“Paranoid interns keep patients alive.”
-Every intern I worked with at Cardinal Glennon (2003-2004)
Storytime. There might not be much of a point to this post – at least for the general public. As they say, this one’s for me. I’m thinking out loud. I usually don’t like thinking about my past a lot, but I feel compelled to here. The school year is over, and I’m TRYING to relax.
So far, I’ve cut, split, hauled, and stacked 3.5 racks of firewood. I’ve taken one AP Chemistry test and worked out the logic behind the answers for the students. I have two AP Bio tests to go through – but that’s just fun for me. And I’m trying to get through a 1,000 piece puzzle, but it’s all just shades of blue to me – so I sit down with it for an hour, and I just get pissed off that a cobalt blue and a royal blue look the same to me. At least I’m taking naps – shhhhh, don’t tell anyone that it’s because my sleep cycle is beyond screwed up. A nap is a nap is a nap.
I actually have to work at relaxing. I want to get in the mirror and yell at me. Just be normal – for once in your damn life, Kesselring. Once. Old habits die hard.
I have been able to run more lately. And as soon as I start running, I think about competing. I don’t WANT to, it just happens. If I’m with someone, I can talk very nicely and I’m content with just getting in the exercise. But when I’m by myself (and that’s 99% of the time), I keep thinking about how to push, push, push.
Which begs the question to me: did I have experiences that MADE me this way, or was I always this way and I subconsciously sought out experiences that reinforced these tendencies? More accurately – what’s the mix? What percentage of the two is it? Which one is more important than the other?
I’d like to pin this down. Because while I want to instill a work ethic in my children and students, I’d like for them to have a healthier balance than I currently do. And it’s hard to shepherd young people through their experiences if I don’t have a clear and balanced view of my own experiences.
Two semi-quick stories…
It’s August 1993. If you are from St. Louis, this is the year of The Great Flood. And it was seriously bad. People from outside the region thought all of St. Louis was underwater. The spring was wet. The summer was wet. The Mississippi flooded so badly, the river was actually about ½ to ⅔ of the way up the steps of The Arch.
But it was not raining ALL the time. St. Louis could just be hot and miserable, too. Like it usually is in the summer. I was a junior, running cross-country in the practices before the school year started. I did train during the summer, as much as a one-year novice that was learning the craft could.
As much as I remember, the day was hot and humid – St. Louis is miserable. The morning workout was nothing remarkable. Run six miles – and then do some work on the track. The assistant coach would run with us to make sure that everyone was keeping the pace honest for their own abilities. This day was nothing special to start.
I was NEVER a remarkable runner. I ran varsity – but our team was not particularly strong. I did the best I could. I was a “try hard” guy, so to speak. But the University of Oregon was never going to be calling for me. The lead pack went out, and I tried to maintain contact with them for as long as I could. But after we hit the turn-around point, the heat / humidity was getting to me (I sweat A LOT; I do much better in cold weather than hot weather, even now).
As the lead pack got away from me, my mind started to drift. Any runner will tell you that when your mind drifts, your pacing slows. I wasn’t trying to slow down – it just happened. It wasn’t even self-preservation. I just lost focus.
Our assistant coach had been running with the lead pack. As I lost visual contact with the lead pack, I lost visual contact with our coach as well. I even remember thinking to myself, “Just survive the run.” It really felt oppressive during the workout.
With about two miles to go, my coach popped out from behind a tree. Never lose visual awareness of where your coach is, friends. NEVER.
He had been waiting for me.
“Kesselring. You’re running the rest of the way with me. You will not fall one step behind me.”
He did not yell. He did not berate me at all. In fact, to my memory, this was in fact supportive. But he did make the statement in such a manner that I felt significantly compelled to hold his pace and not mine. There was no question in my mind how this was going to go down – and I did not really want to find out what would happen if I slowed down, on purpose or by accident.
And so we ran in lockstep back to campus. If I fell even a half step behind, all I heard was, “Kesselring, stay with me.” I intentionally did not put an exclamation mark there – because he did not raise his voice. 28 years later, it’s hard for me to convey his TONE. There was a supportive, yet stern reminder that we were doing things on his terms. Negotiating was not an option for the day.
Maybe he wanted to take thinking out of the equation for me so I could focus on ONE task – the running.
Maybe he wanted to show me that I could handle more than I thought.
Maybe he wanted me to discern the difference between discomfort (something that can be fought through) and pain (something that cannot be fought through).
Maybe he wanted me to “toughen up” (knowing him, I doubt this one).
Maybe he just wanted to get back to campus with him. He wanted a running buddy.
I’m 100% certain of this – I felt miserable. As in I wondered if I would actually make it back to the campus in one piece. I spoke not a word during the time I stayed on his side. As long as we were running, talking was an impossible task for me. With about ¼ mile to go, he started to sprint to the traffic light where one turns into the school. I tried desperately to keep this final, quickened pace. But I’m not a sprinter. I picked up my pace, but I couldn’t stay with my coach – and he didn’t reproach me. I pushed, and pushed, and pushed…
And I got to the traffic light.
And collapsed in the grass.
And puked some more.
And my teammates that finished behind me saw me – and wondered what the hell had happened.
After I had thrown up several more times, my coach started to pull me up. When he got me to a semi-standing position, he leaned over and almost whispered in my ear, “Go to a drinking fountain. Rinse your mouth out and get the acid off your teeth. When you’re ready, please meet us on the track. Good job.” And he gave me a few pats on the back. If you had been more than 2 feet away, you wouldn’t have heard him. In fact, I barely heard him.
That was one workout. One practice out of many. But I remember that one. It sticks out in my brain as a 44 year old man. It’s different even now – because it’s similar to other experiences that I had as an older person that are much more significant than a workout I had as a 16 year old kid.
I’m fairly certain that of all the lessons he wanted me to learn, he wanted me to take away that we are capable of doing much more than we think we can. I certainly took THAT away. I also took away that I need to push, push, push – at ALL times and damn the consequences. He never said that. I inferred that. I made the extrapolation – no one has ever said “boo” about that part. My experiences, well documented on this site, reflect that. For better or for worse, that second part falls on me alone, and I’ll wear that.
The quote I started with is much more significant. Working in a hospital as an intern when I was learning a craft is much more important than a cross-country practice at the age of 16. But they are connected. One can get through residency quite well without triple checking lab results. The intern might actually get rest and do a BETTER job if one takes a different approach. But the way I approached it was to leave no stone unturned. And that is much more akin to the experience I had when I was a teenager.
So? Chicken or egg? Frequently, it’s a rhetorical question that’s fun to discuss but the answer really doesn’t matter. I feel like the answer matters here.
Let me pick another example of something more recent, and probably more relevant, too.
I don’t remember the exact year – this was between 2013-2015. I was still in practice at the time. And, to reiterate, for my “outside of residency” years, I worked at a Federally Qualified Health Center. While I certainly saw children and families across all income levels, the vast majority either had Medicaid (state health insurance) or did not have health insurance. The organization I worked for kept data based on location, but at least 80% of my patients fit this demographic.
Further, at a hospital that IS NOT a pediatric only hospital, pediatricians are regarded just above the roaches by the top administration (or at least, that’s how it was at the place where I was). This goes doubly at a for-profit institution, like mine was. The fact of the matter was that essential services frequently don’t make money – or don’t make a lot of it. The cash cows got treated better. Money talks, B.S. walks as the saying from the 1980s goes.
Every physician I’ve ever met loathes medical staff meetings. They often happen once per year; the physicians and the administrators mingle. Policies get passed, stuff gets voted on, you eat a little cake, and then you go home. Sometimes, the big wigs make speeches, the “top docs” (i.e., not me) vent on a topic, and that would be it.
We had a new CEO for the hospital, and by new, I mean the CEO had been around for about a year. I decided that I wouldn’t be jaded, and I would go with a clear mind and be “the good soldier” and just listen and give everyone a chance. Plus, I could talk to a colleague in another department. Shoot the breeze, vent to each other, and who knew? Maybe something would come of it. A new, beneficial relationship.
As they say, no good deed goes unpunished.
I was talking to a colleague of mine that worked in another department. I had been particularly wound up (big shock here, I know…) This gentleman started to tell me about how he coped with job stress – which he could tell I was dealing with (there was at least a 25 year age gap, if not more). He was telling me that he could deal with just about anything, so long as he could travel on a regular basis. I was curious (as I have never been outside of the United States). I was just asking him about where he had gone and where he still hoped to go.
The CEO entered the room and was glad-handing some of the docs.
Cool. No problem. We kept talking. Discussing favorite destinations was a lot more interesting than the med staff agenda.
The CEO got over to us – and went straight to my colleague.
What follows next, I’ve never known the context. Perhaps it was meant in jest and my skin was thin (fair assessment). Perhaps it was serious (also fair, CEOs are, well administrators after all. A tad cutthroat they are). It’s way too late to ask, and I’ll never know.
The CEO shakes my colleague’s hand – and then the CEO looks at me. He asks my colleague, “Why are you slumming it by talking to him?” The CEO gave a smile. And then the CEO kept working the room – and never shook my hand.
I was shocked. I mean, I knew I wasn’t important, but DAMN. The CEO knew my background and knew where I worked. For-profit vs. non-profit. The words cut to my core – I was acutely aware of where I stood in the medical staff. That confirmed it. I didn’t realize that in the CEO’s eyes that I stunk so much. I should have sniffed my armpits. I don’t think I forgot my deodorant, but I guess that’s a possibility.
I never went to another medical staff meeting after that. I don’t have much pride, but I have enough self-respect that I’m not going to continue to “make nice” for people that clearly didn’t want me around. Best to remove myself from the situation. Fortunately for me, I didn’t have that many years left in practice. Given the way the conversation went, I’m willing to bet my presence wasn’t missed. I know I wasn’t shedding too many tears when I missed those meetings – I conveniently found better things to do when those meetings came up. Funny how that works…
I’ve always been paranoid and suspicious of those that are in positions of power over me. So, did that experience make me MORE suspicious and less trusting of those that have authority over me, or am I just more sensitive and tuned in to those experiences – and when they happen, they stick out more to me because I’m ME?
It would be easy to say that “I have trust issues.” The “why” is key. Is it the experience that made the wiring, or is it the wiring – and the experience just reinforced what was already there?
Those are two examples. One from my semi-youth, and one as a grown adult. They stick out to me now – and clearly have ramifications as to how I interact with people, how I approach work, how I try to conduct myself, and who I do and don’t trust. This is why it’s important to me:
-If the experience influences the wiring (or has more of an impact than our wiring) – then we have to be very careful of who we interact with and how we do it. OR, as an adult, I have to be VERY INTENTIONAL in what I say and do in every case. I don’t know when something will be impactful to another person. That’s kind of scary for me NOW as an adult. I can think something that rolls out of my mouth is completely innocuous and be 100% wrong.
-The flip side is that we have a significant amount of hard wiring, and we seek out things that supplement our tendencies. Going back to my example – if my coach hadn’t taken that approach that particular day, no matter. Something would have come up eventually that would have had a similar effect on me. I’m wired to be a little “Type A”, a little anxious and overprepared, and at some undetermined point – that unknown experience would have impacted me in a similar manner. We still have to be careful of what we say and do to others – but it’s really individual reactions that determine the lion’s share of what happens to us.
This does not obviate me as an adult now from being kind, respectful, and thoughtful. Nor does it take out the aspect of individual responsibility to be responsible for oneself and how we control ourselves. But if I’m trying to get the mix right NOW, or at least getting the mix right for me, then the answer matters.
I’ve looked back at some of the earlier pieces I’ve written, and I wonder now that I’ve had some distance, what they would look like through this lens. I suppose that matters less than figuring things out some I’m better informed for making better decisions going forward. I’m not trying to get out of analyzing missteps from my past (I’ve done PLENTY of that in this forum before!) I have been pretty open about struggling to find the right balance between work and relaxation, doing meaningful things and just goofing off, finding purpose and “just being you”.
So, I’m really interested in the psychology of this. Do the experiences shape us more than our wiring? Or do we seek out and place more importance on certain experiences BECAUSE OF our wiring (are we psychologically selective to an extent)?
I cannot put a nice little bow on this. I’m not that smart, and I’m not that good of a writer. But I’m somewhat troubled by it. As I was crafting this piece in my head, I first thought of this like a splinter – an annoying little thought that gets stuck. I think it’s more than that. Understanding the order of importance, or the percentage of our own make-up as to how we react to things is important – or at least, it seems like it can have some influence on how we anticipate events, react to interactions, and interact with people on a daily basis. I do feel like I need to answer it – at least for myself and so I don’t make a well-intentioned mistake trying to help guide young people through their own experiences (that’s the part that worries me). I don’t think that I get an “oopsies” there. If I mess up for myself alone – fair. But I don’t want to perpetuate any mistakes going forward.
My wife, Sonia, reads all my pieces before I publish them. “What do you think?” I think her comments are instructive, at least to me. Her reactions:
-”Neutral” or “everyday” events and our reaction to them (by her thinking) are probably more influenced by our experiences and wiring. In other words, we are wired a certain way and seek out experiences that reinforce our tendencies. “You can’t blame yourself or put pressure on every interaction. People will react how they react on some level.”
-Traumatic / big events have an ingraining influence on us and our wiring – and are “kind of their own thing.” When something huge happens, it wires us.
-This is a “thinking about thinking” piece – or “thinking about how and why people react like we do” piece. It’s hard to come up with an answer for more than one person.