Sole Purpose 116
What I Would Tell My Younger Self If I Wasn't Afraid to Be Mean (Part 2)

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I wrote about this before, and the response was both humbling and unexpected in the best way. Residents, attendings, and students reached out saying they felt seen in that unfiltered honesty — and it made me realize that those reflections were not actually finished.

There were still things I had not said out loud. Not because they were unimportant, but because they were harder to name. The kinds of lessons that sit a little deeper, take longer to understand, and keep unfolding even after you think you have moved past them. So let’s get into Part 2!

Just Get Up Early

I was recently in a case with an attending I genuinely enjoy working with, and somewhere between steps of the procedure, we got on the topic of morning routines. I mentioned that I had started waking up around 5 AM to get ahead of the day before the texts, emails, and clinical responsibilities took over.

He laughed and said, with the kind of honesty only someone further along can afford: "Just get used to it now, because it never gets better." He still wakes up at 5 AM to work out and handle personal tasks before his kids are up and the day begins.

What stood out was not just his routine, but how consistent that theme has been across nearly every mentor I have spoken with. Regardless of specialty or seniority, there is a shared pattern of protecting early morning hours — before the noise starts and before responsibilities begin competing for attention.

The early hours are often the only part of the day that feel fully controllable. There is a quiet that makes space for intention rather than reaction, whether that is exercise, studying, or simply thinking without interruption. In a profession where the rest of the day can feel unpredictable, that window becomes a way to reclaim some structure.

Getting up early is not a magic solution, and it is not easy to sustain in residency. But it has become one of the most effective ways I have found to create space for myself within an otherwise demanding schedule.

Managing People Is Infinitely Harder Than Managing Tasks

Making a schedule is easy. Organizing a surgical calendar, coordinating coverage, optimizing workflows — that part can actually feel almost calm. It is predictable. It has rules. It makes sense.

Managing people is where things stop feeling predictable.

At some point in training, whether you plan for it or not, you will be responsible for more than just your own work. Chief resident, coordinating students, contributing to research teams — whatever the title, the dynamic eventually shifts. And you realize something that is not really emphasized early on: the schedule is not the hard part.

The hard part is that you cannot make everyone happy at the same time. Someone will always be unhappy with their assignment. Someone will feel overlooked. Someone will interpret a thoughtful, well-reasoned decision as unfair. Even when you spend real time trying to be equitable and transparent, the outcome will not always land that way. You will make decisions that are objectively in the team's best interest and still end up with people feeling frustrated. You will lead with empathy and have it occasionally read as weakness.

There is no version of leadership where every person feels equally satisfied with every outcome.

This was one of the most difficult lessons for me personally. I came into leadership hoping that if I was thoughtful enough and clear enough in my communication, I could minimize conflict. I wanted to be understood. I wanted people to recognize the good intentions behind the decisions.

What I learned instead is that fairness is not the same as equal satisfaction, and good intentions do not eliminate disappointment. Part of growth in these roles is accepting that being responsible sometimes means making a decision others do not like — and that further explanation will not always resolve it. Your job is not to erase the discomfort, but to ensure the decision itself is sound.

Leadership is not defined by universal approval. It is defined by the ability to make thoughtful decisions in complex situations and tolerate the reality that not every outcome will be well received. Once that expectation shifts, the work becomes clearer — even when it does not become easier.

Your Idols Are Going to Disappoint You

At some point in training, you probably have someone you look up to. A mentor you hope to emulate. A surgeon whose technique feels impossibly refined. A leader who seems composed and completely in control. It is easy, especially early on, to build that person into the standard you are trying to reach.

Eventually, that image gets complicated.

Not because those people are fundamentally flawed, but because they are human, and humans are never one-dimensional. The surgeon with the most precise technique may be struggling in ways that are not visible in the OR. The mentor who feels clinically brilliant may be falling short in other areas. The leader who appears self-assured may be dealing with their own doubts in private.

People do not come in curated versions. They are a combination of strengths and blind spots, generosity and limitation — sometimes shifting within the same week.

I have had mentors I deeply respected, people I genuinely wanted to model myself after in almost every professional way. Over time, I also watched some of them make decisions I did not understand or came to recognize that the traits I most admired existed alongside qualities I would not want to replicate in my own practice.

What I have come to understand is that mentorship was never meant to be singular or absolute. No one person is a complete blueprint. Different people will teach you different things, and your growth is in learning how to integrate those lessons into something that is genuinely your own.

That means having more than one mentor. It means being intentional about what you take from each person — recognizing that you can respect someone deeply while still choosing not to emulate every aspect of how they operate. It also means accepting that the people you admire will sometimes disappoint you. They will make mistakes. They will have blind spots. That does not negate what they taught you. It simply places it in context.

The goal is not to find a perfect model to follow. It is to build your own practice, informed by many influences and filtered through your own values and judgment. You are not becoming any single one of them. You are becoming a physician shaped by many examples, ultimately responsible for deciding what kind of clinician and person you want to be.

Your Suffering Is Not a Credential

I had to include this one because I see it constantly in medicine, and I am still not entirely immune to it myself.

There is a subtle culture in training that turns exhaustion into currency. Call nights, sleep deprivation, case volume — we compare these things as if suffering more automatically signals dedication or competence. It becomes an unspoken badge of honor, a way of proving commitment through depletion. Over time, it starts to feel normal, even expected.

But exhaustion is not evidence of excellence. It is evidence of depletion.

Being tired does not make someone a better physician. And while medicine asks a lot of us, there is a real difference between meaningful effort and chronic under-recovery. Fatigue affects attention, judgment, empathy, and decision-making in ways that are well-documented — and deeply felt in real time at the bedside and in the OR.

The culture can sometimes reward the appearance of overextension even as it quietly undermines performance. We learn to equate endurance with value, when endurance without recovery erodes the very skills we are trying to build.

What I have had to remind myself — and what I would tell anyone in training — is that caring for yourself is not an optional add-on or something you do after burnout has already set in. It is part of maintaining competence. Sleep, nutrition, movement, and time away from clinical responsibilities are not indulgences. They are the baseline conditions that allow you to function at a high level over time.

A useful reframe is maintenance rather than reward. No one expects a surgical instrument to perform well indefinitely without being cleaned and maintained. The same applies to the people using those instruments. Function depends on upkeep.

The sooner you stop treating exhaustion as something to aspire to, the sooner you can focus on what actually improves performance, sustainability, and patient care.

In Conclusion

A few months later, I am still learning hard truths about myself and this career. What has changed is not that the work feels easier, but that I am more willing to sit with the discomfort when it is not.

Growth is not a destination where everything suddenly makes sense. It is an ongoing process of reflection, adjustment, and learning in real time. You are not going to figure it all out — I certainly have not. And I am starting to believe that may not be the point. The goal is less about arriving at certainty and more about staying honest with yourself as you go.

What I have learned from sharing these reflections is that there is a real need for this kind of honesty. Not the polished, packaged version — the version that actually reflects what this training asks of you, and what it takes in return.