When I was 10, my family and I lived in rural Pennsylvania. I had three siblings and we made our own fun. We climbed trees, made friends with spiders, and played with the neighbor’s horse until the fence broke and it almost stepped on my baby brother. We mostly played outside to stay out of trouble, but inside could be equally entertaining. There were inside rules—no running, quiet voices, no bouncy ball—which were sometimes circumvented, but almost universally obeyed.
One day, left to my own devices, 10-year-old me disobeyed one of the more sacrosanct decrees of my household: Thou shalt not climb on the cabinets. My need for fun eclipsed my innate desire to follow the rules and up, up, up I went. A moment basking in the glow of my success was followed by panic. My mom was on the porch and would enter the house momentarily. I jumped. White hot pain exploded in my left foot. It had landed, big toe first, in an open box of Legos. I stifled a scream and fell to the floor. “What on earth is going on?” my mom asked. “I think I stubbed my toe,” I lied.
My parents were confused as to how a stubbed toe could cause so much pain, as were the emergency department physicians who evaluated me when my agony had not subsided several hours later. However, I was now committed to my lie and kept retelling the same story. We were reassured that nothing was wrong. My stubbed big toe would heal up just fine on its own. And heal it did, only an inch shorter and fused at the proximal and distal interphalangeal joints. I am reminded of my trivial childhood decision to lie every time I put on a pair of shoes, one of which will forever either be too big or too small. It makes me wonder if the truth and a plaster cast may have been the better option. I also wonder how, without the benefit of time, wisdom, and retrospection, we can know this in advance.
For me, this is also true when it comes to the decisions we make daily. Some decisions are like a mask we put on. Ten-year-old me wanted her “good girl,” rule-following mask to stay intact more than she wanted to have her toe properly addressed. That same year, we fifth graders were eligible to join the school band. During an informational session, they told us that the flute was one of the more difficult instruments to learn. I heard nothing else; that was all I needed to know. Another layer of my mask at the time was proving that I could excel at all the difficult things. Flute it was, regardless of whether or not another instrument would have brought me more joy. The elements of our masks may be genetic, learned, taught, or arise from trauma or other experiences. They are almost always well intentioned.
However, I believe that the mask analogy isn’t entirely accurate. These things do not make up our masks; they make up our casts. They are put on to protect us or to help us move with more ease through our circumstances. There are plenty of resources available to show us how to add layers to our casts. Facebook and Instagram have taught a generation to post smiling pictures showcasing “Living Your Best Life.” The importance of this careful curation of visual snippets of your life is to project the image of who you want the world to think you are. Peeling away the layers and exposing what’s underneath is not nearly as publicized or glamorous.
I was really struggling then too. I didn’t have anyone to talk to because everyone seemed to have all their stuff together except me. If only we had known, we could have probably really helped each other. —Jennifer A. Villwock, MD
I recently gave a local TEDx talk. Some of what I said you might have read before in my last wellness column (ENTtoday. 2018;13:1). Some of it was new. The gist of the talk was about the importance of the stories we tell ourselves about our experiences, illustrated by examples from my life as a surgeon. Some people told me my talk moved them to tears. Several that knew me during the difficult stages in my life that I talked about said, “I was really struggling then too. I didn’t have anyone to talk to because everyone seemed to have all their stuff together except me. If only we had known, we could have probably really helped each other.” I didn’t say anything that most of us haven’t experienced. I just peeled back a tiny bit of one of my casts.
So what happens if you don’t take a cast off or if you don’t know how? It gets itchy. Probably a little smelly too. The strength underneath can atrophy, the skin turning pale. As time progresses, it can take not only an increasing amount of effort, but also courage, to try and take off the cast. Because of this, we may elect to accept the itch. I wonder if more of us were willing to peel back our casts with an attitude of, “Hey, look at this. Isn’t this strange, but also normal considering what we’ve been through? Won’t it be cool to watch this limb rehabilitate and be strong again?”—would we all be healthier as a community?
Because the location and substance of our casts can be so different, generic one-size-fits-all wellness advice can fall short. For example, online wellness modules are typically not universally well received. At best, one size fits some. Additionally, this type of well-intentioned advice can be counterproductive. If you absolutely cannot sit still, hearing that you need to do sitting meditation daily may just create stress and angst and another plaster layer on your cast as you try to comply. Similarly, I dislike running; my marathon-running partner is my exercise-kryptonite. The “couples who sweat together, stay together” mantra does not apply to us; trying to follow it would harm our relationship.
Do you know where your casts end and your own skin begins? As you head to bed and reflect on your day, maybe catching a glimpse of yourself in the mirror, do you ever get that nagging sensation that you’re not who you wanted to be? Great news! This is your own subtle call to action and tomorrow is another opportunity to be the better person you had hoped you would be today. The only question now is what to do with that sensation. Perhaps consider answering the following questions for yourself and experiment with implementing the answers in your own life:
- What foods do you actually enjoy eating that also healthfully fuel your body? Eat those things. If you don’t know, ask for help. Your health insurance may include free health coaching or nutrition perks. Maybe organize a healthy potluck or meal exchange.
- What activities do you enjoy that move your body and keep you active? Do more of that. If you don’t know, consider signing up for a random class or take advantage of a Groupon offer.
- Feeling too introverted or embarrassed for an exercise class? Sign up for a two-week free trial of one of the many exercise apps available.
- Do you have a hobby or interest? Nurture it. Can’t remember what you find fun? Ask a friend or colleague for a recommendation or to come with you to a random community event. (I recommend children’s musical theater. There are few things cuter than a multitude of 5-year olds singing Disney songs!)
- Do you like to create? Decide to make something and, if you don’t already know how, watch a YouTube video and learn (if you’re interested in crochet, check out Wooly Wonders crochet channel ϑ). If you realize you hate the process halfway through, give yourself permission to quit!
- What new horizons would you like to explore through music or literature? Ask a friend if they’ve come across any up and coming artists or find an open mic night. Maybe join, or start, a book club.
And to you medical students and residents reading, or anyone else who’s overwhelmed with their exceptionally busy life, actively thinking to yourself, “I do not have the time, or the money, for any of your suggestions,” I see you. I hear you. I understand. Perhaps a follow-up question to the ones above may be, “What is the smallest next step I can take towards those goals?” Could you carry almonds or other nuts in your white coat pocket to have a healthy snack option? Can you commit to taking the stairs up one more flight of stairs than you normally would while rounding on patients? Can you sneak away for five minutes in between consults to go stand in a patch of sunlight and take 10 deep breaths? Could you focus on having one genuine, human interaction with another person per day?
As you consider these options, be kind to yourself as you experiment. Not everything is going to feel “right.” It may take some time to remember who you are under all the layers and after all the years of focusing on your training and the welfare of others. Try to avoid “should-ing all over yourself” and doing things out of guilt because they’re what you think you’re supposed to do, lest they drain you while adding another layer of plaster.
“Love takes off casts* that we fear we cannot live without and know we cannot live within.”—James Baldwin
*original quote: “Love takes off masks…”
Dr. Villwock is an assistant professor of otolaryngology–head and neck surgery in the division of rhinology and skull base surgery at the University of Kansas Medical Center in Kansas City. She is also a member of the ENTtoday editorial advisory board.