Why I Didn’t Cancel

Last week, I told you about the two intern orientation commitments sitting in my inbox, the emails I'd opened six times and still hadn't responded to. I want to report back: I did them.

Not because I felt ready. Not because the burnout lifted or because some second wind arrived on schedule. I went because I have a rule I apply specifically to teaching: I show up when I say I will. I will cancel a committee meeting, miss a grand rounds, and cut a happy hour embarrassingly short. I have done all of these things this month with minimal guilt, and I'll do them again. But I do not bail on teaching. In the language I used with the interns themselves, it is an anchor value. And the funny thing about anchor values is that they hold whether or not you feel like being held.

The talk was called "Still Standing: How to Stay Whole When the Work Gets Hard." I gave it to the gen peds interns at orientation last Sunday. Sixty minutes, four ideas, a room full of people who start caring for actual patients this week.

Here's the other thing I should tell you: I love this content. Not in the "I care about physician wellness" way that I can perform on command at a faculty meeting. I mean, I genuinely love it, the way some people love talking about fantasy football or their sourdough starter. The distinction between big-T Trauma and little-t trauma, and why it matters to call hard things hard without collapsing everything into catastrophe. The neuroscience of what happens when your limbic system takes over from your prefrontal cortex mid-crisis, and the embarrassingly simple intervention that actually works (one slow breath, maybe with a hand on the door frame =  the half-second it takes to come back online). Knowing your values before the chaos starts means you're not improvising your ethics in real time while caring for a dying patient at 2 a.m.

Everybody likes to talk about what they like to talk about. This is not a groundbreaking observation. But I think we forget it when we're burned out, because burnout has a way of making even the things you love feel like obligations, and the obligations feel like the things that are killing you, and eventually you stop distinguishing between them. I walked into that room depleted. I walked out lighter. Not fixed, not energized in the "I just had a great workout" way, but lighter. Like something got used that had been sitting stagnant.

The slide I spent the most time on was the values one. The premise: residency will hand you dozens of decisions a week with no clear right answer. Academic medicine is hierarchical, and it sometimes pressures you toward choices that don't sit right. If you don't know what you actually value before the chaos starts, you'll be doing that excavation in the middle of it, under pressure, with your prefrontal cortex already offline and your jaw clenched and your attending waiting for an answer. Knowing in advance means you're not improvising. You're just executing.

I didn't mention to the room that the only reason I was there at all was that I'd applied that exact logic to myself. That "I show up to teach when I say I will" is not a naturally occurring personality trait of mine, but a deliberate choice I made a few years ago, when I noticed which commitments I was honoring and which I was quietly letting slide. Teaching stayed. Most other things became negotiable.

It seemed like too much to explain at orientation. But I was thinking it.

What followed the talk was two and a half more hours of teaching and then an overnight shift. The lift I got from that hour carried me further into the day than I would have predicted. That's the part I don't fully understand yet, the mechanics of why talking about something you care about with people who are new to it can return something to you that the rest of the week has been slowly subtracting. But it did.

I'm still tired. The overnight was an overnight. I came home, slept for a couple of hours, and woke up to hours of work for the ethics consult service. The break is coming on July 11th. I’ll be leaning heavily on my values until then.