Finding purpose on your career journey

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Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills

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to build their own research program, whether or not they have a mentor.

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As clinicians, we spend a decade or more as trainees learning to take care of patients.

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When we finally start our careers, we want to build research programs, but then we find

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that our years of clinical training did not adequately prepare us to lead our research

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program.

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Through no fault of our own, we struggle to find mentors, and when we can't, we quit.

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However, clinicians hold the keys to the greatest research breakthroughs.

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For this reason, the Clinician Researcher podcast exists to give academic clinicians

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the tools to build their own research program, whether or not they have a mentor.

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Now introducing your host, Toyosi Onwuemene.

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Well, hello everybody.

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Welcome to the Clinician Researcher podcast.

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I'm your host Toyosi Onwuemene, and it's a pleasure to talk with you today.

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Thank you so much for being here.

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Today's episode actually comes courtesy of one of my sessions with my coaching clients,

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and I'm inviting you to join us as part of our session.

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And if you are thinking about being part of our group coaching, please reach out to me

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by direct message on LinkedIn.

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I'm also on Facebook and Instagram, but more likely to be reached by LinkedIn.

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But I just did want you to get some insight into some of the things we talk about as we

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advance faculty and their careers.

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Enjoy.

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So today, I wanted to share about thinking about our purpose and our vision.

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And I gave everyone homework, and it's okay if you didn't do your homework.

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We'll talk about your homework at the end.

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But just really thinking about what is it that really makes you tick?

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Like what really excites you about your career, what you really want to accomplish?

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And one of the themes that came up a lot last time was that sometimes you're just in survival

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mode.

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You're not even in the end.

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You're not even really thinking about what do I really want out of all of this?

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Where am I really going?

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And that's the way it is when you're so busy and feeling like you're just barely stringing

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two days together.

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It's easy to just go with the flow wherever the flow takes you.

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And many times it's not exactly where we want to go.

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So I didn't want to share my story.

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When I first started, I think I want to start from the point of being a fellow.

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I always knew I was going to do sickle cell research.

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I always knew I was going to do sickle cell research.

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I worked with a...well actually I didn't always know.

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I had a faculty member who was a mentor when I was a med student and she would just take

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me out to coffee every once in a while.

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We would sit and talk about my experience.

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At the time I wasn't thinking about hematology because I was going to be an oncologist, of

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course.

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And my father had died of liver cancer, so I was definitely going to become an oncologist.

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But I met with her every once in a while.

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She would just ask about how I'm doing.

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And that was just a good relationship.

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But there was no plan to change and become a hematologist like she was.

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However, on my journey to becoming an oncologist, I think I realized that I liked the hematology

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piece a little bit more.

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And so 9100, when it was 9100, that's the leukemia lymphoma service at Duke, was kind

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of more interesting to me.

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And Lou Deal, who's one of the older faculty members at Duke, was one of my attendings.

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I just really liked that group.

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And Amy Abernathy, actually, who's now no longer in clinical medicine, was one of my

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attendings too.

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So I had a great group of attendings.

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And I really loved the leukemia lymphoma service.

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So I thought I was going to be a malignant hematologist.

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And then I had one experience on the service where I watched a patient overnight become

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quadriplegic.

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And it just, I don't know, it just broke me because I went home sobbing and just thinking,

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okay, it's one thing for the cancer to kill you.

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It's another thing for us trying to get the cancer where we kill you in the process.

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I mean, he didn't die, but it was just really traumatic.

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And so I knew that was the defining moment that I knew I was not going to be a malignant

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hematologist.

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And then as I started thinking, well, what else am I going to do?

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Then hematology, classical, as people want to call it now, came to the fore because I

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had a mentor who was doing classical hematology.

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And she had sickle cell.

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And she saw patients with sickle cell in her clinic.

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And so that was, I was going to do sickle cell.

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I did my third year capstone talk on transfusion medicine and sickle cell.

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I won an award for it.

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And then I went off to fellowship in Chicago.

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And that was the beginning of a lot of trouble.

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So first of all, one thing I missed was that there are patients with sickle cell in Chicago,

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but they don't go to Northwestern.

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They mostly go to UIC.

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That's University of Illinois, Chicago.

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And so I didn't have access to the patient population I needed to succeed in any research

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endeavor that I was trying to do.

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So I eventually needed to be creative and think about, okay, well, how can I get sickle

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cell research experience?

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And I went to the Children's Health Center and worked with, at the time, Alexis Thompson

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was there.

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And let's just say it didn't work out exactly as I wanted to.

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And I remember one day just crying and saying, I wish I had never come to this fellowship.

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I wish I'd never come to Chicago.

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Oh, the drama.

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Anyway, when I finally came to Duke for my faculty position, I wanted to do sickle cell.

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And clearly I was going to come back and do sickle cell because all the patients with

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sickle cell were at Duke, at UNC too, but they're a lot at Duke.

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And there was no space for me.

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So at the time, they had too many faculty members in sickle cell.

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And in retrospect, I would say there was always space, but people were trying to close the

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door for different reasons.

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And I accepted it.

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I said, okay, well, I guess there's no space for me.

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My backup plan and fellowship, since I couldn't do sickle cell, or I couldn't, in quotes,

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was to do hemostasis thrombosis because I knew that at any point in time, it was going

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to be applicable to patients with sickle cell.

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So when I came to Duke and they're like, eh, we don't really have space for a sickle cell.

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What else do you want to do?

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I was like, sure, I'll just keep going with the hemostasis thrombosis theme.

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And so after I came, then two faculty members left pretty much back to back.

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And then they were like, um, Toyosi, you know how you had said you were interested in sickle

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cell?

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Would you like to take over?

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And at that point I was like, no, no sickle cell for me.

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Thank you very much.

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But anyway, so I will say that long-term, I never came back to sickle cell for my research

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career.

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I still take care of patients with sickle cell, but it's not what I do for research.

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So to some extent, I may have been derailed from that goal.

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However, quickly I realized that I didn't really have a plan for my faculty career,

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right?

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I was just, I was just kind of, you know, I mean, they gave me five clinics a week.

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I was doing, well, not five clinics a week, but I was seeing patients five days a week

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and I was doing that.

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And at the time I was also pregnant with my daughter and it was just rough.

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It was so rough.

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I hated the whole thing.

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I hated the whole thing because I was doing aphoresis.

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So it was one of the things I was doing actually all days of the week.

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And the part I hated was just these arguments I kept having with providers over whether

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we could provide aphoresis or not.

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Then I would turn around and argue with nurses about whether they could do the aphoresis

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or not.

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And it just ran me ragged.

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And at the end of every day, I felt like I was just like someone had run me up against

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a wall and just bruised me significantly and I needed to recover.

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So it was rough.

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Anyway, I say all that to say that I was kind of just being tossed and turned, right?

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Somebody said there's no sickle cell available, so I just didn't do sickle cell.

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And then somebody said, well, here's five days of clinic, five days of seeing patients

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a week, even though you're 80%.

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And I was like, sure, I guess that's the way it works.

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And then I was doing this thing I hated, which was arguing with providers and nurses all

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day.

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And it was like, okay, this is my job.

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I'm just going to grin and bear it.

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And so anyway, I feel like I was the poster child for just going with the flow and the

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flow was not very good for me.

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So Jennifer, not to pick on you, but you talked about being in a supportive environment.

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I wasn't in a not supportive environment, but let's just say the outcome I was having

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didn't make it seem as if there was support.

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It looked like there was support, but the outcome looked like I was being broken to

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pieces.

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Anyway, so I will say that one of the big breakthroughs of my life, biggest breakthroughs

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of my life was really, actually I had several.

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As far as research, I have one that I will talk about at a future session.

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But today I want to talk about how coaching really helped me.

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And one of the most important things that my coach is Judith Holder, and she's a great

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executive coach.

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She does a couple of sessions at Duke.

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She's really awesome.

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I recommend her.

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And one of the things she helped me recognize was closing the gap between my feelings and

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in my response to my feelings.

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So I'll give an example.

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I'd be the kind of person where I'm walking and then all of a sudden, I'm sad.

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And I'm like, wait a minute, why am I sad?

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Then I have to retrace the steps and say, oh, oh, it was three hours ago in the chief's

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office when he said, ha, even a monkey could do this interpretation.

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And in the moment, because I love to please people and make them happy.

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In the moment, I may have laughed and said, ha ha, what a funny joke.

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But three hours later, it hit me that that hurt me.

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But that was three hours too late.

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Right.

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And one of the biggest things that really helped for me was to shorten the gap between

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my feeling in the moment and how I responded to the feeling in the moment.

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So I became a feeler again, like actually someone who could actually decipher and interpret

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how I felt about situations so that I could respond more in the moment.

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OK.

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So what does this have to do with your purpose and where you're going?

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So I feel like I was a poster child for someone who didn't know where I was going or who didn't

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have a plan.

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I mean, I just wanted to be a physician.

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I just wanted to graduate.

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That was it.

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That was my goal.

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Right.

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And as soon as I accomplished that, I don't think I realized that there was a different

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goal for faculty.

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I mean, I was going to do all the things they said I would do, which was see patients, do

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research, you know, the big umbrella.

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But this wasn't the same as residency or fellowship where there's a very clear goal in three or

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four years you're going to be done as long as you meet all these competencies.

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Right.

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There wasn't a clear goal.

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It just seemed like everything was moving, you know, and it wasn't clear.

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I would say, hey, I want to do research.

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Oh, and they were like, oh, well, there's no research.

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So here, do clinical.

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And then I would say, okay, great, I'm doing clinical, but why am I earning a research

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salary?

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It's like, oh, you know, so I just was always kind of just, I was tossed back and forth.

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Anyway, but one thing I knew is that I hated whatever I was doing.

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You know, the feeling like I was being bruised every time I was trying to do my work daily

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in apheresis.

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I hated the feeling of, you know, trying to do research, but I was so busy clinically.

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And so to some extent, I figured out my, what I wanted to do based on all the pain that

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I had.

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So I was running away from pain and therefore entering into what I really wanted to do.

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So I want to help you avoid that to the best of my ability by helping us think intentionally.

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And how would that have helped me?

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Well, when people said, hey, sickle cell is not available.

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I may have said, no, no, no, this is really important to me.

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If it's not available, I'm not going to do this.

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Right.

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So I took whatever was given to me.

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I assumed I didn't have a choice.

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I know now that I did, I did, but I assumed I didn't have a choice.

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Now was sickle cell the real thing?

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To me, I think it wasn't so much about sickle cell.

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And that's probably why I gave it up a little bit more easily was because, was that I really

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wanted to have an impact on a disease that's, that affected a minority population.

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I know that that was important to me.

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And sickle cell was very easy.

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I think for many of us who go into classical hematology, I think many of us to some extent

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have some resonance with sickle cell.

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But anyway, I think it's important.

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I mean, talk about seven things that are important to think about as far as defining your purpose.

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I think the first thing is that it's easy for us when we run towards an end that we

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can see.

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Medical school, it's four years.

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Great.

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I know how this works because other people are doing it.

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I can see them.

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I know the way to the end.

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Residency is the same.

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There are people who graduated, I want graduation.

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I'm just going to follow the path.

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And the same thing for fellowship as well.

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So you may not have to define your purpose at the beginning because you're running towards

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an end that you can already see.

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It's already clear to you what the wind is.

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It becomes harder when you leave the path to where there is no clearly defined end.

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That's the time at which it becomes really important to be very clear about what your

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destination is.

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And it's hard to be clear because you don't see it, right?

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There's nobody who's like, hey, Diamond, this is the destination.

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You just come and be like me, your life will be better.

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There's usually no such person.

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So when it comes to kind of trying to clarify, why am I here?

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What do I want to do?

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You're mostly feeling your way to an end that you can't see physically, but you kind of

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have a sense of where you want to go.

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So to some extent, it's nebulous, but it's really strong inside you.

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You just know where you want to go, even though you can't always put words to it.

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And so it's really important to define where you're going, especially where the destination

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doesn't seem clear to others and mostly to you because the destination really does need

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to be clear to you.

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The telltale sign of ignoring what you're really supposed to be doing or ignoring moving

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towards a thing that really resonates with you is just this feeling of not being satisfied.

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You can't even really explain it.

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You just know that it's like, oh, I know I have all these awards.

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I know people are saying I'm so successful, but somehow this is not it, right?

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And it's not even, it's very weird.

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You can't even really put it into words.

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You just know it's not it.

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You can't really explain it.

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And that's one of those telltale signs that you got to pay attention to that thing that's

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telling you it's not it, right?

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I mean, it's very, to some extent touchy feely, but it's real, right?

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You feel something is off even when everyone's like, oh, don't worry about that.

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No, no, no, you're so successful.

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You're super successful.

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Stop.

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Stop trying to do something different.

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But you know that you're supposed to be doing something different.

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So that's important to pay attention to.

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So I think it's a really deep seated need to figure out what you want to do even when

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you can't really put words to it, because if we don't, we are dissatisfied.

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If we don't, we get to the end of our careers.

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We look back and we feel like we wasted time.

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And to be honest, there's so many people I see in academic medicine who are super successful.

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They have lots of grants.

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They're like, you know, on the poster of everything about the university.

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And if you ask them, they think their life sucks, right?

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And so that's, we don't want to be successful for others to see and brag about us.

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And while we don't feel successful inside.

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So if you're going to clarify this fuzzy feeling that you have, that you're not even clear

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exactly where you're going, you actually do need to do work.

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It takes work to bridge the gap between this is where, who I am right now, and this is

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where I want to go.

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It takes work, but it's really important work.

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And if you're going to do this work, you've got to think of yourself, not just as a physician,

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because before you came to medicine, you were a whole person.

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You had a whole, you just had a life, right?

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And so the fact that you've come into medicine and medicine can be all consuming doesn't

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mean that medicine is everything.

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It doesn't mean it has to be everything.

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And so it takes work that also involves you stepping outside of where you are right now

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and thinking about the bigger picture of who you are.

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And if you're going to be successful in a way that actually resonates with you personally

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as being successful, it is work that you cannot avoid.

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You can defer it, you can delay it, you can ignore it for a long time, but it will always

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come back around.

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It's this thing that's gnawing inside of you waiting to be hurt, right?

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So if you're going to do the work, it's an iterative process.

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So you might think you have a sense of where you're going.

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It's not as if you haven't because you went to medical school, you went to residency,

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you're doing fellowship.

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You have a sense of where you're going.

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So you're doing it.

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You're on the path.

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But every time there's a major life change, usually it causes you to pause and say, wait

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a minute, what am I doing again?

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Where do I want to go?

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So whether that be you meet a new great significant other, you get married, you have a child,

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someone dies, there will always be a life event that causes you to pause, like shakes

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your world enough to say, wait a minute, am I on the right track?

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And those are good times because sometimes those are moments that accelerate your clarifying

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your purpose because your purpose is not a specific disease, even though many times people

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are asking us to just choose a disease.

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It's not a specific disease.

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It's not even a specific specialty.

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It's bigger than that.

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Your specialty kind of just helps you fuel that, just helps you get there, right?

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The other thing I want to say is that most of us come because of impact.

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I haven't met anybody who came to medicine just to be like, well, I just didn't have

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anything else I wanted to do, so here I am in medicine.

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But many people talk about, I came to help people.

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I came to make a difference in people's lives.

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So that's really about impact.

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And based on the perspective of those of us who are gathered here, your idea of impact

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may be different from the ideas of people who surround you, especially your mentors,

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especially people who matter in the academy.

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Like is that what you want to do?

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Oh no, nobody does that, right?

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In general, people tend to push the desires of people who look like them, or the majority,

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right?

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Whatever is succeeding because most people are interested in that.

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It's impactful because it affects more people.

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But for many of us, the impact we want to have is on populations or in places where

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people are not necessarily well-resourced or there are not necessarily that many people

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working in that area.

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Therefore, if you are going to do that, then you have to have courage.

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You have to have support because you're going to be going against the grain a lot and that

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can be exhausting.

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And sometimes you might find that the people who once supported you, as long as you were

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doing what they said, the moment you are defining your own path, which is important for your

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success personally, some people may not take kindly to that because now you're kind of

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going off the beaten track of what they're recommending.

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So it does take courage and it does take support.

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All right.

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That's all I wanted to say.

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I'm going to summarize the things that I said.

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Number one is that the need to define purpose really begins when you feel your destination

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more than you can see it.

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So you know where you have a sense of where you're supposed to go, but you can't really

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say this is it.

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If you're ignoring what you're supposed to be doing, there's a deep feeling of dissatisfaction

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you can't explain that comes with that.

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If you're in a fulfilled purpose, it's a deep seated need and it's really worth your time

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to find it.

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Number four, your purpose is bigger than your day to day work as a physician.

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You have to step outside of your role in medicine to really figure it out.

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Your role in medicine serves your bigger purpose.

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It is not the biggest purpose.

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If you're going to do the work.

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Number five, clarifying your purpose takes work and that work can't be avoided.

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Number six, it's an iterative process.

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There are different life scenarios will bring you back to the drawing board and number seven,

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most of us came for impact, which is going to be different from what generally people

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around us agree with.

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For that reason, it requires you to have courage in moving forward and also to find support

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where you can find it to help you succeed.

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Okay.

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So this is the point at which I want you to pause and just think about yourself right

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now and go back to when you first wanted to go to medicine, why you wanted to be a doctor.

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What did you hope you would do?

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Like you had no idea exactly what this path would lead you to.

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You had no idea that some of us would not have done it if we had known, right?

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But that was a dream you have.

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You're excited.

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Maybe you wanted to help people.

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I don't know what, but I want you to think about it and write it down.

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You can write it on a notebook if you have a notebook with you, on your phone app note,

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note app or your computer or in the chat.

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But just take a moment to think about why did you come?

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What do you really want to accomplish when you first started?

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And now what's the thing that really still makes you excited about being in medicine?

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Now for some of us, we're just like, I have no excitement.

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If I could quit yesterday, I would have quit anyway.

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So if you're feeling that way, just go back to medical school, go back to the feelings

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you had early in the beginning when you were like, okay, this is why I want to be in medicine.

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Now I'm going to give everyone two minutes to think about it, write it down.

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And then we're going to break up into groups and we're going to talk about it.

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Well thank you so much for listening.

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I look forward to talking with you again next time on the Clinician Researcher Podcast.

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Thanks for listening to this episode of the Clinician Researcher Podcast, where academic

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00:21:42,440 --> 00:21:47,720
clinicians learn the skills to build their own research program, whether or not they

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have a mentor.

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If you found the information in this episode to be helpful, don't keep it all to yourself.

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00:21:55,200 --> 00:21:57,080
Someone else needs to hear it.

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00:21:57,080 --> 00:22:01,120
So take a minute right now and share it.

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As you share this episode, you become part of our mission to help launch a new generation

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of clinician researchers who make transformative discoveries that change the way we do healthcare.