Wednesday, November 30, 2011

Insecurity and Intimacy

We had the coolest Ethics lecture ever on Tuesday. It was cool for several reasons:
  1. it was the last one
  2. it was...
    1. genuine
    2. helpful/relevant
    3. humorous
    4. worthy
The speaker was an older family doc in the navy—he was actually an admiral—. The topic was professional insecurity. Having induced a universal from our previous lectures, I thought this would be a powerpoint full of half-baked slides about our litigious society and our collective psychological failings.

But I was wrong. There was no powerpoint. There were no stupid, unnecessary definitions and bullets to introduce us to the topic. Instead the admiral dove into the idea, assuming we all knew what it was.

"We are bilaminar creatures," he said, explaining that we have a confident outer face, and an inner quivering/normal face. The outer face matches what we and others think of our profession; the inner face is ourselves, terrified at the position in which we've been placed. He said that this insecurity is with us throughout our lives.

Further, he said, there are several "nodal points" where insecurity becomes most obvious. Until this time, he didn't have my full attention. But as soon as he began to write nodal points on the board I was all ears, because without knowing a thing about me or my curriculum he recited what I went through this semester.

Nodal Points
  1. First day of medical school
  2. First exam(s)
  3. Clerkships
  4. Graduation
  5. Internship
I'm sure he could've noted more. But this is exactly how I felt!! At the White Coat ceremony I remember thinking to myself, "I am the admissions' committee's mistake. They keep joking about it and reassuring us...but this is real. They didn't know how behind I am, how dumb I am. How can any TACer do this? I am going to fail painfully. How embarrassing. And after I fail, then what?"

This admiral told stories from his first day, his first test, his clerkships, and his graduation. He was hilarious! He also had some hard stories: after doing what he was told by his attending, he was rebuked by a staff internist for sending a woman home when she should've been sent to the ICU or CCU, and for a while he thought he had cost the patient her life. How horrible, how crushing! (He later discovered the woman was okay.)

He soon moved on to solutions to this insecurity problem, which makes anyone unhappy and dysfunctional. He listed several possible ideas: alcohol, drugs, other addictions, other distractions, superspecialization, more degrees.... He rejected all of those (some more quickly than others). Then, he wrote what he thought was the true solution on the board, in six-inch letters.


He said we must find a person to trust and show them our interior—our inner layer, the insecure one—confessing our imperfection, ignorance, and ordinariness. And not to only one person (like a spouse); to a network, a team.

It's a risk. Sometimes, he said, when you show someone your imperfection they laugh and alert everyone, giving you pain. "But most times," he continued, when you show someone your imperfection their response is a relieved and desperate reciprocation, and you create an immediate community.

I've been reading about some fascinating social experiements that go right along with this! Also, I'm reading The Seven Levels of Intimacy.... One of our greatest desires is to be known. And of course, it all goes back to desiring God in the beatific vision. I cannot wait for heaven!

What an excellent lecture. The more we are humble and frank with everyone and the more we can be truly intimate with those God gives us...the better for our profession, our patients, and our country.

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