On the learning curve

More than once over the past week, I wished that I could download information like my trusty phone or reliable laptop. I wanted to install a program into my brain in order to short-circuit the learning curve. While rolling around on the wrestling mats with my partner, I realized the source of this underlying frustration: I’ve learned just enough to realize I don’t know very much.

Because of the organic nature of Jiu-Jitsu, two bodies interacting in space on a flat surface, there are seemingly an infinite number of positions and shapes you can make. Further, with the momentum of previous moves and attempts, you’re guided into another infinity of transitions and submissions. The question is whether or not you can identify the paths and the doors of possibility? Then, is that a path you want to wander down?

Take earlier in the week: I gathered a history from a patient with debilitating throat cancer, before her appointment with the radiation, chemotherapy, and surgery experts. I walked in, asked her what brought her in today, and she ate me alive. I found myself over-confident and under-equipped for her emotional distress and anxiety regarding her prognosis and mortality. The first thing the radiation oncologist asked me afterward: “Was she nice to you?”

And she was, or at least as nice as she could muster. With constantly interrupted sleep for the past month, the inability to eat anything firmer than cottage cheese or protein drinks, and a question mark of death above her head, she was an ornery snapping turtle and I the child poking it with a stick. She ended up deciding to have no treatment: none of the options appealed to her and she wished to allow the cancer to progress. In retrospect, I wish that I had the courage to talk with her about goals for end of life, because the opening presented itself. I didn’t feel at all ready to guide that conversation for a true patient in need. I don’t know if I ever will feel ready for it, except for when it happens.

That’s the third question, isn’t it? First, can you see the door? Second, do you think it’s a good idea? Third, are you more capable than you know?

With Jiu-Jitsu, the cost of mistaking a bad idea for a good plan is a moment of discomfort and some embarrassment that you got caught with your hand in the cookie jar. These low stakes allow me to experiment and push my own boundaries, to find out if objective outcomes or self-perceptions are guiding my actions. With medicine, the stakes are higher while the learning curve stays the same.

I wonder if I could have handled that end of life discussion with the patient, if I had the confidence to initiate it. I wonder how many patients will reel as a result of my earnestly wrong efforts. I wonder how many patients will be hurt by my timidity to boldly take action.

And that’s the curse of the learning curve: once you are fully buckled in, you realize how long the ride. There are no shortcuts to mastery. I must walk through every bramble bush and thorny patch. Enjoy every paved road and clearing.

That’s the only way I’ll get there.

Long Form Sundays

On Death Podcast

7 thoughts on “On the learning curve

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