Taking a Step Back to Move Forward

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This was first written and posted on Doximity’s Op-(M)ed and can be seen by clicking here... I will be writing monthly for them and hope to have a year-long discussion about the trials and travails of being part-time. Whether its enjoying more time with the kids, suffering through a bad Locums placement or learning to be a student all over again, I plan to share it all with all of you. For those that have been keeping up with a lot of my writing, a lot will be familiar. But I hope you enjoy the slightly different perspective.

Taking a Step Back to Move Forward…

“The simplest questions are the most profound.
Where were you born? Where is your home? Where are you going? What are you doing?
Think about these once in a while, and watch your answers change.”
— Richard Bach, Illusions

To an outsider, a hospital often feels like a chaotic place. Varied people flutter in and out of rooms, the color of their scrubs identifying nurse vs. patient care tech vs therapist. Bulky portable X-ray machines compete for hallway space against more streamlined transport carts, shuttling patients to procedures and tests and back again. All this against a soundtrack of monitor alarms in-between intermittent overhead announcements.

For those who work inside the hospital walls, there is a structure and pattern beneath this apparently random Brownian motion. Environmental services with their Zamboni-like machines clean the floors at 4 AM. Phlebotomist follow soon after to draw 5 AM labs. Portable X-rays make their way into the rooms about 5:30 AM. Resident handoffs start at six before the nurses have their shift change at seven. Multidisciplinary rounds tentatively start at eight. Notes finished by twelve so I can get to my first office patient by one in the afternoon.

Patients add improvisation, going off-script to inject their own episodes of distress, instability and crisis. But every day, in each hospital, there is a unique structure and rhythm to the day to anchor and build off of, to manage and cope with the unpredictable nature of the ICU. Almost every day for the last twenty years, I have relied on and used these routines and patterns to navigate and manage my day.

A year ago, everything changed.

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The pace and path to mindfulness

Fast

I eat. Fast. Often, I consume the food I place on my plate before I even make it to the kitchen table. It’s as if I grew up during times of famine, desperate for each and every morsel. On the rare night my family has dinner together, I am usually finishing just as they are starting, and by doing so, send a not-so-subtle message that I value family time together less than just eating.

I drink. Fast. That first beer stands no chance. After my first “sip”, I look sheepishly at my near empty bottle, while others are still using the bottle opener. The joy and satisfaction of a cold beer on a hot day is made all too brief.

I read. Fast. If I like a book, I will devour it in hours. I will keep turning pages until the first light of day sneaks in under the bedroom blinds, signaling me to stop reading and start getting ready for work. The more gripping the book, the quicker my pace and ironically less time to enjoy my escape.

I see patients. Fast. A necessary skill when the hospital is bursting with influenza, the ICU’s are buzzing with patients on ventilators, and my afternoon office is bustling with overbooked patients. I am relieved when I make it through the day without the weight of unfinished charting and unreturned patient phone calls still to be made. But back home, my escape is not without consequence. I feel a gnawing, growing internal uneasiness at the lack of depth and breadth of my numerous interactions.

Slow

I write. Slowly. Frustratingly so for someone trying to create content and build a platform. But I love to labor over sentence structure and word choice. Although slow, it is not painful. When I am able to put to paper the perfect sentence that captures what I see and feel in my head, it generates a soothing and intoxicating internal harmony.

I listen to music. When I do, time slows, regardless of its fast or slow beat. In my car or at a concert. The chords, notes and riffs are felt more than heard, resonating within. Sometimes I get lost within a space that only exists for a brief moment in time.

I cook. Measured and deliberate. I prefer the feel of certain knives in my hand. Cast iron more than non-stick and the warmth of the oven pre-heating behind me. Whether it’s making homemade pizza dough, baking gluten free muffins or smoking a brisket for the better part of a day, I don’t feel that time has been wasted.

I run. Sometimes for hours. Disconnected and separated from phone and home, my foot cadence becomes my mantra as I let go of the competing forces of work, family and social media. I dive deeper into unresolved thoughts and emotions.

Pace

I first learned about the concept of pacing in high school.  Figuring out a “steady” versus “race” pace was a skill needed to survive swimming thousands of yards day after day. I apply the same concept when training for and competing in Iron-distance triathlons. How fast can I push before burning out too quickly? How do I not leave anything in the tank as I cross the finish line? When I think about the activities and actions that bring me the most meaning and happiness, pace is a dominant factor.

Mindfulness often evokes images of yoga, crystals, incense and oils. But the truth is, when the pace is right, mindfulness comes into play without the need for any new age music in the background. Just as I appreciate the cadence of my breathing on a run or the layering of different tracks on a particular piece of music, mealtime can be transformed from mindless to mindful. Tasting the food and enjoying conversation, while being present and in the moment with my family around the table, becomes so much more than quickly ingesting empty calories.

Applying pacing and mindfulness to an otherwise generic patient encounter opens up opportunities to create a more qualitative interaction. Picking up on verbal and non-verbal cues. Recognizing that what is not being said may be more important than what is. Filling in and clicking on all of the blanks and boxes in the EMR might facilitate an orderly collection of important health data points, but it does not facilitate a natural exchange of information, nor does it create a comfortable space that promotes openness and candor.

We make thousands of conscious decisions every day. What should I eat for breakfast? What shirt will I wear? Do I go for a run or a long bike ride?  What will I write for a new blog post? But we rarely pay explicit attention to the pace of our actions. I have lived most of my adult life moving at a fast clip. Transitioning to part-time gives me the opportunity to slow down and be more cognizant about the pace I choose moving forward. By doing so, I hope to reclaim in my work world the quality that has been absent in some of my recent patient encounters. And when outside the walls of the hospital, I hope to capture more often, that internal harmony or resonance that is waiting for me.  If I can just find the right pace.

How Do You Know When Someone Is Broken?

How do you know when someone is broken? When their spirit is fractured? When their sense of self no longer aligns with what once was. When you feel as if you have woken up in a foreign land, but that sense of displacement is coming from you, not your surroundings.

In television shows and movies, that moment for a doctor is obvious. The scene in which a physician cries in the stairwell, knees bent, head hanging dejectedly. A downward spiral into drugs and alcohol that leads to a near-miss in surgery. Or a final, explosive ranting monologue, that alienates the doctor in front of patients and peers. They have snapped. They have broken. At least until the next scene or episode.

Real life rarely follows a Hollywood script.

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Seventeen-years-old and into the Great Wide Open..

sand

Into the great wide open..
 Under a sky of blue”
                  -Tom Petty

In the absence of moonlight, the summer lake house had been pitch dark when we arrived. The five of us had made a spontaneous late-night decision to drive from the northern suburbs of Chicago to Michigan City, Indiana. Now, as dust particles dance in the glow of the morning sun streaming through the windows, I wake up in the large room known as the “dorm.” In other far too small single beds, three of my friends are refusing to acknowledge the start of the day.

The bed squeaks as I swing my feet onto the floor and walk outside to the concrete patio. The house sits on top of a bluff overlooking Lake Michigan. The cool morning air has not yet given way to the sun’s warmth. Peter is already up, coffee in hand. Slowly, the rest of the crew makes their way outside to sit on the stone steps that wind down to the street; Lake Michigan and the beach just on the other side. Hungry, we dig into a box of day old Dunkin Donuts brought from home.

It is the summer after our high-school graduation and we are at Peter’s summer house for a few days. A weekday or weekend? It doesn’t matter. Every day now feels the same. High school is behind us, yet college still feels far ahead in the distance. For the moment, there are no homework assignments, or grades to worry about. The ninety-minute drive to the beach house is as much a declaration of our growing independence as it is a fun forty-eight-hour getaway to squeaky white sand and mid-summer sun.

Still in our shorts and sweatshirts from yesterday, we eat the donuts and drink bad coffee. We talk about the Cubs and summer jobs. We retell inside jokes and repeat favorite movie lines. The afternoon will be filled playing catch on the beach, with the Cubs game on the radio, and cooling swims out to the sandbar. Our personal journeys lie ahead, but for the moment, we are carefree and at ease.

The memory of drinking coffee on the patio before spending the day on the beach is still vivid thirty years later. The cool rock on the back of my legs. The bitterness of that flavored coffee. The hot sand squeaking under my feet. My shoulder, sore from throwing the baseball all day long. The sun’s heat burning my back while lying on a sandy blanket. Swimming to the sandbar. Nowhere to be, nowhere to go. My future completely unwritten.

I didn’t recognize the significance of that day, or that summer, in real-time. I guess that’s the nature of being young and feeling immortal. Maybe it’s the slow and gradual accumulation of responsibilities that come with a job or marriage or children, that enable us to appreciate the days when we could just lie in the sand and bake in the sun. That summer, listening to the Cubs game on the radio with friends, the weight of future responsibilities had not yet entered our world.

Thirty years later, I am, once again, at a place in my life where things are yet unwritten. After 13 years as a pulmonary critical care physician, I chose to start working part-time in July. I have already encountered a few hiccups and speedbumps along the way, but this time I am able to appreciate the freedom and opportunities that lie ahead.

I am attending a TEDMED conference this week. Within the overarching theme “Limitless,” the talks highlight issues of medicine, both directly and tangentially. I am eager to see which talks will directly apply to me and what I can bring to the table. What mix of critical care medicine, parenting, water polo, and writing brief narratives stories related to those topics might spark a conversation with my colleagues? I am no longer a seventeen-year old kid lying in the sun, with no real responsibilities, but my future does require a similar shift in my mindset. And as I hear Tom Petty’s voice singing in my ear, I am focusing, not on what limits me, but on how limitless the possibilities are.