfillment, and sense of accomplishment than an evening out at fine entertainment. Having said that, I’ve been corrupted by books. If my younger self saw me reading Cicero, he would roll his eyes and spit. We change.
I’m happy to see you bring in Maslow. No doubt we fret at the top of his triangle. Our ancestors would scoff at our ennui. I wish I had your problems! Get to work!
Thanks again for a great comment. Love the history, philosophy, and psychology you wove through it. THIS is your strength — most of us simply do not have your exposure and experience.
Cheers
Hi Shawn,
I too was struck by Andris’s take on your post.
As the son of Lithuanian immigrants,I could especially relate to weaving my little boat around the yachts.
Needs and wants ….. the distinction has certainly become blurred in western society.
Our desire to save every life in this pandemic by imposing lockdowns/severe restrictions ,has begun to threaten our need to salvage the essence of human society.
Focused protection rather than global restriction,in my opinion.
Great comments, Ram.
It makes me wonder whether your experience in your little boat allows you to see that threat where others remain blind.
Excellent thoughts all.
Thanks for taking time to post!
Ramunas I share your fears about the “ cure” being worse than the disease…Primum non nocere should the governments’ guiding light.
I can’t help noting that the main support of those wishing to close down the economy comes from those who are secure…eg : on governmental salaries with benefits and pensions…many of those in our profession promoting draconian measures seem to come from those same ranks , working in province subsidized clinics , that includes our salaried representatives who have forgotten the plight of their FFS members.
Those of us in contact with the grass roots are witnessing the economic and sociological damage generated by those with statist tendencies, with more dying from suicide than from COVID as in Japan….more dying of suicide and drug overdose as in the USA.
In one CME it was reported that for every 1% increase in unemployment there is a 1% increase in suicide
There is the Tom Bodett triad that I agree with , “ humans need someone to love, something to do and something to hope for’…all three are being currently denied to the younger generation, the university experience of yesteryear is evaporating.
Being high risk, a 76 year old awaiting a cardiac procedure, in forced COVID isolation since the 18 th of March ( patients lie) …I fear for my children and grandchildren , in particular for their schooling , future employment opportipunes and political freedoms ( from which all other freedoms emanate).
My life is not worth the destruction of their futures…I’m certain that having taken pertinent precautions in looking after the geezer “ dry tinder” generation…the younger generation , taking reasonable precautions, should be allowed to go about their business and so allow the economy to recover.
Don’t get me wrong, I want to stick around and see how it all works out…governments tend , eventually, to do the right thing, but only after exhausting every other alternative and after exhausting every bank account.
If denied, the situation will be explosive with unknowable consequences.
I’m not suggesting the proverbial Eskimo ice floe solution, but perhaps its more humane cousin.