Take Control of Your Sound

Anything is possible

I grew up in a family where I was taught that anything was possible. “The sky is the limit,” my father told me. You can do anything. Growing up in the 80s in a patriarchal society in which women did not have equal access to opportunity, my father told me that women could be doctors. At that point, I had not yet met a woman who was a doctor; however, because he told me, I believed him. He told me there was nothing I could not do and I believed him. My entire childhood was a fulfillment of his words because there was no challenge I encountered that I did not overcome. I took on challenges because he told me that I could. I grew up fearless and without any doubt about my ability to succeed.

And succeed I did. I excelled in middle and high school, earned high honors, and won awards. People would meet my mom and dad and get excited because they knew me. My father was especially proud when people wanted to get to know him just because of me. So, that was my childhood and early adolescence. I rocked the world because my family created space for me to believe I could.

But perhaps not in College

Then I moved to the United States for College. I planned to do a double major in biology and chemistry because chemistry was my first love; but I needed biology courses for my pre-med requirements. So, I thought I would just combine the two degrees and be done. But, as a transfer student with credits from another country, I first needed to meet with the pre-med counselor.

Well, this pre-med counselor was not warm and welcoming. In fact, she was dry, matter-of-fact, and to the point. A double major in biology and chemistry? She frowned deeply. And you want to go to med school? That’s too hard. Your grades are going to be poor and you won’t get in.

At the news, I was devastated. I was 19 years old, in a brand new country and it was the first time in my life that I had been told that something would not be possible for me. I actually reeled from that news. All of a sudden, fear and doubt poured in, I couldn’t think straight. I was just so sad. I really loved chemistry. I couldn’t see a place in my life where chemistry would not exist. I didn’t care as much for biology; but most of the pre-med prerequisites were the backbone of the biology major. If I was going to choose only one major, it made sense to pick biology; however, I could not imagine life without chemistry. I was really sad.

My next stop from the pre-med counselors office was the math teacher, Joe. Joe, who had never met me before, noticed that I looked down and he asked what was wrong. I told him my dilemma and what the pre-med counselor had told me. Joe didn’t seem to think it was much of a dilemma. For him, it was a matter of a practical experiment. He told me, sign up for both. If it turns out that you can’t manage the two, then drop one. And all of a sudden, I could see possibility again. Of course, I would just do both and see what happened.

Long story short, I ended up doing both majors and graduating magna cum laude.

Definitely not during residency

Well, fast forward to my internal medicine residency program where I was receiving some evaluative feedback from my rotations that was negative. For example, in one of my first rotations as an intern, the attending called me aside. His verbal feedback to me over a weekend coverage situation was was that he didn’t see much that was special about me. He said I was probably about average.

For one of my rotations, I didn’t get verbal feedback. I had no idea what was coming until I received the written feedback. ,This fellow, who had supervised me in a cardiology ICU rotation wrote — and I don’t remember the exact details, so this is a loose paraphrase — Toyosi’s fund of knowledge is so poor; but what is even worse is that she has no idea just how bad she is.

I remember reading that evaluation and being devastated. I could taste the venom dripping from the evaluation. I could tell that she thought that I was so bad that she was disgusted that a person like me would be allowed to be in medicine.

Well, you get enough evaluations like that in residency and you get called in to see the residency program director. The allegations against me were many. I was too slow. I wasn’t efficient, I didn’t know as much as I should . . . And so, one of the interventions my program director came up with was to pair me with a former chief resident as a mentor, which may have been the best thing for me. Because in her, I found someone who had the same practical advice as my college math teacher. Susanna told me, if the problem is that you don’t have enough fund of knowledge, then you just need to have a plan for your reading. Susanna gave me tangible advice. What is notable is that she didn’t say, well you are a horrible person who should just give up now, which is the message I had been receiving until now. She essentially said, practical challenges need practical solutions. Go read a textbook of medicine.

Fast forward to the end of my residency program when I was the senior resident on a new gen med rotation.

This new rotation was created because, at the time, 80-hour work limit was beginning to be strictly enforced nationally and my institution was working hard to get everyone under limit. So, this brand new rotation took away overnight call from the senior resident who worked 6-12 hour days. The interns still took overnight call with a night float resident. But they left immediately after presenting the patient. So, the whole team would meet early to learn about the patients together, including with the attending. To make this fit within 80-hours for the resident, the expectation was that there would be no pre-work. Everyone would get together and learn about the patient and formulate a plan together.

See, the problem with this structure is that it takes time to learn about new patients, especially new patients that you didn’t admit yourself; but for the day to run efficiently you already needed a solid plan of care that you can execute early in the day. The absence of knowledge would lead to the team being slow, inefficient, words, that by now were familiar words with which attendings had described me. I also knew I was not in an entirely safe environment where people would give me the benefit of the doubt. My experience is that I would be judged, harshly, and I needed to prepare for judgement. I came up with my strategy. For my team to run efficiently, I needed to have a plan ready for for the interns to execute for each patient as soon as we arrived.

The official day started at about 7:00 a.m.; but each day, I arrived 2 hours early at 5:00 a.m. and sometimes 4:00 a.m. First I reviewed all the patients that had been admitted overnight. Second, I did some reading about their disease pathophysiology; and third, I developed teaching plans for each admitted patient. When it was time to round at 7:30 a.m., not only did I have a plan of care for each patient that was presented; but I also had a teaching point to share for the entire team, from memory! Without notes! At the end of each workday, I would officially sign out at 7:00 p.m. and then head down to the bunker to help my underrepresented minority medical student prepare his presentations, review the list of patients for the day and formulate a plan of care for the next day. If it was a good day, I would be heading home each day at about 10:00 p.m.

For 6-weeks of this rotation, that was my schedule. No, I wasn’t getting enough sleep; but I was not on this rotation to sleep. I was on this rotation to make a statement. Every morning I drove into work, I played only one song on repeat. It was a song by Miriam Webster called “Made me glad.” For 6 weeks of this grueling schedule, I played the song, which encouraged me, gave me hope, and told me that I could. With that song playing in my ears non-stop, I knew that nothing would be impossible for me.

And I nailed the rotation. Surely, people tried but couldn’t find a bad report about me. In fact, I had impressed them all. One of the attendings couldn’t stop talking about me to everyone. Woah, that Toyosi! She is always teaching! She knows exactly what to do. She knows the patients backwards and forwards. Nothing gets past her. Woah, Toyosi. Everywhere he went this attending talked me up. I think he was especially impressed because he had been told I was one of the “average” ones and to see someone who should have been average be so outstanding, blew him out of the water.

And for me, I went through that rotation with the sense of “you think I’m mediocre; how about I show you mediocrity. I was fueled by the knowledge that I would defy every expectation. And you know what! I did it!

Yeah, by the end of the 6-weeks, I was so exhausted, I could barely breathe. Oh it was an impossible 6-weeks; but I had achieved my goal. I had overcome a barrier designed to trip me up. I permanently changed the narrative. And not just for people evaluating me; but most importantly, for myself.

Now, I pause my story to share some important lessons from that come to me from this space.

The lessons from my story

Lesson # 1. Recognize when it is time for a defining fight. When I came to this gen med rotation, there was a mountain of judgement against me. The prevailing narrative was that I was mediocre, inefficient, and had a poor fund of knowledge. There were enough of this negative story that had begun to form a narrative that couldn’t be ignored. So which person was I? The one who could do anything or the one who was so bad that I didn’t even know it? I had nothing to prove to any body but myself. I was fueled for those 6-weeks, not by the hope for a good evaluation. I didn’t care about my evaluators. I was fueled for those 6-weeks by the recognition that a challenge had been set before me that I needed to overcome. There was a challenge before me that I needed to step up and face. And at the end of that 6-week challenge, I walked away knowing that nothing would be impossible for me. But it had always been that way. I had always known that truth. I knew it since I was a child because my father had told me. But somewhere along the way, I had stopped believing it because I started listening to a different voice.

And that brings me to lesson # 2.

Lesson # 2. When the sound of discouragement prevails in your environment, it changes what you believe. When people started to spin a narrative that I could not. Did not and was not. That I poor. At first I didn’t believe them. But then, over time, with enough of these voices coming together saying the same thing, I started to believe it. I forgot about all the evidence that I had stacked up in my past that was contrary to what people were saying. I forgot about all the challenges I had overcome and slowly but surely, as I continued to listen to the narrative, it changed my belief. And my new unbelief changed my behavior. I started to fulfill the prophecies surrounding me. I started to feel mediocre. Because the sound of discouragement around me was changing what I believed to be true about myself, I also was changing into an unbeliever. And for me to go back to my first belief, I needed to change the sound I was hearing.

That leads me to lesson # 3

Lesson # 3. To recover your true narrative, take control of the sound in your environment. For me to remember who I was, I needed to first silence the sound of discouragement and create a new sound of possibility. For my entire rotation, the sound consistently playing in my head was a sound of possibility. Therefore, I went above and beyond the expectations of an environment that had been set up to prove me mediocre. The bar had been set high and I was being lured into a false sense of security. Please come. Don’t do any pre-work. We won’t judge you. But the atmosphere was clearly an environment of judgement. I was not in a safe space of acceptance. And so, I created my own sound. And it was the sound of possibility. And today, it is the only sound that I listen to. In my life today, I silence every sound that does not line up with my fundamental belief that anything I choose is possible.

My calls to action:

Call # 1. Silence every negative sound over your life. Pay attention to who is talking to you and what they are saying. For every negative voice you hear you silence them. To silence them means that you stop listening. Let them keep talking; just don’t be there to hear it. Refuse to listen any longer to any sound that paints you as weak, incompetent, predetermined, and unchangeable, even when that sound comes in the form of evaluative feedback and a cloak of objectivity. True learning environments do not judge you; they create space for your growth. Therefore, do not accept any judgement against you. And, if there are sounds in your environment that you must tolerate for a season, then call to action # 2 is for you.

Call # 2. Amplify the sound of truth until it drowns out all other sound. For every negative sound that you must tolerate a little while longer, amplify your own sound of possibility until it drowns out all other sound. Amplify the sound of truth about your powerful inner potential. Find the song that tells you you can do it and play it on repeat until it resonates. Find the mentors that show you possibility and hang with them until you have the same kind of faith. Create your own sound and space of possibility so that no matter what people say, you always recognize what is true. Amplify the sound of truth until it is the only sound you hear.

Call # 3. Step up and fight. The fight is not for them, it is for you. You have nothing to prove to them but everything to prove to yourself. You step up and fight because you need to recover for yourself the sense of awe and wonder with which you started. You step up and fight because you need to rediscover the possibility of your potential, who you are and what you came to do. You step up and fight because you deserve the win for you, your community, and the world. You step up and fight because there is a fight you fight one time and will not have to fight again. The fight before you is humongous. But the secret of your win is that you do not fight alone. Your fight is a fight of the universe.

How about you? How are you taking control of the sound in your environment?