So You Want to Save the World . . .

Women who go into hematology know that they are destined to save the world. What they don't realize is that they are like the Avatar from the 2005 Nickolodeon series, the Last Airbender. They are destined to save the world; but they haven't mastered the elements yet. If they don't master all the elements, they can't save the world. If they attempt to take on the world too soon, a more experienced "enemy" might end their quest early and take them out of the game.

O Woman in Hematology, before you attempt to save the world, you need to master all the elements. As we explore what it takes to master the elements, the Avatar will be our muse.

Introducing Avatar Aang

For those who are unfamiliar with the story, Aang, the Avatar, was a twelve-year-old kid who was destined to save the world. He was destined to bring balance to the world because he was the only one with the ability to master the elements of the four nations, air, water, earth, and fire. As an Airbender, Aang had already mastered the element of air; however, he still had a long way to go in mastering the other elements. To master the elements, he had to find a master from each nation and learn from them. With trusted companions by his side, he set out on his quest to learn from the masters so he could eventually defeat an enemy who had thrown the world off balance. With enemies actively working to thwart his quest, from the beginning, his success was not guaranteed.

You have great potential; but you're not ready

You are young and idealistic and you know you can save the world. You are a superhero: you feel it in your bones. You know you can make a difference: it's the only reason you came to hematology in the first place. You see the problems no one else sees and can fix problems no one wants to tackle. You empathize with the challenges faced by your patients. You feel their pain acutely and you have what it takes to solve every problem. You have great passion and you feel ready to take on the world. You may be only one person but you know that you can make a difference. And you can. You're just not ready yet. You're not ready to take on the world (not all of it at once). However, you can start first to master the elements one by one and, with each element you master, save a little corner of the world.

On your quest, you will need trusted companions

This quest you have started is hard and, if you are to succeed, you will need trusted companions. You probably already have trusted companions from your training or pre-med days; but you will need to identify and acquire new companions at each step of the journey. On your way, you will meet many people, some of whom will be super friendly; but not all will be eligible or qualified to be your companions. You need companions who will go with you to the very end of your journey, even as they are also completing their own personal quests. You need companions who are willing to stand with you and fight, even though they may get killed in the fight. You need companions who are willing to be honest with you and tell you the truth when it hurts. And, you need companions who will love you through your ugly days. You only need a few companions; but they are critical to your success. Once you identify your companions, you are ready to begin your quest.

You have already mastered one element, but you need the others

By the time you complete your training, you are already quite skilled. To get through internship, residency, and fellowship, you learned to focus, persevere, acquire relevant knowledge, communicate well, and deal with stressful situations. Perhaps the greatest superpower you acquired in your training was the ability to work hard. These skills are important and necessary but represent the tip of the iceberg in functioning in the complex and multi-faceted world of hematology. In a sense, you have all the skills to do the work but first, you also need the structure to organize them.

Step one: In mastering the elements, create your structure

Aang had to master the elements in order and so will you, which speaks to your need for structure. Structure is inherent in our training experiences but not in our faculty jobs. Your first faculty job can be stressful because it frequently lacks the structure we have come to rely on in our training. In training, there are clearly defined metrics and the rules are well-laid out. So, no one is confused about what success looks like. By the end of your training, the expectation is that you will acquire the knowledge, skills, and professional standards to care for patients safely. But in a faculty position where success has many definitions and an infinite number of paths, there is no inherent structure. So, to succeed in "mastering the elements," you need a structured path to follow. Perhaps a path has already been laid out for you by your mentors or faculty development office. However, a pre-defined path to success is not the norm and it is more likely that you will need to create your own structure. Without structure, your save the world mission is dead in the water. Once you have structure, you can think about how the new elements you need to learn fits into the element you have already mastered.

Step two: recognize the element you have already mastered

You need to recognize the element you have already mastered because it is the element for which you need no master. Your strengths are the foundation upon which you build all the other elements. Your strengths also create the platform upon which you first start saving the little corners of the world while you are still learning. You may take your strengths for granted because they come naturally to you. But they are not natural strengths at all. You have been honing these strengths for at least 10 years of your medical training and possibly over 30 years of your life. Don't take your strengths for granted. Rather, own your strengths and use them for good. As you own your strengths, you are better able to handle the many criticisms that come your way. Secure in your own strengths, you can deflect the sting of criticism while also retrieving the data gems hidden within. Recognizing your strengths helps you prepare to interact with the elemental masters who will take charge of your training.

Step three: Find the elemental masters

Once you have identified your own strengths, it is time to recognize the elements you have not yet mastered and go out to find the masters. The key to finding the right master is to find the person who is skilled in the one area you wish to master and learn their one element of mastery. It is a mistake to find one master and hope they will teach you all the elements. One master = one element. Therefore, to get the most of of each master, go to them for their #1 strength. Get grant-writing mastery from a grant-writing master; clinical mastery from a master clinician; and teaching mastery from a master educator. One person can function well in several areas but they are likely to be a master in one. Find one master for each skill you are trying to build. Ultimately, you will end up with a team of masters. And, as you master all the elements, you will become the ultimate master (Avatar) and they will become your friends (run from any "master" who wants to be your master forever). Once you are clear on the masters you need, start first with the element of "air."

Element # one: Air

Air is the element of love, light-heartedness and fun. The element of air is necessary for fun along the journey. On this journey, you will fall flat on your face in public more than once and then turn around to find that someone was recording and the video has gone viral. The element of air allows you to replay the video and laugh at yourself for comic relief. Mastering the element of air is needed so that you don't take yourself too seriously. You will fall a lot and make lots of mistakes and you need to be ready to lightheartedly recover from them while also learning the life lessons they bring. Learning is so much more enjoyable when accompanied by light-heartedness and laughter. Laughter is like good medicine that nourishes your spirit and soul. Your quest to save the world is long and hard; but your mastery of the element of air will cushion your fall. Once you have mastered air, you are ready to move on to water.

Element # two: Water

Water is the element of calm, tranquility, and inner peace. Water is the element of harmony in your inner mind. In medicine, we focus a lot on our outward skills and the things that are easy to measure. However, what is most important for our success is difficult to measure: inner strength and harmony. Your inability to master water will expose you as an anxious, stressed-out mess. If you don't master water, you might be able to help a few people; but you are unlikely to save the world. Master water by caring for your spirit. Take time to meditate, pray, contemplate, be still and listen. Your inner person needs strength for the journey. Mastering the tranquil nature of water gives you the key to unlock its great potential. Unleashed, water can be a destructive force; harnessed, water can be used for hydroelectric power. So master water, which will help you stay focused when violence (yes, there is emotional "violence" in medicine) rages around you. Mastering water both keeps you calm and gives you great power to do amazing things. Therefore, master water and then turn your attention to earth.

Element # three: Earth

Earth is the element of groundedness, the element of connection to things that are fundamental. Mastering the element of earth allows you to connect to the earliest reasons why you became interested in hematology. For many of you, you came because you wanted to help. You identified with your patients' suffering and wanted to make a difference. You also wanted to make things better for those coming behind you. You came to hematology with a sense of your responsibility to do good in the world. Mastering the element of earth helps you stay connected to that core of your spirit and will keep you going as you discover the rough parts of medicine. Mastering earth allows you to survive the disillusionment and cynicism that brings so many down. Mastering earth is also critical to building because you can build great and magnificent buildings only by digging deep enough to lay a solid foundation. Master earth to stay in touch with the reasons why you build. Once you master earth, you can then turn to fire.

Element #Four: Fire

Fire is the last element to be mastered because it is the most destructive of the elements. Fire is the element that, if not controlled, can destroy years of beauty (ancient forests) and hard work (buildings). Unmastered fire is out of control and can easily destroy lives. Master fire by mastering your temper. Master fire by mastering mood swings. Master fire by addressing the root cause of problems so you can do a controlled burn rather than burn the whole house down. Master fire by learning to keep a cool head in the midst of other raging fires. As a fire master, you can apply just enough fire to burn the problem away, not the people. And once you master fire, you are ready to save the world because you can bring all the elements Ito balance as a fully realized Hematology Avatar.

A fully realized Hematology Avatar is master of all the elements

Once you have mastered all the elements, you can now bring balance to your universe. You'll be able to create balance because your mastery of air keeps you light-hearted and airy as you take on serious issues and solve terrible problems. Your mastery of water keeps you calm as you face inane circumstances and people who push buttons until someone explodes. Your mastery of earth will keep you grounded as you battle paperwork and the people who set themselves as obstacles to progress. And finally, you will have mastered the element of fire to do a controlled burning (to the ground) of all barriers to progress in your field while also keeping the rest of the "forest" alive and free from harm.

Becoming a fully realized Avatar takes time

Recognize that becoming a master of all the elements takes time. To become a true master takes deliberate practice with iterative feedback over a lifetime work. You will eventually save the world. But starting today, you will stack up many little wins that, over the years, add up to one very very very big win: You! The fully realized hematologist who, over many years, transformed her world.

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