Climbing the Ladder

We are always climbing the ladder. In medicine, it’s easy to see. In other professions, it can be more obscure. But it seems like the human experience is always to think, “I just need to get through this next month, this next year, this next phase … and then I’ll be happy.” I just need to get through medical school. Once I get through intern year, I’ll feel better. As soon as I’m done with residency, life will begin. Once I make partnership, I can finally slow down a little.

Goals are good, goals are important, but goals get too much credit. Once we achieve a goal, the time spent in that feeling of victory is relatively brief compared to the time spent getting there.

Take weightlifting, as a nonmedical example. Let’s say you want to beat your personal record deadlifting. You spend months progressively overloading, working diligently in a structured training program, honing your nutrition for that high-protein caloric surplus to gain muscle, ministering those neural adaptations to maximize motor unit recruitment with each lift. Some days you feel like the Hulk. Some days suck. But you power through, obsessed with your goal to deadlift more than you ever have. Then the day finally comes. You blast through your previous sub-700-pound record and deadlift one rep at 705 pounds. You feel unstoppable. You revel in the glory, post on Instagram, accept the accolades. There is also some well-deserved self-pride in setting a goal and seeing it through – a powerful display of challenging the human mind and building persistence and dedication. But a week goes by and the flashiness fades. Now you must do it all again to reach that next ladder rung, that 710-pound deadlift. The vast majority of your time – the most precious resource we have – is spent building the foundation to achieve such a feat. You live in the journey, not at the summit.

The challenges of actually embracing this mentality during residency or as an early attending are daunting. And yet it’s still something we must all endure. The someday dream of going to medical school pulls us through being the highest achiever in college, then becoming a resident pulls us through the drudgery of medical school, then becoming an independent provider pulls us through the servitude of residency. And it doesn’t stop there. More goals and levels to rise to constantly present themselves. The ladder to the sky is limitless.

But navigating that reality isn’t about extinguishing the desire to reach the top; it’s about finding ways to enjoy the rung on which you are currently teetering – because you never know when you won’t be on it anymore. As our cancer patients continually remind us, no one is guaranteed tomorrow. Life throws curveballs all the time and any path toward anything is not linear; even electrons like to wobble through a linear accelerator. Tomorrow could find your loved one being called to war, enduring a horrible car accident, or receiving a cancer diagnosis. It could happen to you, too. None of us are above the surprises of life. The vicissitudinous nature of being human forces us to be resilient and adaptable, especially in the face of adversity. But at the end of the day, it is up to each of us as individuals to decide how we will weather the storm. It’s easy to huddle in fear and rage, but it’s more fun to dance in the rain.

Kyra N. McComas, MD

PGY4 resident physician, Department of Radiation Oncology, Vanderbilt University Medical Center.