Finding Meaning

2020 has not been my year.

Last week Spouse and I were discussing the state of the world and its problems, and in our personal universe, Cancer now occupies the #3 spot on the Terrible/Awful List.

#3!

That’s how bad 2020 has been.

(If you’re curious, Racism and Global Pandemic “won” the top two).

I don’t think we’re unique in our opinion of 2020. Perhaps you feel the same.

The General Awfulness of 2020 has led me on a quest for meaning.

And I’m determined to figure it out. Here’s a place where I started:

This academic manuscript is old but remains relevant for 2020. Full text is available; the citation is above.

Ostensibly, it’s about cancer, but the messages can be applied to so much more.

Here’s an excerpt from the introduction:

According to theorists, human beings have a “will to meaning,” a fundamental need to seek meaning and fulfillment in life. Meaning has been equated with purpose in life, life satisfaction, and positively valued life goals. Others view meaning as a sense of purpose and coherence in one’s life, and awareness of the value, fragility, and preciousness of life, or the personal significance of a particular life circumstance … Reker has come closest to synthesizing these diverse conceptualizations by defining meaning as “the cognizance of order, coherence and purpose in one’s existence, the pursuit and attainment of worthwhile goals, and an accompanying sense of fulfillment.”

The authors also differentiate between Global and Situational Meaning, using a framework described by Park and Folkman.

Of the two, Global Meaning is the bigger concept. It refers to “people’s basic goals and fundamental assumptions, beliefs and expectations about the world.” Examples of Global Meaning include an individual’s personal beliefs encompassing religion, spirituality and the order of the Universe; these ideas provide a philosophical structure for interpreting the world, adverse events and life purpose.

Situational Meaning is more personal: it’s the interaction of one’s global beliefs and the immediate circumstances of their life, i.e. where the Venn diagram overlaps.

After studying cancer survivors, the authors of the above study developed a Meaning in Life Scale composed of four elements:

  • Harmony and peace: Positive emotions and thoughts connoting a sense of tranquility, serenity and comfort
  • Life perspective, purpose and goals: This is the individualized meaning assigned to oneself and one’s own life. Optimism about the future is a common thread.
  • Confusion and lessened meaning: This is the bad one on the list, and hopefully this is a temporary state. Per the authors, this is “a decreased sense of value to life and a belief that life is a negative experience.” They go on to say that many cancer patients (read: human beings) experience periods of meaningfulness and also periods of meaninglessness.
  • Benefits of spirituality

For me, 2020 has provided more than ample opportunity to search for Meaning.

Perhaps you relate.

And while I don’t have any answers yet, I’m here to learn.

Comfort with Discomfort

Today, exactly 16 days after finishing my last scheduled chemotherapy, I had my first cancer survivorship appointment.

Survivor.

I am so uncomfortable with that label.

It feels too bold. Unearned. Risky.

How dare I tempt the Fates?

The discomfort is gnawing and visceral.

But having comfort with discomfort is something I’ve practiced for a long time.

(Apologies in advance if you’ve ever been a student/resident/fellow who trained with me. You already know what I’m going to say).

Most people know that medical training involves a hierarchical model of learning. You start with easier procedures and gradually tackle those requiring more skill and responsibility.

By the time you finish residency and/or fellowship, you’ve spent anywhere from three to seven years climbing this pyramid, enough time to gain a level of confidence and expertise to know you can successfully complete the most complex tasks.

For OBGYNs, a classic example of this is a c-section. At minimum, two people are needed for a c-section, one to be the primary surgeon and one to assist. They stand on opposite sides of the patient and work simultaneously. For right handed surgeons, working from the patient’s right side gives you better access to the pelvis with your dominant hand, a mechanical advantage that comes in handy when you need to reach into the pelvis and safely deliver the baby’s head. Thus, when you’re learning to do a c-section, it’s much easier to be on the patient’s right side than the left. At the start of residency you’re always positioned on the right and at some point you become skilled enough to graduate to the other side of the table.

The thing about residency, however, is that even when you’re confidently leading from the left, there’s always – ALWAYS! – someone more responsible than you are. The attending physician (a.k.a. your professor) may not be physically in the operating room, but theirs is the ultimate responsibility for this surgical outcome, because at the end of the day you’re still a student.

The other thing you may know about medical training is that every June 30th, there is a magical turning of the calendar page and suddenly, everyone gets advanced one year. When it’s your turn to graduate, the buck now stops with you.

3 A.M., July 16th, 2005: The buck stopped with me. I was a newly minted fellow on overnight labor and delivery call, doing a c-section with a second year resident. I was confidently leading from the left and everything was going fine, but I recall a sharp moment of clarity when I realized that holy cow, I was the attending, the only attending, and no one was secretly standing by to swoop in and save me if I got into trouble.

The discomfort of that knowledge was gnawing and visceral.

Eventually, though, (and by “eventually” I mean years), I garnered enough experience, learning and growth to develop a level of comfort with discomfort.

What this is:

  • Confidence you can do the work
  • Confidence you can be successful
  • Confidence you can do hard things and then do more
  • Confidence that sometimes things will not go your way and you will need help, and that is ok
  • Confidence that you will be ok

June 4th, 2020: I find myself once again trying to find comfort with discomfort.

Cancer survivorship isn’t my only discomfort of 2020.

The social injustice and systemic racism unveiled after the murder of George Floyd in Minneapolis – where I live – presents a profound opportunity for reflection, action and personal development.

Eventually, though, (and by “eventually” this time I mean the rest of my life), I hope to garner enough experience, learning and growth to develop a level of comfort with the discomforts of 2020.