Defending the Lob, Managing the ICU and Emotional Intelligence

The lob shot.

As a goalie, it’s my nemesis. It was my major weakness in college and even more so today. Standing (or more appropriately treading) 6’3″ tall, with an even longer wingspan, I have always been eager and ready to explode up and out of the water, my arms outstretched, to intimidate a shooter. My height, along with my gangly arms and a quick first reaction, are great tools to disrupt, alter and ultimately block my opponents’ shots.

But my kryptonite is the lob shot. It turns my strength against me. A patient opposing player, by waiting a split second, lets my aggressiveness work against me. By allowing me to rise up and out of the water first, a shooter can then release an agonizingly slow arcing shot, up and over my now sinking self, to then drop into the opposite corner of the net. I react. They wait. And I’m beat.

When I correctly anticipate the lob, it’s demoralizing for the shooter. With minimal effort, the ball is not so much blocked as “caught” in humiliating fashion, usually deterring the shooter from another. But when my legs have already committed to a direct shot, all I can do is swivel my head and watch as the ball takes its time, teasing and taunting me, just out of arms reach, and lands in the net.

In college, it took a while to develop patience. To dial back my brashness, my impulsivity. Wait that extra split second. Take in the arm angle and the eyes of the shooter. Trust myself and my abilities to make the block even if I delay for a brief moment. My teammates challenged me with lobs over and over again in practice, until finally a change occurred. Thinking, instead of just reacting. Using my frontal cortex, instead of my primitive brain. And for a while, I had the upper hand against my nemesis, and my opponents as well.

Tempering my first reaction has never been easy, either in or out of the water. My initial response to life’s challenges tend to be more reactionary and visceral. In one’s college years, that lack of patience and emotional intelligence is somewhat expected, if not the norm. Not so much when in mid-life and caring for the critically ill or teenage children.

The ICU will never be mistaken for an Olympic sized pool. And my children, despite how it may feel, are not opponents on a challenging team. But the unique nature of an ICU and family dynamics make both areas ripe with opportunities for a battle between my brash, impulsive tendencies and my more mature, deliberate and thoughtful side.

The space that exists within the confines of the ICU is awash with challenges. Rooms are filled with the tension that accompanies the acuity and intensity of critical illness. ICU physicians are tasked with navigating multiple health care professionals, who frequently have honest differences in opinions, and sometimes supercharged egos and attitudes as well. Families and surrogates of patients, residents, nurses and students all operate in this landscape, within their own sphere of swirled thoughts and emotions. There are a multitude of relatively quick decisions that need to be made. Do I intubate or not? Do I send them on a road trip for a CT or stay in the more stable confines of the critical care unit? Do I commit a patient to an invasive procedure with potential complications or hold off and continue with the status quo?  But it’s not just the decisions themselves. There is a qualitative component as well. Do I take the extra time to explain my thought process to the nurse, resident or student at the cost of delaying decisions for the next patient? Do I provide more than a cursory update to a family as I exit a room, or do I sit down and invite them to share their angst and fear. Do I do so at the cost of delaying the start of my office and the patients waiting there? Do I share my inner head voice and its whispers of fear, concerns and self-doubt? Or do I project unwavering confidence and certainty? Challenges lie not just in making decisions, but in the manner they are carried out and executed. To grow, not just as a competent clinical doctor, but as an empathic physician as well, one needs emotional intelligence to navigate such complex waters.

These days, back in the pool, I find my old nemesis is back to taunt and haunt me. My height and wingspan may be unchanged, but the same cannot be said about my explosive move up and out of the water. Over-eager and anxious to defend a shot on goal, I now have the added challenge of being a bit slower and quite lower out of the water. I don’t have the luxury of waiting that split second anymore.

I find history repeating itself, with my current teammates showing the way. They challenge me in practice, frustrating me with lob after lob. But they are not content to stop there. They let me know that I may be the only one in the net, but I am not alone in defending it. Through their efforts in games, fighting for position, and playing a team defense, they buy me back the time I have lost. They remind me to trust them. And in turn, trust myself, allowing me to tap into my thinking brain in order to defend the lob.

My experiences with the team continue to parallel my life. Just like success in the net is a result of a team effort, so it goes in the ICU. I’d be lying if I said the years have not affected the excitement and enthusiasm of the young attending physician I used to be. There is now a component of fatigue and burnout that I often need to shake off before rounds. Some days it feels that I am on an island when dealing with a crisis or challenge. That is neither true nor accurate. The nurses, residents and students, along with my physician partners are teammates too. Together, the challenge of taking care of the critically ill seems less daunting, giving me the time and space to harness my thinking brain.

There are moments when instinct and gut reactions are critical for success. But when I am able to bring both parts of my brain to a challenge, the enthusiasm that comes with  impulsivity and brashness along with the wisdom that accompanies maturity and thoughtfulness, good things happen. Not just in the pool or ICU, but in life as well.

 

Hiatus

Time passed. One day became two. Weeks became months. What began as a temporary absence evolved into a void.

No writing. No journaling. No attempt at an opening paragraph. On occasion, I hastily blurted a random thought or two into a voice memo on my phone. But the recorded words stayed in coded form. Bits and bytes waiting to be transcribed and brought to life as words on a page.

For the better part of a year, I have worked on at least one piece of writing at a time. An idea or story. An outline for a book. Always some small part of my brain processing and playing with an idea, while racing through the craziness of my day.

But the last few months have been a bit of a hiatus.

The intensity of my work life and family life converged for a while, with quite a bit of travel mixed in. San Francisco for a conference. Klamath Falls, Oregon for a brief family Thanksgiving. Preparing for my son’s long-awaited homecoming for winter break back in Chicago. Christmas spent covering the hospital and ICU. Ringing in the New Year while working in an ICU in Elkhart, Indiana.

And somewhere between the West Coast and the rural Midwest, I got lost.

That little part of my brain stopped sorting new thoughts and ideas. Instead, I fed it a steady diet of Netflix, cryptocurrency and progressive politics. Comfort food for my cerebral cortex. And as the writer inside me took a leave of absence, I found other parts of myself taking a time-out as well. My running shoes sat untouched most days. My swim bag remained buried in the corner of the mudroom, as I went AWOL from my water polo team. Whatever exercise I managed was mindless and without purpose. As my writing and journaling stopped, so did my desire to physically push and challenge myself.

But I did not close my eyes.

I watched my daughter continue to face the challenges of being a sixteen-year-old junior in high school, navigating the ever-shifting landscape of friends, school and life. Juggling final exams and ACT tests, hours of dance and Poms, injuries, babysitting and a boyfriend. Like her dancing, She stumbles at times. But like she does when dancing, she pops right back up and continues moving forward, becoming more adept and able every time.

I watched my son face the challenges of being nineteen, while working on the universal yet uniquely personal battle between autonomy and dependence. Between freedom and restriction. More often than not, that process now takes place out of my sight, as he currently lives two thousand miles away. I am still coping with this. But each time our orbits align (and hopefully not collide), I see a little bit more of the man he is becoming.

I watched my wife challenge herself to tap into her mathematics and education degrees, putting herself out there to help neighbors, family and friends with the mysteries of high school geometry and pre-calculus. I saw this amazing cycle of confidence build. Not only in her students as they became better prepared for their quizzes and tests, but also in herself as she applied a unique approach to help each student fill in his or her specific knowledge gaps.

I watched. More passive than active. Letting events play out and unfold before me, often while stretched out on the family room couch. My sweatshirt and a comforter worked overtime, protecting me from both the falling temperatures outside and having to actively engage in the world around me.

But it is time. Time to leave passivity behind, along with the comforter and the couch.

Despite the cold, I went for a run outside the other day. A few years ago, running in sub-freezing temps was a no-brainer. Just put on the right clothes and go! Now it’s a bit of chore. It took more thought and effort to push through the inertia of inactivity.

It started with shivering. Time felt slow. Movement felt forced. But ten minutes into the run, my body heat began to build, and with it, the familiar warmth comforted me. The sound of air moving in and out of my mouth layered on the rhythmic sound of my shoes disturbing loose gravel and stone under my feet, brought me back to an old familiar space.

For the next forty minutes my joints ached. My calves and hamstrings burned. I sweat. It was snowing, and the falling flakes were cool on my flushed face as I ran through their vertical descent. And sometime during that relatively routine run that I had done countless times in the past, a small dormant part of my brain came back to life.

It’s time again to write.