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Wednesday Jun 10, 2020

Piece by Piece: Insights From a Residency Graduate

I had not done a puzzle since my age was reported in months. But with normalcy upended by COVID-19, my beloved new wife suggested a 750-piece "Beauty and the Beast" puzzle to replace our weekly date night out. I was tepidly enthusiastic.

[Human head as set of puzzle pieces starting to come apart on wooden background]

Unexpectedly, I was quickly immersed in piecing together characters' details -- Belle's marigold gown, Gaston's pecs, Lumiere's suggestive eyes. The collaborative activity was a captivating distraction from the disappointment of an axed honeymoon to Portugal and a canceled graduation ceremony. For months, I'd been looking forward to sharing a commencement address with graduating medical students and residents. That couldn't happen, but I present these three lessons from my residency experience to you.

Love Yourself

I was on an inpatient rotation at the county hospital when my eyes locked with a beautiful girl's. Her impeccable teeth, flawless hair and warm demeanor made me feel especially gauche in my oversized scrubs and crooked glasses. Prompted by my jaw hitting the floor, Ruby's friend revealed her secrets to me: Implement a simple rotation of asparagus, carrots, kale and pumpkin; begin each morning with a brief, high-intensity workout; and spend at least one hour a week doing absolutely nothing other than willfully allowing your mind to wander.

Though a dog, Ruby still embodied aspirational goals. I was reminded that September day that the prerequisite to bringing joy, kindness and healing to others is putting yourself first. Eat a vegetable -- multiple if you're willing. Self-care is unequivocally the most important job you have. Healing and/or licking is secondary.

The Right Path

In Paulo Coelho's The Alchemist, one's "personal legend" is to identify purpose and pursue it. I've decided that I enjoy teaching, writing and cooking. I have no idea if that translates to becoming a residency program director, dean of student affairs or stay-at-home dad. When I began my intern year, I suffered from the common but dreadful imposter syndrome. Through borrowed purpose and feigned confidence, I tentatively adopted the personal legend of Fareed Khan, M.B.B.S., to improve the lives of others and contribute to a better society. In addition to serving as associate residency program director, Dr. Khan also holds senior roles in our family medicine department and our affiliate community hospital system.

I had never seen long hair on a Pakistani man before him. That signature ponytail was probably older than me. Two months ago, it was abruptly excised in preparation for aggressive rounds of chemo. Without lament or pontification, Dr. Khan immediately resumed his decades-long history of precepting students and advising residents.

I used to believe happiness was algorithmic. If I unlocked achievements like publishing a paper in The New England Journal of Medicine or earning membership in Alpha Omega Alpha, then I'd be accomplished. Instead, it turns out that life is an endless series of problems. (Hooray!) Happiness comes from overcoming those challenges, especially ones that make us angry and worried. Don't dodge and defer them; embrace the problems. Wield your gumption, trust your training, and become your role models.

I'm reminded by Dr. Khan's actions and his favorite book that "If you can concentrate always on the present, you'll be a happy man."

Burnout Is Real

I've heard untoward comments about patients or co-workers emanate from my own mouth. Although I have never reported on an inventory that I felt emotional exhaustion or depersonalization, I know the perennial fight against diminished empathy is grueling and valuable. My residency program director, Eric Warwick, M.D., taught me countless things ('80s pop culture, dad jokes, evidenced-based medicine, etc.). The olfactory lesson is one that changed my life forever: Expose just one centimeter a week.

"The key is to leave the little tree in the wrapper," Dr. Warwick educated me one day in clinic. When you pull the whole car air freshener out of the plastic, it's overwhelming and becomes rapidly depleted. Instead, use just one branch at a time and behold the longevity!

I had originally planned to frame our completed puzzle -- a tribute to our patience, childlike wonder and compatibility as a couple -- but several months after its purchase, our Disney artwork remains idle and incomplete on a shelf. The whimsical characters and French castle were easy to assemble, but the sky, horizon and landscape proved to be too demanding. A designated date night silently dwindled away as we moved onto other activities: spring cleaning, financial planning, writing this post.

That's OK. I know what the finished puzzle would look like. Our purpose in starting wasn't to finish but to try something new. This wasn't a failure. The glee of snapping a corner piece into place or singing along to "Be Our Guest" was real. I can't honestly say my wife and I will return to the puzzle, but I'm proud of the framework we built and this journey we've pieced together.

Arindam Sarkar, M.D., is a recent chief resident and graduate of Baylor College of Medicine’s Family Medicine Residency Program. He will continue in academic medicine as assistant professor in Baylor College of Medicine's Department of Family and Community Medicine. He is thrilled to continue to work with students and residents in inpatient and outpatient settings.

Posted at 09:14AM Jun 10, 2020 by Arindam Sarkar, M.D.

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