My own private ski school

With thanks to MF for the conversation that sparked this post.

I had a problem with timing when I was getting ready to take the Medical College Admissions Test (MCAT). Having spent the previous ten years studying, and then teaching English, I was unprepared for the rapid-fire of multiple-choice after multiple-choice questions and could never finish the practice tests. “You’ve got to pick up the pace,” the MCAT prep instructor kept telling me. “You need more confidence. Stop fussing and attack the questions.” But in spite of his coaching, time after time the “finished” buzzer would ring and I would be stranded on question 34 or 35, puzzling over the correct choice and having left many other questions unread. In a test where unanswered questions are marked wrong, I failed every time.

Not passing the test could be a problem. I had quit a job at a small New England college to change careers and go to medical school—and then spent all my savings paying for pre-med classes. I had put all my eggs in one basket, so to speak, and the MCAT was the thing standing in the way of my new life plan.

Or rather, I was standing in my own way. My education in the Humanities had valued a slow, brooding, thorough, and analytic approach to thinking. Learning science was requiring something new: that I be a quick study, have ready answers, memorize the facts, spit them out. Without flinching. Without doubt. Just because they were. Facts.

Stuck in the middle of being trained to think one way and the necessity of performing while using another, I began casting about in my memory for a parallel activity. An analogy or metaphor. Was there another time in my life I felt confident and had performed without hesitation?

It took a while to come up with the other activity, and when I did it surprised me—because it had nothing to do with intelligence or critical thinking or academe. Growing up in the Intermountain West, the one thing I had learned to do without much self-doubt was to ski. I knew how to attack a steep powder- or mogul-covered slope without much fear and to even ski it fast. In fact, skiing fast was better.

Having come up with this analogy, I put it to the test. I started to imagine each MCAT question as an individual mogul and each section of the test as a steep slope. “Don’t be scared. You can do it,” I would coach myself at the beginning of each practice test. “You know how to ski fast. You can make these turns.” And then I was off and going, planting a ski pole on the surface of each multiple choice question, sucking up the weight of the turn around the pole with my knees, then pushing down off it, gaining speed, and onto the next question and turn. “You can do it. Faster. Faster. You’re strong enough,” the internal mantra went, and pretty soon, I had skied the slope.

Soon thereafter, I finished my first practice test on time, and when I finally took the real exam even found myself gazing back up at the mountainside with a few minutes to spare, considering if I should have attacked a few moguls in a different way and then changing an answer or two as the slope dictated. I did not ace the test, but I did do well enough to get into medical school, and when the med-school acceptance letters came, I knew thanks went not to god, the universe, or a guardian angel, but to my parents, who had hauled my butt to the ski hill every winter-Saturday from the time I was seven- until I was seventeen- years-old.

My stumbling onto this skiing metaphor as a way to pass the MCAT is not just unlikely because I was a science-novice, but because I am not very athletic. I was always in that last-to-be-picked group of kids for team sports in school. I could not run fast, and could not kick a ball or hit one with a bat or a tennis racket. I could catch fly balls and would have made an excellent center fielder on the church softball team, if only I had also been able to throw. But whenever I was lucky enough to launch the softball further than ten feet away, I had no guarantee of where it would go. Given this lack of athletic ability, it really is a miracle that I learned to ski.

It is also a testament to my parents’ tenacity and patience, because somewhere in that long sequence of Saturdays on the ski-hill, something clicked, and the sport started to make sense to me. Then it even started to be fun. By the time I was in high school, I could out-ski any of the girls—and most of the boys—my age. But do not get me wrong: I was no rock-star; no cool, young savant on skis. My skiing was pedantic and hard-earned. But what I lacked in innate talent had been made up for by sheer accumulation of hours spent on the slope.

Nevertheless, over time, skiing became a thing that gave a nerdy girl like me confidence and even a sense of physical prowess. Other activities—both physical and intellectual—did not seem quite so scary, and even if I knew I could not do something well, I was less afraid to try. “I can go wherever you want to take me on the mountain,” I took to saying when spending the day with skiers more expert than me, “but the way I get down may not always look pretty.”

I carried this skiing metaphor from the MCAT and into medical school. A little pre-test skiing pep-talk got me through many difficult exams. The metaphor also proved helpful when things did not go so well. Skiing had taught me not just how to fall, but that in a sport practiced at such a fast pace, falling was inevitable. “Yard sales” are the name sometimes given to those Wide-World-of-Sports catastrophe-falls that leave a skier and ski equipment strew all across the mountainside. I had experienced enough of these to know that even though while I was cartwheeling ass-over-teakettle down the hillside I was sure I was going to die, I would always—eventually—stop tumbling. I could usually then pick myself up, mutter a few bad words, collect my equipment, and start skiing, again. As corny as picking-oneself-up-and-starting-over sounds, it helped me to remember these experiences when I panicked over learning a difficult concept or performed poorly on a med school exam.

My use of the skiing-as-a-way-to-learn medicine grew even larger in residency. Practicing Emergency Medicine and skiing a difficult slope both require a combination of careful decision-making, kinesthetic know-how to perform tasks with your body, and an ability to sometimes fly by the seat of your pants. I would stand at the head of the bed in the trauma bay waiting for a patient to arrive, rehearsing the details of the paramedics’ report in my head, and plotting the interventions that would be required—intubation, fluid resuscitation, a chest tube, and central lines—in the same way that I would pick a line and plan a descent down a steep mountain slope. “You know how to ski” I would tell myself, “you can do this too,” and then the patient would arrive, things would start moving fast, and I was back in my childhood skiing hard icy bumps—moguls sometimes as big as Volkswagens—sucking up turn after turn, bending my knees to absorb the shock of each successive bump, and sometimes getting thrown off course, but always coming back, finding a new line, and setting off down the hill, again. Learning Emergency Medicine this way took some of the fear out of it, and sometimes even made it fun.

Throughout all this, the reality that I was dealing with peoples’ lives was not lost on me: but in my mind, comparing trauma resuscitation and skiing was not a game. Rather, it was a mental device—and a guilty, even shameful secret—that enabled me to do work I cared about. I did not exactly want my patients or residency director or colleagues to know that in the thick of a trauma resuscitation part of me might be carving figure-eight turns in deep powder at the resort where I grew up, but if some hokey mental gymnastics helped me do my job, I figured no one needed to know. My mental gyrations and accommodations might not have been pretty, but usually they worked.

By the time I finished residency, my use of these skiing analogies had become so second nature that I did not think much about them as I started my first full time job. But I did look forward to actually skiing more. My first, real paycheck, post-residency, splurge was for season ski passes for my husband and me at our favorite Utah resort. I would have more leisure time than I had in years and planned on skiing to my heart’s content.

Utah blessed me with a winter of record snowfall, but I had not counted on the time in residency taking its toll. It had been three years since I had skied much at all, and on my return to the mountain discovered that I was more tired and out of shape than I had ever been. I had spent the previous years titrating calories and caffeine across eighty-hour work-weeks and had the extra pounds and flabby body to prove it. My ski clothes did not fit well and my legs did not respond very quickly when I called out to them “Turn! (Damn it) Turn!”

But still, there was something peaceful and familiar about the trips to the mountain—the alternating classic rock and then NPR on the radio, the snowflakes falling on the windshield, the windshield wipers pushing them away. And although sometimes I felt weary after just putting on my ski clothes and carrying my gear to the chair-lift—and some days only made a few runs before heading home—I had to keep skiing. Even poorly, even tired, I had to pay homage to the activity whose memory had sustained me through the work of becoming a doctor. “I think I am just going to be an intermediate skier this year,” I told fellow skiers and family, and stuck to easy, groomed runs—skiing fast, with as few turns as possible. “I’m too worn-out to push myself.”

But then, one day, something interesting happened. My husband had coaxed me back to an old haunt, a favorite steep slope—an open bowl covered with moguls. It had not snowed for a couple of days and the conditions were poor: icy snow with hard tracks carved by previous skiers. “I’m too tired. I can’t do this,” I called out to him.

“Sure you can,” he hollered over his shoulder, and then shot off, leaving me with nothing to do but follow him down the hill.

And then it happened, sometime between standing at the top of the pitch plotting my line—and then sinking knee and chin deep into bump after bump, turn after turn—there was a familiar voice and message, but with a brand new twist: “You can do this,” the voice said. “You can make these turns.” And because I felt worn out and fat and doubted myself it came back: “You’re stronger than you think,” it insisted. “Don’t be scared. You know how to run a trauma resuscitation.”

You know how to run a trauma-resuscitation? I thought to myself and nearly stopped mid-turn. These words shocked me, not only because I had never heard them before, but because in handing back to me my own mantra—but in reverse—my unconscious mind had proved itself smarter than the rest of me. I was stunned. The shameful, secret crutch I had used to get me through medical school and then residency had grown up something stronger and fresher in its wake. The nerdy, un-athletic kid had grown into a skier and then a doctor—and now the doctor was sustaining the skier who had created the doctor in the first place.

I took a breath. This was all a little too complicated for me to understand, so I just kept skiing. And sure enough, memories of practicing emergency medicine kept me upright making fast turns, chasing my husband down the icy hill. The doctor-adult was repaying the skier-child and they both rejoiced in the pure pleasure of it.

I think about these skiing and Emergency Medicine mantras, now, every time I go to the mountain, and when I am at work, too. I suppose they represent some clichéd thing about coming full circle or some kooky psychological accommodation for which I do not even know the name. But all I really care about it that they work. And when I am on the ski slope making fast turns or waiting for my next patient in the trauma bay, I count my blessings: for snow, for parents who taught me how to ski, for skis themselves—and for legs and arms and poles and boots and bindings. And I pause to wonder about a childhood activity that grew to be so much more than the sum of its parts.


17 responses to “My own private ski school”

  1. Beth W says:

    Wonderful essay Annie. I ski my best when I let go of the fear and push myself down the mountain, pretending to be better than my fear lets me believe.

  2. lane says:

    That’s funny and weird about the switching of the “coaching voice” as you were on the slopes.

    That’s the “awareness” that Pandora wrote about as a comment on the Other James post.

    Growing up, being an adult, being able to live in your skin, requires this kind of familiarity with your thought processes, and how you arrived at them.

    Nicely written.

  3. bw says:

    I really like the turn this took when you found yourself using your medical skill to give you courage on the slope — and that so much literal skiing ended up in the post. I didn’t expect either at the halfway point. I wonder if others have similar stories. Certainly I used to perform music a lot more than I have as an adult, which probably gave me a certain degree of comfort in public or performance situations; now I’d have to draw on my experience in the classroom to gear myself up to get in front of a crowd and play music.

  4. bw says:

    p.s. thanks for taking the slot today! i needed the vacation!

  5. LP says:

    AW, I loved this post. Sports were a huge part of my life growing up, and like you, I not only gained self-confidence from being able to do a physical activity well, but I’ve also continued to enjoy the benefits of being able to play right into adulthood. Especially for young girls, sports can provide a way to feel capable and in control. And of course there’s the extra benefit having improved health overall.

    I loved this insight:

    Nevertheless, over time, skiing became a thing that gave a nerdy girl like me confidence and even a sense of physical prowess. Other activities—both physical and intellectual—did not seem quite so scary, and even if I knew I could not do something well, I was less afraid to try.

    …especially the last part, about being less afraid to try other things. Playing sports definitely taught me that there are all kinds of situations you might find yourself in, some of which you’ll win and some of which you won’t. It’s like life lessons in miniature, but they convey pretty seamlessly to real life.

  6. Natasha says:

    When I was born, I had severe respiratory problems including asthma upon excretion. (Mom worked at a chemical lab mixing harsh solutions throughout the full term of the pregnancy. Hey, no complaints, I am out in one piece.) I always had these doctor’s notes that kept me out of PE, but never wanted to be an outcast, so I joined a handball team. We trained really hard. About 30 minutes into each practice, I had an asthma attack. I left to use the restroom and used my inhaler instead and did penalty push ups upon return for staying too long. After a while my asthma seemed to have given in. My doctor said something about scarred airways, who cares, life is too short. I left handball but never stopped working out and pushing myself forward. I realized that there was nothing that stood in my way: whatever I greatly feared I had the power to overcome. Life’s experiences are too beautiful; I wouldn’t miss them for the world! Great post Annie!

  7. Natasha says:

    Asthma upon exertion haha I should read before I post, now I’ll be turning colors all day.

  8. Dave says:

    I was wondering about this strange malady, asthma upon excretion.

    I love the idea — not just the idea, the evidence in this post — that expertise transfers across extremely different endeavors. I suppose I should get good at something.

  9. LP says:

    Dave, your ability to declaim any statement as unerring truth over a scotch on the rocks is a great, transferable, and totally endearing skill. It is your equivalent to hurtling down a ski slope.

  10. lane says:

    Find that man a sales job.

    LP – “declaim”?

    I’ll stop, there I go again, wandering into trivia.

  11. Dave says:

    Declamation is hardly trivial, Lane.

  12. Rachel says:

    You mean everything Dave says over scotch isn’t true?!

  13. LP says:

    Everything Dave says over scotch has the ringing sound of truth to it. Which reminds me of the photo of Dave — one of my favorites, even with the wacky cropping — in this old post. He is, may I reiterate, right more often than he is wrong.

  14. lane says:

    declaim or proclaim

    (I’m not finding fault here)

    just posting an instruction

    Discuss.

  15. PB says:

    I have been traveling for days, just got back – this is so lovely.
    I too was a bit of an athletic catastrophe as a kid – but in high school discovered long distance running. I was not fast, but could run for miles. I remember walking down the halls of high school thinking: “I can run 10 miles and most of them can’t” It did more for my self-esteem than all the A’s and good girl behavior combined.

    We missed you AW – you old rabble rouser.

  16. AW says:

    I had a computer in the repair shop this week and missed out on so much whatsiting! Thanks for comments. LP, I really like the bit about “life lessons in miniature.”

    And, Beth W– I love your blog. Reading it and What I Made for Dinner inspire me.