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

Never Forget the Value of Play

Never forget the value of play.

I wrote that one day when I was walking around the hospital. It was so profound to me at the moment that I stopped in the hallway and wrote it down as a note. Later I would open it up and just look at it because it meant a lot to me.

David was on staff with InterVarsity Christian Fellowship (IVCF).  The year was 1985. I was the president of the local IVCF chapter and David’s job was to be my mentor. For those of you who don’t know, IVCF was started by students and is student run. If there is someone who comes on staff their job is not to lead. Instead they are to mentor and support and develop the leadership skills of the students.  I was going to have a mentor.

I was excited to have someone like him. What would a mentor do? 

Would he peer deeply into my soul and challenge me? Would he shake me up and point out my weaknesses? Would he give me challenging assignments? When we met, I was ready to go! I had my notebook open and my pen ready. 

What he did was indeed profound. 

He got up from our table in the student café and walked me over to play video games.

We played “Centipede”. I was ok at it. Not great. But it was good. It was really good.

David was wise. He was wise enough to diagnose my need. I was too intense. I was so focused and driven that I didn’t need a psychoanalysis or deep reconstruction of my personality. I didn’t need more stress or drive to do things. I needed to “chill out”. I neededto play Centipede. 

I see it even now in the medical students or pre-med college students who come to shadow me. They have this intense driven personality. I laugh because I see a younger me in them. They hang on every word looking for opportunities to excel. 

But what they often need to learn is to be human. How to be present. How to just be.

It is a lesson I have had to learn over and over again through life. I am so thankful for the wise and profound people that have been put in my life to teach me the lessons. 

My college roommate John taught me. We played hours of ping pong. He also taught me by example when he and his future (pre-med) wife almost broke up.  She wanted “quality time.” John was happy just being with her. Or just being. He didn’t need intense wonderful discussions. He was happy to just sit beside her or walk beside her. Sometimes not even saying anything.

I did break up with my wife Sarah (while we were dating) over this. I would drive her crazy in my drive to score a 100%/A+ on our relationship. She did me a kindness by breaking up with me. I was driving her crazy.  I was literally making her ill by my approach to our friendship. And I wasn’t learning the lesson. 

We only started dating again when I learned it was ok to just be human. When I wrote letters, I didn’t have to figure out all of the human condition, each of our personalities and our lifelong destinies. 

I could just tell her about what I had for lunch. Or what I did the night before. Oddly, she liked me more when I underperformed on these letters. She didn’t grade them and send them back to me marked up in red ink. I didn’t think they were very good performances. I was just being a normal person. She liked me more when I did that.

However, I messed it all up again. We got back together and started dating again. And I figured I had better “up my game.” I started all the intense analysis again. Oops. She didn’t like that. I could tell. I went for a 3-mile run. By the end I figured out that I had better call her and apologize. She later told me that she had decided she was absolutely finished with me until I made that call. It saved our relationship and the rest is the marriage that I cherish now.

What is the lesson?

It is ok to just be human.

It is ok to just be.

It is ok. 

Sometimes the best mentoring that you can do is to make someone go play a video game. Or play ping pong. Or go for a walk but not talk. Or just sit beside them.

Thank you, David! And John. And of course, Sarah. Every time I see a Centipede game, I think about you – David – and the profound lesson you taught me. The value of play.

It is ok to just be human.

It is ok to just be.

It is ok.

Categories
Being human Medicine Reflections on Life, Being Human, and Medicine

Burnout

I had passion. I was driven by it. It consumed me. It pushed me forward. I had to follow it. I had no choice. Now I am ready, almost eager, to let others take over. What has happened to me?  

I am tired. Years of pushing burned the candle down. I can flicker up at times but it never seems sustained. I seem to do things because I am supposed to. At times I want to but then wish I could retreat. I dream of just being able to sleep. To know what it means to really rest. For once to not feel so tired. 

I feel beaten down by the repeated tasks that consume me. Rounding is not about taking care of patients or making a difference. It is about how to get through the list. How can I finish and keep up? Another note to write. Another question to answer. Keeping my inbox empty. And there is always another. And then the emails just keep piling up. And then the things that I want to do seem to keep getting undone – length of stay, readmission, survival, appropriateness – it all seems to just stay the same. I feel guilty that I have not achieved more and wait for someone to point out my flaws. Why have I not achieved the best in outcomes? Why have I not pulled it all together?

I am numb. Because I don’t know any other way. How can I keep going when the losses keep piling up? In a field where 90% one year survival is considered good, that means that we are forced to endure losing 1 out 10 of our closest patients. I am supposed to be strong, right? These patients all meant a lot to me! Chris, John, Richard, Patrick. The list goes on and on and it never seems to stop. And just when I get my confidence back it happens again. Another punch to the gut and I just take it. Don’t let it show. Don’t let anyone know. Because how can I? 

I do have a bad case of FOMO (Fear Of Missing Out). I have a deep fear that I will get to the end of my life and have someone come up to me and say, “Surprise! You were tricked. You missed out on life because you were so busy living it that you never felt it – never actually experienced it.” I dream of retirement as a time when maybe I will be able to slow down enough that I can see and hear and feel again. I worry a little bit because lately people have been asking me if I am going to retire soon. I am ashamed to tell them I am only 53 years old and so I have a ways to go. I also am afraid that I will be like others who finally get to retirement and then dream of the past.  They look back to the days that they had purpose and things to do. I think I am a fool. 

What can I do to be able to live today? Is it possible? Can I come and play with the other kids? Or do I have to stay inside and work all day? Am I going to get to go outside while it is still summer or will I get tricked and only finish my work in time for the cold dark winter?



ADDENDUM:

I wrote this prior to my cancer diagnosis and my medical leave of absence. It is raw and honest. I never intended to post it. I wrote it for me but now am going to bravely post it. I intentionally left it with some sense of hopelessness and no real answers because that is really what burnout does to us. In all honestly at that time I did get to go outside and play, but burnout makes it so you are not able to fully enjoy it. Your brain remains inside and hard at work even when you go through the motions of going outside to play.

Now with the perspective of several weeks off I see a few answers:

  1. Dogged Focus on Patient Care: We have to have the strength to be doggedly insistent on focusing on patient care. The pressure of charting in the EHR (Electronic Health Record) can drag us down and distract us. We need to have the EHR be the side item and still insist that the focus of our energy is on the patients. That is where the joy is. A less complete chart is a lesser sin then an incomplete care of the patient.  (The EHR is breaking us. We MUST come up with better solutions. Perhaps the answer is scribes?)[1]
  2. Ring-Fence Your Personal Life: We must put a fence around our clinical or work activities. We have to have time to think, breathe and exist. When you are home, without shame, be home. When you are on a walk, look at the trees and the birds and don’t feel guilty about what is not yet done at work. The undone tasks will always be there whether you spoil your walk or not. Fight to protect work from creeping into the rest of your life.
  3. Put Down Your Phone: Turn your phone off or put it down if you are not on call. If you cannot do this, give it to your spouse or friend when you go out. Ask them to give it to you only if there is an urgent matter that you must attend to. Get in the habit of having your brain free of work. Get free of the addiction to the phone. It is hard for me to do this but I have to. I get twitchy at first without my phone in my hand. Eventually I get over my withdrawal symptoms and start to become human again!
  4. Go Away: Go to the national meetings. These always are inspiring and recharging.
  5. Read Novels: I call these “sorbet for the brain.” Like in an expensive meal where they serve sorbet to “cleanse the palate.” It helps to restore your ability to taste before the next course. Novels can have a remarkable ability to do this for your brain!
  6. Sabbaticals: I still think that physicians should have sabbaticals. A 4-week period to recharge could result in a re-energized far more effective physician. If only health systems could be wise enough to invest in their physicians in such a way.
  7. YOU TELL ME! What else? PLEASE RESPOND TO THIS POST! I really want to hear what you think works!

There is an epidemic going on. The ICD-10 is Z73.0 and the term is “burnout”. The vaccines are not very effective. The treatments are still rudimentary and need a lot more work. Like many papers I think I will need this one to conclude, more research is needed. We desperately need it…


[1]Interestingly the EHR issue is finally getting some attention. Please read this blog post for more information: https://www.healthit.gov/buzz-blog/health-it/strategy-on-reducing-regulatory-and-administrative-burden-relating-to-the-use-of-health-it-and-ehrs-released-for-public-comment