keep going book

Last month, 30 people from 4 different countries and 15 different states + Puerto Rico, ranging from their early twenties to mid sixties, bravely jumped into a two-and-a-half day conversation on Slack about creativity, resilience, and their careers– the fifth version of The Leader’s Library. We discussed the book Keep Going: Ten Ways to Stay Creative in Good Times and Bad by Austin Kleon, and reflected together on the evolution of our creativity from childhood through middle age, and how a career in emergency medicine requires creativity in every possible form. Please see our earlier post for a more detailed summary of the book; below, we share the highlights of the group’s discussion.

Day 1

The first day started out with a personalized welcome video from Austin Kleon himself and introductions of participants. People shared what drew them to The Leader’s Library (connection, reflection, building community) and where they would like to incorporate more creativity (heal personal and societal wounds, bring innovative approaches to “wicked problems”, appreciate the beauty and joy in connections between things.) We then discussed the influence of specific individuals on personal creativity and how some have created a personal creative network (PCN) similar to personal learning networks (PLN). This was followed by a discussion about the spaces where people felt most creative, with many describing the benefit of being outside and disconnected from the activities of daily electronic living, while others felt most creative when connected with others through electronic means. Participants then volunteered their preferred medium for expressing creativity with lots of sharing of paintings, photography, poetry, and welding projects.

Day 2

On the second day, we covered the first 8 tenets of the book. 

1. Every day is groundhog day.

This is really about having a daily discipline: take one day at a time, establish a daily routine, and have reflective practice. Participants discussed morning and evening routines, journaling as an anchor, and the importance of routine in setting boundaries between “doing” and “being”. Some discussed an unease with routines, as our chosen lives as emergency physicians are by nature unpredictable. However, this discomfort belied participants’ flexibility and resiliency– even in pure chaos when nothing is going as planned, we’ll get through, the day/shift/week will inevitably end, and we’ll start again tomorrow.

2. Build a bliss station.

This is a “space” or “time” to disconnect from the outside world to connect with yourself. The concept of being on “airplane mode” even when not on an airplane resonated with many. Participants shared examples of their physical (outdoors, home office, kitchen island) and temporal bliss stations; for some, their bliss station was simply an extra in-tune state of mind. The conversation also revolved around the art of “saying no” and of intentionality when creating one’s career journey. Some highlights: recognize that one’s capacity is finite, and in order to say “yes” to one opportunity, one must say “no” to another; when invited to do something, ask, “What is this person really trying to achieve? Can I help them in a different way to achieve this goal?”; and journal in the days following activities and review how you felt afterward– did this project invigorate you, or were you entirely drained? Use this insight to inform future decisions.

3. Forget the noun, do the verb.

We often define our identity with who we are rather than what we do. Kleon suggests that “creative” is not a noun and that real work is play. We had a robust discussion on what “verb”-ing looks like for each of us. In looking at our careers, many of us recognized our professional “nouns” in one bucket (emails, meetings, academic rat race), and our liberating, expansive doctor “verbs” in another bucket (to help, think, read, teach). We discussed ways to contract bucket 1 (wait 24 hours to answer an email, skip meetings that aren’t action-oriented) and expand bucket 2 (step out of academia, work only on passion projects [that whole “saying no” thing again!]). 

4. Make gifts.

This was about the importance and joy of gifts. This was also about the trappings of “suckcess” and the tyranny of metrics. Kleon suggests that we should leave money on the table, we should forget to take things to the next level, and let low hanging fruit fall off and rot. Instead of the quantitative, focus on the qualitative. Be kind, be generous, be unique.

5. The ordinary + extra attention = the extraordinary.

This tenet resonated with many. Participants discussed ways they’ve cultivated over the past year to slow down and pay attention to the world around them with mindfulness techniques. With slowing down, we can finally focus attention on what we’re paying attention to, then with intentionality nurture this by giving extra attention and create something extraordinary. An interesting angle discussed how Peleton pandemic buys helped people get into the mode to conserve cognitive load and emotional labor, to slow the mind through exercise.

6. Slay the art monsters.

Kleon’s “art monsters” are those ubiquitous beings who somehow create beautiful work while behaving badly and contributing net negativity to the world. We reflected that we don’t want to become “monsters” in the same way, prioritizing output and the final project over the craft of medicine. Kleon argues here that “art is for life, not the other way around,” and this was a good reminder that we chose our careers because we wanted to make our, and others’, lives better, not to drag ourselves or others down. Many discussed this juxtaposition of simultaneously loving their practice (caring for patients, educating others) with living periods of time where pursuing their craft made themselves and others miserable. We all can have monsters coming to visit; the key is keep them around for the shortest time possible.

7. You are allowed to change your mind.

This tenet challenges the obsession with being right (hello, medicine!). Our discussion revolved around history-as-educator (“history may not repeat, but it sure does rhyme”) and philosophy-as-educator [Daily Stoic]. Some participants regularly revisit their own history through re-reading old journals; others learn through reading others’ histories in books, applying lessons from our ancestors’ missteps to our own current leadership challenges. There was also discussion of the (inverse) relationship between confidence in a position and being right. See the Dunning-Kruger prayer. In Kleon’s words, “to change is to be alive.”

8. When in doubt, tidy up.

We closed the day with a discussion of tidying our workspaces, both mental and physical. Sleep tidies up your brain. Tidying up your workspace is an exploration and a great way to focus energy when stuck or overwhelmed. Participants discussed their approach to tidying up offices, kitchens and gardens and the positive creative effects it had on their creativity. 

9. Demons hate fresh air.

On the third and final day of discussion, we covered Kleon’s final 2 tenets. This is one of the more intuitive tenets– that getting one’s bootie off one’s chair and going outside can stimulate creativity and launch us past writer’s block. However, Kleon takes this beyond endorphins and argues that, by going outside, we better integrate ourselves into our communities and reality: “If we do not get outside, if we do not take a walk out in the fresh air, we do not see our everyday world for what it really is, and we have no vision of our own with which to combat disinformation.” Participants had varied strategies for getting themselves OUT, though most agreed that getting outside had been critical to their physical and mental wellbeing over the past year. Several people cultivated a habit of photographing their surroundings while out walking, a practice which helped them stay present. One participant shared that for them, this tenet took on a metaphorical meaning– by letting their internalized shame out to “fresh air” through writing or speaking, its power over them lessened. 

10. Plant your garden.

Kleon, and our participants, focused on seasonality here. We don’t expect plants to flower in the winter, nor do we furiously cling to an oak tree’s leaves when they tumble off in the autumn; why, then, in academic emergency medicine, in medical education, in medicine in general, do we completely disregard this natural rhythm and instead attempt to overpower it with a decades-long continuous stream of hard work? Why are we surprised that our creativity stalls periodically, when we know innately that everything in our world is cyclical? Participants brainstormed ways to integrate periods of recuperation and recharge (what Kleon calls “dormancy” in this essay) into their professional lives, not just for rest, but also to enhance creative output. One participant reflected, “I’ve personally struggled with having to ALWAYS be ‘on’ in terms of being creative, but now understand that creativity ebbs and flows and the key now is to capitalize when the time is right.” 

Synchronous Conversation

We closed out The Leader’s Library with a live video conversation, during which participants ranging from medical student to late-career professor mused about the connections they formed during The Leader’s Library, new ideas they’d be taking back to their institutions, and shocking realizations they’d had while learning from and with their co-participants. Independent of differences in prior life experiences and current situations, all participants affirmed a renewed appreciation for the role of creativity in their professional lives.


Whether in the US or India, academic or community emergency medicine, medical student or faculty, leading or trying to lay low, our facilitators and participants all need to keep going– and the past year plus has made this an incredible challenge. We’ve known a solution to this challenge since our preverbal years– taking a handful of crayons to a blank page helped us cope with doctor’s visits and tortuously slow restaurant service, art allowing our brains to take a break from the world around us and observe with a new lens. Participants left the fifth iteration of The Leader’s Library with plans to better support creativity in themselves and their colleagues, with a goal of improving not only the quality of their work, but also the quality of their existences

The facilitation leadership team were wholly inspired by the participants and their vulnerability and candid insight. Stay tuned for our next turn in the fall and until then, ta-ta for now!

Dina Wallin, MD

Dina Wallin, MD

ALiEM Series Editor, The Leader's Library
Co-Medical Director of Pediatric Emergency Medicine,
Zuckerberg San Francisco General Hospital;
Director of Didactics, SFGH-UCSF Emergency Medicine Residency;
Assistant Clinical Professor of Emergency Medicine and Pediatrics,
University of California San Francisco
Felix Ankel, MD

Felix Ankel, MD

Department of Emergency Medicine
University of Minnesota Medical School
Regions Hospital