A Pearl Wisdom from the Runningquack's Pen

One of my favorite things about my tenure as a student at the medical school in which I now teach was the annual spring "String of Pearls" lectures. These lectures are a series of brief speeches given by faculty members chosen by the medical students. They're supposed to impart a "pearl of wisdom" to all four classes of medical students. I've had the honor of being selected to give a "Pearl" the last four years, and last year's speech had to do with both medical school and running, so I thought it might be of interest. Here it is, with some minor modifications:

When I got asked to speak this year, I wasn’t quite sure what I was going to do. I thought about putting together a bunch of amusing pearls. I was going to start out with my colleague John Brice’s rules of critical care – air goes in and out, blood goes round and round, oxygen is good, always pee before you do a procedure and move on to the cardinal rules of surgery. If you're curious those are #1 never stand when you can sit. #2 never sit when you can eat. #3 never eat when you can lie down. #4 never lie down when you can sleep #5 don’t “f” with the pancreas, but after those two I really couldn’t come up with anything else. At that point, I decided to fall back on the universal rules of public speaking the first of which is supposedly “know your audience, which is a bit problematic here. Some of you are M0s who are a combination of really excited and absolutely terrified because you are about to start medical school. Some of you are first years, who are feeling pretty good at this point because you are getting ready to have a whole summer off after a year of hell. Some of you are second years who are a whole lot more similar to the M0, because right now all you can think of is that you have boards in a few weeks and then after that you are going to the wards and you are actually going to be expected to know something. There also might be a few third years who have nearly developed a permanent grin because they are getting ready to be fourth years, and a few fourth years who are starting to lose that perma-grin because the are now realizing that they have forgotten everything they learned as a third year right before they become real doctors. Since I have a fairly diverse audience, I thought I‘d rely on a really cheap tactic and talk about hobbies.

So as a lot of you who have spouses or significant other have already found out, or are getting ready to find out, they are going to have a fair amount of time at home on their hands that you aren't going to have. When I started my third year of medical school, my wife took up long distance running. She started with a marathon that she ran my fourth year of medical school, and has kept going since then (since last November, she's run three marathons plus a couple of half marathons). She talked me into finishing one (note I don't say running one) my third year of residency, and at that point, I pretty much figured my running career for anything but an occasional 5K was over. So you can imagine my surprise when about eighteen months ago I came home from work and she told me that she had signed me up for a marathon. The catch was that particular marathon also happened to be in about ten days. I hadn't run at all in the better part of a year. I was out of shape and this was her not so subtle way of telling me I needed to get back in to it. I somehow managed to finish in a really, really bad time. What I took away form it was that I really hate running, but I really like racing – those of you that do it probably know what I am talking about. It doesn’t really make any sense, but for reasons that are completely unclear to me I'll get up at 3 AM and go stand in a freezing dark drizzle for an hour and a half to run double digit miles with no hope of winning just so I can get a tech shirt and a cheap medallion. That said, the entire time, I'm actually running, I'm thinking "why the hell am I doing this". I've done several marathons and a bunch of half marathons at this point. That is going to strike all of you in different ways. Some of you have probably done more, faster and better than I have, in which case you really aren’t too impressed (and let me be clear, I'm absolutely not impressed with it, my major claim to fame in the last marathon that I ran was that I drank a Pabst Blue Ribbon a bunch of fraternity guys offered me at about mile 23 and kept running). My wife kind of thinks it is cute that I have done it, but doesn't really consider me a runner – which I think is legitimate. Worse than that, my almost 7 year old recently ran a first 5k, and I don’t think really considers me a runner either. But I have learned a lot from running, and I think some of it applies to medical school, so I thought I’d spell a couple out here.

Point number 1 – do your personal best, and don’t worry about how everybody else is doing. The first thing that I figured out is I'm not going to win. Things have to go terribly wrong for a lot of other people for me to be competitive in an athletic event. I have on a single occasion won my age group in a small 5k, but I was the only 34 year old male in it. In a race of several thousand people, most have no illusions about coming in first. So why do you race if you aren’t going to win? Most people actually end up racing themselves and going for personal records. What you are really trying to do is run the best race you can on that particular day. Hopefully that will be the fastest you have ever run that distance. The personal record approach is well applied to medicine as well. I think this is very important, particularly for those of you just starting out. All of you are used to being at the head of the class or you wouldn't be here. For some of you, you will remain at the head of the class and it will be status quo. By definition though, half of you will end up in the bottom of the class. Furthermore, all of you are coming with different backgrounds, and that will give some of you an advantage over the others. The point I am making is don't worry about what your colleagues are doing, do the best you can do. The same thing will happen when you start your clinical rotations. Some of you who excelled in the classroom will become very mediocre clinically; some of you who were middle of the road in class will become superb clinicians. What you really need to do is do your best. I would argue that you should continue down that path the rest of your career as well. If you always do your best for your patients, you shouldn't have any trouble looking at yourself in the mirror or sleeping at night.

Point number 2 – Develop a peer group you can rely on. Something else I've noticed about people who run is that they tend to really try to help each other out, largely out the goodness of their hearts. There really isn’t a whole lot in it for them. Most runners worth their salt have figured out that it doesn't take away from their run to help you out with yours. People train together, plan strategies together, and encourage each other on the course. They also get excited when their friends do well. I think this is exceedingly important for medical school and residency as well. What you are learning is difficult. Help each other out. It is in your best interest to have strong colleagues around you, so work to move everybody up to the same level. Don’t be a gunner at any point in your career. Furthermore, your peer group is going to be one of your best sources of support. Knowing that other people are going through exactly what you are going through is a very powerful and very helpful thing. I tell the interns that they are all going to have at least one bad month that year. The thing is, it isn't going to be the same month for everybody. If you talk to each other, you support each other, and you realize you are not alone. Isolation is a very bad thing in medical school, residency, and your medical career.

Point number 3 – choose a path for the right reasons. I've figured out that I am too slow to run a really good 5k or 10k, and I don't have enough time to train to run a really good marathon, but I've settled in running what I would consider solid, but not great half marathon times. How did I figure that out? I tried all of them and stuck with the ones I like. Choosing a medical specialty is much the same. Try everything and enjoy everything: for those of you sitting in the audience who are just starting your medical careers, I would bet that most of you have an idea of what you want to do. (Rural Medicine in South Carolina, right?). I would also bet that most of you will change your mind. I came in sure I was going to be an orthopod, and I'm an Internal Medicine Doctor. Make career decisions for the right reason. You are most likely going to find people that you would like to emulate in all of the specialties you rotate through. When you are in your residency, you are going to be dazzled by certain dynamic subspecialists, and think you might want to go in to that field. What I would really encourage you to do is sit back and look at the disease processes you are treating, and decide if you like treating them, or not. Don’t get me wrong, I think it is very important to model on people, but your colleagues will change over the years and your patients will change, the medicine will remain the medicine. What will keep you interested and challenged is choosing a specialty that you like, not one that is easy or pays a lot, or has a great lifestyle, because things can change very rapidly. Cardiothoracic surgeons for years were the king of the hill, then stenting came along and they cannot find enough cases to CABG these days. It’s very hard to get in to interventional cardiology, but one really good development in clot busting drugs and that could dry up as well. Make sure you like what you are doing.

Point number 4 I’ve learned from running - stretch after the race. I’ve run races an immediately gotten in to cars and traveled five or six hours. The next day I can’t move. It took a little while for me to realize that I was much better off taking some time to enjoy the post run festivities that usually accompany a race of any decent size. If I do that I usually feel pretty good the next day. This is the prototypical "stop and smell the roses", take time for you comment. While you are in medical school, while you are in residency, while you are a physician, take time to relax. Enjoy your friends and family. Have hobbies. Go out to dinner. It is important, otherwise, you are going to hurt yourself.

Before I leave you today, I’d like to tell a story that reiterates one of the most important points I have made today. Around the turn of the 19th century a man named Henry Wellcome started a company that eventually became Burroughs Wellcome and subsequently the pharmaceutical giant GlaxoSmithKline. One of Mr. Wellcome’s hobbies was collecting medical artifacts and literature from around the world. Much of this is now housed at the Wellcome Collection in London, where it is simply known as “The Wellcome”. On the wall near one of the water closets in the Wellcome Collection there is a plaque that bears this imperious, but wise advice from King George V of England, “Always go to the bathroom when you have a chance”, which if you think about it, sounds a whole lot like “always pee before you do a procedure.”