Opinion
A PIECE OF MY MIND Jonathan S. Hausmann, MD Division of Rheumatology, Beth Israel Deaconess Medical Center; Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.
Corresponding Author: Jonathan S. Hausmann, MD (jhausman@bidmc .harvard.edu). Section Editor: Roxanne K. Young, Associate Senior Editor.
One Stroke at a Time I’m sitting at the stern of the boat, hands on the oar, anxiously waiting to row the Head of the Charles regatta, the world’s largest two-day rowing event. In front of me is Paul, my college coxswain. He is busy making final preparations for the 5000-meter race. Behind me are seven other Amherst College alumni, trying to keep warm in the chilly autumn breeze that is blowing across the river. Aside from a one-hour practice yesterday, none of us has rowed in years. We span several generations of alumni, having graduated from 1990 to 2006. To my surprise, five of the nine people on the boat—myself included—are physicians. There are several medical specialties represented: emergency medicine, sports medicine, primary care, and Med-Peds. The women’s alumni boat is similarly packed, with four physicians or physicians-in-training. Clearly, the abundance of physicians in my boat will be useful in the event of a medical emergency. After all, most of us are no longer at the prime of our lives; at best we are weekend warriors, trying to relive our glory days from college. As we line up with the other boats in preparation for the race, I wonder why so many of us rowers became physicians. Is there a common thread that drew us from one interest to the next? In its most basic form, rowing is the repetition of one simple movement, called the “stroke,” which involves dropping the blade of the oar on the water while propelling the boat forward through a coordinated contraction of muscles in the legs, back, and arms. Although appearing deceivingly simple at first, the coordination of muscle fibers across eight different individuals to propel a 50-foot-long, 2-foot-wide boat down the river is truly amazing. When things are going well, the boat becomes alive, with a heartbeat, speed, and purpose, acquiring abilities not found in its individual parts. This is not unlike the coordinated teamwork required to care for a patient in the hospital, where teams of physicians, nurses, pharmacists, and technicians systematically work together to keep patients afloat, with outcomes that would be impossible for any single individual to achieve by himself or herself. Perhaps it is the enjoyment of working in teams that attracted us to rowing and medicine? “Ready, all? Row!” We quickly pull up to the start line and begin the race. I wanted to find out more about the connection between rowing and medicine, so I asked my college crew coach, Bill, what he thought. He had been surprised by the abundance of physicians on the boat, but he thought that rowing “attracts highly actualized individuals,” which includes physicians, among other demanding professions such as lawyers and financiers. And granted, Amherst produces a lot of these professionals, so my observation may be have been influenced by selection bias. However, Coach Bill mentioned that his brother continues to win every year at the Head of the Charles in a
5-person boat that includes two physicians, two financiers, and one ex-CIA agent. I contacted the alumni office at Amherst to see whether they noted any trends in college rowers becoming future physicians. Although they didn’t have this information readily available, they referred me to the online alumni database for more information. From graduating classes between 1990 and 2006, there were 18 rowers who had become physicians, and four of them were on my boat. During this period of time, Amherst College rowers were 40% more likely to become physicians as compared to nonrowers. So perhaps my observations weren’t totally unfounded. We are halfway through the race and our coxswain expertly steers us under the Weeks bridge, one of the most difficult parts of the course because of its 90-degree bend. As we safely pass under the bridge, I hear the sound of our oars reverberating against the bridge’s brick walls, while spectators above shout, “Go, Amherst!” It is at this point, when my muscles are burning, that endurance begins to matter. Multiple studies have shown that rowers have some of the highest V˙ O2max in sports. V˙ O2max measures the maximum capacity of an individual to use oxygen during exercise, and it is an extremely important factor in maintaining high aerobic output during a race. This physical endurance that rowing demands is not unlike the mental endurance required for the study and practice of medicine. I remember spending 12 to 14 hours a day studying for medical school examinations in various coffee shops throughout New York City. The same mental endurance is required to sit through each of the USMLE Step examinations. And, not surprisingly, endurance is essential when working 30-hour shifts during my inpatient rotations as a resident. I don’t know if there is an intellectual equivalent for V˙ O2max, perhaps “IO2max,” but I’m certain that physicians would do very well on this measure. But rowing and medicine require more than the ability to endure hours of grueling work. They require grit. Grit is the audacity to set and follow long-term goals. Although a few people may be born with grit, I became gritty through rowing. Prior to my rowing career, I never did anything particularly strenuous. I wasn’t an athlete. I wasn’t tough. Kids made fun of me. Once, a boy half my size kicked me. I—and others—would have called my 14-yearold self a “dork.” This all changed once I started rowing. I endured months of painful winter training in dark, musty gymstoprepareforthespringseason.Irowedsohardthat my hands bled. Rowing made me physically and mentallystrongandtaughtmetopersistdespiteadversity.This lesson that I took from my rowing days, more than any other, allowed me to become who I am today. A boat packed with larger, younger rowers is passing us. Paul shouts for us to do a “power ten,” or ten
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JAMA September 3, 2014 Volume 312, Number 9
Copyright 2014 American Medical Association. All rights reserved.
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Opinion A Piece of My Mind
strokes at maximum intensity. “One, two …” my lungs burning, my hands cramping, my legs trembling, I ask myself, Why I am doing this again?” ”Five, six …” Why do I subject myself to such torture? “ ... Nine, ten!” Surely this can’t be good for me? Some of the first articles about rowing that appeared in the medical literature asked similar questions: “Whether the training and exertion demanded of those who take part in the University BoatRace are of so trying a character that in numerous instances the constitution is liable to be permanently injured?”1 Thankfully, newer literature on rowing provides a resounding no to that question and instead highlights the incredible physiology and athleticism of elite rowers. So if rowing is generally a healthy thing to do, why is the experience so physically painful? Could this possibly be part of the attraction to the sport? Do some people actually enjoy the pain that rowing brings? Apparently, the answer is yes. Studies have shown that people derive pleasure when their bodies are signaling danger, while their minds know that they are safe. This has been termed “benign masochism”2 and explains why we enjoy such varied activities as roller coasters, bungee jumping, and horror movies. I do not doubt that a similar benign masochism attracts many of us to medicine. Whether it is memorizing hundreds of muscles, blood vessels, and nerves for a gross anatomy exam, or staying awake for innumerConflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the Disclosure for Potential Conflicts of Interest and none were reported.
894
able hours to care for patients, the reward of enduring the struggles of the practice of medicine is often immeasurable. We are nearing the finish line. Paul shouts for us to increase our speed and power and “Let it all out!” In my peripheral vision I see a large green buoy representing the finish line. Finishing a race is not unlike completing one of the many requirements to become a physician, such as taking a board exam or finishing internship. In rowing, as in medicine, we tend to commemorate these events—the crossing of the finish line—as those of most importance. However, looking back at my rowing career, my most meaningful moments were not the race finishes, but the Saturday mornings spent rowing with friends, mist rising from the Connecticut River as the sun warmed its surface. In medicine, I hardly remember my medical school graduation, but I do remember my patients, including the first one I ever saw, an elderly gentleman after repair of an abdominal aortic aneurysm. In the end, we are defeated. We have finished 36th out of 43 boats, with a time of 18 minutes and 21 seconds. I look ahead in my career and see many finish lines yet to be crossed: residency, board exams, completing fellowship, and getting a real job. However, I try not to focus on those moments, because the moments that really matter are the ones in between. Perhaps that’s another thing that rowers and physicians share—the ability to live life one stroke at a time.
1. Morgan JE. University Oars: Being a Critical Enquiry Into the After Health of the Men Who Rowed in the Oxford and Cambridge Boat-race, From the Year 1829 to 1869, Based on the Personal Experiences of the Rowers Themselves. New York, NY: Macmillan; 1873.
2. Rozin P. Towards a psychology of food and eating: from motivation to module to model to marker, morality, meaning, and metaphor. Curr Dir Psychol Sci. 1996;5(1):18-24.
JAMA September 3, 2014 Volume 312, Number 9
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of Sussex Library User on 08/09/2015
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A PIECE OF MY MIND Jonathan S. Hausmann, MD Division of Rheumatology, Beth Israel Deaconess Medical Center; Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts.
Corresponding Author: Jonathan S. Hausmann, MD (jhausman@bidmc .harvard.edu). Section Editor: Roxanne K. Young, Associate Senior Editor.
One Stroke at a Time I’m sitting at the stern of the boat, hands on the oar, anxiously waiting to row the Head of the Charles regatta, the world’s largest two-day rowing event. In front of me is Paul, my college coxswain. He is busy making final preparations for the 5000-meter race. Behind me are seven other Amherst College alumni, trying to keep warm in the chilly autumn breeze that is blowing across the river. Aside from a one-hour practice yesterday, none of us has rowed in years. We span several generations of alumni, having graduated from 1990 to 2006. To my surprise, five of the nine people on the boat—myself included—are physicians. There are several medical specialties represented: emergency medicine, sports medicine, primary care, and Med-Peds. The women’s alumni boat is similarly packed, with four physicians or physicians-in-training. Clearly, the abundance of physicians in my boat will be useful in the event of a medical emergency. After all, most of us are no longer at the prime of our lives; at best we are weekend warriors, trying to relive our glory days from college. As we line up with the other boats in preparation for the race, I wonder why so many of us rowers became physicians. Is there a common thread that drew us from one interest to the next? In its most basic form, rowing is the repetition of one simple movement, called the “stroke,” which involves dropping the blade of the oar on the water while propelling the boat forward through a coordinated contraction of muscles in the legs, back, and arms. Although appearing deceivingly simple at first, the coordination of muscle fibers across eight different individuals to propel a 50-foot-long, 2-foot-wide boat down the river is truly amazing. When things are going well, the boat becomes alive, with a heartbeat, speed, and purpose, acquiring abilities not found in its individual parts. This is not unlike the coordinated teamwork required to care for a patient in the hospital, where teams of physicians, nurses, pharmacists, and technicians systematically work together to keep patients afloat, with outcomes that would be impossible for any single individual to achieve by himself or herself. Perhaps it is the enjoyment of working in teams that attracted us to rowing and medicine? “Ready, all? Row!” We quickly pull up to the start line and begin the race. I wanted to find out more about the connection between rowing and medicine, so I asked my college crew coach, Bill, what he thought. He had been surprised by the abundance of physicians on the boat, but he thought that rowing “attracts highly actualized individuals,” which includes physicians, among other demanding professions such as lawyers and financiers. And granted, Amherst produces a lot of these professionals, so my observation may be have been influenced by selection bias. However, Coach Bill mentioned that his brother continues to win every year at the Head of the Charles in a
5-person boat that includes two physicians, two financiers, and one ex-CIA agent. I contacted the alumni office at Amherst to see whether they noted any trends in college rowers becoming future physicians. Although they didn’t have this information readily available, they referred me to the online alumni database for more information. From graduating classes between 1990 and 2006, there were 18 rowers who had become physicians, and four of them were on my boat. During this period of time, Amherst College rowers were 40% more likely to become physicians as compared to nonrowers. So perhaps my observations weren’t totally unfounded. We are halfway through the race and our coxswain expertly steers us under the Weeks bridge, one of the most difficult parts of the course because of its 90-degree bend. As we safely pass under the bridge, I hear the sound of our oars reverberating against the bridge’s brick walls, while spectators above shout, “Go, Amherst!” It is at this point, when my muscles are burning, that endurance begins to matter. Multiple studies have shown that rowers have some of the highest V˙ O2max in sports. V˙ O2max measures the maximum capacity of an individual to use oxygen during exercise, and it is an extremely important factor in maintaining high aerobic output during a race. This physical endurance that rowing demands is not unlike the mental endurance required for the study and practice of medicine. I remember spending 12 to 14 hours a day studying for medical school examinations in various coffee shops throughout New York City. The same mental endurance is required to sit through each of the USMLE Step examinations. And, not surprisingly, endurance is essential when working 30-hour shifts during my inpatient rotations as a resident. I don’t know if there is an intellectual equivalent for V˙ O2max, perhaps “IO2max,” but I’m certain that physicians would do very well on this measure. But rowing and medicine require more than the ability to endure hours of grueling work. They require grit. Grit is the audacity to set and follow long-term goals. Although a few people may be born with grit, I became gritty through rowing. Prior to my rowing career, I never did anything particularly strenuous. I wasn’t an athlete. I wasn’t tough. Kids made fun of me. Once, a boy half my size kicked me. I—and others—would have called my 14-yearold self a “dork.” This all changed once I started rowing. I endured months of painful winter training in dark, musty gymstoprepareforthespringseason.Irowedsohardthat my hands bled. Rowing made me physically and mentallystrongandtaughtmetopersistdespiteadversity.This lesson that I took from my rowing days, more than any other, allowed me to become who I am today. A boat packed with larger, younger rowers is passing us. Paul shouts for us to do a “power ten,” or ten
jama.com
JAMA September 3, 2014 Volume 312, Number 9
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of Sussex Library User on 08/09/2015
893
Opinion A Piece of My Mind
strokes at maximum intensity. “One, two …” my lungs burning, my hands cramping, my legs trembling, I ask myself, Why I am doing this again?” ”Five, six …” Why do I subject myself to such torture? “ ... Nine, ten!” Surely this can’t be good for me? Some of the first articles about rowing that appeared in the medical literature asked similar questions: “Whether the training and exertion demanded of those who take part in the University BoatRace are of so trying a character that in numerous instances the constitution is liable to be permanently injured?”1 Thankfully, newer literature on rowing provides a resounding no to that question and instead highlights the incredible physiology and athleticism of elite rowers. So if rowing is generally a healthy thing to do, why is the experience so physically painful? Could this possibly be part of the attraction to the sport? Do some people actually enjoy the pain that rowing brings? Apparently, the answer is yes. Studies have shown that people derive pleasure when their bodies are signaling danger, while their minds know that they are safe. This has been termed “benign masochism”2 and explains why we enjoy such varied activities as roller coasters, bungee jumping, and horror movies. I do not doubt that a similar benign masochism attracts many of us to medicine. Whether it is memorizing hundreds of muscles, blood vessels, and nerves for a gross anatomy exam, or staying awake for innumerConflict of Interest Disclosures: The author has completed and submitted the ICMJE Form for the Disclosure for Potential Conflicts of Interest and none were reported.
894
able hours to care for patients, the reward of enduring the struggles of the practice of medicine is often immeasurable. We are nearing the finish line. Paul shouts for us to increase our speed and power and “Let it all out!” In my peripheral vision I see a large green buoy representing the finish line. Finishing a race is not unlike completing one of the many requirements to become a physician, such as taking a board exam or finishing internship. In rowing, as in medicine, we tend to commemorate these events—the crossing of the finish line—as those of most importance. However, looking back at my rowing career, my most meaningful moments were not the race finishes, but the Saturday mornings spent rowing with friends, mist rising from the Connecticut River as the sun warmed its surface. In medicine, I hardly remember my medical school graduation, but I do remember my patients, including the first one I ever saw, an elderly gentleman after repair of an abdominal aortic aneurysm. In the end, we are defeated. We have finished 36th out of 43 boats, with a time of 18 minutes and 21 seconds. I look ahead in my career and see many finish lines yet to be crossed: residency, board exams, completing fellowship, and getting a real job. However, I try not to focus on those moments, because the moments that really matter are the ones in between. Perhaps that’s another thing that rowers and physicians share—the ability to live life one stroke at a time.
1. Morgan JE. University Oars: Being a Critical Enquiry Into the After Health of the Men Who Rowed in the Oxford and Cambridge Boat-race, From the Year 1829 to 1869, Based on the Personal Experiences of the Rowers Themselves. New York, NY: Macmillan; 1873.
2. Rozin P. Towards a psychology of food and eating: from motivation to module to model to marker, morality, meaning, and metaphor. Curr Dir Psychol Sci. 1996;5(1):18-24.
JAMA September 3, 2014 Volume 312, Number 9
Copyright 2014 American Medical Association. All rights reserved.
Downloaded From: http://jama.jamanetwork.com/ by a University of Sussex Library User on 08/09/2015
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