You Can’t Pee!

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NaBloPoMo 2017: Field Notes from a Life in Medicine

When my son was little we lived in an apartment where the kitchen was a separate room, with only a small window through which I could see what he was doing in the living room while I cooked.  Once when he was about five months old, I looked out and he was lying on the mat in the middle of the floor, playing happily with the toys dangling from arches overhead.  I swear I only turned around for a minute, and when I looked back he was gone.  Empty mat, toys still dangling, no kid, no sounds.  I can’t remember what I was doing, but it felt like a slow motion eternity getting out of that damn kitchen to find him.  Something heavy must have fallen on him or he was otherwise suffocating or dying, for sure.  …He had just learned to roll over, and he had rolled and rolled and rolled himself into the space under the air conditioning unit near the window.  He was turning over a dried jasmine leaf he’d found on the floor.  Not long after that I decided I had to buy food preparation gloves.  Just in case my kid needed me anytime I was handling raw meat, this would save me the infinitude of time it would take to wash my hands—I could just pull the gloves off and bolt!  Because you know, 30 seconds could mean life or death for a toddler in his own living room.

Please laugh—I did today when I told the story to a friend.  It came up as we explored the phenomenon of moms putting everything for their kids before themselves.  We compared notes on how long we had ever held our urine.  What mom has not done this?  You can’t pee!  Because you never know which minute you’re not with your children will be the one during which your neglect will kill them.  Thankfully children grow and become more independent, and we can free our bladders again eventually.

It’s not just moms, though.  One of my teachers in the hospital gave herself a urinary tract infection as a resident.  She had so much to do every day, so many patients who needed her that she felt guilty taking time to pee.  I did the same thing in clinic for many years.  I could not justify making patients wait another minute when I was already 15 (usually more) minutes late seeing them. I don’t do this anymore.  In a fit of efficiency last week, I stepped into the restroom after I set my lunch to microwave for 2:00.  It literally takes only a minute to pee.  I don’t usually run late these days, but even if do, now take care of my needs first.  It’s better for me, and better for my patients, whose doctor is not distracted by preventable physical discomfort and dying to end the interview or exam to get some relief.

Our culture still expects moms, doctors, nurses, teachers, and many others to sacrifice selflessly in service of our charges.  UTIs are the least important consequence.  Over 50% of physicians in the US report at least one symptom of burnout, and 400 doctors kill themselves annually.  That is the equivalent of my entire medical school, dead, every year.  It’s not all because of the job, but the obligatory selfless-giver mentality in medicine definitely contributes.

So whatever helping profession you are in, please take time to take care of yourself.  We need you whole and healthy to take care of the rest of us and our children.

Go pee.  I will wait.

On You, the Elite Athlete

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NaBloPoMo 2016, Letters to Patients, Day 28

To All Patients:

What would happen if you thought of yourself as an elite athlete?

I present tonight the first phase of the presentations I have given this fall to physicians, corporate executives, and tomorrow, a corporate design team.  See how it applies to you:

***

What makes you exactly the same as Pat Summit, Martina Navratilova, Michael Jordan, Dana Torres, Peyton Manning, Serena Williams, Wayne Gretzky, and Walter Payton?  You are an elite athlete.  You have a specific skill set which you spent years training and honing.  You continue, through practice and discipline, to refine it.  It’s an upward striving, just like an Olympian—Higher, Faster, Stronger!  And, you’re part of a team.

So how should you take care of yourself—your very valuable, elite athlete self?

Fuel & Train

  • “Regular people diet and exercise. Athletes fuel and train.” –Melissa Orth-Fray
  • Our bodies are our vehicles. Elite athletes’ vehicles require premium fuel and meticulous maintenance.
  • We all struggle with the same challenges—time, motivation, discipline.
  • Each day we have an opportunity to walk the talk, and practice what we preach. Every good lifestyle choice, no matter how small (apple instead of candy, stand rather than sit), is a step of intention toward health.

Rest & Recover

  • Chronic sleep debt increases risks for diabetes, obesity, impaired immune function: GET MORE SLEEP.
  • Rest and recovery are integral for sustaining long term performance and injury prevention—ie burnout. This applies for both physical and mental exertion.
  • Take your allotted vacations and really disconnect.  The world will still function (temporarily) without you.
  • Broaden your methods: 15 minute walk, 10 minute meditation, 5 minutes of journaling—unwind, unload.

Manage your stress

  • How do you know when you are ‘stressed?’ How/where does stress manifest in your body?
  • What are your existing resilience practices? How quickly do you abandon them when things get busy?
  • Exercise mindfulness: Live in the moment; breathe deeply; speak and act intentionally, not incidentally.
  • We are no different from toddlers—easily emotionally hijacked when tired, hungry, over-extended.
  • Elite athletes use the disciplines above to manage their emotions and stay focused.

Cultivate positive relationships

  • Coaches, teammates, trainers, psychologists, equipment managers—no athlete succeeds alone.
  • We thrive when we feel seen, heard, understood, accepted, loved, and safe.
  • It is only when our relationships are strong and we feel connected, that we can truly care for ourselves and our teams.
  • Who is your support network, and how do they hold you up?
  • Who do you support, and why/how does this fulfill you?

 

What is your sport?  Who is your team?  How does caring for yourself benefit those around you?  And finally, what can you do today, tomorrow, next week, next month, and in the next year, that will elevate your own health and well-being, and that of your team?  Please share your ideas in the comments!

On the Critical Importance of Self-Care

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NaBloPoMo 2016, Letters to Patients, Day 6

To Patients Who Feel Overwhelmed:

Put your own mask on first!

In my spare time, I go around talking to other doctors about how to take care of ourselves.  You may or may not be aware of physician burnout.  It’s quite the trendy topic in medical circles these days, and not in a good way.  Over 50% of physicians report at least one symptom of burnout (emotional exhaustion, depersonalization, or low sense of personal accomplishment), higher than the general population.  Physicians also kill themselves at much higher rates than the general population.  I’m grateful for the opportunity to study and speak on physician health and well-being, because it informs my practice in ways I had not anticipated.

To be clear, physician burnout is not a problem of personal weakness on the part of doctors themselves.  The healthcare system in the United States has evolved to such a dysfunctional state that some of its best and brightest find themselves despondent, depressed, and ready to quit.  And yet, we are called to persevere in the system as it is, even as we strive to improve it.

I see the same pattern in American society generally.  Technology and other advances have created a world of 24/7 hyper-stimulation, global comparisons of productivity and innovation, and immense pressures to be perfect, or at least appear so.  Men and women live under constant scrutiny and competition.  Do I make enough money?  Is my work impressive enough (to others)?  Are my children in the right activities?  Am I doing enough?  I see, hear, and feel it from my patients every day—the anxiety, the uncertainty, the angst.  The suffering is real, if not totally tangible.

For those of you whose exercise routines hold you up, how quickly do you abandon your workouts when things get really busy?  What about quality time with your friends?  What about your painting, knitting, writing, reading, skating, volleyball, music, and sleep?  Everybody recharges a different way, but I see a common pattern of ignoring the low battery alerts and pushing ourselves to empty—physicians and patients alike.

Our systems need to change, no doubt.  Medicine, business, education, politics…  We need to get clear about what and whom we really serve.  In medicine, I believe physicians should lead the movement toward a more humane internal culture.  There is no way we can take excellent care of our patients if we are not well ourselves, and we cannot wait for corporate leaders and policy makers to advocate for us.  The same is true for you, our patients.  What do you need to be healthy?  What can you change in your habits, environment, and relationships to meet these needs?  And in making such changes, what positive ripple effects could you have on those around you?  Can you lead by example?

If we all put our own masks on first, like they say on airplanes, how many other people’s masks could we help with?