echoes of fourth year

Dec 31, 2021

Edward Kai Yan Tie MD’22

      For me, self-care—all those varied practices and protocols that help us maintain our sanity, our  physiologic functioning, our sense of being more than what we do or our usefulness to others—has  been a lifelong journey, a tool for both surviving the everyday and building a life worth living,  especially in a professional world as challenging and stressful as medicine.  

      How I think about self-care is largely indebted to my mom. In one of my earliest memories, she  is bent over a small bowl in our kitchen, grinding a bunch of herbs and other unknown flora with a  mortar and pestle until all the leaves and roots had lost their shape, having been pressed into a  formless, fine mixture of earthy brown and black. She had broken a sweat doing this. A dedicated  practitioner of traditional Chinese medicine, my mother had thought that I was looking sickly. She then set herself to brewing a concoction that would “calm the fire within my spleen.”  

      The first arduous step of preparing this herbal treatment—the slow violence of the mortar and pestle and the human effort directing it—was absolutely essential to the potency of the final product and its ability to quell the inflammation within one’s body. After a few hours—a labor of love—the herbal soup was done. It tasted bad—acrid and bitter but also somehow sour. I remember struggling to finish  it. But my mom was strangely glad I had hated it: that meant the roots had concentrated enough, its poor taste promising its effectiveness.

      I see so many lessons in this memory. The first was that my body needed care—it was porous,  open to the vicissitudes and insults of the outside world, liable to change or deteriorate without my care and attention. I think most of us inherently know this as embodied beings, but we are so quick to forget. This belief that our bodies are membranes exchanging with the world around us, of course, is a perspective on corporeality that is deeply indebted to the cosmology of traditional Chinese medicine.  Practitioners approach the body as a vessel subject to inflaming and stagnating forces, its balance easily tipped by our personalities, our diet, the weather, our occupations. In short, the lifeworld around us can nudge our bodies towards health or unhealth.

      We know this in Western biomedicine too, that our bodies and the minds are biosocial entities drawing on our genetic past, reflecting structural and social realities, shouldering the stresses and challenges of our everyday lives.  

      Self-maintenance of both is crucial. On a daily basis, we must find ways to expunge the detritus of our modern, stressful lives from our bodies and minds—whether that means sleeping well, eating well, engaging our bodies in physical activity, reflection and meditation, finding purpose in our work,  etc.  

      The list goes on—and I find that many of my peers in medical school have been sufficiently programmed enough to know what self-care looks like. We often know what needs to be done; the hard part is doing it. My mother’s second lesson is a similarly difficult truth. Sometimes doing the right thing for yourself doesn’t feel quite right, or is initially deeply uncomfortable, demanding a kind of  behavioral activation we aren’t always capable of. Sometimes the very thing that needs to be done repels us in its importance and centrality. We have to parent ourselves: give ourselves the necessary medication, do what needs to be done.  

      I don’t know what the complete answer is here either. How do we begin the hard work of self care that needs to happen when medical school already demands so much of us—those long hours on the wards, even longer hours at home drilling multiple choice questions, our innumerable research and extracurricular obligations.  

      During my third and fourth-year rotations, I never achieved that ideal of the well-balanced life that seems so enticing in its impossible perfection. You already know what I mean: that unattainable  fantasy of regimentation, that vision of maximized productivity in work and leisure quantified in 8 hours of restful sleep every night, at least 30 minutes of exercise 5 times a week, and whatever discrete number of UWorld blocks a day (the more the better).  

      I can, however, easily describe the liminal moments of third and fourth year when I found time for myself. It always happened at home, far away from the hospital and clinic.  

      Picture this: me in my room, sitting calmly in bed, listening to music, reflecting on the day, and feeling out those parts of me that had been split and scattered by the exhaustion of a day’s work.  Within that well of respite, I gathered those parts of me that are more than medical student, health care provider, whatever roles the world has assigned to me. Some of those parts have names: me as a son, brother, lover, musician, writer, thinker, critic, listener, lounger, singer, dreamer. 

      I contain multitudes. Indeed, that is the real promise of self-care: that we reconstitute ourselves, expand our vision of who we are to exceed that of what we do, what our jobs are, what the world expects from us—a starkly impoverished caricature of what a human being is. 

Edward Kai Yan Tie

Brown Medical School - Class of 2022

Edward Tie is a fourth-year medical student at Brown interested in psychiatry, medical humanities, and narrative medicine.