In medicine, we live between two spheres: a small one of safety and control, and a larger one of risk, courage, and purpose. Most of us move between them unconsciously—retreating to the small one when we’re afraid, stepping into the larger one when we feel brave. Over time, though, we learn that we can choose.
The larger sphere is where purpose resides. It contains risk—the possibility of failure, exposure, uncertainty—but it also contains energy, compassion, light, life, and grace. In that sphere, we find that by making ourselves vulnerable, we become indomitable. The act of stepping forward, undefended, becomes its own kind of strength.
I see this clearly whenever I teach clinical skills to fourth-year medical students.
At one station, they must consult surgery about a patient in septic shock from acute cholecystitis. It’s a simple exercise on paper: recognize the emergency, call for help, and advocate for the patient.
But the real lesson isn’t about communication—it’s about choosing a sphere.
The simulated surgeon pushes back: “We’re very busy right now. We’ll come in a few hours.”
At that moment, the student—the lowest person in the hierarchy—faces a decision. Some accept the delay. Some question the response politely, then retreat when they’re rebuffed. But a few do something remarkable: They stand their ground. They state, calmly but firmly, that the patient is critically ill and needs to be seen now.
They risk being wrong. They risk embarrassment. But they choose courage—and in that instant, they step into the larger sphere.
For many, it’s a defining moment—the moment they stand up to power on behalf of someone more vulnerable and, perhaps for the first time, feel fear and move forward anyway.
During the debriefing, I ask what they learned. They mention communication, teamwork, patient care.
Then I ask, “What was the real challenge?” And they realize that it was finding the courage to advocate when it felt unsafe.
That’s medicine: Patient advocacy. Risking discomfort to protect another human.
And in those moments, I’m reminded of something myself: How easy it is, even after decades in practice, to feel the pull of the small sphere—and how necessary it is to choose the larger one again and again.
Every clinician, at some point, faces that same choice: Stay small and safe? Or step outward, into the sphere where growth, empathy, and meaning live?
And when that moment comes—for my students, for my colleagues, and for myself—I hope we all choose bravery.
Matthew Ryan
Newberry, Florida