This is an essay adaptation of a perspective I gave to the MD/PhD program at Emory, on the theme of "My MD/PhD Journey". Obvious caveats apply: I'm just finishing this thing (in my M4 year). I had a unique journey, but so will you if you go down this path. I'll drop in some slides from the talk below. Apologies in advance for the armchair philosophy. And remember, this is free advice, so take it for what it’s worth ;)

1. You will get Older, and you will get Out.

Getting Older is the process of slowly moving out of a narrow orbit that circles you and your story, and into a larger orbit about a story that is bigger than you or me. It is going from "Big Me" to the "little me" as David Brooks writes in the Road to Character. Less you, more other. Getting Out means you inch your way towards the end of this thing, and that end can take many forms (defeat, drudgery, victory, fulfillment etc.) but one way or the other, you will finish. Because Getting Out is a guarantee, rest easy, and enjoy yourself; the infiltrating lie that this will go on forever can be dismissed.

2. You are Worthy; Work does not determine Worth.

My dog Rufus thinks you are worthy. He knows the truth.

This is a difficult one, but everyday you must "unmask" the lie that your worth is determined by the work you do, the value you add to something. This is an idea Henri Nouwen writes about beautifully in The Life of the Beloved. This is hard to accept because you are a value-adding person who has been taught by school, family, church, instagram, facebook etc., that your worth is determined by grades, admissions, scores, likes, mentions and awards. If this is you, then failure will destroy you. But there's hope. If you believe first (or come to find out) that you are a creature of infinite worth and dignity, then you will see the work you do as an extension of your creativity, an expression of yourself, and though failure will feel personal - it will not wreck you, your value is not in extrinsic validation, it’s intrinsic. You will rise again and again for the challenge, and hopefully the fun and fellowship. This is really hard to say, and I don’t even believe I truly operate like this, but in my moments of failure, when I have fallen short, this idea helps me appreciate that improving as a student is quite distinct from my value as a person.

3. Serve the Work. Do not make the work serve you.

We are obsessed with what we can get out of something, of what value we can extract. Recognition or reward. If you serve your craft first, learn its nuances, dedicate your efforts to understanding and navigating your model, you will find yourself on the inside of a wonderful secret, you will be on the inside of emerging, brand new knowledge, and you'll be with an intimate group of people who care about the work as well. You will "accidentally" enter into a group of experts who share a common language. It will not be contrived. It will be authentic. And that is the difference between being given a seat at the table and finding it enjoyable, versus taking a seat at the table and always looking for a more prestigious table, with more elite people, and going hungry all the while.

Inspiration (first, come alive).

This is my whole MD/PhD Journey in a snapshot. The person in the center is a friend and also my PhD advisor. I met this person through happenstance, and in the midst of trying to find work that gave me meaning, I stumbled on this friendship. I wasn't sure what I would end up doing in the next year, much less the rest of my life, but my gut reaction was that this was a good person who I would really enjoy working with. It's that simple. Then in the course of coming along side someone I admire, I happened to be exposed to a field that filled me with wonder. I honestly found the work exciting, enjoyable, and compelling. After this picture was taken, I got on a plane and went on my first organ procurement. Transplantation is the convergence of spirituality, science, surgery, and ethics. It brings new depth of meaning to the word "gift". Becoming a transplant immunologist was never a part of my plan, it was a gift I stumbled into while doing some very erratic, but very earnest searching. And then I picked this thing. I am not completely sure why sometimes, I think it has to do with what I've written already, knowing the person I was working with was a good man and being excited by the work. But at some point I stopped trying to find something better, and picked this thing. I decided to give it my full energy, or as best I could, as distractable as I am.

A bit cheeky but this is another way of framing some ideas, less philosophically, more pragmatically.

This first point is a joke, but it points to a truth. The worst thing you can do in your PhD is to set yourself up against your Thesis Advisor. I have seen it done in large and small ways. I think we can take a nod from general relationship paradigms on this one. I heard a church sermon once by Andy Stanley where he illustrated the difference between marriages that work and last, and marriages that fail. The difference is not communication or money or passion or whatever you might guess. The difference was that in the long lasting, happy marriages, folks chronically overlooked their partners real flaws. They almost became a little delusional about the flaws. I'm not saying we should be delusional, or condone an abusive relationship or something like that, but I am saying that making your relationship work with your advisor will go smoother the more you align with them. This does not mean giving up a sense of self, and simply becoming a technician, instead of a thinking graduate student. It means that after you have discussed an experimental plan, or a finding, or a scheduling decision about vacation time, or how you will or will not be teaching this semester, or which projects you will lead, or whatever... you commit to the plan. Early on I ran into a serious failure in graduate school. I nearly returned to medical school. During that time I set myself up, at least emotionally, against my advisor. It did not last very long. I realized very quickly that we were aligned on all the important things, and that this failure was really something I had to work through and figure out myself. And once we realigned, and settled on a plan to recoup the lost ground and move forward, the work carried on and things got better. To be clear, this is not an encouragement to pursue a PhD with a malignant advisor, it is an encouragement to make your relationship with your advisor work best by seeing the best in them as much as possible as a habit. If you are in a terrible situation, as I have seen some colleagues in, get out of it and find an advisor who is supportive. It’s just too often that I have heard graduate students pin their failures on their advisor. It’s an easy thing to do. And sometimes justifiable. But it really won’t help you, them or the work.

It's important to commit to the relationship between you and your advisor, and that means re-committing, especially after set-backs, disappointments, and failures.

Serving the work is a tricky, interesting thing. It's what some people call "flow" I suppose. It's also that split second decision you make when something breaks down, and you get fed up or you get interested and think "I wonder what's going on here," and you end up taking the vacuum cleaner apart. You'll doubtless have times when you have to take the vacuum cleaner apart. And you can get frustrated, and think of all the stuff you were supposed to get done that day, the groceries, the dog, the dinner... or you can hit pause on reality, and enter the problem and figure out what's broken. That's hard. But I promise it's a small meditative trick that will make the PhD seem much less painful. A lot of what you do is extraordinarily niche. The instruments are finicky. The assays are subject to change based on the lot number of the reagents. I can hear the computational PhD's groan at the thought of all the variance and the folks who are interested in reproducibility gather their swords as I write this. But it's true. A given lot of FBS may result in more robust cell-culture for some mystical reason. You may be called on to figure it out. But these puzzles are worth solving, and if you can convince yourself to get into the "flow" state of just working on a thing, instead of distracted by the could-have's, then the work will go faster. That's part of serving the work. You allow the work to speak first, and you respond. The opposite thing is forcing the work to be something for you. Before I chose to pursue transplant immunology I tried about a dozen different ways to get into informatics. I had worked at a software company and I was really interested in building a brand around myself as an informatics type, like a future CIO or something. I thought it made a lot of sense, given my background. But I would meet with folks and afterwards think, "Man, I'm kind of forcing this." I wasn't in love with that work. It was interesting. And boy are we in the era of data and informatics in healthcare. It is a sexy field. And I really wanted to be at the helm of something exciting like that. But I was making that work serve me. I couldn't ever get to the point where I was interested in getting inside the problem and understanding the way it worked.

Serving the work is pursuing deep focus. Making the work serve you is forcing yourself into domains and trying to extract value. It's really the difference between authentic interest and faking it.

Quick and Dirty Experiments.

This is a lot like the "Fail Fast" motto of the start-up culture (the start-up culture is sort of vexing to me, because I basically think it's just being entrepreneurial which is not new, but it's a bunch of folks who want what they do to sound sexier than it really is à la the authenticity vs. fakery conundrum). In any case, it's sort of akin to failing fast. I read this piece of advice from the famous ant biologist E.O. Wilson in his book, Letters to a Young Scientist. One of the gems in that book is that E.O. Wilson encourages young scientists to do quick and dirty experiments. Follow a hunch directly to the lab and test it. Don't bother setting up all the controls perfectly. "Just Do It". Just go into the lab, and do the damn experiment. Stop planning every last detail. Just do something. For the sake of figures, please power it up appropriately. I read the same thing in a small volume by one of my heroes and the father of transplantation, Sir Peter Medawar, in his similarly titled book Advice to a Young Scientist. In a chapter where he addresses how young scientists can best equip themselves to be a scientist, he warns against too much time in the literature and not enough time just doing experiments, "Few sights are sadder than that of a young research worker always to be seen hunched over journals in the library; by far the best way to become proficient in research is to get on with it..." But always follow up with a large, well-controlled, appropriately powered experiment to make sure what you’ve observed is not driven by artifact.

Just do it.

Another quick bit here, along the lines of doing something practical, is to continue to generate data. Roughly every week you should be doing an experiment, small or large, whatever, just do an experiment to move yourself forward. It may be one of those fine-tuning, trouble-shooting experiments. it may just be replicating an observation. It may be one of those long, Hail Mary types, where you're in the lab till the next morning. But once a week, do an experiment. And after you do it, make figures, and go ahead and put them in a slide deck, one that you just keep adding experiments to. Slide decks are sort of like the virtual, more presentable lab note book. This of course involves you cleaning up the presentation, but boy, you will feel good about your life if you have new data every time your PI asks. Medawar said it well again in Advice to a Young Scientist:

Sir Peter Medawar’s face when you haven’t been doing experiments

It is psychologically most important to get results, even if they are not original. Getting results, even by repeating another's work, brings with it a great accession of self-confidence; the young scientist feels himself one of the club at last, can chip in at seminars and at scientific meetings with "My own experience was..." or "I got exactly the same results" or "I'd be inclined to agree that for this particular purpose medium 94 is definitely better than 93," and then can sit down again, tremulous but slightly exultant." - Sir Peter Medawar, Advice to a Young Scientist

Lastly but most importantly. You. You are becoming someone. This whole journey will take on average 8 years. You're going to be done with your twenties when it's over, at least. Think about yourself 8 years ago. How different are you from that person? You can expect a similar difference to grow between yourself now and yourself in 8 more years. And who are you becoming? This is sort of the quiet truth. No one will tell you how to become a person. They will give you the tools to achieve some industrious goals. But people won't sit around and talk to you about if you need to be kinder, or more compassionate, or if you seem divided about your inner life. They will talk to you about your results. And if you are not also considering the first part, the who you are becoming, and you are only focused on this second part, the what you are doing, that second part will come to replace the first. "Who are you?" will be a surrogate for "What do you do?" But that is a diminished life. You don't want to be a scientist. Or a physician-scientist. You want to be a human being, connected in fellowship with others, a person with purpose and meaning, a person who who has considered their character and confronted the flaws and fractures within it, working towards a vision of goodness in themselves for the benefit of those around them. You want to be formed. You will be formed one way or another, by forces outside of yourself, or by an inattention to your inner life. You can be intentional about understanding these forces and choosing what you are being influenced by. And you can choose to become a person you are proud of. I think Clayton Christensen sums it up best:

“I promise my students that if they take time to figure out their life purposek, they’ll look back on it as the most important thing they discovered at HBS. If they don’t figure it out, they will just sail off without a rudder and get buffeted in the very rough seas of life. Clarity about their purpose will trump knowledge of activity-based costing, balanced scorecards, core competence, disruptive innovation, the four Ps, and the five forces.” - Clayton Christensen, HBS Professor

The formation of your character is more important than the fabrication of your curriculum vitae.

A focused development of your inner life is as important as your work, and the two are in a dialectical relationship. It's just that we often under-develop the inner life, focusing only on work. And the conversation is one-sided, and we become only half the person we ought to have been. So over the next 8 or however many years this thing takes you, make sure you invest time and thought into who you are becoming.

About 4 years ago I found myself at a very difficult place. I was not the person I wanted to be, not even remotely. I started meeting with a group of guys about once a month. We ate steaks, discussed life, personal struggles, our ambitions and aspirations, and the kind of men we wanted to be. I met these guys through a pastor at my church, without much direction except, "these are some good guys, they're interested in living intentionally, see if you want to meet with them." We went up to one of their lake houses for a sort of retreat, where we all took turns speaking about our lives, uninterrupted, for hours. We grilled, sat by a fire, ate meat, drank beer, and pondered who we were becoming. A lot happened over the next four years, but two of those guys were in my wedding, and we have continued to support each other through life's twists and turns. The thing I’m proudest of is that I’ve got a clearer vision of my purpose and the “who” I am becoming, and even though I often miss the mark, I have an aim.

Your MD/PhD journey will be unique. But I hope some of these ideas help you along the way: You’ll get older, and you’ll get out. You are worthy. Serve the work. Stay in alignment with your mentor (as long as they’re good people), generate data as fast as possible, and don’t ignore your inner life.

Some good books, also anything by Atul Gawande.