The Passion Manifesto: Why Every Medical Student Should Rethink "Traditional" Medicine. (Part 1)

A personal yet rational case for the pursuit of the moon, and stars... and throw the asteroids in while we're at it. Heck, wrap it all up for a "to go" order. 

I can’t push these questions out of my mind.

They seem to invade my skull with a fervor that can only be explained by the fact that the answers will determine what my future life will hold.

Will it be a life defined by passionless work, constantly feeling out of kilter in an environment that just wasn’t quite made for me? Will it be the romantic visions I indulge in of a man on a mission in the heart of a wild land, with an invaluable skill and zeal to match, righting the wrongs in a forgotten corner of the world? Will it be relegation to a large grey building filled with sick and dying people who in many cases won’t lift a finger to help themselves, but frustratingly expect to be cured by modern wizardry and a pill? Will it be the life of a nomad, drifting from here to there; in and out of towns and countless lives, cursed with an incurable nomadic soul? Perhaps the life of a key-clicking storyteller will be mine. Writing the stories that deserve to be told of the unsung hero, the underground hero that deserves recognition and a face.

These are the questions that have been floating through my cerebral cortex of late. They will not go away, they will not improve, I cannot banish them from my thoughts.

Some people seem at ease living a life unexamined. I cannot indulge thusly. I need my existence to mean something. I need my action to be meaningful and deliberate. I need the possibilities to be endless. I need to believe that I can be passionate about how I am living NOW and not just scraping for a grade, which will POSSIBLY eventually lead to a small measure of meaning. I need to be on top of my game and in the moment and full of the rapturous joy of living. Pain? I can handle it if an end is in sight. Disappointment, I can weather it if I am convicted of my cause. Grief, I can bear it if I see the purpose in it. What I cannot abide is an endless number of days filled with a transient existence… mere platitudes in exchange for a real life of weight and substance.

Money is fun, yes, but past what is needed to maintain some semblance of comfort it matters little me. I hold this view principally because I have little of it, if I possessed a fortune my tune would doubtless change. That very fact is a good reason to steer clear of fortunes. Money. That pitiless taskmaster under whose whip so many voluntarily bows their heads. That alter upon which so many sacrifice their souls and lives.

Embrace the gambler?

Some would call me a gambler. Willing to risk the safety and certainty of a “stable” and “responsible” choice in lieu of the moon. “The paradigm you seek is unattainable,” they say. “The reality you pursue is not measurable or concrete in a way that we agree with, and it makes us uncomfortable,” more accurately reflects the sentiment.

I am not lauding the senseless disposal of resources into that most heinous of bandits in need of a prosthesis, but at the gamblers heart is not evil. That misguided soul has hope, albeit of a gnarled and mangled fashion. They would turn nothing into something, if they had their wishes. All the gambler’s underpinnings are not sordid and ominous. They possess the ability to lay things of importance down, to detach themselves from the sure thing in pursuit of the dangling possibility. A gambler is really an entrepreneur, gone wrong.

To harness that talent means to be a successful investor, to over-indulge and misalign that same gift means to fall into that certain and stealthy abyss. Addiction or passion? The wafer thin wall that separates the two is often nearly translucent. That may be why so many won’t allow themselves near it, for fear of breaking through.

Passion is a strangely amorphous, yet universally desired, commodity. It as been directed at nearly every conceivable endeavor from the seemingly mundane act of button collecting to such adrenaline-drenched pursuits as hurling one’s body from a ledge wearing naught but a glorified sheet stuffed haphazardly into a backpack. The domicile of this enigmatic feeling is often hard to predict. It can spring up and take root in nearly any soil; no matter how seemingly desolate or blank the slate appears. Passion is also desired by nearly all humans, but in spite of all these favorable characteristics, this most sacred of grails is a painfully scarce commodity.

I am going to hazard a wager. My wager is this: that nearly every singular activity at which a passion has been directed throughout the whole of history could/ has/ or will be molded into a monetarily feasible proposition. Creativity and ingenuity will be required, more in some cases than others, but the POSSIBILITY is there to turn nearly every activity or passion into a business model.

Now I will take that last paragraph, blind fold it, and turn it loose in a different direction. Can a person find something they are passionate about doing, an activity that drives them to pursue perfection unharried, in virtually any existent professional circle? It is an interesting question to be sure.

Is passion even possible in medicine?

Sadly, medicine has one of the greatest potentials of any professional to be a soul sucking passion-sink. I have been a first hand observer of this throughout my life. My family is somewhat of a medical mafia family. The strange customs and rituals, the secretive and enigmatic lingo, the bleeding together of home and work, the all consuming nature of the "family business," and even the fact that a lot of blood flows in the course of doing business... all similarities between my medical family and the mob. 

I HAVE seen many family members use the profession as a means to do great good, while preserving and USING their external passions to do so and I laud them for this ability. I have also seen people in my family loose themselves, their spark, their drive and passion, because they pursued medicine instead rolling the dice on a dream. 

If one is going to "do medicine," without losing their soul... it is going to be a no-holds-barred royal rumble. It is not a profession that generally rewards the balanced individual. The individual that seeks a medical career, but also desires a sane lifestyle. People that work a normal amount of hours or try to work more efficiently are often viewed as being a slacker (I am experiencing this first hand as I try to keep balanced during first year).

In the established medical system, the gambler is wholly vilinized. Keep your head down and follow the protocal. Don't make waves. Don't suggest a good idea to an attending or you'll be singled out for a good old fashioned pimping. Work harder. Whether you are working smarter or not is of lesser importance. Give up your hobbies. Be consumed by the profession. Cover your ass in lieu of making the objectively correct decision.

These are generalizations sure, but too often accurate ones. The really sad thing is that many times the aforementioned traits are touted as preferable or morally superior in some skewed sense.  It isn't explicilty verbalized this way, but the predominent currents flow from these icy tenents. Going down this rabbit hole is supposed to somehow makes you a better doctor. 

This is NOT the case.

The new generation of doctors are beginning to realize this. As compensation decreases and information load increases, young would-be doctors are forced to take a hard look at medicine for it's face value. The days when benjamins could universally override doubt are slowly coming to a close. This article has some salient points and perspective on why this is the case. Suffice it to say that the ROI is often not good enough anymore to make people part with their less secure dreams and a "balanced life."

The status quo is being challenged. The "medical establishment" is realizing that it is having a harder time recruiting the top tier of innovators and free thinkers that will push medicine forward. 

Passion and innovation must be rewarded or this will continue to happen. The gambler must be embraced and utilized. Balance must be encouraged. A more human person will also be a more humane person.

Can a medical student (as I find myself) find passion in medical school by starting a medical school blog, even if they currently find their situation passionless? Can a previously stolid accountant breathe passion into his professional world by changing a venue, entering a niche, or altering a mental paradigm? Can a barista gain a passion for their work by starting their own mobile coffee cart instead of working at a major coffee chain that shall remain nameless (it rhymes with car-ducks). I posit that in many or most cases this is possible.

Not ALWAYS possible though... If medicine is not your passion GET OUT MAN! Make a responsible exit strategy and EXIT. If you can be passionate in a different part of medicine, CHANGE your course. Get into something that you think is FULLY great.

The tortuous road to the moon.

When a person sees that it is not a feasible proposition to turn their current pursuit into a passion... why then do they persist? There is no excuse for this! There are more niche market opportunities now than there has ever been in the history of the earth! That statement should be self evident in describing the possibilities. Allow me to provide examples.

There is a guy who’s living, his calling, his passion is to read the mail of complete strangers and expose their secrets to the world… His name is Frank Warren and he is the founder of Postsecret.com

There is a man named Jerry Greenfield who thought he wanted to be a doctor. He, in fact, applied on three separate occasions to medical school and was denied each time. He thought he wanted to be a doctor, but it didn’t seem to be working for him. He decided to take stock of his passions. He loved ice cream. He wanted to start a small business. He took a $5 correspondence course on ice cream making and promptly opened a small ice cream shop in Burlington Vermont with his long time friend Ben Cohen. You may have heard of his shop. It’s grown a little since then. It’s called Ben and Jerry’s.

There is an individual who was in medical school at Harvard University. During his time there, he found that he was spending much of his time writing instead of studying as religiously as many of his classmates. Realizing that art of the pen was his passion, he decided not to discard it and continued writing feverishly throughout his four years of medical school. When he graduated, instead of stuffing his aspirations on the back shelf and entering a full time clinical career, he began the risky proposition of writing full time. It turned out to be a good move for him, because in 1994 he became the only creative artist ever to have works charting at #1 in film, TV, and book sales simultaneously. If you have ever seen the film Jurassic Park, watched the television series ER, or read one of his numerous best-selling books, you have appreciated Michael Crichton’s decision to follow his passion.

Engaging in passionless work is one of the greatest crimes that can be committed against oneself and society as a collective entity. Creating a passionate place where one can use their natural gifts for betterment of humanity and fulfillment of self, conversely, is one of the greatest goods.

These thoughts continue to consume my mind. They will leave me no peace until I have donned the unitard of action and wrestled with my doubts. Will it require a roll of the dice or a calculated reshuffling of the cards I have been dealt? Likely Both. The platitudes must stop. My life can have passionate direction. It will. It must. This is my manifesto.

Through the slightly course language, this guy makes a great point. 

Comments

[Emily Wilkens]

One of my favorite sections is The Gambler's Heart. "The gambler's heart is not evil..." My brother always talks about the risk to reward ratio and how if you always consider this well, that gambling is actually a very calculated thing. Our conversation would always be about the hazards of things like hitch-hiking, that wing-suit diving stuff, or him hitting massive jumps in the ski park--things with innately dangerous qualities. But I think it applies to the gambling we do in our decisions about career stuff too. What are you risking? Is it worth the risk, to you? To one person, the risk of hitch-hiking isn't worth it. To another, it is. I think the Gambler's heart can be evil if she doesn't recognize that her decisions affect more than just herself. For example, I realized after a while that me hitch-hiking stressed my family out in a way that made it not worth it. It was a conversation I had with my dad where he expressed what it did to him, one that really made an impact on me.

There is a fence to walk!

An important part of this whole process for me has been to not generalize one side of the fence as a place where I'd be caged in, and the other where I'd be wild and free, and instead, letting the fit of the field dictate where I go. Being a PA would have been a wild and free things for my heart IF I was built to do it--I would have thrived. Pursuing writing seems to be a "free-er" existence at first thought maybe?, but the reality is, that there are big ways it could fence me in if I were not fit for its field and enjoying being in the field--PASSIONATE ABOUT IT.

I believe in these kind of manifestos--in the writing and reading of them! I'll bet writing this uncovered a lot of things you knew but didn't know you knew! :) Super good, Jeremy! Thanks.

[Emma Lister]

I can’t even remember an exact moment when I decided to be a doctor. It was always just part of me, part of where I was going. No one in my family was as a physician before me, so I’m not sure from where I even got the idea. I just know once it was in my head, there was no other path for me. I am a pediatrician because the first time I cared for children as a medical student I felt the passion to be better flare up in me. I still feel that every day. I can deal with all the administrative hoops, paperwork, idiotic parents, and long hours because I am so sure I am meant to care for those kids. In your profile here, your philosophy is described. It says “If you truly love what you do, you will do it well.” I love taking care of my little patients, and helping them heal. So I strive to do it well, and I feel fulfilled whether I am in that large, grey building or in the far corners of Malawi.

Perhaps an important question to focus on is what do I really love to do? And do I need a medical degree to do that well? The second part of your philosophy as written in your profile is “If you do something well, regardless of what it is, you will be happier for it.” If you can do what you love better because you have trained as a physician, it follows that you will find more fulfillment and joy in it than you would without that training. Because that training allows you do it well. There is passion in that- pursuing tedious training now because it will make you happier in the long run. If that training won’t make you any more adept at what you are being called to do, then you will never find passion in it. And why waste precious moments pursuing something you don’t love?

I don’t know what the right answer is. Like your video said- Don’t spend your life doing something you hate. Never stop exploring, whether you are exploring the farthest corners of the world, or exploring the most important aspects of yourself, who you are, and who you want to be.

[Chelsea Bartlett]

You've put into words what I've been struggling with for the past year. There is so much that I want to do and that I feel I've been called to do but none of it is going to be easy and it will take a lot of sacrifice. It's hard to follow your dreams when those around you think your desire to do something "crazy" is just a phase you'll get through then you'll go back to doing what normal people do. It's hard to not live up to people's expectations for you because you don't follow the path they want you to.
Honestly, I'm not scared of what will happen if I do follow my dreams. I'm terrified of settling for a comfortable life which would be so so easy to do. You've encouraged me to stay the course...Thank you!

[Michael J. Matus]

I am am first year resident in Internal Medicine.

First, I completely agree with living your life with passion - completely involved in all you do. I also believe one can have a balanced life. In addition, our system is evolving to better accommodate this. For example more and more hospitalists and intensivists have the option to work one week on - one off. Thats six months of free time a year with enough pay to do what you need to do!

Second, as I become more involved in healthcare policy and learn from pioneers at conferences focused on new technology and advances in medicine - more than any other time we are in an age of SUPERB innovation. Medicine is evolving so fast in the areas of telemedicine, genomics and the overall fundamental ways in which we deliver medicine I am convinced this will make us better physicians and provide more care to those in need.

The opportunity to meet another human being in the ER who is sick, really sick, and to diagnose and treat - to actively contribute to their life - is simply amazing. These cases are examples of the integration of biochemistry, pharmacy, philosophy and clinical judgement and is a literal intellectual playground for those involved. I do feel bad for those who focus on the negative aspects of the system and the hurdles that inevitably pop up. I have had the privilege to work with attendings who seep passion and excitement - some into their 70s.

In regards to medicine stifling creativity and ideas towards efficiency - I do agree that medical school does not allow for this. However, now in residency, my program is very excited and welcoming of ideas and policies to make work flow more efficient, reduce cost and generally make life better for all parties. And there is plenty of room in healthcare for those who think outside the box - and having an MD only magnifies your influence.

Also, so many of us want to do so much and do EXACTLY what we think that is - today, however, I meet people all the time that do not position themselves appropriately - then choose to have a family and are then bound to a job they dislike or hate but are no longer in a position to explore other options. Medicine is such a beautiful base to build one's life.

But this is only one humble Intern's opinion.

[Student Doctor GM]

@Michael J. Matus - Your comment and most especially your thought that, "Medicine is such a beautiful base to build one's life", really hit home. A fantastic sentiment and dead-balls-on-accurate.. but there is much to be resolved. To quote another great thinker, "The unexamined life is not worth living."

[PGY-5]

I agree with most of your points, having been on both ends of the spectrum, but the speaker's coarse language pales in comparison to your grammatical and spelling errors. They make it hard to take much of your perspective seriously.