Its June in Lincoln, Nebraska.

The birds are out. Robins, cardinals and the beautiful meadowlark with its melodious song. You just finished your shift at the local hospital as an administrative clerk.

The short drive home.

You smile in gentle anticipation of an evening jog. As you pull into the driveway, you check the mail.

Shuffling letters.

Then you stop. Your heart stops. You gasp for air. With your hand-me-down Honda Accord half parked in the driveway, you take off running into your family’s house.

“I’m in. Medical School. The letter says so!”

Its a day among many milestones that every physician remembers as long as they are alive and practicing. The day they got into medical school. In the idealistic stupor of acceptance to your institution of choice, you are blind. Though you are rightly excited, relieved and grateful - you have no idea what you’re in for.

Over the next 10-years, painful truths will be exposed about your beloved profession. And you will be forced to confront your choice of becoming a physician.

Hi, I’m Chuck, from 3DEEPERCUTS and I wish to share with you:

“How to survive medicine” - A Manifesto (Part I).

In this pieces, I will cover 3 areas in the 3DEEPERCUTS survival package. 1. Living Close, 2. Home Equipment, and 3. Chunking Down Goals.

I write to you as an antidote to the concept of “burn-out” which is frequently a topic at physician professional events.

When I started my journey in Medical School followed by Naval Service, Residency and now in Private Practice, I uncovered one fundamental truth about myself:

I realized that I am a physical person and I require regular, intense bouts of exercise in order to function like a normal human being.

The trouble with choosing the path of a “healer” (ironically) is that the training pipeline is designed to make you physically and mentally ill.

• You will not have much money to live on for about 10-years

• You will frequently be tired

• You will frequently face stress and social isolation

• And worse, unless you are extremely creative, you will not find much time for physical exercise

#1  Living Close.

As a medical trainee, you will not have much control over your schedule. However, your choice of apartment-living IS under your control. Find a place walking distance from both your hospital and the gym. If you can’t find something walking distance, then focus on finding living quarters within 2-miles of the hospital and the gym.

During your medical school exam weeks and during your busy call weeks of residency, every minute counts. In school, you are spending 6-hours a day in mandatory lectures. In residency, you spend 10-plus hours a day either rounding on the wards or sitting in a cramped resident room hammering out progress notes and discharge summaries on a squeaky chair with poor ergonomics.

In my case, I was a pathology resident which meant 10-12 hours per day of sitting at a microscope or standing up grossing in the histology laboratory.

The lifestyle is unhealthy by any standard.

If you have even 45-minutes of down-time per day, you don’t want to waste that time commuting. There were some folks out there who were dead set on owning a home in the suburbs during those early years.

You might be one of those people.

But odds are, if you’re reading this, you are wired like me and are looking for ways to be a healthy doctor. To practice what you preach. Rather than an overweight, burned-out ghost of your former self.

If you wish to survive in medicine, live close to work.

#2 Home Equipment.

If you’ve read my prior writing on Living Room Fitness, then skip this part of the piece. If not, read on. Your university may have a fitness center on campus.

Great.

Its unlikely to be open at the odd-hours required to maintain a fitness habit through the training years. Most fitness centers are open from 6 AM to about 10 PM. However, some hold more restrictive hours.

• Most are closed on Holidays

• Most hold shorter hours (8 AM to 4 PM) on Weekends

But what about an off-campus gym like 24-Hour Fitness?

That could be an 10-mile drive from work, plus the 15-minutes it takes to walk from the hospital wards, through the tunnel, through the parking garage ramp, past the annoying people who take forever to exit the parking garage ramp.

By the time you drive off to the off-campus gym at midnight (or whenever your shift ends), you would’ve wasted nearly an hour of precious down-time. You could have spent that time reading, sleeping or spending time with your intimate partner. All of these “down-time activities” are required to recover from the stresses of physician-training.

Therefore, if you are a physical person, you must create a physical back-up plan.

Create a small, portable and collapsable fitness center in your Living Room. Your Living Room Fitness Center is what you fall back on during your surgery rotations, or on holidays and weekends.

Its what you use during those insane cram-weeks of the first 2-years of book-work. Surprisingly, you do not need much space in which to get a decent work-out. A simple 10’x12’ living room big enough for a mat, a flat bench and a set of PowerBlocks. Kettlebells and some resistance bands are a nice addition and can be purchased either used from a gym or on eBay. All of this can fit into a student-sized budget if you are patient and smart about it.

Where most of us fail (including myself, for years) is we do not set clear boundaries to our work-out time.

Most of us will just say “Oh I need to work out in the morning” and hope for it to happen.

It may last for a couple days. Maybe a week. Then it fades out when you get busy. You wake up in the morning, tired from the previous days work. The allure of zoning out and scrolling Apple News on your iPhone is more attractive than lifting.

The solution? A written plan.

Studies from behavior psychologists have consistently showed when we have a specific plan, we are more likely to adhere to it. So you got your Living Room Fitness center all set up.

• What time are you going to work-out?

• From when to when?

• How many reps are you going to do?

• Which exercises are you going to do?

• When does your training session end?

These crucial details are what Bill Phillips refers to as “Crossing The Abyss” in his 1999 book, Body For Life.

There is always benefit to having a written training plan, even if things do not go according to the plan. In fact, I can guarantee they will not go according to plan. But you know what?

It doesn’t matter.

The more you write a work-out plan and attempt to see it through to fruition, the more you will get addicted to the subtle dopamine hit of adhering to an agreement you made with yourself.

Self-confidence, self-trust and a positive mental attitude will ensue.

But it starts with action. After months and years of doing this, the work-outs will become less about weight-loss and more about psychological empowerment. When you rewire your neural circuitry as described above, you will be blown away at how the other areas of your life begin to improve.

#3 Chunking Down Goals

Body For Life uses a 12-week training plan. 4-months is a nice block of time to chunk-down your fitness goals. Keep a wall-calendar cross-off each day you adhere to your plan.

Apply the same weekly benchmarks to other areas of the medical training processes. That could be:

• 100-new Anki cards made per week

• 2-chapters per day of physiology

• 4-paragraphs per week of a scientific paper you plan on submitting

• 5-pages per week of notes

• 500-old Anki cards reviewed per week

• Write for 10-minutes in a journal every day

• Fill-out 1 residency application section per week

These short-term carrots will give you something to shoot for. The reward is you get to keep playing the game.

One last story.

During my job as Medical Officer at a Combat Logistics Battalion aboard Camp Pendleton, CA, I struggled with maintaining weight standards. I was not squared away. I was embarrassed.

I had spent the preceding two years in San Diego and had settled into an apartment with my now wife. We were at the point in our relationship where it made sense to be together. She had a good job at the Naval Hospital down there and I didn’t want to make her move.

So I drove 45-minutes North on the I-15 everyday for work. Both ways.

The hours and days of commuting added up. Within 6-months I had a solid inner-tube of fat around my waist because I had not changed my eating habits to account for my increasingly sedentary lifestyle.

I remember the day I was overweight by 2-lbs and had to “get taped”. As the officer-in-charge of the medical clinic I felt like a fraud. I was a fraud. Had stand there while one of my own corpsman measured my waist circumference.

I looked him in the eye and said: This ends here. Sorry HM3.

He laughed: Don’t worry about it Sir.

After that I was obsessed with finding ways to adjust my lifestyle. My work-outs did not have structure. My diet was disorganized. I managed to “will” my way back down to about 165-lbs through long weekend bike rides. But I spent way too much time doing it. It was not a sustainable practice, especially as I transitioned to pathology residency at one of the most intense programs in the country at Barnes-Jewish Hospital.

Over the next several years as I adjusted to Civilian life I developed a system for running, lifting and diet management which worked with residency life.

My system may or may not work for you.

But the process involved with taking a total life inventory and writing down structured work-outs for yourself is a super-power.

I hope you make it work for you.