Complementary Tensions: Desire, Ambition, Hope, and Longing

We are all driven by a constellation of emotions and thoughts that arise from an accumulation of our collective experiences in life. Within these experiences, there are also desires, ambitions, and hopes we carry for something else in our lives. As we navigate these on a personal level, how is it they can be best used, or managed, in our professional lives?


In summer 2021, many of us hoped that our worlds would soon become clearer as the pandemic was presumed to be waning. I know I did, as did the rest of the AAPL staff. The fall brought different results, however.

What hopes had you made for yourself, your family, your practice environment, and your friends or peers? How did you have to adjust those hopes yet again?

With new hopes, renewed plans inevitably emerge for our futures. And, as I speak with many people across all generations, it seems most, at some point, have taken a degree of pause in their lives to reflect on what is truly important to them as humans in our complicated world. Emerging from these reflections, most certainly, is a recognition of whether our accumulated past experiences may, or may not, have contributed to a positive sense of well-being and whether professional or personal satisfaction is a result.

For many of us, the sense of happiness is positive, but many of our peers, unfortunately, do not have a positive sense of well-being, professionally or personally.

Perhaps not surprisingly, many of these conversations with others included considerations of even larger questions such as “Why are we here?” and “What’s our purpose?” One went philosophical in quoting a fellow psychiatrist, Carl Jung: “The decisive question for man is: Is he related to something infinite or not? That is the telling question of his life. Only if we know that the thing which truly matters is the infinite can we avoid fixing our interests upon futilities, and upon all kinds of goals which are not of real importance.”

Whether you are on the positive or negative side of the well-being balance, however, there typically remains hope. Hope is all-pervasive and fuels ongoing efforts to pursue change. Coupled with hope, among an array of other diverse thoughts, feelings, and emotions, are also desires and ambitions; some of these may even reach a true sense of longing.

Interestingly, as one considers these notions, desire (at least from a definitional perspective) forms the foundation of each:

  • Desire – noun – is a strong feeling of wanting to have something or wishing for something to happen; typically, these are external and objective.

  • Ambition – noun – is a strong desire to do or achieve something, typically requiring determination and hard work.

  • Hope – noun – is a feeling of expectation and desire for a certain thing to happen, typically something positive and doable.

  • Longing – noun – is a strong desire, especially for something unattainable, typically internal, and subjective.

Without getting too far into the rigorous debates of psychology or philosophy (accepting there are many) and recognizing we each already carry a unique set of ideals, values, and beliefs for how we live our lives, there is no doubt from my perspective that the complementary tensions of desire, ambition, and hope have recently been challenged in unprecedented ways.

How each of us copes and how each of us moves forward is where we differ as individuals and as professionals. Our families, patients, and practices depend heavily on how we continue to cope and adjust as physician leaders.

Matching our ideals, values, and beliefs with our changing hopes and desires, once clarified internally, allows our natural ambitions as physician leaders to continue creating the needed positive changes for both our professional and personal environments.

Our innate ambitions have brought each of us to our respective career stations so far, and we each have yet more to achieve individually and collectively.

It remains incumbent on us to do so and to do so collaboratively within our support networks for the betterment of our industry and society as a whole. AAPL’s broad array of resources and its active community network is one such set of resources!

No doubt numerous resources exist, but the Greater Good Science Center at the University of California, Berkeley is another resource, and it describes 11 keys to well-being on a personal level and for a larger-scale level as well (

  1. Altruism

  2. Awe

  3. Compassion

  4. Diversity

  5. Empathy

  6. Forgiveness

  7. Gratitude

  8. Happiness

  9. Mindfulness

  10. Purpose

  11. Social Connection

As you look at each of these key areas, recognize that as a physician, you are already addressing each in a variety of ways. For example, compassion, empathy, altruism, purpose, and social connection are inherent to every practice environment. Diversity of patients within our environment, coupled with the awe created by the complexity of human medicine, allows us to recognize how we should be grateful and happy for the privilege of being physicians and that we should be ever mindful of the responsibility we carry for helping our fellow humans in their times of need.

And however one defines or uses forgiveness, we must also forgive ourselves for any of our past reactions or regressions secondary to the stresses of being a physician in today’s environment. We must forgive to better allow ourselves to move forward with renewed hope and purpose while we re-channel our desires and ambitions.

From that UC-Berkeley Center: “…forgiveness is a conscious, deliberate decision to release feelings of resentment or vengeance toward a person or group who has harmed you regardless of whether they actually deserve your forgiveness. Forgiveness brings the forgiver peace of mind and frees them from corrosive anger. While there is some debate over whether true forgiveness requires positive feelings toward the offender, experts agree that it at least involves letting go of deeply held negative feelings.”

I further offer that perhaps we each forgive ourselves more so than we already have as we continue to look for how to manage our sadness, anger, and possibly depression or burnout by reaching inside and drawing on our spirit, that inherent longing we all carry inside. As physician leaders, our healthcare industry needs us to do so, and our patients most certainly need us to do so!

So where does longing fit into this piece of our puzzle?

In their short essay “As Far As Longing Can Reach” (Parabola, 2006), Peter and Maria Kingsley describe longing as something far more complex than the simple definition mentioned above. For them, longing “…originates from the Greek concept of thumos, and thumos means the energy of life itself. It’s the raw presence in us that senses and feels, the massed power of our emotional being…left to itself, longing makes it possible for us to go all the way to where we really need to go. There is no reasoning with passion and longing, although we like to deceive ourselves by believing there is. All we ever do is reason with ourselves about the form our longing will take. Longing is the movement and the calling of our deepest nature. Longing longs for us. It wants us to wake up, to become conscious. It is divine intelligence longing to become known. We already have everything we need to know, deep in the darkness inside ourselves. And if we can find the courage to face it, it will take us back to where we belong.”

I am privileged to have recently become a part of an online think-tank initiative named iRewild Institute ( Through research-based initiatives, iRewild is working to restore the natural connection between people and the natural world.

Each thing or being we meet in nature, everything that we observe, has its own hidden existence if we have the skills to perceive it. iRewild calls it “raising eco-consciousness.” It’s transformative for human well-being and vital for the recovery of a more sustainable world.

Without being overly religious, in Zen there is a teaching: “Before I sought enlightenment, the mountains were mountains, and the rivers were rivers. While I sought enlightenment, the mountains were not mountains, and the rivers were not rivers. After I reached enlightenment, the mountains were mountains, and the rivers were rivers.”

These latter two tangential thoughts are simply examples for highlighting our need to not only satisfy that inherent longing we each carry, but also to recognize and reassess our connections to a simpler approach in life and to seek ways for reconnecting with the natural world around us.

Brought together, the various themes in this piece are a recognition we as physician leaders have so much yet to offer. Still, we need to do so by employing new and different channels or methods in leading ourselves, caring for our families, and helping those around us also to manage their hopes, desires, ambitions, and longings better.

William Carlos Williams is credited with this simple reminder: “The only way to be truly happy is to make others happy.” As physicians and as leaders, our desires, hopes, ambitions, and longings are often predicated on this basis: helping others live better, happier, and healthier lives.

Remember, leading and creating significant change in healthcare is our overall intent as physicians. AAPL focuses on maximizing the potential of physician-led, interprofessional leadership to help create personal and organizational transformation that benefits patient outcomes, improves workforce wellness, and refines the delivery of healthcare internationally.

We all must continue to seek deeper levels of professional and personal development and recognize ways to generate constructive influence for one another at all levels. As physician leaders, let us become more engaged, stay engaged, and help others become engaged. Exploring and creating the opportunities for broader levels of positive transformation in healthcare is within our reach, individually and collectively.




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