I'm a big fan of at a glance measures that provide disproportionate insights into the big picture. When visiting the home of fellow physicians, one of my favorite metrics is the height of the toilet reading journal pile in the bathroom.
Pile is an interesting word to describe this phenomenon. In addition to connoting a heap of items lying atop one another, it is also a prior generation's term for hemorrhoid - likely originating in the 1400s from the medieval Latin word pila meaning "ball."
Most of us (or at the very least our partners) would agree that the toilet reading journal pile is a comparable pain in the keister.
And You May Ask Yourself: Well, How Did I Get Here?
As a resident, I developed a habit of tearing into the latest Annals of Emergency Medicine and identifying the 3-5 most interesting articles in the publication to put on my radar. Friends in different fields of medicine had similar relationships with JAMA (I usually read A Piece Of My Mind and tossed back the rest) or The New England Journal of Medicine.
Inevitably, somewhere on the path from resident to attending, my reach exceeded my grasp. I wanted to be the kind of doctor who deeply read 3-5 articles of every journal I received. I became the kind of doctor who dog-eared 3-5 promising articles in every journal and unceremoniously tossed them into a stack.
After a couple of years, the stack took on a life of its own. First, it outgrew the magazine rack and went from a horizontal to a vertical configuration. Then it began to metastasize - a couple of years' worth of journals atop the toilet tank, another half decade of journals stacked as tall as your toddler in the corner with a plunger unhygienically leaning against it.
Once the throwaway magazines started to arrive, it got really interesting, because these were shoved into the cabinet beneath the sink, never to emerge again.
It was like the early 1980s roach motel commercial...journals check in, but they don't check out.
A strange phenomenon occurred when I cut back. Those piles started to decrease in size for several reasons.
Thank Marie Kondo And Grandpa
Part of it was attributable to a trend toward decluttering. As I get older, I witness aging family members drowning in their possessions, frequently in homes too large for them to manage.
They cannot extricate because they don't want to sort through their clutter, so they inhabit a lightweight version of hoarder reality television shows. Worse, they rationalize their inaction by telling their kids, "You want your inheritance? This mess if the cost of admission."
I fantasize about right-sizing our home as soon as the last kid leaves the house, renting this one out and slow traveling the better part of the year for at least a month at a time.
Cutting Back Leads To Tuning In
The other freak change? The shifts I work now are infrequent enough that they inspire me to read up on the literature. When I get two cases of urethritis on a single shift, I review the latest CDC guidelines to see if they've changed since the last free Tarascon Pharmacopeia I picked up as conference swag.
Hopeful male patient accompanied by pregnant girlfriend: Maybe it was from my new boxer shorts?
Me: It was not your new underwear.
(If life imitates art, it appears to be low art: The Jerry Springer Show).
When I have a life-threatening bleeding ulcer in a patient on novel anticoagulants, I review the latest article on reversal techniques.
People Love Spending Time On Their Hobbies
Like other hobbies, medicine has recaptured some of the novelty in learning that I hadn't experienced to this degree since leaving residency.
So to those who fell in love with medicine when she enticed you with the hoochie mama dance moves (or when he had all his hair), when the attraction was brimming with romance and possibility - perhaps cutting back is the path to renewing your vows?
You might take to appreciating a salt-dappled beard that bestows a senior statesman panache, or the elegant, sultry figure she cuts with the added confidence of time. Medicine can get more interesting with age - especially if you do it less often.
The added time and energy I found in cutting back has allowed me to renew my dedication to read or discard what's in my toilet reading journal pile.
Isn't it high time you sh*t or get off the pot?