From Sports Psych to Work Psych

A long time ago in a far, far away place (ok, Florida 2003), I had a session with a sport psychologist geared towards my tennis. People often speak of “the loneliness of the long distance runner,” but I think there is no lonelier sport than tennis. Its you and your thoughts against your opponent. No coaching. No time outs. No team huddle.

Two things have stuck with me since that session:

1. All pressure is self created.

2. It can be hard to distinguish between reality and the stories we’ve made up that become our new reality.

The latter is something I’ve thought about quite a bit about as an intern.

Making mistakes is a given as an intern. Contrary to what you might think, mistakes usually aren’t grievous or harm a patient (knock on wood). Interns aren’t given enough power to really harm someone (well, hopefully)! If most newbie interns are like me, they’ll ask a senior resident if they’re unsure.

Mistakes are generally more misdemeanor in their nature yet the blow to your psyche just as tough. I’ve found my flubs to be in having my note not save in the electronic medical record (and having to write it again), forgetting the very specific way to write an obstetrics admission history and exactly which forms to fill out (and having to ask a senior for help), not being able to get tasks done fast enough, forgetting which retractor is the sims vs the narrow deaver and so on and so forth.

Senior residents are like moms – they have eyes in the back of their heads and are the most efficient people you’ve ever seen. They practically troubleshoot a problem before it even happens. Even if you ran around all day getting stuff done, they will find the one or two things your forgot, which is, after all, part of their job!

In turn, being an intern becomes more of what you didn’t do rather than what you did do, which is a huge adjustment from medical school where anything that you did do was praised. There are no more gold stars as an intern.

All of this isn’t bad – its a fact in moving from school to the working world as I’m told by my friends who went through this adjustment a good 5 years before me.

However, for the type-A, high strung, coffee carrying, self-diagnosed obsessive compulsive personality disorder intern, as many of us are, the “what I didn’t do” can spiral into the “what I am not.”

The “I made a mistake” turns into “I am a mistake.” You can convince yourself that you were the “questionable admission” into the residency program and that most everyone around you thinks you’re inept. If you don’t recognize that this entire environment you’ve now created for yourself is, in fact, a story rather than reality, you could dig yourself into a pretty deep hole.

Fortunately, senior residents were once interns themselves and, like moms, can have a nice nurturing manner that lets you know you’re doing ok (this is of course, provided you have nice senior residents like myself).

Still, this whole “being an intern” thing has been an adjustment. I’m hoping the growing pains are over soon!

Until next time…

Great Graduation Speeches

Surely, many have heard Steve Jobs’ commencement address at Stanford in 2005 encouraging grads to “not settle.” Or JK Rowling’s speech to the Harvard Class of 2008 speaking of the benefits of failure.

But, I’d wanted to share a graduation speech that was mentioned in the commencement address given at my graduation last week. I had not heard of it and, lo and behold, the is a wonderful 10 min excerpt created on YouTube that condensing the message into its most salient points.

The entire address, found spoken here or as a transcript here, is worth a listen or read, in my humble opinion. Put simply, the entire speech struck me. Many of you may have probably already experienced what Wallace speaks of – the day in and day out of adulthood. While, surely, there have been months of my life that have been day in and day out, the vast majority of my “professional life” has been moving on from one exciting, seemingly insurmountable task to the next. The SATs. College. Finals. The MCAT. Medical School. The Boards. Third Year Rotations. The Match. Graduation. There has always been a dangling carrot in the not so distant future, ready for the taking. I’ve been extremely lucky.

I think the fear of the mundane is one reason I chose medicine. I’ve been promised a career that is “ever changing” in which I will be a “life long learner.” Yet, still, I fear an ordinary existence. I am fiercely protective of my “extra-curricular” activities, namely running, as I see them as an insurance policy against a potentially humdrum daily life. With running, there will always be a new PR to chase, a fun race to run, a new path to try out. Running can turn any ordinary day into an extraordinary.

I don’t aspire to notoriety or celebrity, but I do hope to be extraordinary and exceptional. At least, that is how I hope people will describe me one day.

Yet, as a sat at graduation last week, looking at the platform of distinguished and exemplary physicians, I wondered what my exceptional is going to be. At times, I think I want to be like them – a well recognized physician. At other times, I crave being a wonderful wife and mom, raising little Noa, Cody, and Reeve (names subject to change) to extraordinary existences for themselves. And, in the next minute, I ponder keeping running a big part of my life, like the ladies of Oiselle, and somehow intermixing this why my “professional” career. Entrepreneurship. Social Media. Family Life. There are many things I could imagine wanting to be great at. I guess in the terminology of “lean in,” I’m not always sure which way to lean.

Do I need to know what this balance will be at 27 years old? Scarily, sometimes I think so. The “early bird catches the worm” is a cliche for a reason. But, maybe not. 27 years old, as I hear from others, might be on the younger side in the working world.

What I do know is that I need to spend the next 4 years hopefully becoming an exceptional physician. I hope to keep running and maybe dabble in social media or writing, but know that my blinders need to be put on and the sole focus my main profession: medicine.

I think the choices of my professional pie can, hopefully, be put off until my 30s, when I set up my “real career.” Surely, my tastes and preferences will change by then as I didn’t even like this whole running thing when I entered medical school.

In terms of the potential banality of daily life? Here is something I’m going to remember from Wallace’s speech:

 If you’re automatically sure that you know what reality is, and you are operating on your default setting, then you, like me, probably won’t consider possibilities that aren’t annoying and miserable. But if you really learn how to pay attention, then you will know there are other options. It will actually be within your power to experience a crowded, hot, slow, consumer-hell type situation as not only meaningful, but sacred, on fire with the same force that made the stars: love, fellowship, the mystical oneness of all things deep down.

Not that that mystical stuff is necessarily true. The only thing that’s capital-T True is that you get to decide how you’re gonna try to see it. This, I submit, is the freedom of a real education, of learning how to be well-adjusted. You get to consciously decide what has meaning and what doesn’t. You get to decide what to worship.

If there’s one thing I’ve learned from running, it’s that the mind dictates the experience – your race or your life.

TELL ME: A FAVORITE SPEECH OR ADDRESS?

And, if you’re a real graduation speech junkie, here is a list compiled by Business Insider on the top 23 commencement speeches ever given.

 

 

 

Apartment Makeover

A huge thanks to my mom and sister for spending the past month scouring Target, TJ Maxx, and Home Goods for everything in this apartment!

This rug that my parents used in a prior house served as the inspiration:

Sadly didn’t keep this backpack.

Here are the before pictures.

Here are the after pictures:

One trick I learned from my mom – the more furniture you put in a small space, the bigger it will look (to a point).

After 9 years in dorms, I’m more than elated to live in an adult space! [And, I did end up painting the walls myself!]

TELL ME: ABOUT YOUR FIRST APARTMENT/HOME…OR POST SOMETHING YOU WANT IN A DREAM HOME IN THE COMMENTS!

Thanks, again, Mom and Allison!

The decorating team…

And, thanks to my entire family for supporting me through med school!

I love you, Mom and Dad!

Until next time…

For My Parents…

Graduation is impending and before my family arrives, I wanted to write something about them. There are many people to thank and, although its said by many, I really wouldn’t be a doctor without my parents.

My parents are an interesting breed. I like to think of them as “progressive traditionalists.” Both were raised in South Alabama and my moral compass and etiquette standards are in line with such upbringings (or at least I like to think so).  If we’re having “company,” you clean as if the Queen was arriving.  If you don’t receive a hand-written thank you note from me, you can assume that I am sick, injured, or dead. And, if said thank you note is written “incorrectly,” (meaning incorrect greeting to all recipients or not personal enough), I’ll probably have to write a new one.

However, my parents are very forward thinking and open minded. I like to think my parents told me to “lean in” before that was the cool thing to say or do. I was always encouraged to be able to take care of myself. I can hear my mom repeating, “You girls need to be able to take care of yourself without a man – you can’t rely on other people to support yourself!” It was never questioned that I wasn’t capable of anything I wanted to do, even when klutzy Meggie would trip down our stairs every day or make the toilet overflow and run down the walls the day before the house inspector came to close on our house (true story).

My parents are the most selfless people I know. Looking back, it seems like every waking moment of theirs was spent thinking about how to better our (the kids) lives. Meggie loves gymnastics and wants to learn her kip really badly? We’ll build a bar in the backyard! Allison wants to take acting classes? Sure! I can’t think of a moment that my parents didn’t go above and beyond to help me go above and beyond in what I wanted to achieve.

To this day, even at the age of 27, it seems my parents internal compass revolves around us children. Maybe that’s how all parents are, but I wanted to put it out into the universe how much I appreciate mine. At an age (27 years old) well considered “adulthood,” my mom is running around our hometown finding furniture and dishes for my new apartment and my dad drove me to one of my residency interviews this winter telling me “his favorite thing to do is spend time with his children.”

Growing up my parents would always tell me, “We are FOR you, not against you” whenever I would tell them they were being “so unfair.” While my family has surely pointed out my faults — my clumsiness, my naivete — my capabilities were never questioned. I thank my parents for first believing in me, which, in turn, helped me believe in myself. Because of my parents, I thought of myself as smart, strong, and able. There wasn’t nothing I couldn’t do if I worked hard.

All of these things are said about many parents, but I just wanted to speak of mine.

So, thanks, Mom and Dad. You’re the best. I love you.

[P.S. A Happy Happy Birthday to my best friend in the entire world, my sister, Allison! 25 years old. Don’t go have a quarter life crisis on me, Ally!]

[P.P.S. Little Harry you’re cool, too. I felt bad leaving you out of this.]

On Being A Beginner Again…

After 8 years total of school + 1 of research, I am well versed in the best highlighting techniques, the best pens to write with, how to cram 40 lectures into you brain, how to check off check boxes really well, how to take 8 hour tests, and how to manage constant, low level anxiety fairly well. Unfortunately, the cruel twist of fate here is that just slapping on two more initials behind my name (“M.D.”), only gives me enough knowledge and power to actually kill someone [accidentally, obviously.]

Being a beginner is one of my most hated things. I hate not being proficient and feeling like I am slowing down efficiency. Books can only teach you so much; experience is where the meat and potatoes of graduate medical education lies. Unlike in school, I can’t out-read my beginner-ism (my fall-back thus far).

The hardest thing for me, being novice at something, is to learn how to balance efficient mastery with purposeful understanding of the skill or concept. I pride myself on being able to learn things quickly, but sometimes I let my yearning for efficiency undermine taking my time . In fact, when I try to learn something quickly and can’t pick it up, my frustration leads to anxiety and that anxiety slows me down even more. Its like I develop a brain block or something.

I’m going to be a beginner at a lot of things come July so I need to get used to it. Guess I need to get an Erica Sara “Say It, Do It” bracelet that says “take your time.” Slow down. Learn the skill/concept correctly. Then be efficient.

Easy as 1, 2, 3. Right?

TELL ME: HOW DID YOU HANDLE BEING A BEGINNER WHEN YOU FIRST STARTED YOUR JOB?

Until next time…

Why Athletes Make Good Students

I’ve been in some sort of “sport” since I was in diapers, whether it be dance, gymnastics, tennis, softball, or running.

Refueling after dance with some help from my little sis…

Being active in sports taught me the value of a good work ethic from a young age. Sports have taught me independence, how to stand up for myself, discipline, goal setting, how to take criticism, and how to be humble.

I’m convinced I wouldn’t have made the journey from diaper dancer to doctor without the influence of sports. Here are a few key reasons why:

1. The Ability to Take Criticism: Having multiple coaches, all with different coaching styles, has helped me learned to filter “good criticism” from “that person is having a bad day and taking it out on me.” In addition, learning to take corrections and apply them quickly is often the difference between a good athlete and a great athlete. Same goes for a student or budding professional. The perfectionist in me can sometimes have a hard time hearing criticism, but I remind myself that it will a) only help me to improve and b) better to know now than to make the same mistake again. Knowing what corrections I need to make gives me a tangible plan of attack for improvement.

2. Work Ethic and Discipline: If you want to win or be noticed for your sport, you have to put in the time and effort. In balancing school, practice, and social life requires you to do what you are supposed to be doing when you supposed to be doing it — aka discipline. Learning these two skills is fairly paramount to doing well in most anything.

3. How To Stand Up For Yourself: There is no greater teacher of self defense than being cheated in a tennis match. If you want to have a fair match, you better speak up and stand your ground. [Put your kids in tennis just to learn that skill.]

Sports have taught me to never put limits on my life (or that if I do put limits, it is of my choosing, not because I could not). It has taught me that I am strong and capable.

Should I have a daughter, I’ll be putting her in sports once she can support her own head [and the bow I will put on it] :).

Here are two cool causes/promotions that support strong women in sports!

1. Activyst Athletic Bags

Activyst promotes female empowerment through sports in developing countries. Athletic bags made by Activyst (and bought by the fashionable female athlete) help fund some fairly awesome endeavors: a soccer field and girls’ community center in Nicaragua and a soccer team in Uganda. Purchase one. Spread the word!

2. Believe I Am Superwoman Giveaway

Believe I Am is wants to hear about the superwomen in your life! One lucky gal will get an Erica Sara for Believe I Am Strong necklace and a “strong” tank. Who inspires you? TELL THEM.

TELL ME: THE MOST IMPORTANT LESSONS YOU’VE LEARNED THROUGH SPORTS AND WHAT SPORT/ACTIVITY YOU DID AS A KID.

Until next time…

 

On the Unanswered “Why?”

My past month has been primarily spent on the pediatric oncology service. Many days, I come home sad. Many days, I find myself at a loss of words as to what is appropriate to say to these families.

Do you smile at the mother of a child with a newly diagnosed cancer when you pass her in the hall? Is a “hello, how are you doing” ok or will it make her upset?

Is saying “I’m sorry” admitting defeat or appropriate for the cirumstances?

How do you look at child who is a shell of himself or herself after we’ve pumped them full of chemo, to make them eventually better, only to have them suffer terribly in the interim? Who can’t get out of bed or even have enough energy to play on an iPad?

What do you tell the mother who asks, “What happened to all of my prayers? Where are all of my unanswered prayers?” I’ve heard that having a child is like having your heart live outside of your body. And watching someone’s heart break in front of the parents’ eyes has really impacted me this month.

And, how can you listen to the screams of a child having his or her mediport accessed without wanting to yell, “No! Stop! You’re hurting him!” even though you know it must be done.

My sadness was compounded on Monday with the Boston Marathon bombings.

A new set of unanswered “whys” ensued.

What was the motive?

Who would do this?

Are my friends ok?

As many people have written or mentioned, it really could have been any of us. My first marathon I finished at 4:09:59, fairly close to finish time at which the bombs went off. My sister and her friends were at the finish, cheering me on. Most of us have these experiences – as runner or spectator – making it easy to imagine it happening to us or a loved one.

I felt it would be remiss of me not to mention the Boston Marathon bombings, but also don’t feel I can state as eloquently my feelings on what has transpired better than some of my friends (real or internet). Here are some links to really wonderful posts:

Boston 2013 – Finding Faith by Gia

Boston by Emily 

Love. Strength. Boston. by Pavement Runner 

Boston Is For Runners… And It Always Will Be. by Susan

Boston by Lauren (also has some good links)

Of course, I don’t have the answers to the unanswered “why” questions. But, what the world lacks for in answers, we make up for with hope, I guess.

I hope that less toxic, yet more effective treatments for children’s cancers will be developed so children suffer less through their treatments.

I hope my patients with the grim diagnoses are the exceptions to the rule. If a certain disease has a 20% survival rate, why can’t my patient be in that 20%?

I hope we can improve those survival rates.

I hope I can bring a bright spot to a family’s day while they are in the hospital, even if I am just with them for a few minutes.

I hope that the perpetrator of these horrible, senseless acts is found.

I hope that there are no more deaths from this attack.

I hope those who lost their limbs can get prostheses. And then I hope they will finish the Boston Marathon some day.

I hope the families affected are finding solace in this difficult time.

I hope for better gun control laws.

I hope for more good deeds to make headline news than acts of violence.

With much love.

And, until next time….

On Synthroid and Elite Athletes

Recently, an article was published in the Wall Street journal that has really got me thinking.

The article profiles “US Track’s Unconventional Physician,” an endocrinologist by trade who has treated several high profile athletes for “subclinical hypothyroidism.” To summarize the article, typical TSH (thyroid stimulating hormone) cut-offs are around 5, depending on your laboratory, and, I presume, depending on the signs and symptoms of the patient. Dr. Brown, the physician profiled, considers his threshold to be 2, meaning that, to him, a TSH of 2 combined with symptoms means an underactive thyroid. He has been prescribing synthroid (thyroid hormone replacement) for some athletes he has diagnosed with hypothyroidism…with good results…15 Olympic gold medals and counting.

By sub-clinical, the medical establishment means that the patient’s free T4 (thyroid hormone itself) is normal, while the TSH is elevated or slightly elevated.   To my best understanding, this is a somewhat newer disease entity that has not been as well characterized or protocolized in treatment schemes. In addition, one could argue that a sub-clinical case is actually a future overt hypothyroid patient waiting to be found and supplementation should be started to prevent any adverse effects of the disease. However, as a caveat, I am just a medical student and not a board certified endocrinologist or even a doctor (yet), so, I would take what I write here with a grain of salt (and I’m also writing this a fairly quickly, no time for editing!).

Now, to be clear, I am not an endocrinologist nor am I a professional athlete, so I really have no dog in this fight. But, I did read the article with a keen interest as “curious observer.”

Here are the questions that popped into my head as I read:

1. What is the mechanism of this disease? 

The most common cause of hypothyroidism in the US is Hashimoto’s thyroiditis, an autoimmune disease in which you have autoantibodies against certain proteins in the thyroid gland (for example, thyroid peroxidase). However, seeing as autoimmunity was not mentioned in the article, my best guess would be that hard training suppresses the hypothalamus, which is upstream in the chain of events in stimulating the thyroid gland (hypothalmus secretes TRH–> pituitary  secretes TSH –> thyroid secretes thyroid hormone), somewhat like how anorexia can cause you to stop having a period (hypothalmic suppression then suppresses the menstrual cycle).

2. Is this effect reversible when the person stops training if he is claiming that it is the hard training that is suppressing the thyroid?

Or, stated another way, is this a temporary under-active thyroid? Or have they permanently lost thyroid function?

IF my proposed mechanism is what Dr. Brown or others was thinking, then is this effect reversible when not in a hard training mode and did has anyone retest TSH at that time to see? [If anyone has any papers on this, please send along! Not enough time for a thorough literature search tonight…]

3. Do the athletes stay on synthroid (thyroid hormone replacement) after they are done competing?

Excess thyroid hormone isn’t without consequence! Unless you like heart arrhythmias (atrial fibrillation in this case) and accelerated bone loss…

4. Has anyone suggested that this is due to some sort of immunosuppressive process and, if so, is it somehow linked to the seemingly increased rates of gluten intolerance in elite runners?

I actually have no data to back up that gluten intolerance claim it just seems that nearly every elite runner that I’ve met (which is like, what, 5?! really making a claim on nothing here) is intolerant to gluten.

Just an interesting thought to me…is there something about hard training that abnormally affects physiology to make these people susceptible to depressed thyroid function and gluten intolerance? However, these might be “true, true, unrelated” – both entities found in elite athletes, but in no way related in how they come about.

5. Does this constitute a new performance enhancing drug?

And, here’s an ethical issue I’m not sure I want to add my opinion to, seeing as I’m not a professional endocrinologist nor athlete and really have no place giving an opinion.

Surely, if you need replacement therapy (if you have Hashimoto’s, if you had your thyroid gland surgically removed) it isn’t “performance enhancing” as you do need thyroid hormone to live.

However, is adding replacement to someone who may not necessarily be hypothyroid, but is tired and has a borderline TSH constitute using a performance enhancing drug? I’m not really willing to say without knowing more information. Also, who isn’t tired? Were these athletes having more symptoms other than fatigue?

It’s just an interesting idea to ponder.

6. If Dr. Brown is right, are we missing an entire population who needs hormone replacement? Should you replace hormone in, say, a 35 year old male with a TSH of 3.5 who is a little tired, but isn’t an elite athlete?

Anyways, speaking of tired, I need to settle down the brain, read some on gynecology, and go to bed.

TELL ME: THOUGHTS ON THYROID HORMONE REPLACEMENT IN ELITE ATHLETS? PERFORMANCE ENHANCING OR NOT? MEDICALLY NECESSARY? IS THE MEDICAL ESTABLISHMENT MISSING A WHOLE GROUP OF PEOPLE WHO ACTUALLY NEED THYROID REPLACEMENT BUT CURRENTLY AREN’T GETTING IT?

Until next time…