S8E14: The Moving Finish Line in Medicine

Sanila: I feel like . . . oh my gosh, I just lost my train of thought. Chloe, please cut this out. I totally blanked. Oh my gosh.

Hạ: I believe it will come back to you. It's there.

Sanila: I hope so.

Hạ: It's there.

Sanila: Welcome back, "Bundle of Hers" listeners, to Season 8, Episode 14. I have been thinking a lot today about where I'm at in my medical school journey. For some of you who may not know, or for those who may know, I am just around the corner from match. And the next step for me is residency. And I've kind of been thinking about all of these different finish lines and what finish line comes next for me.

Moreover, I was thinking about how getting into medical school four years ago was the dream. At some point, that felt like the finish line. Then it was getting through pre-clinicals, then Step 1, then Step 2, then my sub-I, and now residency, and so forth.

It almost feels like the finish line keeps moving. And if it keeps moving, is fulfillment even possible in medicine? That's what we're going to be talking about in today's episode.

I have Hạ with me as well, who will be joining.

And also just a disclaimer that thoughts and opinions expressed on this podcast are our own and do not necessarily reflect those of our respective schools or employers.

Hạ, you're kind of on the other side. You are at the finish line that is next for me, which is residency. And I'm just curious if this has been a thought for you recently at all.

Hạ: Yeah, it has definitely been a thought. For context for some of the listeners, I'm a pediatric resident, which is a three-year residency. And actually, for a lot of us, even by the time we end first year of our intern year, we're already starting to think a little bit about what the next step is. Because fellowship applications, if you choose to apply to fellowship, happen at the end of second year, so you're already starting to think about it.

So it was a very pervading question that was in our mind. Like, "What are we doing next? How should we figure out the rest of our residency education based off of that?"

And it was something that I felt was very exhausting, because I felt like there was this moment where I could take a deep breath and go, "Oh, great. I made it." And then once again, there's another new thing that you have to think about, and more new questions and existential crises to have to weigh in where to go next. So very much resonates with me.

Sanila: Oh my gosh, it never ends. I'm telling y'all. I feel like there are so many unique milestones in medicine, and it kind of feels like these finish lines are almost predetermined in some way.

We have exams we need to pass, clinically high-achieving. There are so many journal articles we can read through. And for some of us, that is a big goal. Then there are residency applications that we need to beef up and then match into a residency. And as I just said, it just feels like it never ends.

I've been thinking recently about how these milestones make us feel. And for me, I feel like it's sometimes good to have something to work towards. It gets me out of bed, makes me feel like there's a goal in sight, and it just kind of gives me a purpose for my day-to-day. So I guess, in that sense, it's beneficial.

The finish line I'm chasing right now is residency. So hopefully match will go well. If not, no one will know, but there will be signs. I've decided that I'm going to spend all my life savings on gnomes and just put them up in my yard. And that will be my sign. So for anyone who drives by my house on Match Day, you will know.

So today, we're also joined by Puja, who is a third-year medical student. And I kind of thought it would be cool to hear her take because I guess her next finish line will be where I'm at now, and I think that would be a good perspective to have on today's episode.

With that, Puja and Hạ, I was wondering what finish lines you both are chasing right now, because it seems like we're a little bit in different stages of our medical school journey right now.

Puja: I feel very much at the beginning of my journey compared to y'all. And so my next finish line is Step 1. It feels like I've gotten a lot of things done in the past, but also see a lot more finish lines.

Hạ: Step 1 is a very scary finish line and quite a beast, so best of luck with it. But I'm sure you'll do amazing, Puja.

And actually, similarly, mine is also . . . the first finish line is getting a job, and then the second finish line is finishing residency. But then the third one, all in the span of a year, is actually taking boards.

So after graduating residency, we have more tests that we get to take. And this one is the exam to make me be board-certified to practice as a pediatrician. So that is another. I will be studying and thinking about studying with you, Puja.

Sanila: Oh, gosh. Yeah, I feel like at this point I've taken so many exams in medical school. But Puja, I feel you. I feel like the first big goal was Step 1. That was the first big exam that I had to take that was multiple hours. And at the time, it felt really scary. I feel like when I was in your position, all I could think about was passing Step 1. That was just the immediate goalpost for me.

Puja: Yeah, absolutely. I feel like that has been my main focus, potentially taking up a little bit too much of my energy, as that's mainly what I'm doing. But yeah, I am really looking forward to being on the other side of it and being like, "Oh, yeah, Step 1, finished that. Did it. It was hard, but now I'm done." So hopefully that'll be me in a little bit.

Sanila: Yeah, I hope so too. Keep your head up, queen. Don't let your crown fall. You got this.

I feel like all of us, we're in the same medical journey, but we all have different goals right now. And I don't know when I first noticed the finish line moving. I guess it just feels like whatever finish line is in front of me is the next goal, and I don't really think actively that that is going to move.

I guess I just started reflecting on that today, which is why we're having a conversation about it. But it just feels like whatever the next goal is, I have to get there. And since it seems like the next goal pops up as soon as I finish that goal, it sometimes feels like the achievement isn't as satisfying as I was expecting.

Hạ: I don't know if you all had this experience for your orientation, but when I started med school, it was legitimately the first week orientation and we're given this presentation where . . . Bless his soul, I think it was well-meaning, but we were presented by one of the admin people, basically, all the data going, "If you want to match into neurosurgery, this is the amount of papers/publications you need to do. This is the Step score that you need to think about."

And suddenly I went from going, "Let's celebrate this achievement that we've done," which is a really big achievement, to, "Let's think about that next step and where to go from there."

And similar things like that were a very big story, but I think there are always those moments throughout the journey that I've been going through in medicine where it feels like, "Oh, I want to take this breath of relief." But then there are these little things reminding me, "Nope, it's the grind. You have to keep going. And once you get to this point, then you have to look at this next point."

It's really hard because sometimes I just want to sit and go, "Hey, I'm really proud of all that I've done." But you feel like you can't even have space to feel proud about it because suddenly someone else there is making you feel like you're going, "Chop, chop. You have to move forward and keep moving."

Sanila: Yeah. And it really sucks. At least for me, when I was reflecting on getting into medical school, I feel like the stakes were so high that I just kind of felt relieved that I had gotten in somewhere. And it felt like that set the tone for all the other things I accomplished after that.

I think that just set me up to kind of feel behind, even when we're all objectively succeeding. We're all making progress in some way. Maybe it looks a little bit different from other people and their timelines, but I think if we all paused and took a look back at where we came from, we would recognize that we have accomplished so much, and we have climbed mountains that I wouldn't have dreamed of climbing four years ago.

And I think that's something I've really struggled with, is needing and wanting to celebrate more and then not feeling like I have the time nor the space to do that because, as you said, Hạ, there's always something else that comes after it.

Puja: Yeah, I feel like that. I don't know about y'all, but I am the kind of person where if I have an exam or something coming up, I put a lot of my focus on that and will say, "Oh, I'll hang out with friends after I'm done," or, "I'll do something nice for myself after I'm done." But the issue with that mentality coming into med school is that you're quite literally never done.

And so you finish an exam and you feel great. I remember when I finished my last shelf, I was like, "I feel great." I treated myself the next day and got my eyebrows threaded. And I'd been neglecting that for low-key a year, and I felt really amazing.

But then a few days after, I was already so stressed for another exam. And so I never really gave myself the chance to completely recuperate and do all the things I'd promised for myself because I was like, "Well, I have to start studying for this or figure out my schedule."

And so I think that was the first moment I realized I didn't have that much balance in my life.

Sanila: Yeah, I feel that. This is the "I'll be happy when" mindset that I want to talk about, because there have been so many things I've pushed off in life just trying to survive and make it to the next goal or finish line.

For example, one of the things I do is I let the mess in my room pile up until I have a big exam. And then I tell myself I'm going to clean it after, and that will be my reward, is doing basic life things that I should be doing every day too.

Then it's hard because I come home to this messy room, and then it just puts me in a bad mood. I don't feel productive. I feel like that just kind of spirals everything else.

And I think that's kind of the theme for, like you said, Puja, having something that's coming up that's big that is going to take a lot of mental energy and effort, and then just pushing everything else to the sidelines.

And I think that just adds to this culture of chasing competence and not contentment. There's always something to win at. Medical school feels like this really big game that somehow you can't ever really win because the win changes.

Hạ: I think it does go into how it is such a mindset that is very pervading. And also just the culture around us makes it really hard to sometimes push back against that mindset or feel like we can reimagine something that is better than that mindset.

One of the things that I don't think I did it quite as well in med school, but then in residency I've had to force myself to do a lot more, is going, "Oh, it is okay to find these little morsels of joy and these little morsels of moments for me to prioritize myself over everything else."

And this also means oftentimes, as someone who overcommits, letting go and going, "This deadline that I've set for myself, if I was in med school, I would have finished this already. But it's okay that this gets pushed back a few days. That's fine, because right now, in this moment, I would rather prioritize spending time with friends or going on that walk or just going through my phone watching funny videos and all the latest cute animal news out there in the world."

And those things, it was very hard. And sometimes I still feel a lot of guilt about it. Sometimes I sit and I go, "Huh, this feels not great, and I should totally do more." But at the same time I have to then also challenge that and go, "No, I should prioritize my joy," because that blends into me ultimately being a better person at the job that I do.

Sanila: Hạ, that is such an important mindset to have and a really hard one to achieve, I feel like. It's so difficult to take advantage of those little moments where you do have joy and not feel guilty about it, and let yourself have the space to celebrate your small wins.

And it's difficult to the point where I feel like I've started thinking about medical school as Type 2 fun. In the moment, everything sucks and everything's gray and exams are hard and I have to spend so much time doing things. And then I get past these hurdles and I look back and I'm like, "That was kind of fun, I guess." I don't know. It feels like Type 2 fun. But then at the same time, it doesn't.

So I guess I don't really know what to think about it. It just feels like there's a little hill each time and it just gets bigger and bigger.

And I don't really know what the cost of this moving finish line is. I've been trying to think of both the pros and cons.

I feel like one big con I've been thinking about is just this feeling of chronic dissatisfaction. You feel like because this finish line keeps moving, you can't really celebrate your wins or have time for things that make you feel joyful. And then your identity just becomes tied to productivity. For people who are in medicine and high-achieving or in academic settings, that, I feel like, is a very difficult place to be.

Puja: Yeah, I feel like "morsel of joy" is going to be a new motto in my life now. That just sounds so lovely.

I think that's a good reminder . . . Sanila, kind of what you were saying. Sometimes you remember the happy parts of a challenging situation a lot more than the bad parts. And so I think sometimes you look back and you're like, "Yeah, it wasn't that bad." And you kind of forget in the moment all of those emotions and feelings that spiraled in your head.

I don't know about y'all, but when I get stressed, I'll be like, "But then if I don't do this, then this isn't possible. And then like 20 years in the future, all of these repercussions will happen." It just gets so big that at one point you're like, "What am I doing? I think I am just stressing myself out about things that are so far in the future."

So morsel of joy. I love that in the status quo real-time.

Sanila: I was going to say, girl, I've been spiraling a lot lately, especially about my rank list and what my future is going to look like. And I too have to remind myself that it's not worth putting myself through something twice, stressing about thinking about it before it's actually happened and then having to go through it again once it's happened. I just think I deserve a little bit better than that, and I think we all deserve a little bit better than that.

Now, that's way easier said than done, but it's something that I'm still working on too, is trying not to stress about the things that feel out of my control. And I definitely feel really out of control right now with not knowing if I'm going to match and what the next four years of my life are going to look like. But I guess I just have to go through it and hope for the best.

And I've kind of been wondering why is medicine built this way? Why does this happen in medicine, or what about medicine leads us to feel like we can't celebrate our wins or like there's something always more? Is that a good thing to have in medicine?

Hạ: One of the things that I reflect on a lot, as has been mentioned before, is that we are all high-achieving. And I would also like to believe that a lot of us, at our core, care a lot about the work that we do. And because of that, the stakes of the work that we do . . . Also because they are our patient. The way that a lot of people describe it is they're patient lives. The stakes feel a lot higher.

And so we always feel this moving finish line because we're always thinking about the stakes and the impact, the profound impact that we can have on patients' lives and their families.

One of the things that I've had to uncouple, though, is seeking that desire for competence for my patients versus that moving finish line because of what the medical institution tells us or what academia tells us is important.

I've had to really work about thinking about that and separating those two, because really, when I focus just on, "I'm moving the finish line because I always think I can be a better clinician. I always think I can have better conversations with families and practice this better," it's something that, while there are moments that are hard, it can still bring me joy because I know that it is something that I am doing because I really care.

Versus when I feel like I'm moving the finish line because I feel like, "Oh, I need to get publications to go on to this next stage and land this job, or get this promotion," it feels like I'm losing a lot more of myself.

And that's something, for me personally, that I've had to break down and think a lot about, as I've been throughout these years since intern year when you start thinking about, "Oh, am I applying to fellowship?" or, "Oh, in pediatrics, am I going to do an additional chief year as chief resident?" and all of that. It was something that I had to really break aside.

But I feel like in medicine, the education and training system is just building this finish line and making us always feel like we have to strive to be better. And that comes into burnout and us working and all of that. But I think in re-envisioning it, we have to uncouple those things and go back to what finish line speaks most to us at our core.

Sanila: Hạ, I think that is honestly very profound. It's this question of are we chasing competence for our patients, or because the system that we're in forces us to do that? Are we all products of our circumstances? So, basically, who are we chasing this competence for and why?

I think exactly what you said, both things can be true. I think you can successfully take care of people and feel confident in the skills that you have now, and then also recognize that there's always more to learn. And as long as you're learning for yourself and for the people you're taking care of, I think that's what medicine should really be about.

We all want to learn more because we want to be competent. And I think that competence should look like being able to provide safe, compassionate, evidence-based care for people and not necessarily beefing up an application for fellowship or blah, blah, blah, even though that is kind of also what we're forced to do. It is really hard to uncouple those, but I think that's something that's important to think about.

Puja: Oh, that was so good. I feel like I'm getting some tingles.

Sanila: Yeah, and chills.

Puja: Yeah. I'm such a lover of analogies. And when both of you were speaking, I feel like in my head a clear image of an institutionalized view is just the finish line moving, whereas as maybe a bit of a more growth mindset focused on patient care and self-fulfillment is more like, "Oh, I just ran a mile and that was great. And now I'm going to run five miles and that was great," and working yourself up to a marathon or something like that.

Instead of seeing the finish line as moving out of reach, kind of seeing a whole new journey sprouting from the end of one finish line to the next. I don't know. I thought that was just so beautiful.

Sanila: Yeah, maybe the finish line is moving with us. When we are training for a marathon . . . which for our listeners, I'm in the process of training for one right now. And every time I go on my long run, I think about selling my bib. So if you see me, please don't ask me about it. But I have to remind myself that what matters is the amount of time I spend on my feet and not necessarily, "Did I run nine miles this week like I was supposed to?" Because then I feel sad if I didn't, and then I feel guilty, and then I feel like I have to push myself harder the next week.

But I think remembering that I can run more now consistently than when I started, and that is still something to be proud of. Maybe I have a long way to go before I get to marathon level, but I'm having fun in the process. Kind of. Maybe it is Type 2 fun still, and maybe I only know how to have Type 2 fun.

I think what matters is trying and reminding ourselves that we have time to get to where we need to be. And maybe the finish line is just something that moves with us.

And I think in medical school, too, there's a lot of comparison culture. And so we're always comparing our finish lines to other people's finish lines. As I mentioned at the beginning of this episode, everyone's timeline looks different. People are in different stages, even within their medical journey, and when you're in a cohort of people that sees each other pretty frequently and people talk, I think it gets really hard to remember that your small wins deserve celebrating, and so do other people's.

Other people's wins don't necessarily have to take away from yours, and we all don't have to run the race at the exact same speed or finish at the same time. I think it's just we will get there at some point and that's going to look different for everyone.

And then that brings me to the next thing I was talking about, which was can ambition and peace coexist? Kind of what we've been talking about, about chasing goals, feeling competent, getting to the finish line. How can we do that and also feel fulfilled or feel at peace with the way that our journey is going?

Puja: That is such a good question, and one I feel like I have not mastered yet at all.

Sanila: That's okay. I don't think I've mastered it either.

Hạ: I haven't either. It's very hard to master it, I feel like.

Sanila: So we're all in the same boat. Well, I for one want to be a little bit better about celebrating my small wins this year. I think even getting to this point where I'm applying for the match process is huge, and I forget that because, for me, the next goal is matching. And I need to remind myself that four years ago I wouldn't have dreamed of being in this position, and I should celebrate that. I think I should get myself a sweet treat, because I deserve one.

Hạ: Highly support sweet treats. And I think that comes into the other thing, is just always constantly reflecting on where we were and where we are now. I feel like, for me, sometimes I forget those little moments, but then there'll be moments where I'll be like, "Oh, I have grown a lot."

I think the best example is now as a third-year resident, we currently have new third-year med students. It's one of their first two rotations right now. And seeing they are filled with so much love and definitely so much more medical knowledge about random facts than I have.

But just seeing as they're trying to get used to the system, and then sometimes there are things that just seem so now ingrained and instinctual to you, it helps you realize, "Oh, I used to also be very much uncertain, confused. And there were definitely things that didn't seem obvious to me that now seem obvious." That's kind of a sign of how much you have grown, and it's helpful to keep reminder of that.

Sanila: I think the idea of looking back is so important because, at least for me, I feel like I'm always looking forward. When I was a third-year like Puja . . . and maybe Puja can attest to this, or she has secretly mastered the art of being at peace. But I was looking at fourth-years being like, "Oh my gosh, I can't get to that point where I'm going to graduate and then go into residency." And now that I'm here, I look at you, Hạ, and I'm like, "You're doing it. You're in residency. When am I going to get to that point?"

And it's so hard to stop doing that and actually look back on the progress that I have made and feel proud of that.

Puja: That's definitely, I think, a shared experience for so many of us. Sanila and I are in a Spanish class together right now, and I think I'm the only third-year in it. And so I, like, see all of these amazing fourth-years who are taking the time out of their schedule to take the Spanish class. And in my head, half of me is like, "One day I'll get there too, and I'll be this close to matching." And the other half of me is like, "I will never be here. This seems so far away."

It's like sometimes comparing is a way to kind of see how you feel where you are in the midst of things, but it can become very intrusive quickly if you're not aware of what your thoughts are doing.

Sanila: Puja, I'm so glad that you brought that up. Because literally, when I realized you were in our Spanish class, my first thought was, "Oh my gosh, she's doing this as a third-year. I should have done that when I was a third-year and taken time out of my day and schedule to do Spanish so that I could take advanced Spanish the next year."

Which I guess just reaffirms this point that we're always comparing ourselves, and it's often very conflicting to what other people are thinking too.

Puja: Yeah, the grass is quite literally greener on the other side. And I think that's so true in medicine where I think any person you see, there's probably going to be something where you're like, "I wish I could do that."

Or when we have these amazing guest speakers come in, I'm always feeling like a fangirl and being like, "That's amazing. I can't believe that they were able to do that." But then they're talking about their journey of how that happened, and I think I just sometimes forget that I'm on my own journey and I could have an experience like that too, or maybe have had experiences like that, but I'm just not looking at my story the same way as I'm looking at others.

Sanila: Yeah, highlighting your story is important, and also just thinking of the things that make you feel fulfilled, I think, is important too. Maybe that should be the goal, is what makes us fulfilled, and how does that change, and how can we keep doing the things that we love?

I feel like the things that are fulfilling for me right now, as a fourth-year, is just spending as much time as I can with my family, my loved ones, making most of the time that I have off before I basically sell my soul and work so hard in residency. Hạ, God bless you, you are crushing it.

Hạ: Well, you're doing OB, so that is a different type of residency. In pediatrics we'll often be at deliveries, and I'll look over at the OB residents, and my heart goes out to them every time I see them.

Sanila: We're all going to make it, y'all. To our listeners, I hope you feel hopeful and not dismayed.

But yeah, I've just been thinking about what things have been fulfilling for me, and I wonder if those are going to change when I'm in residency.

Puja: Have you felt like things that make you feel fulfilled have changed throughout your medical school journey, or has that stayed pretty consistent?

Sanila: I don't know. I feel like when I was in college, the things that made me fulfilled were definitely achieving good grades and passing my exams and things like that. There were things outside of school that made me happy, but I definitely coupled fulfillment with academics. And I've tried really hard to uncouple that, as Hạ mentioned, when I've been in medical school, and I'm trying to focus on the things that bring me joy outside of that.

I think the nature of medical school is that you will accomplish things because you kind of are forced to. You have this timeline you have to keep moving on, and so that kind of becomes second nature for us, and it's expected of us. And so I'm really trying to focus on things outside of that that make me happy. So I guess in that sense it's changed from pre-medical school to now.

As far as within medical school, I think it's been fairly consistent. Being able to spend time with my friends and participate in my hobbies and try new things has stayed the same.

This is my first season learning how to ski, and it's been super fun. It's been hard to ski on ice. I will say that that hasn't been great this season. But being able to do that with the people that I love and knowing that they are helping me learn how to do that is very fulfilling. So I think the goals for what I want in my life have expanded to include things outside of medicine as well.

Hạ: Everyone has different moments when they really figure out what fulfillment means for them, and it changes, too, hearing about it.

I felt when I was in med school, I was starting to prioritize community and things outside of academia a lot. But sometimes also med school, it feels very much like you still feel very entrenched in the academia.

With residency, I felt . . . and maybe it's just because I'm around co-residents who all really care about things outside of residency. And also our big thing that we like to say is we're cheap labor, so they can't really fire us. So there's nothing that they can really do. We have to do something pretty egregious for them to get rid of us, so they're kind of stuck with us.

With all of that, definitely I feel like as time has gone on, actually more and more things that are the pluses to just clinical care have been less important to me.

I think one of the things that is still in academia that has persisted has been primarily just being able to do teaching and also work in medical advocacy and health equity. But all of the other BS has just not mattered as much as things like just being able to have time with my friends and my family and being able to eat really good food. I also now have a huge Labubu Pop Mart collection, and that is really fulfilling for me.

But all to say is things can really . . . I do feel like things move, and in a way sometimes once you get more and more out of the academia and away from the school training and those next steps, it's actually really easier often to rethink about what fulfillment is too.

Sanila: Yeah, that's a very good point. And I think, too, part of reframing this mindset around fulfillment is trusting and enjoying the process. So instead of telling myself, "I need to know 90% of the material in this book in order to be successful," maybe the goal is just learning and knowing something more than I knew yesterday, and that can be enough too.

I've been trying to work on reframing and adopting a better, healthier mindset for that, and I think it's still going to take a little bit of time for me to feel okay with that and not feel an overwhelming sense of guilt.

Puja: Yeah. And I think sometimes you have to also acknowledge that . . . let's say at 8:00 a.m., you're like, "I'm so mindful. I'm going to have a great day. It's going to be a happy day." And then it's 1:00 p.m., and you're a total 180. It's like, "I'm hating everything." And then by 3:00 p.m., you're like, "Okay, wait, I was going a little too wild. I'm fine. Everything will be okay." I think it's okay to acknowledge that it's okay to have changes in your mindset and kind of pivot as needed.

Sometimes I feel like, especially with New Year's resolutions, the moment that I'm not hitting one, I'm like, "Oh, boy, it's not going to happen." And sometimes I just have to remind myself we can just take a break and try again, and it's going to be okay.

Sanila: Yes, I totally agree, Puja. And it kind of makes me wonder maybe the goal isn't arrival, but alignment, figuring out what we enjoy and then figuring out how we can modify the process, or control or change what we can in being a product of your circumstances to align with what we think makes us happy.

And I want to start asking myself more, "Did I have fun? Was I kind? And did I try?" Maybe that should just be the goal.

Hạ: I love that. I'm going to write that in my journal and every day ask myself that at the end of every work shift.

Sanila: True. I mean, for me, those three things add to my fulfillment in some ways. And I wonder if there are other questions that I just haven't thought about asking myself that would also make me feel more fulfilled.

So, for our listeners, I have been questioning if this moving finish line is a bad thing or if there's a way that we can kind of reframe it to make it work for us. I don't know if it's possible, but that's something I'm working on.

And maybe this finish line was never meant to be crossed, but it just exists to keep us growing, especially in a field that demands lifelong commitment and learning.

The question now is "Can we move with this finish line without losing ourselves in the process?" And I think growth is part of the reward and not just the result.

Other reflective questions I have for y'all, if you have the bandwidth to think about them, are "What finish line are you currently chasing? And what would it look like to feel fulfilled before you cross it?"

And then if you're feeling like taking it a step further and having an action point, I encourage y'all to think of one recent accomplishment you did not celebrate for whatever reason and share it with someone or find a way to celebrate that, even if it is just getting yourself a sweet treat.

And then, of course, if you enjoyed our episode today, don't forget to subscribe, share the episode, and then join the conversation on Instagram, @bundleofhers.