Ready enough

Some of the clearest insights into how we show up as leaders come not from professional milestones, but from much earlier moments. This is one of mine. It was late summer, and my older sister, then 4 years old, was in full meltdown mode over the impending start of pre-Kindergarten. To assuage her anxiety, my parents launched into a week-long blitz of pep talks: pre-K was for big kids, she would have a lot of fun, and she would meet new friends. While their campaign didn't convince her, it stirred something in me. I was 3, and suddenly, I wanted to go to pre-K. My mom, hoping to shut that down quickly, said, “Not yet. You can't go because you're not toilet-trained.” According to family lore, I woke up the next morning, declared myself potty trained, and announced, “I'm ready.” To my mom's surprise, it was true. She hadn't anticipated this turn of events, but since school was still a few days away, she figured I'd forget. I did not. We walked into the classroom on the first day of pre-K, and I did some exploring as my mom chatted with the teacher. I was excited to be at school, and my mom's call to leave caught me off guard. I completely lost it. Through tears, I reminded her of her promise, launching into a 3-day tantrum of escalating intensity. Utterly defeated, my mom somehow managed to convince the school to let me in. My tantrum wasn't just about anger; it was, in hindsight, a pint-sized act of civil disobedience. Less civil, more disobedient, perhaps, but what started as a stubborn preschooler's protest has grown into a deeper conviction. Belonging doesn't require permission, and leadership often begins with the belief that you're ready, even when no one else has said so. I've written about mentorship and leadership in this column, usually with humorous glimpses of me and my children.1-4 But stories like this one, from childhood, sometimes offer the clearest window into how I see the world, that readiness can be self-defined, and that sometimes, you have to act like you belong before anyone hands you a seat. We spend a lot of time in academic medicine trying to prove that we are “ready,” ready for more responsibility, ready for the next role. But readiness is a moving target, one often defined by others. What I've learned, starting with pre-K and continuing through nearly every stage of my career, is that sometimes, readiness isn't about waiting for permission or an invitation. It's about being clear on purpose and knowing what to do when you find that door. Sometimes you need to knock, like asking a mentor to nominate you for an award, or give it a gentle push, like volunteering to lead a project before you feel fully ready. It's the grown-up version of walking into the classroom, certain you belong, even if no one was expecting you to stay. Every now and then, when the door doesn't budge, you have to remove the hinges entirely. That's what a colleague and I tried to do years ago when we created the first handbook for pediatricians caring for hospitalized children.5-8 Frustrated by the lack of practical clinical resources, we pitched an idea, found a publisher willing to take a chance on a group of trainees, and rallied over 100 resident, fellow, and faculty authors toward a shared goal. What started as a passion project led to full-time careers in the emerging field of hospital medicine. In medicine, our approach to development can be slow and hierarchical, often lagging behind the pace of change in the world around us. I have a stubborn belief that we can do better. So, here's my challenge to you, whether you're early in your career or well along the path. Trust your clarity of purpose. Don't let someone else's “not yet” become a barrier. When you know what you want, do the work to be ready, and don't wait for someone to open the door. You're ready enough. The authors have no funding to report. The author declares no conflict of interest.