McPherson’s St. Nicholas & Reflection

By Loren Deutsch

I recently posted a photo from a playbill on some of the LAS social media sites. The playbill was from a Conor McPherson play titled St. Nicholas. Hopefully, you follow us on social media Instagram, Twitter, and Facebook and saw the photo! McPherson is a contemporary Irish playwright and his plays are thought-provoking and often include themes about the human condition. He uses dark humor and haunting stories to explore love, fear, self-loathing, growth, death, and other topics. I had learned about McPherson’s work from someone dear to me and for that reason, his plays have a special place in my heart.

Although I do not normally blog about plays I felt that St. Nicholas provided some reference points about LAS medical coaching and scholastic management in terms of self-reflection and the importance of learning how to learn. For the record, McPherson hit it out of the park with St. Nicholas!

The two-part play begins with an unnamed narrator broadcasting his feelings about regret and self-loathing to the audience. Throughout Act I the narrator becomes increasingly toxic, lonely, and isolated. He is languishing as a theater critic who was in love with an actress. Unable to realize his own professional aspirations as a playwright, the narrator negatively critiques a play that stars the actress. In fact, the narrator’s anger and jealousy impact all facets of his life and he laments about his parenting, his marriage, and his decision-making. It is uncomfortable to watch this person become completely undone. He is gruff and flawed, petty and condescending, but aspects of his humanity occasionally poke through, particularly in Act II. Gradually, the audience comes to understand the narrator’s worries and self-doubt as he questions his ability to sustain a relationship with anyone. These worries are couched in fears about failure, worries that we all face at one time or another. McPherson’s narrator must contend with failure, as he confronts unrealized goals and misunderstandings.

When a medical student or resident encounters test-taking difficulties or exam failure, they too grapple with feelings of uncertainty and vulnerability, particularly when failure is juxtaposed to prior experiences.
While I watched the play, I thought about a medical student whom I worked with a few years ago. Initially, he was referred to me by his dean, after failing a high-stakes board exam. During our first meeting, the student discussed that as he was taking the exam he was becoming increasingly aware that he had not adequately prepared. He said he felt embarrassed and ashamed that his school had referred him for academic support after he achieved a failing test score. The student was very worried and said he had been agonizing over what his family and friends would think if they knew he had failed. He said he had not been able to bring himself to tell them.

As we discussed his feelings and the nuts and bolts of his exam preparation, I acknowledged the difficulties he was describing, particularly his feelings about failure. At times like this, when there is little or no established working relationship, and personal information is shared, I have learned to say less and listen more. My goal is to try and understand the student’s perspective, to support his feelings and experiences, and not judge the situation. The approach of “less is more” can help toward a positive working relationship and over time, this philosophy has become an important aspect of the LAS relational model.

As an aside, people often assume that medical students and residents do not encounter academic hardship or professional setbacks, largely because they are smart. While it is true that these individuals are smart, it does not mean they are impervious to academic difficulties. At some point, most students contend with some kind of academic failure (or at least the possibility of one) and the fears associated with unrealized goals. Medical students and residents are no different (and I’ll explore that topic in an upcoming LAS blog).

Months later, after we had stopped working together, I followed up to check on his progress. At the time, he told me that when I acknowledged his feelings of vulnerability and the difficulties he described, he said he felt understood, and that made it possible for him to come back for more support. Before I had acknowledged his feelings, he said he had felt terrible and doubted he would return because he was embarrassed and worried that the support would not help. Feeling understood can make a difference.

To bring this back to St. Nicholas, it is important to mention that the LAS medical coaching model involves growth mindset goals starting with intentional time for self-reflection. In ACT II of St. Nicholas, the narrator’s sense of self begins to evolve. His vulnerabilities no longer pre-occupy him and dominate his narrative, instead he appears able to identify the importance of human connections, even when they are imperfect. This premise is embedded in all LAS learning plans (medical education and general education).

The narrator learns that some goals require reexamination so that we do not miss the forest through the trees. Sometimes our day-to-day experiences and relationships are more challenging than expected. They require extra work or more support in order to sustain the connections. I think McPherson is telling us to pay attention to the complexity of daily life and perhaps the fragility of the human connection. As joyful as happiness feels, we cannot cherry-pick our emotions. Sometimes sustaining joy requires effort.


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