All,

Well, it's that time of year. Every year following the
holidays and new years there is a time of
reflection... and I suspect this year will match any
year of the past or for the forseeable future. The
difficult part is that it is always met with some
sadness and melancholy. Again, I would guess that this
year will match any year of the past or for the
forseeable future. Strange to me, however, that
reflection rarely dwells upon what has been gained...
and more importantly, what has been learned. And so I
pen this email to you to share some of my
reflections... both in the context of what I think
I've learned (or been reminded) and the various
emotions. As it was so adeptly pointed out earlier, I
am sure this email will be long... so as always, if
you are busy, feel free to skip it. As usual, it is
likely to have nothing of consequence.

I'll start my thoughts with Marx... so the next few
sentences will keep me out of public office (as if I
wasn't already out for other reasons, and as if I want
to associate with that crew). But I think it's a
useful starting point for this dot-to-dot puzzle of a
discourse. Well, Marx would tell you that there are
three classes in society, and each class is defined by
more than just its accumulated wealth. As opposed to
the Calvinist, Marx argued that after time, each class
was defined by an inherited (or via oppression)
attitude on life. It was not attitude that defined
possessions (or lack of it), it was possessions (or
lack of it) that defined attitude. The lower class
looks at life helplessly: life events happen to me and
I have no control whatsoever save to just try to stay
alive. From this perspective a life-event happens, and
a man responds like a stick in a river, being pushed
in the direction that the current takes him. The
middle class man sees life as under his control:
life-events happen, but for the most part, he sees
these life events as completely under his control. His
works define the moments... and the natural corollary
is that every life-event is under someone's control...
so everything in life is someone's responsibility (or
fault... i.e., lawsuit). And then there is the
upper-class man that looks at life as an exercise in
ultimate control- he completely controls life
events... largely because he completely controls the
lives of other people that make these events for him.
And his control is held tight because the people he
controls have one of the two earlier perspectives.
Now, I'm not advocating for the class distinctions,
nor am I saying that one life perspective is better or
worse than another... nor am I suggesting that these
classes should exist. It just is what it is. And as
Marx suggested, it would take a revolution to change
that.

I note this small watered-down piece of philosophy
because the issue at hand is all about perspecitve. So
here's some personal insight. I used to look at life
as a series of defining moments- put all of the
moments together and you have the outline of a life.
This outline is what you will someday look back on as
the definition of your life. But my perspective, as
Marx would predict, was that of the middle class- the
defining moments in my life were going to be regularly
scheduled events, well under my control and design:
high school graduation, college graduation, medical
school graduation, residency completion, marriage,
faculty appointments, etc. The common denominator of
all of my "planned" defining moments was that they
were all under my control, and while life existed
outside of my control, with enough effort, I could
define these moments, and these moments would in turn
define my life.

But it didn't take long to be shaken from my
perspective... I told you early on in this journey
that I had been through far worse life events than
this, and that is true. And after each of these life
events, I sought someone to blame.... thinking that
the bad things in my life were surely someone's
responsibility... but with no one discernable to
blame, I was left with only anger and frustration.
Anger that consumed me.....I would butt my head
against the brick wall of this lesson... only to find
greater and greater frustration that my "life"
philosophy did not fit very well with real life. All
the time failing to realize the lesson that was just
before me: Life is what happens to you while you are
making plans. And so it is with trying to put a
square-peg philosophy into a round-hole reality of
life... it just doesn't work, save to create more
frustration and angst.

But by the fourth major life lesson years ago, I had a
breakdown. A small, but necessary existential crisis.
And that crisis was not so much a function of the
event, but by the realization that my life philosophy
was wrong. Sufficient to say that the time was very
dark, and there was nothing nice about it... save the
special feature of all such emptiness and darkness.
In the dark and empty, you find great focus, as there
is absolutely nothing there to distract you. Just you
and your life thus far. And there is absolutely
nothing to do (or that you can do to change it). It is
like a mental straight jacket, and all you can do is
think. In that darkness, I realized my error... It was
not the wrong philosophy I had adopted, it was the
wrong perspective. True defining moments were life
events that were not defined by me... they were events
that happened to me. Now lest you think that I changed
from one social class perspective to another (the
lower class 'fatalism'), I didn't. But there is a
marriage between the two class perspectives (lower and
middle) that I think is probably right. (The upper
class perspective is ridiculous, obscene, and in the
best case, transitory). So here was the adjustment....

I still believe that there are defining moments in our
lives. And like a dot-to-dot puzzle (see attachment A)
the sequence of the dots defines the outline of our
lives. But the key piece is that we cannot control or
manufacture these moments. Not to say that graduating
high school wasn't important, but in the grand scheme
of my life, it didn't really change how I see myself
or my life. And that statement is very defensible when
you think back about the day before your graduated
high school and compare it with the day after. Not
much difference between those two days.

To the contrary, defining moments occur quite out of
our control. It was my dad leaving, my best friend
committing suicide in college, my first real love
leaving me stranded at an airport in a foreign
city....and many more (some of which were happy
moments, by the way)... and now, Katrina. Yes, all of
those were definitive defining moments because after
the moment, my life would never be the same again. And
that is the epitome of "defining." And none of them
were under my control... and certainly, none of them
were planned.

But I'm not a fatalist- I do believe we all have
control in our lives. For if there was no control,
then there could be no responsibility. No, all we have
to do in life is die, and since we always have a
choice, we always have responsibility for our actions.
But we do not have control over what happens external
to us, just control over what is internal in us- our
thoughts, words and deeds. And the essence of the
philosophy is this: You can't control (or predict) the
defining moments in your life... but you can control
how you respond to the moment. To use the dot-to-dot
analogy... you can't control the dots, but you can
control the direction your pencil moves once it hits
the next dot. And the beauty of the picture (your
life) is a direct product of how you respond to each
dot. Consider attachment B and C.... you be the judge
(Sorry about the armadillo thing... finding a dot to
dot on the internet is tougher than I thought). This
is not to say that the best life is one in which you
move directly from one dot to the next... first off,
it's impossible since you don't know when the next dot
will appear, and secondly, a rigid linear dot to dot
puzzle is rigid and boring. But it is to say that you
don't want to spin circles around one dot... the line
has to go on or the picture ends in an abstract piece
of crap. The art of life is not getting too bogged
down in any one moment, nor getting too far off course
as you ricochet off one dot so that your pencil leaves
the canvas (to mix art metaphores) such that you don't
stand a chance of seeing the next dot. And this last
point is important, because at the end of the day...
the worst thing you could do is to cower around one
dot such that your life's picture is composed of only
three or four dots.... because not many pictures can
be composed with only three or four dots. A line, a
triangle, a sqaure, a trapezoid... I guess, but not
much more than that. And that's a shitty life picture.

And the other curious feature of defining moments is
that they always seem to be uncomfortable... even if
they are good moments. Uncomfortable because you feel
the stretch of your life as it changes... but akin to
physical growing pains, the discomfort always
parallels expansion.... and deep inside, whether you
realize it or not during the moment... your life's
picture is expanding into something much more
interesting that it was even hours before. And with
each defining moment, as long as the pencil keeps
moving forward, the picture expands.


But now the reason for this email... I suspect you are
getting tired, and the strength you had in September
is beginning to wane. How could it not? Five months of
this is just an incredible strain. And like a long car
trip, the last 10 miles are always seemingly much
longer than the first 10. And like all great struggles
in life, that bastard of a question starts sneaking
in.... "is it worth it?" It's that same thought that
inspires Navy Seals to ring the bell. It's the same
thought that keeps a fighter down once knocked down.
And with fatigue at its maximum, you may begin to
revert to a survival mentality... "what's in it for
me?" Perhaps it is manifest in the thought of
leaving... or more likely just the fear and angst that
comes with prolonged uncertainty.... not knowing if
this lost time will affect the physician you will
become.

Well, know this. I've seen many great physicians in my
time... and I've seen many terrible ones, too
(remember, I used to remediate residents for a
living). And the one distinguishing feature between
the two was not the knowledge each held... not their
technical skill... not even their communciation or
interpersonal skills... it was the failure to live up
to the first fundamental lesson of this team:

"Requisite for being a great physician is being a
great person. If you are not a great person, you can
not be a great physician... for it is people that the
physician cares for, and if there is not goodness
within you, there cannot be goodness to come from
you."


So there has been medical knowledge lost in the past
few months no doubt... but there has been no character
lost. To the contrary, each life picture...predicated
on character... has expanded in proportions that would
take twenty years for the average physician to
accumulate. Each of you has kept the pencil moving
from dot to dot... even when things were very rough,
you didn't quit. And in doing so, you defined the
outline... the very character of your life thus far.
So come what may, I hope that in your contemplation
and reflection of what we have lost that you take a
moment to think about what you have gained.... and
think about how important that character is to the
life of the physican who lives at the bedside.

And all of this I thought of while spent a couple of
days by my grandmother's hospital bedside a couple of
weeks ago... And all I could think about is how much I
would want her doctor to be one of you. Any one of
you. Whether you knew the right medical knowledge was
quite immaterial at that momement... I just wanted
someone who wasn't going to give up on her. And in
those moments, it seemed to me, I just needed someone
of character to be her doctor.

So here is our defining moment... and like all
defining momements, either you will define the moment
by how you respond to it, or the moment will define
you... What will you do next? Will you keep the pencil
moving to see what comes next? Or will you pick the
pencil up?

Even with great sadness in my heart for what has
happened to you and what we have all lost... and with
great frustration in my soul at those whose actions,
inactions or incompetence have adversely affected our
lives and induced so much pain... my pencil stays on
the page, seeking that next dot in my life. No bravado
in this email this time... no admonishments about the
weakness of quitting. I just want you to know where I
stand. I'm just not going to quit. And I know that
that might mean going forward alone or with only a few
of you... but I just can't quit on this. I've
sacrificed too much... you have sacrificed too much...
I want too badly to be a part of what comes next,
because whatever it is, it's a hell of a lot better
than what came last. And you know the funny thing?
There is absolutely no doubt in my mind that our team
will be great again... it's just what happens when you
have truth on your side and good people at your
back... and when it is really great again... maybe
next month, maybe next year.... I don't want to be on
the outside looking in always regretting that I quit
too early and I didn't see it through... I just don't
want to wake up in the middle of the night for the
rest of my life thinking about how I didn't see it
through. I just want to see our greatness happen, and
I'll get up every morning when I don't want to, and
I'll work when I am too tired to, and I will drive to
wherever I have to. It just means that much to
me...just to see this happen.

Good night, all... you'll sleep well, I'm sure...
mostly because those 10 minutes won't bother you.

Wiese

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