When I’m asked for career advice, I have 2 standard responses. (I forget where I heard these first; I’ve had many great mentors).

1. When you lean your ladder against a house, assume you are going to get all the way to the top. Make sure you lean your ladder against the right house.

2. What do you like to do during the day? Like for actual chunks of time, the small activities that compose your day: talking on the telephone? internet searching? writing on a computer? writing with pen and paper? pacing? being outside? being alone? running? talking to one person or groups of people? looking at spreadsheets? organizing? vacuuming? driving? Make a life that allows you to fill your day with the little concrete chunks you intrinsically enjoy.

And then I feel wise. And then silly. Who am I to give advice? I am a family doctor! But, not currently. I’m not sure what I “am”. 

The medical profession is a weird one. It’s such a big up front commitment. You dedicate so much time and life force to it. So much so, that you must be a selfish idiot to leave it. But time is just sunk cost. Should that tie you to something for your entire life?


There are significant challenges at every step to becoming a doctor. Once you conquer one step, you are hand-led directly to the next one. For an achievement junkie, it’s an appealing treadmill. When I decided to go to med school I was 23. I’d just gotten married, was trying to run competitively, and kept getting injured. I knew I loved science, wanted to help people, and loved hard work. I wasn’t afraid of the challenge. Perfect match! 

I was a good med student. 5 years. I had my first 2 boys in medical school. I worked hard. I chose family medicine, because I loved the complexity of care and emotional intelligence required. I was a good resident. 3.5 years. I worked with the most amazing colleagues and patients. After residency, I had my 3rd boy, and I continued to work with patients in need, who motivated me to be a better doctor. And I waited to understand what my life’s work would be. I was still searching. I went back to school and got a Masters in Public Health. I was still a good student. I published some health services research articles, continued working as a family doctor at a community health center, consulted for a non-profit health insurance company. 



One of my favorite profs in med school had a great definition for parenchyma. Parenchyma: the essential, distinctive, functional part of an organ, the bulk of a substance. She would tell us, “Parenchyma is the there, there.” I was looking for my existential parenchyma. 

And then I started running again, after 17 years off. And I felt more alive. Like being plugged in to a power socket. 

I met Sally, in October of 2010, on a long run. You know when you find your people? She is my people. I started helping out with various little Oiselle projects. Shenanigans. Because I loved it, because I couldn’t stay away. [Mac was witness when Sally first offered me keys to the office. I think I said I wasn’t ready. Awkward!]


I started working out again. On the track even. I could still scamper! I got super into running, got injured, rehabbed correctly and got back out there. 

I was still practicing medicine, teaching residents, doing some research writing, consulting, but my heart was pulled to running. To Oiselle. My there, there. 

One day I was evaluating applicants for a family medicine leadership award, and I stumbled onto the idea of the autotelic profession. The most sustainable profession for any individual is the one that is autotelic (meaning having an end or purpose in itself). Doing the thing that gives you flow, a state of intrinsic motivation, immersed in what you are doing, for the sake of the activity itself. Characteristics of the autotelic state: merging of action and awareness, sense of control, high concentration, loss of self-consciousness, decreased sense of time, the perfect balance between a challenge and your own set of skills. 


Aha! So maybe my career advice is decent, just applied to the functional AND cognitive level. What do I like to do every day? I like to spend some time outside every day, preferably running or at least moving my body. I like to talk with runners about their training, their struggles, their joys. I like to look things up, research data, organize random thoughts into to-do lists and emails. I like big projects that have a beginning, middle, and end. I like learning new skills. I like to think about the ways physical activity can transform people into better versions of themselves. I like to write. I like to draw stories out of people that normalize mental health struggles. I like to talk about feminism, and surround myself with people who challenge and improve me. I like to laugh. And have serious conversations. I like to wear ridiculous outfits and wear no makeup. I like to mobilize runners’ ankles and do Graston. I like to do different things every day. 


In early 2015, one of my boys became seriously ill. I found myself unable to be in a medical office, to listen to anyone else’s suffering. It was too much. I couldn’t bear it. I stepped away, for a “little break.” I haven’t returned yet. I am still a family doctor, but I’m not practicing right now, even after my son has returned to his life path. And I’m ok with that. 

What am I doing? Honestly, I don’t know. But I’m doing what I love. Every day I go into the Oiselle office, and time disappears. I try to empty my email inbox. I hand address some letters. I joke with Heather, I talk with the most amazing elite athletes, I scheme on grand girls’ athletic empowerment programs, I commune online with our Volée, I try on awesome athletic apparel and high-knee around the office, I work out with Sally, I look at beautiful graphics, I teach myself html coding, I ask Alisoune about a customer service issue, I get immersed in Google Analytics, I plan a fashion show, I text Fleshman, I write a blog intro, I organize a road race, I talk about birth control and kegels, I research group dynamics and organizational growth, I learn about web design. I’m in the flow. Every day is different, and I can’t wait for the next one. 


And what about the house that my ladder is leaning against? Well. Sometimes I imagine that my Oiselle house and my family medicine house will magically grow together. That I can point to the union and say, “See, it was meant all along and everything worked out just right! I did this and then this and then this and then everything made sense and I was at the top of both houses.” But all I know is that for right now, I am doing what I love. It has meaning to me, and that is enough. 

- Not the End


Sarah Lesko, MD, MPH

Corp. Dev., Oiselle 

December 11, 2016 — jbarnard

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