There are a lot of things I’m quite happy to suck at. I’m awful at swimming, I can’t sing, dance nor play the guitar, my ability to code is mediocre at best and despite my best efforts, I suck at drawing. Could I improve with dedicated practice? Almost certainly. But sucking at these things don’t keep me up at night because they don’t matter a whole lot to me. All skills are on a bell curve and for some, I’m happy to settle for average.
But in other fields, like writing, speaking or medicine, the game changes. These skills have great significance to me and developing excellence is not merely a hobby but a necessity. Writing and speaking are the most powerful tools for communication we have and through these I believe we can change the world. Developing these skills is thus a prerequisite for meaningful action. Medical excellence is a moral requirement for improving the field of medicine, and waging war against disease is a battle I am happy to fight.
There exist areas in our lives that demand excellence, where doing a good job is not just a fleeting interest but a moral requirement. Some areas we willingly choose to bear the burden of, some we are simply given by circumstance. Whatever they are, it is our duty – perhaps even our fate – to do them well.
“Why did you do all this for me? ” he asked. “I don’t deserve it. I’ve never done anything for you.”
“You have been my friend,” replied Charlotte. “That in itself is a tremendous thing. I wove my webs for you because I liked you. After all, what’s a life, anyway? We’re born, we live a little while, we die. A spider’s life can’t help being something of a mess, with all this trapping and eating flies. By helping you, perhaps I was trying to lift up my life a trifle. Heaven knows anyone’s life can stand a little of that.”
In my apartment there are four elevators, though most of the time at least one is broken. Because four is a criminally small amount for an apartment with 500+ residents, when I enter from my floor, the lift often already has people in it and the trip down often requires multiple stops.
The atmosphere in apartment lifts can be variable, sometimes on rare occasions it is empty and you enjoy the solitude, sometimes there are people talking and you try not to eavesdrop, but fail since the space is so small, but mostly the atmosphere is tense, driven by a desperate desire for the lift to reach the appointed floor as fast as possible and to please, please stop stopping at these floors where strangers get on who hear you breathe and cramp up the space. When the lift opens at my floor and there are people inside, the look in their eyes say God, did you really have to press this lift at this time? Couldn’t you have waited a little bit and gotten on another one? In response I hurry in, overwhelmed by this guilt and and smash the door-close button and tap my feet and adopt the same hurried attitude as everybody else. But recently I’ve started an experiment.
The experiment is instead of hurrying in, I instead meet everyone’s gaze and smile at everyone in the lift. It’s not a terribly big smile, that would be a little weird, but enough where one feels recognised and feels like I’m happy to see them. All of this takes less than a few seconds, I do it as I walk in so as to not waste time, then I resume the journey down.
Most of the time I get nothing, I’ll smile and people either don’t see or they see my smile and ignore it. This hurt at first but soon I realised it was the default and now I don’t really mind. But sometimes, something magical happens: I get a smile back. And then I know I have connected with somebody, that we have seen each other, and acknowledged each other’s existence, and this makes me happy. Occasionally, these moments even result in a little conversation, a casual How do you do? or a comment about clothes or something we are holding. These moments are rare, last only a few seconds, but are so precious, for it is frankly quite difficult to build enough trust with a stranger to engage in conversation, but somehow, a smile acts as an invitation to speak, it is an act of generous curiosity and says, I don’t know you at all, but I appreciate your existence, and this can spark amazing things.
Smiling is one of those things that take incredibly little effort but can have enormous expected values. Such gifts are nothing short of magic.
In my experience being around top medical students, a field notorious for its immense learning curve and volume of content, one of the key ingredients for excellence is consistent practice.
Top students tend to study, hone their physical exam skills and speak to patients throughout the year rather than right before an assessment. Every day they are improving, 1% at a time, and over the span of years this leads to amazing results.
Other factors influence excellence, no doubt: one’s socioeconomic status, level of human supports, studying techniques and more will shift the playing zone. However once a certain level of stability has been reached, the distance between action and results seems to shrink with effort and consistency.
This trend might not be limited to learning, but extend to other domains also, as Malcolm Gladwell writes in Outliers:
Their research suggests that once a musician has enough ability to get into a top music school, the thing that distinguishes one performer from another is how hard he or she works. That’s it.
Today my ward round finished early and I was drinking coffee with the team. I sat there listening quietly as the doctors twenty years my senior discussed topics such as the late Queen’s life, what life was like before the internet and their wonderful stories from decades practicing as a physician. As a student, my participation in this conversation was limited: they were all full-time doctors before I was born and I could not relate at all to the world that they were discussing.
However, by some luck, the topic of books arose and titles such as Harry Potter and The Alchemist began to be discussed and I felt myself contributing to these topics, slowly at first, then more eagerly, and the doctors welcomed my enthusiasm. Our little discussion grew into a passionate affair and I began to feel a kinship in our little discussion, for at that moment, our united interest in fiction seemed to break down hospital power dynamics and we were able to debate and share opinions not as student to consultant, but as reader to reader.
One of the deepest powers of literature is the ability to touch people universally, across generations and time.
I have a friend at my clinical school who is a firefly – he cheers up everything he touches, wherever he goes. Whenever he laughs, everyone around him laughs, it’s one of those infectious ones where even if you didn’t find something that funny or didn’t quite get the joke, just the sound of his laugh makes the thing funnier and you begin to laugh yourself. He has a set of amazing white teeth and when he smiles you can see them all like little stars in the light and sometimes I wonder if they shine in the dark, like a portable torch.
One day I was mentally and emotionally drained, I had been scrubbed in for a long surgery and the prognosis wasn’t good, and as I sat in the common room dehydrated, sore and sleep-deprived, I thought of how devastating the news would be to the patient when they woke up, and my eyes began to well up and threatened to overflow when he walked in.
He noticed my concern, sat down next to me asked me what was wrong and when I told him he listened, really listened, not the listening most people do when they go mm-hmm and ask vague questions and tell you what you should do, he instead put his hands on my shoulder and let me pour my heart out while he sat next to me quietly and that was all I wanted. When I finished he simply sat with me for a bit, holding space, and didn’t say Everything will be all right, or You should cheer up, but rather that it was fine to mourn, it was even natural to mourn, because the people you care about deserve to be mourned over, it is a testament to who they are and what they have meant to the world, it is a recognition of their worth and place in your heart, that if something bad happens to a friend you should be upset, that love and its pain are what make us human.
When he said these things I was glad because he was able to put words to my emotions, and this made them more manageable to deal with, but more importantly, I was touched that he chose to spend close to one hour with me and carry my burden, when he could’ve easily ignored me and gone home to his own bucket of struggles and responsibilities.
I am lucky to know people who are fireflies: my partner, this friend and a few others, these are people who are beautiful during the day, but really shine when life feels unbearable and void of meaning. Their role is to provide a light, to reaffirm one’s place in the world and to guide one out of the darkness. To the outside, it doesn’t appear they are doing much, they may simply be sitting there, or patting one’s back, or listening intently, but inside, magic is happening, for these small acts of service are often enough to light a small but steady flame.
“It is an act too often neglected,” said the fox. It means to establish ties.”
“‘To establish ties’?”
“Just that,” said the fox. “To me, you are still nothing more than a little boy who is just like a hundred thousand other little boys. And I have no need of you. And you, on your part, have no need of me. To you, I am nothing more than a fox like a hundred thousand other foxes. But if you tame me, then we shall need each other. To me, you will be unique in all the world. To you, I shall be unique in all the world . . .”
This morning my alarm went off and it woke me up but not fully. I woke up in that grey zone between consciousness and unconsciousness for I was deep enough where I could have slept past the alarm and resumed my peaceful slumber, but also shallow enough where I could have pulled myself out from bed, stagger across the room and turn my damn phone off if I wanted to.
I decided to get up, despite only having entered my bed five hours prior, despite having a quite interesting dream that was rapidly leaving my memory but perhaps still salvageable if I dived back into sleep right then to rescue it, because there were consequences for not doing so: I had a surgical ward round to attend at 7am and attendance was mandatory and I would rather not risk the chance that nobody would notice.
There were certainly reasons why I would turn up even if there was no attendance: the rounds are filled with learning opportunities, the team is quite friendly and each day promises new conversations, new stories to be uncovered, new bonds to be formed between colleagues, patients and doctors, but at that moment, at 6am, these reasons might not have been enough to force me out of bed – no, I needed the extra edge of punishment to take action.
Our behaviours are often driven by motivation, but sometimes, when we’d just don’t feel like it and would really rather just not, setting artificial stresses and accountability measures can be a force for action, an insurance against laziness.
Joining a running group creates a commitment to run, and the danger of social disappointment gets you moving; hiring a piano teacher creates a cost to be paid, and the danger of wasted money gets you practicing; writing a to-do list creates an expectation to be productive, and the danger of self sabotage puts you to work. These actions create a final hurdle for our lazy selves to jump through, a hurdle that hurts more than others, because the pain of punishment is generally more memorable than the pain of unrealised reward.
And thank God these hurdles exist, because without them I would have missed a pretty great day.
What makes literature different to movies or television? There are many distinctions to be made, of course, but one primary difference is the ability for the audience to create their own story.
In movies or television, it is easy to be swept along the experience. The main character has Brad Pitt’s face, there is no need for you to picture somebody else, and there is no ambiguity that he has this voice, or these eyes, or walks in this manner. The music comes on at a predetermined time, conveying a particular atmosphere, saving you the trouble of imagining it yourself. You are mostly being told a story, the same story as everyone else, and whilst there is room for interpretation, how you experience the story is largely at the director’s mercy. It is more of a passive experience.
Literature, on the other hand, requires far more effort from the audience. In each reader’s mind, every character will have different eyes, every voice will have a particular accent, every scene will have its own hues of grey or blue or pink. Descriptions are rarely long enough for you to perfectly picture a scene or a person or a building, nor do I think you want to, because part of the fun is letting the reader fill in the gaps themselves. It is why movie remakes of books are so controversial, for nobody has the same world envisioned in a novel, and one can feel cheated if their favourite character looks different or their favourite scene got removed, for it suggests that their world is not as valid.
This dance between the author and the reader is one of the reasons I love fiction. On one hand, the author constructs a scaffold for you, nudging you along their world, but you are free to – or rather, you must – experience it your own way. It is a much more personal experience, for your world is yours, not anybody else’s, and nobody can really understand why you like this character so much or why you enjoyed this scene more than that one or why you were touched by this particular description or quote in passing, because even though you read the same words as everyone, your respective worlds are vastly different.
When done correctly, as in when the scaffold aligns with your worldview and your interests and your attention span, and you begin to playfully interact with it, and maybe even enjoy it, the experience can be quite magical.
Chatting to patients is my favourite part of medicine. There is so much to be learnt, more than just their medical conditions, but also their life experiences, lessons they’ve learnt along the way and their ways of managing suffering. The last topic is of particular fascination to me so for the last few weeks I’ve been asking patients, how do you overcome the shock of becoming sick, of realising that your body is slowly deteriorating and being rudely reminded of your mortality?
Here are some of the answers I’ve received (de-identified for confidentiality).
“Life is filled with suffering, you know. I’ve known suffering when I was young and over the years I’ve become used to dealing with hardships. I think when you come to expect the struggle it becomes less difficult to manage.”
“I’m a believer in God so I think all of this has a purpose, it’s all according to His will. That gives me great strength because I know that whatever happens, I’m in good hands. My church community is great too, I know they are always praying for me.”
“I don’t think I handle it very well. Alcohol and weed help. A lot of it.”
“I try not to think about it too much. I’ve always been a cup half full kind of person and just hope I’ll be lucky.”
“Oh… I don’t know. I distract myself, I guess. Ever heard of Genshin Impact?”
“I have two little kids and the thought of leaving them behind is terrible. I need to get through this so I can watch them grow up and attend their graduation and watch them become amazing adults.”
“Yeah it was shocking. All my dreams and plans for the future were gone, just like that. My boss was actually my best supporter through this: he let me take all the leave I wanted and told me to come back when I was better.”
“Pfft, this thing? I’m already feeling better, there’s nothing to worry about.”
“I’m ready to die. When you’ve lived as long as I have, the pain of living slowly outweighs the joy of it. So if this kills me, I don’t think I’ll mind too much, I’ll only regret not spending more time with my family when I had the chance.”
