PERSONAL AND PROFESSIONAL DEVELOPMENT
Holding the Opposites BY HELANE FRONEK, MD, FACP, FASVLM, FAMWA
I
N HER THOUGHTFUL ARTICLE,
“The Abortion I Didn’t Have” (The New York Times Dec 2, 2021), Merritt Tierce describes becoming a mother at age 19, sharing a struggle we all face: the difficulty and importance of holding the truth and validity of two opposing realities. A gifted student anticipating an academic career, Tierce’s path is interrupted when she becomes pregnant and faces motherhood and marriage before feeling ready for either. This is not the usual telling of this story, in which love for her son transcends her sacrifices and she triumphantly states she would do it all over again. Instead, she chooses the more difficult and honest discussion. She bravely
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M AY 2022
faces the grief of losing her dreams of career and identity; her sadness at not experiencing the excitement of welcoming a child, knowing she wasn’t ready; and her guilt at being unable to be the mother she would have wanted her son to have, due to the deep depression that followed — while also acknowledging her love for her son. What’s important about her discussion is that, in the simpler lens we often look through, we abandon our younger self, implying that her hopes and dreams were unimportant. With her courageous choice to hold these opposites, Tierce offers us a crucial pathway to greater mental health and resilience as we travel the challenging road of life. We might have had a traumatic child-
hood, emerging from pain and loneliness with skills of resourcefulness and resilience. We are held up as models of strength and encouraged to appreciate the difficulties for what they taught us. However, by doing that, we turn our back on our younger selves and trivialize the suffering we experienced. When we hold the opposites — that we should not have had to endure an abusive childhood and that we emerged with significant strengths as a result — we show compassion and respect to all aspects of ourselves and allow for greater integration of our whole being. The ability to hold these opposites is extremely important in medicine. While most physicians make the right diagnosis and offer appropriate treatment most of the time, each of us gets things wrong and encounters adverse outcomes. Medical culture’s emphasis on what we could do better, important for quality improvement and continuous learning, tends to highlight our failings. The focus on our mistakes and resulting fear contributes to burnout and stunted professional growth. A smart, conscientious former medical student called me after a minor complication during her surgical residency, wondering, “Will I ever be a competent surgeon?” Being able to hold these opposites — that she will do most things well and she will also make mistakes — allowed her to find space for both truths to exist. She is now a confident, compassionate, and thoughtful surgeon, excited to contribute to her patients and her field. While taught to look for the “unifying diagnosis,” this is one aspect of medical practice in which accepting a dichotomy is essential. Without understanding that we are both competent and flawed, we set ourselves up to trivialize our failings or ignore our abilities. Neither stance allows us to be the best physicians we can be. Dr. Fronek is an assistant clinical professor of medicine at UC San Diego School of Medicine and a Certified Physician Development Coach.