I remember one of my favorite attendings telling me this story during residency.  Since then, I’ve heard different variations, but the overall point really struck me and stuck with me all these years.  It’s something I remind myself from time to time when I feel like things don’t seem right.   In the story, a teacher pulls out a large jar, 5 big rocks and a bottle of sand.  She asks a student to come up and transfer the rocks and the sand into the jar.  The student pours the sand into the jar but is only able to fit 3 of the rocks.  The other two can’t fit no matter how hard the student tried to shove it in.  The teacher then asks another student.  The second student places the 5 big rocks into the jar first and then pours the sand into the jar.  Everything fits perfectly.  As you may have guessed already, the big rocks represent the priorities in your life.  Perhaps it’s family, friends, your well-being or career.  The sand represents all the smaller things in life that may seem super important in the heat of the moment.  If you constantly prioritize the small things, you may never have room (or time) left for the big things in your life.  And by the time you realize that, it may be too late.    What and who are the big rocks in your life?  What do you truly care about?  Are you making it a priority?  Are you doing that things that you claim to care about?   Or are you letting the small things that come up day to day hijack what you truly want to devote your time to?  Are you prioritizing something in theory but have the baseline guilty feeling (like having a small pebble in your shoe) that you should be giving more of your time?   If any of this resonates with you, just know that you are not alone.  Just letting this story sink in and recognizing it in your own life, can be the first step to making a positive change.    Priya

My son loves the Dogman books and we have gone through many as part of our bedtime ritual.  Lil Petey is Petey the Cat’s son and likes to ask “WHY?” over and over and over (and over) again which drives his Dad absolutely mad.  So naturally, when I would come across those lines in the book, I would make sure I used my most annoying “Why???”  voice.  It would elicit strings of giggles from my son, making it so worth it!   Well now there’s a Dogman movie and of course we had to go see it in the theater.  Much to my amazement,  I really enjoyed the movie and recognized several scenes, taken straight from the book.  I even remembered how the Dogman character came to be.  Super proud moment for this Mama.    One of the scenes was the infamous “Why” dialogue between Lil Petey and his Dad.   I was shocked to find that Lil Petey’s voice in the movie produced a very inquisitive, curious (and dare I say cute?!) “why”.  It was not the annoying voice that I used when reading to my son at bedtime.  And it reminded me of one of the most important steps in becoming self-aware.    Always ask why.  Question everything.  Question why you’re doing what you’re doing.  Doing things a certain way for a long time doesn’t automatically make it rational.  Are you doing it because you intentionally want to do it?  Or are you doing it because that’s what you’ve always been doing and never thought about it? The path to change involves breaking old patterns by questioning them and only keeping them if it truly serves you and your life is some positive/constructive way.  If you don’t ask why, then you may never know if that’s truly what you want.  Asking why will take you out of routine, mindless cycles and force you to be present and in the moment.  It will help you to be intentional about what you choose to believe.    In Emergency Medicine, how many times have we done something a particular way because that’s just how we learned to do it?  And how many of those ideas were later debunked and retired into the “myth” hall of fame?   Reminds me of a lighthearted but powerful story out there.  I wanted to give proper credit, but couldn’t find the true origin of the story.  It’s impact is timeless and priceless so here is my adaptation of the story.  A woman made pot roast for dinner and her friend asked for the recipe.  When she read over it, she asked why the recipe states to cut both ends off the roast before placing it in the pan.  The woman said she cut the ends off because that’s how her mother always prepared pot roast.  The young woman then asked her mother who replied that that’s how her mother always made it.  Both the young woman and her mother asked the grandmother who said she would cut off the ends because the roast was always bigger than the pan she had so she had to find a way to make it fit.    What are some things you do reflexively just because that’s the way you initially learned to do it?  Is it serving you in a positive way to continue doing it that way?  I challenge you to get curious.  You may be surprised by what you uncover.  Priya

For as long as I can remember, my life was all about the “grit, grind and suck it up willpower” to achieve my goals.  I kept a positive attitude and knew how to “keep on keeping on” because let’s face it- as a student in medicine, life was regimented during the schooling days.  The steps were laid out and I just needed to do whatever it took to keep progressing towards the one big goal of becoming a doctor.  I’ve always seen myself as someone who needed to study harder or work harder than others in order to achieve the same results.  So pushing myself and using willpower became my superpowers.  I would pride myself on being able to pull off “all-nighters” and 30 hour calls during residency as a rite of passage to achieving my dream of becoming a doctor.  As a new attending after residency, I felt as though the sidewalk just abruptly ended and there was no longer a cleared path for me to walk.  The learning curve was high and I had difficulty figuring out my own identity, especially without the positive reinforcements I received in residency.  I still felt like I had to work harder than my colleagues so I continued to push myself by staying late after shifts, doing charts at home in order to keep up and prove my worthiness.  This worked for me in my early years, but as life progressed, I struggled to find a balance.  I would spend off days recovering from my shift and finishing notes rather than living life.  I felt lost. Everyone else seemed to be thriving and I felt like a failure.  On the outside, things seemed fine.  There was no rock-bottom moment.  I was a positive, energetic person, but on the inside, I was in constant survival mode and spinning in a web of negativity.  I was a cheerleader for others, this came naturally to me.  But I spoke to myself in a different way.  It was more of a tough love, berating myself and constantly “trying to be better.”  It felt safe to be on this self-improvement journey because then I didn’t have to accept what I thought was the “real me” in that moment.  I just didn’t feel like I was good enough.   I was living life, but I wasn’t LIVING life.  I wasn’t present.  I felt dissatisfied.  I would ask myself “is this what I signed up for?”  I felt guilty for feeling this way because my life was really not that terrible.  I felt a lot of shame for not “having it together” at this stage in my life.  It felt like an endless cycle.  I felt stuck. I remember reading a book at bedtime with my son and he stopped me mid sentence to ask a question about one of the characters.  I couldn’t give him an answer because I had no clue what I had just read and had to re-read the page so I could bring myself back to reality and answer his question.  I wasn’t paying attention.  I was there, but I wasn’t THERE.  In the moment.   My mind was off somewhere in La La Land thinking about my “to do list” or shift at work.  I didn’t like how I was showing up and I knew I had to do something about it.  This is when I started on a different self-improvement journey.  I came across concepts about habit change, neuroplasticity and mindset work. I became inspired by the teachings of Brooke Castillo and I joined her program called “Self-Coaching Scholars.”   I learned how to become aware of my thoughts and thought errors (trust me there were plenty of them), manage my mind and learn tools to live an intentional, purpose-filled life which by definition is a life of ups and downs, successes and failures.  The things I’ve learned along my journey have been a game changer.  It can be applied to so many things that we, especially physicians, try to work on all the time. It’s something that I wish I learned a long time ago.  I thought to myself- I have to get out there and talk about it.  I have to increase awareness of the fact that these concepts are available to us any time and any day but we have to know that it exists in order to reap the benefits. I felt a strong desire to share my story and teach the concepts I’ve learned because let’s face it- there’s a mass exodus of physicians, especially in Emergency Medicine.  This is alarming.  People are getting frustrated and burning out.  I’m not ready to throw in the towel but I completely understand those who are.  We are losing good docs who are passionate about practicing medicine.  If we continue along this trajectory, who is going to take care of our loved ones?  I was taking care of someone who asked me how it was possible for me to smile so much.  I asked him how he could tell I was smiling since I was wearing a mask.  He said he could see it through my eyes.  And for the first time in a really long time, I could honestly say that the smile that I wore on the outside matched how I felt on the inside.  Amidst the chaos of the ER, there was a sense of peace within me.  I often think about my “one person, one percent” rule.  If I can share my story with one person who is struggling right now… someone who may feel, even just one percent of how I felt before I started on my journey, it is all worth it.  That is my why.  Priya

Can you go a whole day without judging something or someone?  Seriously, can you?  I thought I was a nonjudgmental person- I prided myself on that.  Until I tried to go a day without having any judgements and I fell flat on my face.  Literally.   I fell flat on my face and judged the curb I tripped on.  I lost my perfect streak within minutes of starting.  Epic fail.  Oh wait, that was a judgment too.    It’s hard to go a day without having any judgments.  As humans, it’s what we do. It’s how we’ve literally survived the caveman days and evolved.  Holding someone to a nonjudgmental standard is like asking a fish not to touch water.    Plus being judgmental can come in handy.  For those cavemen, it was in their best interest to fully judge the saber-toothed tiger who was about to eat them for dinner.  Sure you can be nonjudgmental, but you’ll also be dead.    So are we all doomed to be “judgmental jerks” for the rest of our lives.  Absolutely not. When is life ever black or white and nothing in between?  Here in lies our power to choose.  The power to realize when it’s appropriate to be judgmental and when it’s more appropriate to get curious.  Curiosity can be a superpower if we remember to utilize it when it counts most.  Our ability to get curious in times when our primitive reflexes want us to react and judge, will set us free from unnecessary suffering.  The kind of suffering we put on ourselves because we’re closed off to ideas that are different from ours.    The next time someone says something that makes you react- can you hold space and ask questions?  You don’t even have to directly ask that person.  Maybe it’s someone you see on tv.  You may never meet this person.  You feeling some type of way only affects you, not them.  You can do this quietly to yourself in those situations.  Can you ask yourself “I wonder what they must have gone through or experienced to say something like that?”  It won’t make what they said right and it certainly doesn’t mean you agree with them.  It just means that you hear something that isn’t in alignment with what you believe and you decide to put yourself in their shoes for a moment.  Judgment is a quick release that will make you feel really good in the short term, but it will only magnify the division that already exists amongst humans.  Getting curious will seem really awkward in the beginning but it will produce ease in the long term.  If more of us practiced this, may be we could see each other for our similarities rather than differences.    Try it.  Get curious.  What do you have to lose?     Priya