How does stress manifest physically for you? 

I’ve asked patients for years now.  Some people know exactly what I’m talking about and answer without hesitation—“Oh, migraines—MONSTER migraines.  As soon as I feel one coming on I know I’ gotta unplug and go for a run!”  Some need a little prompting—I give them other examples like chest tightness, loss of appetite, or insomnia.  For others, it helps to ask what their significant others or children tell them.  “What would your wife say if I asked her,” usually gets a pretty immediate and animated reply.  Very occasionally, even after all of that, some still don’t really understand the question, or deflect, and we move on.

I noticed neck pain as my stress signal sometime in my 20s.  I suspect my body learned this nerve pattern during residency, when my heavily laden white coat pockets dragged my posture toward the floor for well over 80 hours a week.  I remember taking the coat off (aaaaahh, relieeeeef), then picking it back up later to put it on (aaaaaarrgh).  I’d say it probably weighed a good 5 to 7 pounds.  If you’ve never experienced this, and you’re also looking for a great laugh, check out this video of the Try Guys wearing boob weights for a day. You’re welcome!

For years a simple backrub or even just a good night of sleep would take care of it.  But in spring of 2010 I started having a hard time sitting still at work.  Increasingly I was distracted by tightness, and eventually searing pain, all around my neck and shoulders.  It was diffuse and constant, and I could never find a comfortable position, day or night.  Ibuprofen would not help, and hour long massages only very briefly.  It had been six months since starting a new position, and I was ‘way more stressed than I realized.  The day before vacation I thought, I bet this goes away in Colorado.  And voila, by the time we landed in Denver I was already feeling like myself.  After a week in my happy place, I returned to work expecting the neck pain to recur.  Happily, it didn’t!  Hooray, all fixed!

Not so fast.

A month later I developed astonishing pain and sensitivity in my right forearm—cubital tunnel syndrome—to the point where I had to roll up my sleeve because I could not stand the touch of the fabric.  I barely got through CPR training one morning; I told my mind-body physician friend, thinking he’d recommend a supplement or something.  He listened compassionately and reflected how often he’d heard the same story from patients.  “Sometimes the body just puts it in another place,” he said simply. 

Thankfully at the end of that week, I went away to my first ever mindfulness retreat with other medical educators.  I could not remember the last time I had so much quiet time to myself, not having to rush somewhere, make a decision, or take care of someone.  After dinner we had free time and I climbed into a bay window and started writing.  On a random legal pad I dumped everything that had swirled in my mind for however long—deep, complex thoughts that poured forth from the pen in a torrent, pages and pages full.  By that night going to bed, my forearm felt normal, and that pain has not come back.  I’ve been journaling regularly ever since.

Over the years, the neck pain has come and gone, and improved significantly since I left that job.  But even in the last two years as I have taken on more at work, and in the past six months of utter chaos, it has only recurred mildly. 

***

Out of nowhere last week, I developed a sore throat.  Strange.  It came on and worsened suddenly over a few hours, then abated after an hour Zoom call with my Braver Angels pals and a big mug of honey tea.  I had no other symptoms—no fever, body aches, fatigue, nasal congestion, or headache—just a really irritated throat, and only on the right side.  On further reflection, I had also been doom scrolling, eating, and online shopping more. Huh. 

This is exactly what happened back in March, when I wrote four blog posts in eleven days about the pandemic.  Looking back, I see the same pattern of behavior—staying up late, reading voraciously, ruminating, anticipating, problem solving, and looking for things to do to help.  For days in a row I had mild, barely perceptible throat irritation and nothing else.  It came and went, without discernable patterns or correlations. 

New body sign!  How fascinating.

This time I had to call in sick to work.  The team sprang into action and rearranged schedules.  My patients all agreed to speak by phone; my colleagues did their physical exams in my stead.  Everybody was so understanding and gracious, their day turned upside down, all because I had a sore throat for a few hours. 

Rightly so.  What if it were an infection?  What if the person I was with 5 days earlier, who was now home sick, had COVID (they didn’t, and we were both masked and distanced, together for only 15 minutes)?  What if I ignored the sign of potential infection and came to work, and then transmitted to the team and my patients?  Yes, it was a huge hassle for everybody to make last minute workflow changes.  But that was nothing compared to the potential, exponentially larger hassles of a whole workforce having to stay home sick, all because of me.

Right now we should take no chances.  Now more than ever we must build, sustain, and advocate for work systems that support the health and well-being of the workforce.  We need to make it safe—and expected—for employees to take care of themselves, thereby caring for coworkers and clients.  Short term inconvenience is the investment for the returns of long term loyalty, cohesion, and success.

If we slow down and pitch in—if we all take care of each other on the team—maybe we will have the mental and temporal space to notice new patterns.  Not just new personal body signs of stress, but new community signs of need, new collective signs of connection, and new team signs of creativity, innovation, and core values expression.  Wow, wouldn’t that be something?