The Power of NO!

 

“I realized for the first time that when I said NO, I was in actuality saying YES to something else, and until I discovered the ability to honestly say NO, I could never ever say YES to anything”

 

In my position every year I mentor one or two students who are applying to medical school. These students shadow me 8 hours each day as I move through clinic, hospital and nursing home in my daily rounds and we have this informal continuous dialogue on all things pertaining to the field of medicine and humanity in general.

 Last year, one of my students asked me a very curious question while we were having coffee at the doctor’s lounge in the hospital, about whether the word YES had more power than the word NO.

 This is the story I told him….

 “For the first three years of my practice, I refused to take a single day of break from work” I said as I sipped my coffee.

 “My pager was on 24/7. My patients could and did reach me at all hours of the day and night. I did this partly because I needed to. I could not afford to not be available. I had started a solo practice amidst a sea of large, well-established group practices. The only way I could stand out was by offering incredible access.”

 “But I also did it because I loved being a physician. In some ways being always on call fed a subtle egotistical satisfaction. Gradually my practice grew. I found my waiting room filled with patients. However I did not see, ….. could not see …. that the population of patients that I was attracting were invariably the ones that emotionally and psychologically avoided the responsibility for their lives. They thrived on my patience and my willingness to indulge their every whim. I was enjoying the rush of healing and serving this growing population”.

 “Then one night I woke up overwhelmed by enormous pain in my stomach. I staggered to the bathroom, hugged the commode and started vomiting. The waves of pain and nausea refused to stop and finally I had myself admitted to the hospital where I was diagnosed with a stomach ulcer. Lying there on the hospital bed, I had an epiphany of sorts. I suddenly realized that if I died, right then, none of my patients would have been at a loss to find a physician who could serve them just as well within 24 hours of my demise. This flash of insight seems obvious now to you and me, but right then it hit me like a thunderbolt”.

 “You see at that moment I discovered the other face of an age-old truth. We all are taught from a very young age that it is morally wrong to accept a reward that has not been earned. We learn this with so much force that we often spend our lives earning each one of our rewards twice over just to be sure we don’t violate this moral rule. In this way we become strangers to the grace of receiving. But reward has a vital place in this world. What most of us take a lifetime to learn, is the corollary of the first rule. Just as it is a sin to accept unearned reward it is an equal sin to refuse the acceptance of reward that has been justly earned. I realized that I did not have to earn my reward twice over each time. What is more, I realized that all my rewards were already earned by me and that I was serving as a physician purely for the beauty and nobility of the role. I saw clearly that there was no additional patient to be sought after to come to my door. But perhaps most importantly, I realized for the first time that when I said NO, I was in actuality saying YES to something else, and until I discovered the ability to honestly say NO, I could never ever say YES to anything”.

 “In that moment I discovered that all creation was one and equal and that I could not serve any part of it with goods stolen from any other part even if it were with goods stolen from myself. I learnt that I had to first and foremost reward myself, ensure that my well was full before seeking to slake the thirst of my fellowman. And what was more; I had to conduct myself in a way that demanded that my fellowmen conduct themselves with discipline and respect. I realized that when I indulged their every whim out of misplaced compassion I was doing them and myself equal injury. And when I gave away my service without demanding that the recipient earn it, I was blaspheming the essential sacredness of the gift.”

 “I walked out of that hospital the next day with a spring in my step and a gleam in my eye and have never looked back. My practice never suffered. I did not turn away anyone in true need; I merely insisted that they also take responsibility for themselves. I stopped saying, “Yes” to every request and insisted on setting some boundaries. I insisted on being home for dinner with my family every evening and began to walk out of the office at 5:30 pm every day even if I had to leave papers on my desk. Overtime, it was very rare that work piled up on my desk at the days end. I entered into a call sharing rotation with a couple of other doctors who I trusted. Soon I started seeing a new breed of patients. People who were truly ill, who cherished what I offered and put my advice to good to use. My reputation as a doctor who cared for his patients grew and the fact that I insisted on my patients taking responsibility for their health empowered them.”

 “Looking back I now wonder at the power of this simple word, NO! No other utterance is more feared and more maligned in our culture. Yet to be able to say it, one has to have a clear sense of values and a sense of purpose. Indeed this is the first thing that should be taught in schools and colleges… the How To, Why To and When To of saying NO!”