Miles in my Shoes 1.0

Monday, October 25, 2010

Grand Rounds - Lessons Learned

When first presented with the topic for these Grand Rounds, I immediately thought that it was too broad a topic to do any justice to. Having been through four years of medical school, four years of an OB/Gyn residency, and the first three months of my three year Maternal-Fetal Medicine fellowship, I wouldn’t even know where to begin cataloging or recounting what I’ve learned.

Then it dawned on me.

The Karate Kid.

Anyone who knows me, or has been through any of the aforementioned steps along the way, has probably heard my Karate Kid philosophy to surviving medical training. For those of you who have not seen the movie (you should be ashamed of yourself, go rent it now), I’ll narrow it down to the build-up and pivotal scene that brings the philosophy together. For a good portion of the movie, we watch Daniel perform a myriad of menial, tedious and seemingly disjointed chores for Mr. Miyagi. He paints the entire fence surrounding Mr. Miyagi’s home, sands the floors on his hands and knees from morning ‘til night, and manages to methodically wax a bunch of old clunkers parked in the back yard to the point of making them look brand new. All the while, he begs to be taught the art of karate as he had been promised, only to be rebuffed with cryptic sayings and apparent ambivalence.

Mr. Miyagi simply seems thrilled to have himself a handy man, while Daniel frets that his entire future, more precisely his love life and personal safety, is becoming increasingly bleak and out of reach. He is proud, to a fault at times, and idealistic. He is sure of what he wants, even though he doesn’t seem to understand what that goal actually entails. And at his lowest point, feeling beaten down, exhausted, marginalized and far from any appreciable reward, he simply feels like quitting.

And it’s in that moment, he puts it all together. Literally:

While it may seem like a stretch, I would hazard a bet that this scene resonates with anyone braving the grueling, methodical and oftentimes thankless journey through medical education. Trudging to anatomy lab day in and day out, memorizing endless lists of bugs and drugs only to forget them shortly after the test, or percussing the borders of the heart knowing full well you’ve never seen a doctor perform such a banal task. You spend hours producing handouts that promptly get thrown out when finished, weeks developing presentations that are usually cut short or never see the light of day, and years taking impersonal, closed exams that supposedly measure your worth to faceless powers-that-be. Your pride is wounded on a regular basis and it seems like open season on idealism.

But what remains constant, and what Mr. Miyagi stresses throughout this scene is to concentrate. Keeping your eyes on the opponent at all times is akin to maintaining sight of your goal despite the minutia that is expected of you. In our profession, some of the most valuable skills acquired or lessons learned appear to be the most innocuous and repetative at first. When I was told to throw a minimum of fifty knots with each hand on a nightly basis as an intern, it seemed more an exercise in arts and crafts in the face of such overwhelmingly big subjects for serious surgeon to master. Then came my first encounter with the kind of intraoperative bleeding I had only read about to that point in my career. It was a situation where wasted motion, slow hands and, most importantly, faulty knots could easily lead you down a road you, your attending, and your patient never want to travel. I had come to a point where thought and action, and in my case reaction, had been brought closer in an almost subconscious way. On a larger scale, with every subsequent graduation and promotion, I can look back and see a similar synergy of tasks and exercises culminating into the skills and knowledge required to both advance my own career and teach what I’ve learned.

In a way, painting the fence, sanding the floor and waxing on and off has made me into the physician I am today and will continue to mold me into the physician I hope to be down the road.