Finding The Oasis Of ‘Flow’ And Keeping Yourself Challenged

“What the hell is this?” I exclaimed as Chamberlain slid the scribbled napkin across the bar to me. I took a minute to actually look at what he had diagramed. Being the master psychologist he is, he said nothing in response to my question with the most porcelain of poker faces. Now I had seen a lot of things written out on a cocktail napkin before: surgical techniques, IOUs and the like, but I had never seen this type of chart before. 

There on the bar parchment was a diagram of an X-axis and a Y-axis.  Written below the X-axis was “Skill Level” and to the left of the Y-axis was “Challenge.” There were nine boxes. Across the bottom from left to right were “Apathy,” “Boredom” and “Relaxation.” In the next row up, there were “Worry,” “Neutral” and “Control.” Then on the top shelf (Chamberlain has probably never served anything “Top Shelf” without coercion since he left his private practice) were “Anxiety,” “Arousal” and finally in the top right corner, “Flow.” (See https://joshuaspodek.com/doubly-improved-representation .)

Chamberlain started to smile as he studied me studying the chart. “How’s your flow?” he asked. I looked right and left down the bar to see if anyone was within earshot, thinking that he was asking me an enlarged prostate/urological question and that he had something he needed to discuss. 

I picked up my libation, swirled it, and admired the amber hue, smiling at the irony of how much it looked like urine. “What do you mean by ‘flow’? Are you having a problem tinkling?” I answered. 

“Emotional flow,” he answered. Now that is a relief, I’m thinking to myself, as I just didn’t have enough energy right then to go the urological route of discussion.

Straightening his tie, he continued his line of interrogation. “You are a surgeon, correct?” I nodded the affirmative. “Where are you on the chart?” he inquired.

I had to study it again for a few seconds before answering. Looking up after a brief pause, I put my finger down on the napkin right in the center of the square labeled “Control” on the right end of the X-axis.

He cleared his throat with a loud guttural sound. When Chamberlain clears his throat, you know that he is dismissing everything you just said as either psychobabble or pure BS. (Is there really a difference between psychobabble and pure BS? Yes, there is. Psychobabble is that more erudite, academic sounding BS.) I looked up at him with that expression of “I know you are the psychologist and I know you know that I don’t really know.”

My bartender friend then continued on about how “Flow” was a term for “being in the zone” in positive psychology. “Oh, man, I love being in the zone,” I affirmed, now that I knew what he was referring to. “So you think you are still in ‘control land’?” he said while tapping the upper right hand square labeled “Flow.”

I peered down for a couple of seconds. While I wanted to be in the “Flow” square, I knew I rarely landed there in real life. But oh what a feeling when you did find yourself there occasionally. 

So “flow land” was geographically located at the preferred intersection of high challenge level and high skill level. One hundred-eighty degrees opposite of that location was the undesired land of “Apathy” with the neighboring suburbs of “Worry” and “Boredom.” Now I started thinking about how this chart related to the surgical and clinical practice sandbox, and how I knew a lot of the residents in these different areas on the psychological land map. 

Chamberlain then interrupted my silent contemplation. “This is the map that can chart how long a practitioner can go on without going totally mad and burning out,” he stated. He pulled the napkin back from me and started his tutorial. “Up here in the land of flow, the skill level of the individual is very high and the challenge is commensurate. This is where the beast feels best. It is the oasis so to speak. It’s a high challenge, high skill level. Now when the skill level is high and the challenge is low, bad, bad things can start happening in the cranial vault over time. Boredom and apathy ensue, and practice burnout begins.” 

I had to interrupt his soliloquy. “Man, I know a lot of colleagues down there. These guys come out highly trained and then there just aren’t enough of the tough cases on a monthly basis for these folks to feed on,” I said. “How can they overcome that?”

“Very tough question,” Chamberlain replied. “This is a very difficult situation to solve.” I nodded my head in agreement that it was a tough deal to solve, but I still yearned for his take. “Practice environment,” he flatly proffered.

“What do you mean by that?” I asked. He replied, “Go to the hunting ground where there are the types of animals you wish to hunt.” So now the light went off and I replayed several of the conversations I’ve had recently with “burnouts” in my monkey mind. 

“I totally get it. If you don’t match the arena to the player when you come out of training, you could imprison yourself for the next several decades,” I told him.

“Yes, my good man, you’ve got it. The graduate who loves general practice and has that skill set can do very well in a rural practice, possibly even solo. But if you take that young doc who has a penchant and training for complex limb salvage, and put him in that same rural practice, he will go stark raving mad in less than five years,” the master shrink declared. “That doc’s skill level is just so high and the challenge so low that discontent is only a short time away.”

“But Chamberlain, there can be a real conundrum here with certain folks. What if the limb salvage doc has big city phobia?” I asked, already knowing the answer.

“Oh, now you’ve really upset the apple cart. That’s why students really need to do some introspection prior to selecting their postgraduate training. They have to match their dream of practice to the environment that makes them thrive the most. The penguin simply cannot live in the high mountain desert.”

Chamberlain and I closed down the joint, poring over the napkin and talking about different examples we personally knew. We came to the conclusion that it would be great for there to be some mechanism for young doctors to make sure they put on the right jersey for the sport they really ultimately wanted to play in before they ended up in the football stadium carrying a tennis racket.