Everything Happens For a Reason, I read on a magnet for sale in the hospital gift store, between the wine-mom memes and stained-glass flower-shaped suncatchers. I'm in the gift shop to get my afternoon chocolate, a rich, indulgent little ball I rely upon to wake me up after lunch. All day I peer into my microscope and tell other doctors what is wrong with their patients. As a pathologist, I need to be alert. I scan the gift store shelves for the bowl of foil-wrapped bon bons and see another motivational quote: Embrace Optimism. I am reminded once again of Successories.
Successories was a popular store in the late '80s. I'd peer into it on my way to the mall food court, filled with glossy landscape photos in shiny black frames featuring some motivational saying — usually one large word would be the focus, TEAMWORK or AMBITION, something like that, followed by a short rousing quote.
Despite the mockery Successories weathered — epitomized by the spoof versions that emerged during my college years — you can still buy Successories prints online, and display them with or without irony. The human need for glib affirmation isn't a trend that dies easily.
Affirmations of the self-improvement and motivational variety are more common today than ever, both online in spaces like Instagram and in three-dimensional space. It's completely normal to be aggressively chided at all times. You can be at someone's house for dinner and be served with a napkin ring that tells you to Eat, in front of a wall bearing a sticker that tells you to Celebrate Your Family, then inspect yourself in a bathroom mirror engraved with See the Good.
Everything Happens For a Reason, I read while searching for my after lunch treat. As an adult and a doctor, I am filled with scorn.
How naive can you be? I mentally address the future magnet purchaser. Have you actually considered what "happens"? I suppose they mean the small things: I found a quarter, so now I can buy that chocolate. Or even big things, like if I hadn't moved to San Francisco I'd never have met my husband. For a moment I imagine acquainting the author of this magnet with the actual "everythings" that happen to people that I have learned from my work. Take for example the tumor I examined before lunch. It is rock hard and grey and it will eat the person alive from the inside. Someone made and grew it, and I weighed it, described it and took it apart. I photographed it for the surgeon like a trophy. It may kill the patient.
As a pathologist I know every single thing that could go wrong with a person and what sorts of procedures you'll need when those things do happen. I know about widely metastatic cancer when you're 23 from no known cause. I know how you can be feeling fine, just a little gassy so you go in for a checkup, and it turns out your whole abdomen is filled with a gelatinous tumor, biology's primordial revenge. I know that you can grip your chair to stand up and your bones can crumble beneath you because they were silently filling with a destructive lymphoma and you had no idea. I know you can be in your 30's and healthy, then get a cut on your leg while walking through a marsh and be dead from a yeast infection in three weeks. What could be the reason for any of those?
I chose medicine and then pathology in part because I wanted to get real and know about all the everything that could happen. I didn't want to spend my days deceived by the disguises our mortality wears, to be fooled by our civilization that hides the chaos of biology and physics. So I dove deep and understood everything I could about how things go wrong. I did so the way we understand biology — through naming, classifying, and categorizing. I've acquired this knowledge to help patients, but I also did it for my own personal reasons — I've identified all disease, so now I can prepare for any and all biological disasters, my own and others'. I can see the catastrophes looming, and I'm — intellectually, at least — ready for any of life's unexpected problems. I know how things happen the way they do.
The downside to this approach is that, as I've learned about disease, instead of becoming empathetic and enthralled by our own wild nature, I've become more cynical. Crunchy tumors and crunchy vessels are the real sounds we make, not the nonsense that spills from our mouths. (And people wonder why small talk is hard for me.)
I've seen the animal that is us and I have shrunk her into tiny, categorized boxes. Dr. Brene Brown calls this kind of rehearsing for tragedy "foreboding joy." To expect the worst is a protective mechanism. Sure, it works in the moment, but putting on this armour leads to toughness and detachment. It's a method to minimize vulnerability.
I've considered this kind of toughness an antidote to the pretense of positive affirmations, but it turns out that living in a mental dress rehearsal for the worst things that can happen is tiring. I'd guess that the habit of expecting the worst afflicts a lot of my physician colleagues, and likely contributes to the crisis of burnout.
Perhaps the opposite of those phoney quotes that drive me crazy isn't the harshness that comes easily for me, but rather honesty. Your vulnerabilities are really mine too. We have to accept our lives as they are and not deny the uncomfortable uncertainties. As Mariana Alessandri says in her 2019 essay on cheerfulness: "Forced cheerfulness is a denial of life. All experiences taste different, and if we force a smile through the sour ones, we are not living honestly." My efforts to fend off illness and bad things can't prevent my life and the lives of those I love from unfolding without order and someday ending. Even when I understand how our mortality works, it still doesn't ultimately make sense. There are too many mysteries and too many profundities beneath our mechanical selves.
If I were to try to live more honestly and wholeheartedly, I'd need more grounded affirmations, without the sugar coating. We all need new quotes for better living, something to inspire even when times are tough — when you need inspiration, not just to be told how to feel. Often poetry is the real balm. Poet Mary Oliver provides excellent guidance in her poem "Sometimes," in which she offers these "[i]nstructions for living a life: / Pay attention. / Be astonished. / Tell about it."
I've been trained to do the first: Pay attention. It's not easy. To do it, and regularly, you need to cultivate habits and mental accommodations to our distractible nature. Name, see, feel and even smell what you are seeing. Even if it's a colon tumor.
Be astonished. Wonder. Get out into nature, even into the wildness of your own body. Your body is not a commodity. Reclaim your curiosity for your own mental health and soul. In medicine and in modern life we want to box up and categorize the uncategorizable. But is there anything truly ordinary?
And the third? Tell about it: That's what I'm doing these days. I'm writing about pathology for non-pathologists. I don't yet know who is interested, but I'm enjoying the process of unboxing my categorized disease and terror. Sharing my perspectives on disease and visual literacy helps me remain curious, which might be what I needed. I estimate I'm midway through my career at this point, but after all — as they might say at Successories, with an appropriately majestic nature photo as a visual metaphor — it's not over till it's over.
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