Your Internal Dialogue

Reader Goal: Pause and Reflect on Your Own Internal Dialogue

Long before I was a cardiac surgery resident, I was a competitive gymnast.

Gymnasts are dedicated to the pursuit of perfection, honing one skill at a time. As a gymnast I learnt to flip once, before learning to flip twice. It was an exhilarating process, a passion.  

However, in some ways, the circumstances in which I first learned to chase perfection were less than ideal. 

There was a lot of yelling in gymnastics, even when we nailed our routines.  The culture of the sport relied on constant yelling, punishment, and occasional beratement to drive us to perform better. 

Sometimes that did work.  A threat of a rope climb if one did not stick a landing, would drive us to focus and work harder.  Being yelled at for a bent knee or flexed foot would motivate us to fix it.  I began to internalize this type of rhetoric in which I was surrounded, believing that success is forged in a toxic and exhausting state.

One of the many reasons I find surgery incredible is that it mirrors gymnastics with its similar dedication to the pursuit of perfection and the necessity of strong foundations.  

However, within a few weeks of intern year, I noted that I was inadvertently internalizing the same mindset that I had developed during my time as a gymnast. 

For example, one day I was in a cardiac case that I had been in multiple times as a medical student, but for the first time as an intern and first assist. Even though I recognized the steps of the case, I struggled to catch on to the flow of the case. 

As I felt myself getting frustrated, a dialogue began to unfold in my mind: ‘I should be able to do this, why can’t I do this?.  I am not doing a good job. I should be doing better.’  Each thought  reflected  my own self-criticism.

Meanwhile,  no one around me was actually disappointed with me, and instead were very encouraging. My negative mindset was purely internal, serving no productive purpose. 

Four months into intern year, I have had more learning moments than I can count. And too often, I still find myself overcome with  negative and critical internal dialogue, reminiscent of that from my time as a gymnast.

However, residency is already exhausting enough in and of itself, without negativity and self-doubt. This kind of thought process  is often more destructive than constructive. 

Through conversations with peers and with mentors, both inside and outside of cardiothoracic surgery, I know I am not alone in this dialogue. So here are a few ways I have begun to pause to try to shift my thought process:

• Am I being patient with myself at this moment?

• Am I going to let myself keep moving forward, or will I let this moment fester?

• Will it serve me to process this experience with negativity?

• Am I being kind to myself?

I make a conscious effort to try to list a number of positive events from the day, and not just the negative. I hope that after reading my experience, that you can also jot down a few stopgaps to help you pause to build a productive internal dialogue. 

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Dr. Jenna Aziz is a cardiothoracic surgery resident at the Ohio State University.

The opinions expressed in the article are not affiliated with any institution, company or product. The article should not be interpreted as medical advice.

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