Letting Go: A Life Lesson at Home and at Work

Anxiety palpable, he gripped the bike's steering wheel that sunny Saturday afternoon. The sweat formed beads on his forehead like morning dew on grass.

"Don't let go of me, Dad," he declared.

"I won't until you tell me you're ready," I replied.

Hesitant, he propped his right foot on the pedal, followed by the left. His grip on the handlebar tightened. Slowly he started pedaling. Like a newborn giraffe awkwardly gaining its balance, his bike wavered left and right as he began to lurch forward.

Foot by excruciating foot, the bike gained momentum. My back felt as if I was 100 years old as I followed behind, my hand still attached to his seat. I began to test him, letting go momentarily to give my aching back some respite. He kept going. Without letting on, I let go of his bike completely.

With the wind to his back, he pressed forward. At that moment, he realized my absence. His momentum carried him away from the safety net of the road's center, and like a bowling ball, he veered toward the sidewalk gutters.

He fell unceremoniously to his side, his ego every bit as bruised as his legs.

"Dad, I told you not to let go of me," he snapped. "I quit, and I don't want to do this anymore."

He stormed off back to our house, leaving me to pick up his fallen spirit and bike.

Just Like Riding a Bike

Teaching a child to ride a bike is a versatile life metaphor. As a pediatric hospital medicine attending charged with leading a resident team, teaching a child to ride a bike became a metaphor for managing learners in the clinical setting.

Letting Go

Physicians are notoriously type A personalities, and the challenge of leading neophyte physicians in a residency program provides a unique opportunity for letting go. When I led my first resident teaching team, I was only 2 years removed from my own residency training. I had only just become comfortable with implementing my own care plans, and the prospect of supervising others in making their own was daunting.

Imposter syndrome constantly reared its ugly head. To avoid a veritable "blind leading the blind" scenario, I quickly fell back on a memory of a former attending of mine. Prior to starting rounds, he would mention, "I am the guardrails and am here to keep us from falling into the gutters." I would quickly adopt this mantra, and the pressure to "do everything" eventually dissipated. Rounds became more collaborative, educational, and enjoyable as my team practiced their own clinical autonomy. Supervision became focused and less micromanaged.

Falling Is Part of Learning

As medical professionals, we carry the heavy burden of our oath to "do no harm." Although rare, mistakes do occur in any learning environment. With proper resident oversight, the more serious ones are averted. More common mistakes include delays in care, incorrect labs ordered, or conveyance of wrong information to patients and families.

As with my son's bike-riding lessons, I normalized these "falls" prior to leading a new clinical team. It does not excuse carelessness but allows for accountability within the learning process. The burden of "do no harm" is great and many learners can sometimes fold because of guilt. To mitigate this burden, first I allow time for the team to process and guide them through the circumstances and choices that manifested the error. Second, we discuss how to best proceed with the consequences and how to treat our patient. Last, we talk about how future errors can be prevented. As with my son, I do my best to avoid lingering too long on the fall and always view situations with a focus for future improvement.

Getting Back Up

The following day, my son again invited me outside so he could ride his bike. This time around we talked about setting both feet down when he felt off-balance to lessen the impact of a fall. We also installed a new support handle onto his bike so I did not have to run alongside while bent over.

"Are you going to let go of me again, Dad?" he asked.

"I won't let go unless you are really ready this time," I replied.

He remained skeptical but he proceeded to mount his bike.

"Okay, I am ready," he said.

Slowly he gained his balance. I felt his center of gravity adjust as the bike carried his momentum forward.

"Okay, Dad, let go," he crowed as I released my grip.

He and his bike moved down the street, as swift as the wind, leaving me in his wake.

It was one of my proudest moments as a father.

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About Dr. Giancarlo Toledanes

Giancarlo Toledanes, DO, is an assistant professor of pediatrics and a pediatric hospitalist at Texas Children's Hospital and Baylor College of Medicine in Houston. His professional interests include quality improvement, health equity, faculty development, and social psychology. When he is not in the hospital, he is a cook and a handyman to his wife, an amateur LEGO builder to his son, an aspiring unicorn to his daughter, and a walking burp cloth to his baby daughter. Connect with him on Twitter: @ToledanesGian

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