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Being human Reflections on Life, Being Human, and Medicine Reflections on the Christian Life

Compartmentalization: How Putting Thoughts Aside Can Be Both Constructive and Destructive In Your Life

Compartmentalization. That is a big word. It is an important concept we were taught in flight training.  The idea is that you can block thoughts from your mind so that you can focus on what is important in the moment.

Let me share an example. We were doing our preflight for a helicopter flight from Norfolk to Camp Lejuene. The pilot I was flying with mentioned that he had a headache. We finished the preflight and had a nice flight. We landed, taxied to our space and shut down the helicopter. Once we were shut down I asked him then how his headache was. He seemed confused for a minute and then remembered. “Oh. My headache! Ow!” He pulled a packet of Goody’s powder out of his flight bag and downed it. 

During the preflight he had done as he had been trained. There was no room for him to be distracted while flying. He needed to be completely alert and focused on the flight. Once the flight was completed, he had the “luxury” of being able to feel and notice his headache again. That is compartmentalization.

This can be a valuable thing for a pilot who has to focus on his mission. In life it can be either good or bad.

I know people who are terrible at compartmentalization. They don’t have just one storyline running in their head. They may have 3, 4 or even dozens of thought-lines running simultaneously. When something bothers them, it can be very hard for them to focus or rest. When they lay down at night, they can’t just decide to turn off the bothersome thoughts. The thoughts just keep going and going. Sometimes the thoughts are intrusive and are about things that cannot be fixed. In that setting I wish for them the ability to compartmentalize.

We talk about techniques to help them do this. Journaling can help. Another technique is to write things down so that they can be temporarily put away. “I can’t fix this now. I will write down reminders so that I can shift my attention and do what I need to do now.” 

A corollary to this is, “Not my circus, not my monkeys.” In this version, the problem is truly about something that is not your responsibility and something that you cannot fix. In this setting, you hopefully can acknowledge those facts and then move on with life. You might not like what the monkeys or the circus are doing, but whether you worry about it or not really isn’t going to change anything. You might as well push that over to a corner of your brain called the “not my circus” area and go on with your life.

It was another day and another mission. This time I was in control and practicing landing the helicopter in a tight landing zone. For this exercise, the crew chief in the back of the helicopter would call out instructions to me. Forward, back, left, right and so on until we were carefully landed. I completed the exercise without problems but felt tense the entire time I was doing it. I just wished there was not the loud buzzing in my ear. It was then that I realized that I had forgotten to cancel the low altitude warning. This was an alarm that was warning me that I was getting close to the ground. On landing you generally cancel the alarm. I had forgotten to do so. I was so focused on my task that I had ignored all of the alarms.

Sometimes we see people doing things that are nothing like what we would expect from them. Infidelity is one of those things. How could a man or woman after years of marriage forget all of the good that went before? Can they just ignore all of their shared experiences? Can they ignore the love that they shared? How could they become willing to sacrifice what had before been so very precious to them? 

I am convinced that compartmentalization plays a large role. They are able to push the thoughts of their past aside and focus on the new person or relationship that is in front of them. They lock the past away to a place in their brain where they do not have to look at it. They also lock away the ideas of the destruction and harm that they are causing to themselves and their family. 

The alarms are blaring, “altitude, altitude, altitude” and yet they ignore the alarms. They fly their lives, their marriage, and their families into the ground.

Compartmentalization is a tool. Like any tool it can be effective or dangerous.

Electric saws scare me a little bit. Every time I see the large spinning blade I imagine fingers cut off or worse. If you are building a house or doing other types of carpentry, they are necessary and effective tools. But they are also dangerous. You have to respect the risks of the tool. You need to know what precautions to take before you begin to use it. 

I am not as afraid of a chain saw. Probably because of my time using them on the farm, I am more familiar with them. I do know however to wear solid shoes, heavy jeans, leather gloves and generally I wear eye and ear protection. I also know about the risks of kick back and ways that I am comfortable using the saw and ways that I am not.

Compartmentalization is the same way. It is a powerful and effective tool to allow you to focus and achieve things in life. It can bring you peace in times when you do not have control. The ultimate compartmentalization is in trusting God.

As a flight surgeon I learned about a lot of the bad things that can happen while flying.  If I am not careful when I am sitting on a commercial airline I can imagine bad things happening. I have absolutely no control over what happens. As we approach landing in bad weather with a strong crosswind and poor visibility I could drive myself crazy. Or I can compartmentalize. The pilots are well trained. The rate of aircraft crashes is remarkably low. Whether I panic or not won’t change our odds of a safe and successful landing.  The dozens and dozens of aircraft crash stories get put away. I don’t need them in the moment. I trust in the ones who are in charge.

What about in life? Cancer certainly is a huge uncertainty. This past year has brought endless cycles of grief to people we know and love. How can you live in a world where there is suffering and injustice? 

One of my favorite quotes is this, “We can live in a world where there is violence and injustice because we know that God is in control and that His process is being worked out.  And in this – the righteous can live by faith.”  Another one is this, “God remains quiet. But it is not a cold and uncaring silence. It is instead as if He is saying, ‘Peace, child. You cannot understand.’”  It doesn’t have to make sense. But you can park it (for a little while at least) in the area that says, “I know that God is in control and I can let Him handle this.”

As in many things it comes down to balance. Compartmentalization is a powerful tool. It can also be dangerous. You need to make sure that you use it safely. 

Compartmentalize so that you can ignore a headache to focus on flying a helicopter safely and complete your mission? Yup. Use it to help you so that you don’t obsess over things you cannot control? Sure. Trust God even if you can’t control what is happening? Absolutely. 

Compartmentalize to enable you to ignore or betray the trust of your loved ones for a momentary gain? Nope. Neglect problems in your relationships because you don’t want to deal with them? Also nope. Ignore the alarms sounding in your head about the implications of what you are about to do? Never.

We climbed back into the helicopter to head back to Norfolk. We briefed on what was important. We talked about what we had to pay attention to. A lot of other things would be safely and effectively put aside for the duration of the flight. We knew what we were doing. We used compartmentalization to not be harmed by thoughts we didn’t need to focus on during the flight. We could pick those thoughts back up once we landed and shut the helicopter down again.

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Being human Reflections on Life, Being Human, and Medicine

My Desk is a Mess Again – The Struggles of a Process Oriented Thinker Living Life in a World of Entropy

I went to sit and work at my desk, but it is a mess again. It is covered by a jumble of medical journals, sailing magazine, tax receipts, and various pieces of mail. I had it perfectly cleaned just a few weeks ago. It is so frustrating how it rapidly seems to accumulate stuff. It is like my desk is a magnet for messiness. If I leave it alone, it will inevitably become messy. 

I know. It is my fault. I am the reason it gets messy. But it seems like it magically goes from order to disorder.

Life seems to go from order to disorder.

It is because of entropy.

Entropy is (according to Wikipedia) “a scientific concept, as well as a measurable physical property that is most commonly associated with a state of disorder, randomness or uncertainty.”  In essence the concept of entropy is that unless energy is exerted, things in nature tend to end up in a state of disorder.

So, the problem with my desk is not my fault. 

It is entropy. 

In other words, one of the key forces of the universe is this drive from order to disorder. So, when my desk gets messy it is not my fault. It is the fault of entropy. 

In order to counter entropy, energy is required. My desk tends to get really messy and then I commit myself to “the big clean”. I sit down and go through all the clutter. I sort and file things. I through a lot of things away. 

The “big clean” is me inputting energy into the equation to undo the entropy. Now I could choose to input energy every day. That would fight the entropy on each occasion. Smaller amounts of energy could counter the smaller daily amounts of entropy. Or I could do as I usually do and let the entropy take over until it reaches a crisis. At that point I then input a much larger amount of energy to counter it.

Entropy is something that is frustrating to those of us who are process thinkers. We want to think that we can design a perfect system, one in which our personal energy is invested up front, and then have things continue to work smoothly.

Computer programs generally seem to work that way.  Write the program. Hit run. Sit back and let it work.

Unfortunately, life is not like that.  I referenced this in a prior blog post, “The Time I Saved the World.”[1] In my youth I naively thought that I could once for all fix a problem and not have it come back. It is SO frustrating when the problems just seem to repeatedly and annoyingly come back.

I sat in our heart failure excellence improvement team (EIT) meeting this week. We were looking at our quality measures and at some numbers that had gotten worse. Deep down I was frustrated and feeling a bit like a failure. Each of these problems we had fixed at one point. We had processes that we designed and implemented, and we had our outcomes improving and exceeding expectations.

But entropy sits in the back of the room and mockingly laughs at me. “Do you really think that you could fix these problems just once? You are a fool!”

Queue the sinister arch nemesis laugh… “Ha ha ha ha ha ha…”

The issue of course is that as soon as we achieve an outcome, without persistent energy, things continue to slide back again. Early on we designed some amazing pathways. I even presented them on posters and in presentations at national meetings. Our health system even made some nice fancy flyers celebrating our success. We had an interview once on the television news about some of the processes we had in place. But then people changed positions or had their responsibilities and focus shifted. The energy that was holding back the entropy dropped off. Things went right back to where they were before.

“An untended garden always grows weeds,” I say in the meetings. 

I feel like a failure at times. As a process thinker I still believe deep down that if I was competent I would have fixed each and every problem once and for all. When the problems come back I think I must not have been good enough to really have permanently fixed them.

But then my desk is messy again. I see the problem now. I am a process thinker who wants to put in a big push of energy and then sit back and not exert energy. I am not the person who is okay constantly putting in smaller amounts of energy to maintain things. That is not who I am. I am a process guy not a maintainer. I want to build the machine but not run it.

This is a very important life lesson. It goes far beyond my messy desk.

  1. Entropy is real. If you leave things unattended, they will degenerate into disorder.
  2. Energy is needed to counter entropy. You must put energy into whatever is important to you if you want to maintain it. 
  3. You can do this continually or you can do it in large amounts on an infrequent basis. The latter method is riskier because sometimes you can’t undo that damage from the disorder that occurs.
  4. If you are a process thinker you should over time begin to understand the principles of entropy and energy so that you are not harmed by them.

It is true for quality outcomes in healthcare.  Constant energy is necessary. When you achieve success, fight to make sure that the sources of energy are not pulled away. It is the nature of organizations that they will constantly look at where they can trim away expenses and personnel. That means that you must constantly be ringing the alarm to get them to keep resources in place. Registries and watching the data are important so that you can remind them (and yourself) to keep your sources of energy in place.

It is true in relationships. If you do not exert energy, disorder will ensue. It is far better to not let the desk get messy and then have to fix it. If it really matters to you, input the energy into the relationship before a crisis ensues. After I initially wrote this I made a point to tell my wife how much I love her. I should think about constantly putting energy into that relationship.

I have been amazed at how many relationships have been destroyed after years of success. There are many causes, but the truth is that no matter how long people have been together, without investing energy, chaos (disorder and destruction) can occur.

If it is important to you then it is going to require energy. Entropy demands it.  

What matters to you? Make a mental list. Spouse? Children? Career? Faith? Health or fitness? Home? Yard? (Sailboat? 😀)

Unless you are willing to invest continued sustained energy, you will lose them to disorder and chaos. Can you please be intentional? Can you decide what matters and then push yourself to put the energy in that is required to make and keep them?

My desk looks better again today. 

It isn’t going to last.


[1] https://manmedicineandmike.com/the-time-i-saved-the-world/