Hey everyone, it’s Medicine Mondays again. This will be a short post about why you should “Starting with The End”.

Starting with The End?

Yea.

First, a little background. I had a little staycation this weekend. We went over to the North Shore and spend a few nights at Turtle Bay. The kids had fun with the pool, slides, and the beach. Unfortunately, we weren’t able to see any turtles since it was a little windy and the waves were kind of choppy. The turtles don’t usually show up when it’s windy.

We didn’t spend too much money on this staycation compared to the California Family Trip last year. However, I think it was a pretty fun time for my wife and the kids. We all got a little fun in the sun.

Anyways, it made me realize something that I kind of already knew, but wasn’t able to really put into words. In fact, it kind of all came together when I heard a recent AMA from Charles Hoskinson. I can’t remember which one it was, but in one of them, he talks about “starting with the end”. I’m actually not sure if that was exactly what he said, but it was something to that effect. The general gist of it was that whenever you set about to create something, you don’t start off with what is happening now, you start with what the end product will be.

Seeing as how The Match just concluded and there are a whole slew of new interns who will be starting their internship in the next few months, I felt it was an appropriate time to talk about this concept.

Now that you kind of know where you will be for the next few years, you should probably take some time to think about Starting with The End.

What do you mean?

I’ve talked about it before, but being in medicine can be isolating. Many are away from friends and family for extended periods of time. Your high school and college friends won’t understand why you can’t hang out… or you may not even really talk anymore. It’s not really anyone’s fault really, it’s just that during training it becomes difficult to focus on anything outside of what is in front of you.

So now, before you get caught up in training with your razor sharp focus on learning and being in Survival Mode, think about where you want to be.

30 years from now, what will make you happy… and what you can do to achieve that? For example:

• What kind of work do you want to do?
• Do you want to get married and have kids?
• Do you want to move back home?
• When do you want to retire?
• Where do you want to retire to?
• What places will you want to have visited?
• What things will you want to have done?

It might be really weird to think about these things when you’ve just had the next 3+ years of life laid out for you, but I can assure you that the days are long, but the years are short. At the top of your life’s plan should be your happiness and how to achieve that.

What about you?

So, now let’s go about “Starting with the End”. For me, if I went back to when I first matched into internship and residency, I didn’t really have a plan other than to survive. I figured everything would work out once I had the MD behind my name, and the ABR Certification backing me. For the most part, I wasn’t really wrong — but I wasn’t really prepared.

So then, if I can channel the Sensei back in March 2007 who just matched, I don’t think he would have had all the answers to the questions I listed above… but I’ll try:

Back then, I’m pretty sure Sensei wanted to work in private practice after finishing residency/fellowship and eventually become a partner in a small group. More so than that, he wanted to work in a smaller community hospital where he had a good relationship with his colleagues and was the go-to guy for the more difficult cases in his specialty. For the most part, he tried to do that after finishing with his first job. However, that’s ultimately not where I ended up.

At this point in Sensei’s life, it was pretty much already a foregone conclusion that I would be marrying Mrs. Sensei, it was just a matter of when. Kids were always in the cards as well, with hope for 1 boy and 1 girl, which is what happened.

It would have been nice to move back home. However, “which home”? My wife is from New Jersey and I’m from California, is it really fair to choose one over the other? Ultimately, the way the job market worked out answered the question for me. I wouldn’t have been opposed to coming home, but it wasn’t a make or break option.

I think that the Sensei back in 2007 had always assumed he’d be working until 65 and retire “like a normal person”. The whole idea of an earlier retirement of the 20 Year Career, came much later. However, I think that if I had embraced the 20 Year Career back in 2007, I’d be a lot farther along than I am now. Hindsight is always 20/20 though of course.

The Sensei back in 2007 had no idea where he’d want to retire to. I can assure you that Hawaii was not even in the conversation at the point for either work or retirement. However, the Sensei today is planning to retire wherever my kids end up. Maybe it’ll be one of these places.

The Sensei back then didn’t really plan to do much traveling. However, I kind of wish I had traveled a little bit more, although I’m not really sure when I could have done it during all of my training. Additionally, I really don’t like flying all that much, so it isn’t that easy to get me on a plane for a short trip. That said, I do want to take the kids to Japan or Europe when they’re a little older. The wife also would like to return to Atlantis Bahamas someday so the kids could see where we got married. I think they would enjoy the slides too.

If you had asked the Sensei in 2007 about what he would have wanted to have done, I seriously doubt “writing a blog” would have been on his list. However, it’s on my list now. I’d also like to eventually write a book or book(s).

The me from 2007 and the me in 2018 aren’t quite the same people, to be sure. However, we’re more alike than we are different. Different, but same.

TL;DR

Starting from The End.

I think it’s a good concept for happiness, so you don’t lose sight of what you really want.

The me from 2007 and the me in 2018 aren’t quite the same people, to be sure. However, we’re more alike than we are different. Different, but same.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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