Tag Archives: health

#AtoZChallenge: More Fun, Less Frazzle

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“Rule #6: Don’t take yourself so Goddamn seriously.” From The Art of Possibility, by Rosamund Stone Zander and Benjamin Zander.

This can be a hard lesson for physicians. We do such serious work, after all. There is always another patient to see, another result to review, another call to answer—now! But I have to pee, when can I pee?

In my first year of practice, I remember a particularly hard day. I was running late (I’m still always running late) and the patients that day were all complicated. No simple UTIs or colds to give me some air. I huffed and grunted my way through the visits, occasionally buzzing by Rose, my medical assistant, to answer messages in between. My bladder felt like it might actually explode, but I could not stop to go to the bathroom—there was no time! I was so afraid to fall even more behind, to fail in some way. Eventually, Rose posted a sign above my workstation: “TAKE A DEEP BREATH.” It was an instant reality check:  I couldn’t go on like this, I’d burn out before my career even started! Immediately I realized how unnecessary, and downright silly, was all the rushing and grimacing—and I laughed out loud. Since then I have never again reached that depth of anxiety and sullenness in a workday. I am forever grateful to Rose for her sign, her loving reminder to slow down and take perspective. God bless her.

If we’re not careful, we physicians could all easily drown in the drama and strain, over and again, every day. And is that really what our patients need from us—to be Frazzled balls of tension and urgency, bouncing haplessly from one task or person to another, barely holding it together (and in)? Is that what we want for our colleagues and staff, to have to put up with our irritable and pressing demands?

It doesn’t have to be that way. In my third year of medical school, on my inpatient internal medicine rotation, Chip Dye was my senior resident. The service was busy; we always had a full census of sick patients. But I never felt harried or anxious because Chip set the tone for the team. Always smiling, always willing to answer any question, and finding any opportunity to laugh, he made it safe to learn. He exuded confidence without arrogance, calm without sloth. After rounds he led the team to attend morning report (daily educational conference and community gathering).  He always made sure we ate.  And there was always time to pee.

It’s not that he underestimated or ignored the work that awaited us. He just knew that we would accomplish it all better in a lighter, happier state of mind. When it came time to buckle down and divide tasks, Chip prioritized them with realistic expectations and we all got to work. No muss, no fuss, no stress. It would all get done because we laid out our plans in advance.  We self-respectfully reserved time and space for meeting basic bodily and communal needs. Thanks to Chip for leading by example.

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From Facebook, I can’t remember where or when!

We can always have some Fun at work, no matter how hard the day gets. Whether it’s telling a silly joke, watching a ridiculous viral baby video, or posting a fun meme on the workroom bulletin board, lightening the mood helps everybody get through a little easier. Laughing relaxes us. Stephen Colbert is quoted as saying, “Do you know what I like about comedy? You can’t laugh and be afraid at the same time—of anything. If you’re laughing, I defy you to be afraid.” And if we can overcome our fears of not getting it all done, of not being enough, we will all be better off—physicians and patients alike.

potheads

Also from Facebook…

 

 

#AtoZChallenge: Drudgery and Discipline

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Well this is scary… It’s only day 4 of the A to Z Challenge and I’m already feeling blocked! ACK! I had what felt like a semi-brilliant idea for ‘D’ –a week ago. I even wrote a short draft. But now I’m embarrassed to continue—it feels redundant and self-indulgent. I’m a little paralyzed by fear. What to do now?

I signed up for this challenge partly to make myself sit down and write every day, or at least attempt it. I’ve kept a running list of my favorite words, declared a theme, committed to a program. I am now accountable. It is up to me to practice the Discipline of daily writing.

I can’t imagine that writing this blog will ever become Drudgery, because if it ever does I can just stop. The blog itself is beholden to no one. But it’s something I created, something that I want to cultivate and develop. Quality of the content is bound to vary; I cannot be the perfect culmination of my best writer self every time! So regardless of how I feel about this post, I have resolved to publish something today, and I will have to find a way to make it good enough. It’s hard work, and it’s what I signed up for.

So this gets me thinking… How many physicians think of their work as drudgery? Sadly, the answer is more than we’d like to admit. Statistics abound on the alarming increase in burnout among physicians, physician suicide, and the associated decline in patient satisfaction and health outcomes. The defining features of burnout in any field are depersonalization, emotional exhaustion, and low sense of personal accomplishment. That’s as good a description of drudgery as I’ve ever seen.

Most of us experience some symptoms of burnout at one time or another. How do we get through it? Many of my colleagues rightfully look to operations—promoting streamlined workflows, simplifying documentation and coding, and standardizing protocols. But these changes come slowly, and we must function in the existing, cumbersome and inefficient systems while we advocate for the changes we want. So in the meantime, we forge ahead with gritty discipline.

Medical training remains rigorous, though in recent decades we have made it more merciful. From the premedical curriculum, to clinical rotations, to on-call responsibilities as attending physicians, our professional lives require us to be there for our patients when we’d rather be communing with friends, attending our children’s school plays, or just sleeping. We made a commitment, took an oath. And for the most part, our work rewards us with rich opportunities for lifelong learning, hearty fellowship, and the privilege of caring for humanity in the most intimate ways. The discipline—the commitment to the work—pays off in spades.

In my reflections on physician health and well-being, however, I always come back to another domain of discipline—that of self-care. Medicine attracts caregivers. Sometimes we are also control freaks, and exhibit somewhat masochistic tendencies. When we let these traits take over, they upset the balance needed to thrive in the complex medical milieu. We need to maintain objectivity with compassion and sensitivity, calm and clarity with intuition and judgment. We cannot do this effectively if we constantly run on empty. When we neglect our body/mind/spirit, we get irritable, and our work and relationships suffer. Ever seen a toddler clunk her head on some furniture while walking? If she’s well-fed and well-rested, she’s likely to keep moving, intent on getting to her favorite toy on the other side of the room. If she is tired and hungry, however, the same innocuous thump may trigger a full-scale meltdown of epic proportions. It’s no different for adults. We need regular feedings, rest, and playtime just as much as our children do. For my part, when I speak to colleagues on burnout and resilience, I focus on the discipline of self-care. It’s what we can control now, while we continue the necessary work of systems change.

Fortunately, I have chosen a profession that feeds my soul. It is a calling, a vocation. I have also chosen to indulge in a hobby, writing, that fulfills me similarly. Both require commitment, discipline, and practice to be done well. Both run the risk of becoming drudgery, under certain circumstances.

This post has been an exercise in Disciplined Writing. I wanted to write while inspired, and it just was not happening. So I had to simply sit down and get to work. But as Liz Gilbert discusses in her brilliant new book, Big Magic, inspiration did visit me, however briefly, in the process.  That will keep me coming back to practice. I will continue this exercise all month—thank you for bearing with me!

#AtoZChallenge: Cursing, Curiosity, and Connection

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Welcome to my first attempt at the Blogging A to Z Challenge!  26 posts starting April 1, one for each letter of the alphabet (I get Sundays off).  I’m exploring meaningful words to apply to perceptions, attitudes, behaviors, and relationships. It’s a personal journey, part of my mission of self-assessment and development through writing.  Thank you for stopping by, and please feel free to comment! 🙂

 

Sometimes we get angry, and we need an outlet. But often we need to suppress, get through the situation with grace and smiles.  Sometimes the need for professionalism and control can turn into chronic repression, which can then lead to sudden and violent explosions, often on those we love most.  Psychology tells us that children (and adults, as well) do this because it’s safest to lose it among those who truly love us, and we know this subconsciously.  But the scars left on these relationships can be disfiguring.  It’s dysfunctional, and there is a solution:  Curse It All.

A colleague in mind-body medicine told me once that he recommended to his patients to tantrum. I was incredulous at first, but then I saw the light.  Venting, done appropriately, can be cathartic and liberating.  One day I became abruptly livid, I won’t tell you why, but suffice it to say it was over something small, that represented a chronic dysfunctional pattern in a longstanding relationship (Cryptic is also a word for this post!).  It occurred to me that this was the perfect opportunity to try the tantrum method.  I was home by myself, and I share no walls with my neighbors.  I took a pair of jeans, held them by the cuffs, and proceeded to pummel at the bed, all the while screaming expletives at the top of my lungs, stomping, and flailing wildly.  It took maybe 45 seconds, tops.  Afterward I felt a new calm, a lightness that had seemed impossible just minutes before.

Cursing, or swearing, has some interesting benefits. It can increase pain tolerance, strengthen bonds of solidarity, and help us convey conviction and passion.  So I endorse it, as long as we use these words strategically.  A follow up experiment to the pain tolerance study found that daily swearers, people habituated to the practice, had less analgesic benefit compared to occasional swearers.  We now also have access to adult coloring books, giving us a visual route to unload intense emotions.

sh-t storm coloring book cover

image from Google

But then there is more work to do. Sometimes it’s enough just to have vented, but I think we serve ourselves best when we can take some time and energy to evaluate.  The first step here is to get Curious.  I first learned this from my life coach.  In conflict, it’s so easy to only see our own point of view.  Emotional hijacking causes tunnel vision.  So once the emotions have dissipated by way of swearing and chopping bed with jeans, we can once again see and think clearly.  Curiosity asks open-ended questions:  What just happened here?  How did I get to this place?  Why do I fly off the handle like this whenever (fill in the blank)?  Advanced curiosity is where assumptions can also be challenged:  What story am I telling about the other person that causes me to react this way?  What other story can I tell that would help us both suffer less and get to mutual understanding?  These are well-established techniques in coaching and psychology.  I refer you to Rising Strong, Brené Brown’s newest book, in which she describes the process of using curiosity as the springboard for healing from adversity and living ‘wholeheartedly.’

 

Why is this important? Because humans live to be connected.  Anger can be blinding.  It arises first and so intensely when we have other, more distressing feelings underlying, such as sadness, shame, rejection, and guilt.  Anger serves to protect us from the pain of those emotions, and also keeps us from moving through them, healing them.  The repression-explosion cycle costs us energy and connection (to self and others), and ultimately keeps us from living truly, freely, joyful lives.  Cursing decompresses emotions, allowing us to open the door to relationships with curiosity.  Then, when we uncover the answers to the open-ended questions, we can start to reconnect with what we love about our partners, our children, our friends, our colleagues, and ourselves.

So go ahead, detonate those strategic f-bombs!  Find the padded space to rail and flail.  Then savor the possibilities of newfound clarity of mind and heart.  How much better could it get?  We never know, but it could be spectacular.