Finding purpose on your career journey

0:00 Welcome to the Clinician Researcher podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. As clinicians, we spend a decade or more as trainees learning to take care of patients. When we finally start our careers, we want to build research programs, but then we find that our years of clinical training did not adequately prepare us to lead our research program. Through no fault of our own, we struggle to find mentors, and when we can't, we quit. However, clinicians hold the keys to the greatest research breakthroughs.

0:40 For this reason, the Clinician Researcher podcast exists to give academic clinicians the tools to build their own research program, whether or not they have a mentor. Now introducing your host, Toyosi Onwuemene. Well, hello everybody. Welcome to the Clinician Researcher podcast. I'm your host Toyosi Onwuemene, and it's a pleasure to talk with you today. Thank you so much for being here. Today's episode actually comes courtesy of one of my sessions with my coaching clients, and I'm inviting you to join us as part of our session.

1:20 And if you are thinking about being part of our group coaching, please reach out to me by direct message on LinkedIn. I'm also on Facebook and Instagram, but more likely to be reached by LinkedIn. But I just did want you to get some insight into some of the things we talk about as we advance faculty and their careers. Enjoy. So today, I wanted to share about thinking about our purpose and our vision. And I gave everyone homework, and it's okay if you didn't do your homework. We'll talk about your homework at the end. But just really thinking about what is it that really makes you tick?

2:01 Like what really excites you about your career, what you really want to accomplish? And one of the themes that came up a lot last time was that sometimes you're just in survival mode. You're not even in the end. You're not even really thinking about what do I really want out of all of this? Where am I really going? And that's the way it is when you're so busy and feeling like you're just barely stringing two days together. It's easy to just go with the flow wherever the flow takes you. And many times it's not exactly where we want to go. So I didn't want to share my story. When I first started, I think I want to start from the point of being a fellow. I always knew I was going to do sickle cell research. I always knew I was going to do sickle cell research.

2:42 I worked with a...well actually I didn't always know. I had a faculty member who was a mentor when I was a med student and she would just take me out to coffee every once in a while. We would sit and talk about my experience. At the time I wasn't thinking about hematology because I was going to be an oncologist, of course. And my father had died of liver cancer, so I was definitely going to become an oncologist. But I met with her every once in a while. She would just ask about how I'm doing. And that was just a good relationship. But there was no plan to change and become a hematologist like she was. However, on my journey to becoming an oncologist, I think I realized that I liked the hematology piece a little bit more. And so 9100, when it was 9100, that's the leukemia lymphoma service at Duke, was kind of more interesting to me.

3:29 And Lou Deal, who's one of the older faculty members at Duke, was one of my attendings. I just really liked that group. And Amy Abernathy, actually, who's now no longer in clinical medicine, was one of my attendings too. So I had a great group of attendings. And I really loved the leukemia lymphoma service. So I thought I was going to be a malignant hematologist. And then I had one experience on the service where I watched a patient overnight become quadriplegic. And it just, I don't know, it just broke me because I went home sobbing and just thinking, okay, it's one thing for the cancer to kill you. It's another thing for us trying to get the cancer where we kill you in the process. I mean, he didn't die, but it was just really traumatic.

4:09 And so I knew that was the defining moment that I knew I was not going to be a malignant hematologist. And then as I started thinking, well, what else am I going to do? Then hematology, classical, as people want to call it now, came to the fore because I had a mentor who was doing classical hematology. And she had sickle cell. And she saw patients with sickle cell in her clinic. And so that was, I was going to do sickle cell. I did my third year capstone talk on transfusion medicine and sickle cell. I won an award for it. And then I went off to fellowship in Chicago. And that was the beginning of a lot of trouble. So first of all, one thing I missed was that there are patients with sickle cell in Chicago, but they don't go to Northwestern.

4:51 They mostly go to UIC. That's University of Illinois, Chicago. And so I didn't have access to the patient population I needed to succeed in any research endeavor that I was trying to do. So I eventually needed to be creative and think about, okay, well, how can I get sickle cell research experience? And I went to the Children's Health Center and worked with, at the time, Alexis Thompson was there. And let's just say it didn't work out exactly as I wanted to. And I remember one day just crying and saying, I wish I had never come to this fellowship. I wish I'd never come to Chicago. Oh, the drama. Anyway, when I finally came to Duke for my faculty position, I wanted to do sickle cell.

5:35 And clearly I was going to come back and do sickle cell because all the patients with sickle cell were at Duke, at UNC too, but they're a lot at Duke. And there was no space for me. So at the time, they had too many faculty members in sickle cell. And in retrospect, I would say there was always space, but people were trying to close the door for different reasons. And I accepted it. I said, okay, well, I guess there's no space for me. My backup plan and fellowship, since I couldn't do sickle cell, or I couldn't, in quotes, was to do hemostasis thrombosis because I knew that at any point in time, it was going to be applicable to patients with sickle cell. So when I came to Duke and they're like, eh, we don't really have space for a sickle cell. What else do you want to do? I was like, sure, I'll just keep going with the hemostasis thrombosis theme.

6:17 And so after I came, then two faculty members left pretty much back to back. And then they were like, um, Toyosi, you know how you had said you were interested in sickle cell? Would you like to take over? And at that point I was like, no, no sickle cell for me. Thank you very much. But anyway, so I will say that long-term, I never came back to sickle cell for my research career. I still take care of patients with sickle cell, but it's not what I do for research. So to some extent, I may have been derailed from that goal. However, quickly I realized that I didn't really have a plan for my faculty career, right? I was just, I was just kind of, you know, I mean, they gave me five clinics a week. I was doing, well, not five clinics a week, but I was seeing patients five days a week and I was doing that.

7:01 And at the time I was also pregnant with my daughter and it was just rough. It was so rough. I hated the whole thing. I hated the whole thing because I was doing aphoresis. So it was one of the things I was doing actually all days of the week. And the part I hated was just these arguments I kept having with providers over whether we could provide aphoresis or not. Then I would turn around and argue with nurses about whether they could do the aphoresis or not. And it just ran me ragged. And at the end of every day, I felt like I was just like someone had run me up against a wall and just bruised me significantly and I needed to recover. So it was rough. Anyway, I say all that to say that I was kind of just being tossed and turned, right? Somebody said there's no sickle cell available, so I just didn't do sickle cell.

7:42 And then somebody said, well, here's five days of clinic, five days of seeing patients a week, even though you're 80%. And I was like, sure, I guess that's the way it works. And then I was doing this thing I hated, which was arguing with providers and nurses all day. And it was like, okay, this is my job. I'm just going to grin and bear it. And so anyway, I feel like I was the poster child for just going with the flow and the flow was not very good for me. So Jennifer, not to pick on you, but you talked about being in a supportive environment. I wasn't in a not supportive environment, but let's just say the outcome I was having didn't make it seem as if there was support. It looked like there was support, but the outcome looked like I was being broken to pieces.

8:23 Anyway, so I will say that one of the big breakthroughs of my life, biggest breakthroughs of my life was really, actually I had several. As far as research, I have one that I will talk about at a future session. But today I want to talk about how coaching really helped me. And one of the most important things that my coach is Judith Holder, and she's a great executive coach. She does a couple of sessions at Duke. She's really awesome. I recommend her. And one of the things she helped me recognize was closing the gap between my feelings and in my response to my feelings. So I'll give an example. I'd be the kind of person where I'm walking and then all of a sudden, I'm sad.

9:05 And I'm like, wait a minute, why am I sad? Then I have to retrace the steps and say, oh, oh, it was three hours ago in the chief's office when he said, ha, even a monkey could do this interpretation. And in the moment, because I love to please people and make them happy. In the moment, I may have laughed and said, ha ha, what a funny joke. But three hours later, it hit me that that hurt me. But that was three hours too late. Right. And one of the biggest things that really helped for me was to shorten the gap between my feeling in the moment and how I responded to the feeling in the moment. So I became a feeler again, like actually someone who could actually decipher and interpret how I felt about situations so that I could respond more in the moment.

9:52 OK. So what does this have to do with your purpose and where you're going? So I feel like I was a poster child for someone who didn't know where I was going or who didn't have a plan. I mean, I just wanted to be a physician. I just wanted to graduate. That was it. That was my goal. Right. And as soon as I accomplished that, I don't think I realized that there was a different goal for faculty. I mean, I was going to do all the things they said I would do, which was see patients, do research, you know, the big umbrella. But this wasn't the same as residency or fellowship where there's a very clear goal in three or four years you're going to be done as long as you meet all these competencies. Right. There wasn't a clear goal. It just seemed like everything was moving, you know, and it wasn't clear. I would say, hey, I want to do research.

10:33 Oh, and they were like, oh, well, there's no research. So here, do clinical. And then I would say, okay, great, I'm doing clinical, but why am I earning a research salary? It's like, oh, you know, so I just was always kind of just, I was tossed back and forth. Anyway, but one thing I knew is that I hated whatever I was doing. You know, the feeling like I was being bruised every time I was trying to do my work daily in apheresis. I hated the feeling of, you know, trying to do research, but I was so busy clinically. And so to some extent, I figured out my, what I wanted to do based on all the pain that I had. So I was running away from pain and therefore entering into what I really wanted to do. So I want to help you avoid that to the best of my ability by helping us think intentionally.

11:20 And how would that have helped me? Well, when people said, hey, sickle cell is not available. I may have said, no, no, no, this is really important to me. If it's not available, I'm not going to do this. Right. So I took whatever was given to me. I assumed I didn't have a choice. I know now that I did, I did, but I assumed I didn't have a choice. Now was sickle cell the real thing? To me, I think it wasn't so much about sickle cell. And that's probably why I gave it up a little bit more easily was because, was that I really wanted to have an impact on a disease that's, that affected a minority population. I know that that was important to me. And sickle cell was very easy. I think for many of us who go into classical hematology, I think many of us to some extent have some resonance with sickle cell.

12:04 But anyway, I think it's important. I mean, talk about seven things that are important to think about as far as defining your purpose. I think the first thing is that it's easy for us when we run towards an end that we can see. Medical school, it's four years. Great. I know how this works because other people are doing it. I can see them. I know the way to the end. Residency is the same. There are people who graduated, I want graduation. I'm just going to follow the path. And the same thing for fellowship as well. So you may not have to define your purpose at the beginning because you're running towards an end that you can already see. It's already clear to you what the wind is. It becomes harder when you leave the path to where there is no clearly defined end.

12:48 That's the time at which it becomes really important to be very clear about what your destination is. And it's hard to be clear because you don't see it, right? There's nobody who's like, hey, Diamond, this is the destination. You just come and be like me, your life will be better. There's usually no such person. So when it comes to kind of trying to clarify, why am I here? What do I want to do? You're mostly feeling your way to an end that you can't see physically, but you kind of have a sense of where you want to go. So to some extent, it's nebulous, but it's really strong inside you. You just know where you want to go, even though you can't always put words to it.

13:29 And so it's really important to define where you're going, especially where the destination doesn't seem clear to others and mostly to you because the destination really does need to be clear to you. The telltale sign of ignoring what you're really supposed to be doing or ignoring moving towards a thing that really resonates with you is just this feeling of not being satisfied. You can't even really explain it. You just know that it's like, oh, I know I have all these awards. I know people are saying I'm so successful, but somehow this is not it, right? And it's not even, it's very weird. You can't even really put it into words. You just know it's not it. You can't really explain it. And that's one of those telltale signs that you got to pay attention to that thing that's telling you it's not it, right?

14:16 I mean, it's very, to some extent touchy feely, but it's real, right? You feel something is off even when everyone's like, oh, don't worry about that. No, no, no, you're so successful. You're super successful. Stop. Stop trying to do something different. But you know that you're supposed to be doing something different. So that's important to pay attention to. So I think it's a really deep seated need to figure out what you want to do even when you can't really put words to it, because if we don't, we are dissatisfied. If we don't, we get to the end of our careers. We look back and we feel like we wasted time. And to be honest, there's so many people I see in academic medicine who are super successful.

14:56 They have lots of grants. They're like, you know, on the poster of everything about the university. And if you ask them, they think their life sucks, right? And so that's, we don't want to be successful for others to see and brag about us. And while we don't feel successful inside. So if you're going to clarify this fuzzy feeling that you have, that you're not even clear exactly where you're going, you actually do need to do work. It takes work to bridge the gap between this is where, who I am right now, and this is where I want to go. It takes work, but it's really important work.

15:38 And if you're going to do this work, you've got to think of yourself, not just as a physician, because before you came to medicine, you were a whole person. You had a whole, you just had a life, right? And so the fact that you've come into medicine and medicine can be all consuming doesn't mean that medicine is everything. It doesn't mean it has to be everything. And so it takes work that also involves you stepping outside of where you are right now and thinking about the bigger picture of who you are. And if you're going to be successful in a way that actually resonates with you personally as being successful, it is work that you cannot avoid. You can defer it, you can delay it, you can ignore it for a long time, but it will always come back around.

16:19 It's this thing that's gnawing inside of you waiting to be hurt, right? So if you're going to do the work, it's an iterative process. So you might think you have a sense of where you're going. It's not as if you haven't because you went to medical school, you went to residency, you're doing fellowship. You have a sense of where you're going. So you're doing it. You're on the path. But every time there's a major life change, usually it causes you to pause and say, wait a minute, what am I doing again? Where do I want to go? So whether that be you meet a new great significant other, you get married, you have a child, someone dies, there will always be a life event that causes you to pause, like shakes your world enough to say, wait a minute, am I on the right track?

17:00 And those are good times because sometimes those are moments that accelerate your clarifying your purpose because your purpose is not a specific disease, even though many times people are asking us to just choose a disease. It's not a specific disease. It's not even a specific specialty. It's bigger than that. Your specialty kind of just helps you fuel that, just helps you get there, right? The other thing I want to say is that most of us come because of impact. I haven't met anybody who came to medicine just to be like, well, I just didn't have anything else I wanted to do, so here I am in medicine. But many people talk about, I came to help people. I came to make a difference in people's lives. So that's really about impact. And based on the perspective of those of us who are gathered here, your idea of impact may be different from the ideas of people who surround you, especially your mentors, especially people who matter in the academy.

17:52 Like is that what you want to do? Oh no, nobody does that, right? In general, people tend to push the desires of people who look like them, or the majority, right? Whatever is succeeding because most people are interested in that. It's impactful because it affects more people. But for many of us, the impact we want to have is on populations or in places where people are not necessarily well-resourced or there are not necessarily that many people working in that area. Therefore, if you are going to do that, then you have to have courage. You have to have support because you're going to be going against the grain a lot and that can be exhausting.

18:34 And sometimes you might find that the people who once supported you, as long as you were doing what they said, the moment you are defining your own path, which is important for your success personally, some people may not take kindly to that because now you're kind of going off the beaten track of what they're recommending. So it does take courage and it does take support. All right. That's all I wanted to say. I'm going to summarize the things that I said. Number one is that the need to define purpose really begins when you feel your destination more than you can see it. So you know where you have a sense of where you're supposed to go, but you can't really say this is it. If you're ignoring what you're supposed to be doing, there's a deep feeling of dissatisfaction you can't explain that comes with that.

19:17 If you're in a fulfilled purpose, it's a deep seated need and it's really worth your time to find it. Number four, your purpose is bigger than your day to day work as a physician. You have to step outside of your role in medicine to really figure it out. Your role in medicine serves your bigger purpose. It is not the biggest purpose. If you're going to do the work. Number five, clarifying your purpose takes work and that work can't be avoided. Number six, it's an iterative process. There are different life scenarios will bring you back to the drawing board and number seven, most of us came for impact, which is going to be different from what generally people around us agree with. For that reason, it requires you to have courage in moving forward and also to find support where you can find it to help you succeed.

20:03 Okay. So this is the point at which I want you to pause and just think about yourself right now and go back to when you first wanted to go to medicine, why you wanted to be a doctor. What did you hope you would do? Like you had no idea exactly what this path would lead you to. You had no idea that some of us would not have done it if we had known, right? But that was a dream you have. You're excited. Maybe you wanted to help people. I don't know what, but I want you to think about it and write it down. You can write it on a notebook if you have a notebook with you, on your phone app note, note app or your computer or in the chat.

20:46 But just take a moment to think about why did you come? What do you really want to accomplish when you first started? And now what's the thing that really still makes you excited about being in medicine? Now for some of us, we're just like, I have no excitement. If I could quit yesterday, I would have quit anyway. So if you're feeling that way, just go back to medical school, go back to the feelings you had early in the beginning when you were like, okay, this is why I want to be in medicine. Now I'm going to give everyone two minutes to think about it, write it down. And then we're going to break up into groups and we're going to talk about it. Well thank you so much for listening. I look forward to talking with you again next time on the Clinician Researcher Podcast.

21:37 Thanks for listening to this episode of the Clinician Researcher Podcast, where academic clinicians learn the skills to build their own research program, whether or not they have a mentor. If you found the information in this episode to be helpful, don't keep it all to yourself. Someone else needs to hear it. So take a minute right now and share it. As you share this episode, you become part of our mission to help launch a new generation of clinician researchers who make transformative discoveries that change the way we do healthcare.