Eyes closed, shallow breaths.
A serene, deserted beach in the south of France, in the near future. Children playing far away in a field, their laughter carried by the wind to nearby cliffs, where it glances off the soaring cliffs and echoes softly in my ears. Waves gently sweeping across the land, creating transient, unique impressions in the sand…again and again. My fingers slowly intertwine with those of another, and I am gratified by a warmth that envelops me. I grasp more tightly, dig my toes into the wet sand, and gaze out at the horizon.
As I write these lines, I admit that I feel the allure of this romanticized sketch, even though my purpose is to now caution against such Elysian abstraction. A propensity to fantasize is built into human nature; it is the reason we escape into virtual realities through books, movies, video games and even our careers. And while envisioning that beach in France certainly enchants the senses, what is the effect of absorbing oneself into such idealized images?
As a part of “The Healer’s Art,” an elective course for first-year medical students, we were given the opportunity to practice “mindfulness,” by silencing our thoughts and turning our minds to the present. It was neither simple nor simplistic, and I began to wonder why we have difficulty tuning out future-oriented thoughts about our ambitions, our fears, even what we want to eat tonight – anything but the present scene. This inability to fully devote our minds and ourselves to the present is particularly germane to medical training. Given the amount of time that must be invested in both education and training – years that often seem to stretch indefinitely ahead of us – the medical path naturally encourages its travelers to engage in constant projection into the future, to worship the idea of arriving at some distant goal, be it geographical, financial or professional.
As medical students, it will often be tempting to imagine ourselves in a future time and place regarding our careers, as well as our lives, in general. Physicians who are a little farther down the road than we are state that this kind of idea worship will accompany us throughout our professional career, either when considering ourselves (“Should I take that job? Will it allow me to get to the ‘next level?’”) or our patients (“What will his clinical outcome look like?”). This projection can motivate us to work hard now to become the doctor we envision in our mind’s eye. After all, we need to plan and position ourselves for success, and it is essential to the well-being of our patients that we think about where we would like to be in 10 to 20 years. In doing so, we come to appreciate what particular skills or interests we possess that will best suit us for a certain field and enable us to best serve our patients.
Despite the benefits of visualizing future scenarios, such projection can also inhibit one’s ability to focus on the present, as well as increase personal anxiety. I sometimes find myself not listening to a patient as much as I should be, instead contemplating, “Could I see myself doing the surgery that would help this lady? Maybe I should set up an opportunity to find out about that.” By not listening to this patient, I rob both of us the opportunity to establish personal contact and, for me, to learn as much as possible about the case in order to best handle a similar one in the future. If I do not pay attention to the present, I am not best preparing myself to be a compassionate and competent physician. Constantly thinking about the future does not necessarily translate into being more successful in the future.
A subtle trap occurs when we do find ourselves dwelling on future possibilities. Danielle Ofri, MD, PhD, who delivered a compelling talk at our school a few months ago, described this cognitive nearsightedness – she said that what we imagine initially as the diagnosis, and around which we establish a treatment plan, is given such preference that our vision is reduced. As a result, we may miss other likely, potentially more threatening possibilities. We need to be wary of this trap and continually bring ourselves back to the present, focusing on a new piece of history or a new symptom that could lend weight to a different diagnosis.
Orienting our outlook and actions around our initial thought is not simply relevant to patient care; it also has the potential to impact our own lives. In “Mere Christianity,” C.S. Lewis states that, “The thrill you feel on first seeing some delightful place dies away when you really go to live there…” There is always a discord between what we imagine something will be like and what it actually is like. I spent weeks during the first semester of medical school envisioning the exact speciality that would be the best fit for me. As I have discovered more about otolaryngology, my view of it has changed significantly. Fortunately, it has piqued my interest even more, but so have other specialities, and much of the anxiety that I felt during those weeks could have been lessened if I had not given so much weight to a single idea. I have been told that this conflict between our present ideas and the future reality will always exist. Take, for example, the shift in urological interventions, as described by my brother – many surgeons are not doing procedures now for which they trained in residency, and many are also doing procedures now that they never did in residency. We need to realize that what we imagine life will be like is just that – an exploration of hypothetical possibilities, not a single absolute certainty – and that we must always be aware of and receptive to other options.
Isn’t medical school at least slightly different than you had imagined, in terms of the people, the institution and the courses? And wait, wasn’t getting into medical school what we envisioned as “making it,” allowing us to finally do what we wanted to do? Another major issue with this type of anticipatory thinking is our propensity to constantly modify the idea, each new fantasy giving rise to and slipping into the next. We imagine one scenario, and then find ourselves within it, only to move on to the next new scenario – the one in which we imagine we will be truly happy.
Becoming a full-fledged physician takes a long time, and our careers will hopefully continue long past the point of initial autonomy. Habitually thinking about the future only makes the path seem longer and interferes with our ability to appreciate the present. As medical students, it’s critical that we take time to enjoy the steps along the way and the awesome privilege to learn about the fascinatingly complex human body. Do what you can to focus on the present, whether it is asking a patient deeper questions about his or her medical history or hobbies, writing down something new that you learned today, or simply exercising (there is nothing like a sore body to turn your mind to the present).
Maybe I will discover one day that the beach in France does not look the same as it did in my mental travel guide. Surely I cannot determine today whether the idea-turned-reality will be better, or worse, or simply different. I will have to wait to find out. For now, I will try to turn my gaze from the horizon to the beach, because the person I love, sitting next to me right now, the patient in the waiting room, the here and now in all of its capacious, rich glory, deserve just as much of my study and contemplation.