Clarity of purpose

As with many others in medicine, my life’s guiding force has always been the clarity of my professional ambitions. I’ve adopted the message from Dr. David Sugarbaker’s presidential address to the American Association for Thoracic Surgery that clarity of purpose and focused attention represent the essence of excellence. Dr. Michael DeBakey is famous for saying that the pursuit of excellence was his objective in life. My father has also always reinforced the concept that success is when opportunity meets preparation.

My drive to become an excellent surgeon and a C-level executive continually invigorates me and dampens the disappointments and my daily failures. “Good enough” rarely is. Everything I’ve ever wanted lies on the other side of fear, and I’ve learned that fear is surmountable with clarity of purpose and the healthy marriage of rational planning and childlike hope. Thanks to my parents, mentors, and some of my own research, I’ve conscientiously planned the steps toward executing my career goals within each stage of my training thus far. And it really came as no surprise that at the beginning of medical school, the top three CliftonStrengths themes of my talent DNA were Focus, Futuristic, and Significance.

Goals have always served as my compass. The process of evaluating whether a specific action will help me move toward or away from my goals has become instinctive and makes me both efficient and a valuable team member. I’m fascinated by the future. It’s vibrant, detailed, and energizing. The exact content of the picture will depend on the logistics of my city, institution, and relationships, but nonetheless, the picture is rich and inspirational. To me, work is not merely a job, rather a way of life in the pursuit of professional and personal excellence. I love being around people who feel the same way, and accordingly make a solid effort to celebrate their accomplishments and feel invigorated rather than threatened.

Just as unprecedented events of the first half of 2020 have rocked all of our worlds, they have made me mentally revisit these personal qualities that I have for so long viewed as strengths. Now I contemplate the flip sides and how it may be best to adapt in the face of uncertainty.

The year began with two arduous months of studying for my first medical licensing exam, Step 1. The weight of this exam encumbers medical students from the first day of classes, especially after understanding the Match data and the stiff competition of applying to certain specialties. I met each day of this dedicated study period with focused attention and confidence, but not without concerns about my fluctuating performance on practice exams and the cumulative fatigue that had been building for weeks.

I didn’t fathom how the experience could get worse until my grandfather passed away the day before my test. I almost didn’t find out what happened because my family members always attempt to protect me from news that they perceive as emotional distraction. Yet after I reminded them, as I always do, that, to me, knowledge is wealth regardless of timing, I realized that I had to be quick and decisive about whether or not I would still sit for the exam as previously planned. Sorrow was knocking at the door, but I knew I couldn’t welcome in the depression, anger, and other stages of grief. Performing well on my exam was an important component in my grandfather’s vision for the success of our Korean-American family and was how I could best honor him in that moment. As Dr. Sugarbaker had suggested, the secret to discovering my purpose at that particular moment in time was closing my eyes, opening them again, and seeing what was directly in front of me. In that moment, it was the Prometric computer monitor. And with this clarity of purpose, I did what I had to do.

The tears eventually flowed deeply when I delivered my grandfather’s eulogy. The anger, when I laid awake each night with insomnia, thinking “why me” and fretting over the impending results of my exam performance. And now the acceptance, as I write this post and pray for understanding of the indelible impressions of Korean traditions of hierarchy, rigid stubbornness, and confusing acts of love that my grandfather left with me. I initially felt guilty and callous for not allowing myself to be more overcome with the emotion I “should” have felt immediately after the loss of a loved one. It was perhaps wrong to view death as a delay, an obstacle, or a tangent in my anger after the fact.

But death also brought clarity of purpose and even salvation from the shackles of secondary emotional baggage and competing interests in my own life at the time. Our family came together in solidarity for the first time in years. I was afforded a second to breathe. My grandfather’s legacy and the promise of his eternal peace and freedom from suffering resound in my heart and my mother’s every day since. Clarity of purpose was both the driving force and direction. Death brought unmistakable loss but also served as the prerequisite of resurrection for me and my family. You that seek what life is in death, now find it air that once was breath.

In a similar way, the coronavirus pandemic naturally made me and so many others take pause. As the morbidity and mortality tolls rose, supplies ran short, and my education was put on hold in the best interests of patients’ and our own safety, I couldn’t help but feel a sense of deja vu with the “why me” mentality. The landscape painting of my future was becoming hazier as announcements of changes to our curriculum and residency program applications became the new normal. Do intense focus and clarity of purpose hinder the quick adaptation of our strengths and priorities in unprecedented circumstances? I felt the same guilt and callousness as before while I continued to work from home and attempted to regain some semblance of normalcy in my life. In the darker times, I drew inspiration from my mentors on the front lines as well as Dr. Craig Smith, who is Chair of Surgery at Columbia University in New York City and credited with being the pandemic’s most powerful writer. Each day, he writes a letter to the department–and eventually to the entire world–that personifies resilience through his clarity of purpose and focused attention. Here is one poignant excerpt from March 27:

“We find a way to pull out of an anxiety-driven small view and rise up to the big view. For what it’s worth, I’ll offer a personal example: Picture me in the final stages of drying up the minor bleeding that typically follows straightforward replacement of two heart valves. All is very routine until the back of the heart starts to bleed; it’s coming apart. This is a patient I looked in the eye and agreed to care for, to the best of my ability. The preoperative probability of death was ~2%—something like COVID-19—suddenly that has become a very real number, and closer to 50%. I’m not ashamed to confess that my first reaction, 100% of the time, is crippling anxiety and self-doubt. Can I put Humpty together again? But there is no one but me to take care of this. The only response possible is to turn down my thermostat and start trying to do what must be done to save the patient. At least half the time that saves the patient. Back to this reality, we can expect the vast majority of COVID patients to do very well. Even most of those who go on ventilators survive, but not by chance. They survive because we don’t give up.

There is no flip side to holding steadfast in one’s clarity of purpose, even and especially during a pandemic. My CliftonStrengths theme Futuristic must also be one of Dr. Smith’s. When the present proved too frustrating, people looked to Dr. Smith for the big view and to conjure up visions of the future. My personal visions have always energized me, but I realize they can also energize others. In fact, I think my personal relationships with friends and past partners who wanted a picture of the future have been rooted in my particular ability to raise their sights and thereby their spirits. I’ve been able to paint it with hope for them.

However, the pursuit of this vivid future is like the legend of the Holy Grail. My grandfather’s passing, additional illness and loss of family and friends, COVID-19, and the pattern of uncertainty that is 2020 so far have all made this message abundantly clear. Tomorrow is just as valid a representation of the future as is one month, one year, and one decade from now. Each chapter in our lives is not predetermined or fixed. There is no tabula rasa or self-fulfilling prophecy. The concept of clarity of purpose has many layers, but most importantly, it must be a singular purpose in the moment.

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