when to hold and when to yield

I am listening to and very much enjoying Atul Gawande’s Better in the car. I read his first book, Complications, and loved that as well – this is similarly thoughtful in its mulling of both the details and higher order questions involved in medicine.

One quote today really struck me:

“The hardest part about being a doctor is knowing what you have power over and what you don’t.”

This reminded me, of course, of the marvelous Reinhold Neibuhr prayer that asks for the serenity to accept the things we cannot change, the courage to change those we can, and the wisdom to know the difference.

This also made me think about how I often act as though sheer force of will or kilowatts of anxiety will allow me to extert control over whatever unruly thing/person/issue is bothering me. How wrong and foolish I am! As Gawande points out (in the context of medicine, but it’s applicable broadly) the boundary between where we have power and where we don’t is often conceived as a bright line, but it’s in reality a fuzzy gray distinction, interpreted differently by everyone. Perhaps I ought not beat myself up too much for not having accurately and definitively mapped that border just yet. Perhaps it will never be permanent; perhaps it is always shifting.

I was then expecting Gawande to extemporize for a while about the need to know when to let go. He didn’t. He launched, instead, into a passionate defense of the power of fighting for something or someone. He gave several examples, all compelling, and it really made me think about the ways we fight for things. The ways our small choices demonstrate whether or not we believe in something. What it means to fight for something – the words are dramatic, the act is often not.

This turn of narrative flipped my reminiscing on its head, and made me wonder whither the distinction between fighting for things and people I believe in and irrationally trying to control the uncontrollable universe. A similarly blurry boundary, I imagine. Accepting what I do not like has never been a strong suit; I’ve been bratty and childish when I did not like an outcome, I’ve whined and cried and complained when my own firehose of effort did not change an unpleasant reality. But perhaps in these reactions one can see a kernel of goodness, an earnest desire and dogged commitment to making my corner of the world into what I’d like it to be. In this interpretation, taken to the extreme, just letting go seems to be giving up.

Which is which? I think the answer is “it depends” (one of the least favorite comments of a woman who likes certainty). For now, I’ll feel somewhat heartened by Gawande’s defense of the power of determination and belief, and will let it relieve some of the pressure I feel to learn to let go. I surely have enough control neurosis to be able to relinquish some and still have plenty left.