We learn by repetition. But no matter how much I learn, I seem to always forget more. The Kreb Cycle. Bugs and drugs (bacteria and their antibiotics). The criteria for diagnosing Marfan’s Syndrome. I could memorize them, know them cold, ace the test, and two weeks later, someone would ask me and I’d shrug. I dunno.

Patients forget things all the time, too. It frustrates me only because I keep forgetting how hard it is to remember things unless they are repeated and repeated (which, since it keeps happening, would make you think that I’d finally remember not to get frustrated).

So I tell my heart failure patients to avoid things that contain lots of salt, even if they never touch a salt shaker — things like cold cuts and hot dogs, sausages and even a slice of white bread (yes, a single slice of white bread has as much salt as a bag of potato chips). But when they come in with swollen feet or lungs filled with fluid and they say they haven’t touched the salt shaker, and I ask about what else they have eaten, I often get a sheepish reply: “Hey, let’s go over the salty foods again?”

My patients are way smarter than I. Especially the engineers who, intrinsically knowing that repetition is the key to learning, ask the same question over and over again. But each time they ask, it’s with a twist that turns into a sort of negotiation. Each time, I fall for it. It recently ended something like this: “So if I sweat a lot when I exercise, well, then I can eat a pastrami sandwich and a pickle because the salt in sweat cancels the salt in food.” It reminded me how I once asked my seventh grade catechism teacher if you can cancel out sins by doing something good — in my case, the sins were the unclean thoughts I felt towards a blossoming redhead named Kelly who sat in front of me. I figured I could cancel out that sin by giving up peas for Lent. (By the way, I didn’t really like peas back then, although I do now. I won’t comment on how I feel about Kelly now, whom I haven’t seen since seventh grade.)

To really, really learn something, you have to repeat it so many times that it becomes a habit. Habits are like learning without trying. In my case, it seems I learn bad habits much more than I learn good habits. I remember one particularly bad habit.

When I was in fellowship training, my daughter and I would squeeze together on a fluffy chair for a bedtime story. One night she asked, “Daddy, are you on call tonight?” “Yes, Francesca, I am.” “Oh, Daddy, I hope that the bastards don’t call tonight." To my shock, she explained that whenever the ER rang my pager, I’d mutter, “The bastards are calling.” I got so many calls and muttered so many times, it was a habit I didn’t even know I had. (I have long since abandoned the habit of exasperated muttering at the ER, who, if anything, now makes my job far easier.)

Which, at long last, brings me to my point: we are creatures of habit and habits are hard to break, so you might as well form good habits, like exercising every day, eating healthy all the time, don’t curse at my telephone, and never, ever answer negotiation-style questions from an engineer.