Pushing "Reset"

Courtesy www.systemserenity.com

"We must always change, renew, rejuvenate ourselves; otherwise we harden." 

- Goethe

The culmination of my professional training - the American Board of Anesthesiology Oral Board Examination - has finally come and gone. When I say "culmination", I really mean it: after undergraduate school and then a brief stint as an engineer, I completed two years of graduate school, 4 years of medical school, and 4 years of residency training (with some small glitches along the way) to get to the point of being a board-certified anesthesiologist. And now, after roughly an hour of Socratic method-style oral Q&A in a hotel suite on the 15th floor of a fancy Marriot hotel in Miami (I know, sounds surreal, like a scene in a spy movie), it's all over (assuming I passed... tbd in a month or so!) No more formal testing of any kind until recertification in 10 years!!!

In reality, being a professional means you are never really "done" studying and learning, but this marks a huge change in the landscape of how I have been spending a substantial amount of my time for several years. I've talked about the role transition I went through after residency ended, and the "stress of no stress" when I found myself with more free time. But over the past few months, the ebb and flow of stress crested again with my preparation for oral boards. Now I'm faced with the dilemma of how to truly press the stress "Reset button". So, what are some options?

1. Take a vacation. An ideal vacation would be, well... ideal, but even a short trip after the culminating event could help to reset work priorities, physical presence, and mindset. I could have easily flown home and gone back to work the day after the exam, but instead I chose to spend a few days in Florida to explore an area and culture that I have never experienced. The lifestyle, climate, and food are very different from what we're used to out west, so it was a great way to rejuvinate and appreciate the life choices we've made.

2. Clean house. For me, this meant going through all my study materials, purging papers, and tidying up my home office again. An uncluttered environment makes for a mental "clean slate", thus that you can focus your efforts on the next tasks that come your way.

3. Write some stuff down. Whether it's journaling or just jotting down some items as a list, putting your thoughts into writing can help clarify your upcoming priorities. Some lists that I needed to make include "to do's" that I have been neglecting in favor of study, some physical fitness goals I'd like to achieve this summer, and a list of resources I'd like to check out to keep my mind focused on continuous learning at work (now that the automatic mandate of studying has been lifted).

4. Try a "routine challenge". By this, I don't mean "challenge your routine." Most likely, your routine is going to automatically change with your reset. Consider adding something new to your daily routine, perhaps something you've been wanting to incorporate into your daily life but previously felt you were too busy to add (yoga practice, a daily walk, meditation, etc.) Do it "challenge style" - try completing the activity for X minutes/day on a total of, say, 30 consecutive days.

5. Start a new endeavor. Similar to the above idea, is there any particular activity that you've been wanting to do but have put off due to your previously busy/stressful status? Want to take up piano again, learn a new language, take a class on fine chocolate? Dive in now! I have a long list of these (including the ones I just mentioned), and I'm planning on tackling them one by one starting now!

What about you? Do you have any ideas for me on how to press Reset? Share them here!

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Gossip: The Donut of Stress Relief

Source

 We all cope with stress in our lives using good techniques and not-so-good techniques. I'm knee-deep in preparation for my upcoming oral board examination, and to act like I'm handling the stress perfectly would be a complete fake out. I have fallen into some of my own old, less effective habits (chocolate, anyone?)... but by taking a few minutes out for personal reflection or talking with friends/loved ones (two of the positive tools I commonly use), I've been able to identify and minimize some of the coping methods that aren't as effective.


The other day while struggling to place an IV on my first patient, I was chastised by the surgeon for not coming back to the OR on time. (We are all tracked by hospital administration on our records for "on-time" arrivals to the OR each morning). Of course I always strive to be efficient and on time, but when safety or patient-related factors preclude this from happening, such is life. Unfortunately, some surgeons take for granted the anesthesiologist's part in the patient's perioperative experience. After this encounter, the surgeon's antagonistic tone persisted in the OR, causing my blood to boil and further stress to invade my day. Later while having lunch in the lounge, another anesthesiologist at my table was randomly talking about how bad of a surgeon she thinks this particular person is. I glanced at the surrounding tables. There were other people eating lunch, but no one else seemed to be paying attention to our group. "He is killing me today; I could just wring his neck!" I blurted out. And the negative rant ensued...

After this catharsis I felt better for about an hour, but then I felt guilty. I began to think about the other people in the lounge. Had they heard me talking negatively about another provider? Why did I engage? It's unprofessional, and if I had been listening in on my own conversation, I would have been left to assume that the gossipers are indescriminating... who else could they unleash about?

So while I have discussed the benefits before of narrative reflection for stress relief, gossiping at work is not the best way to accomplish this. It's like eating a donut: you want to do it and so you indulge, but it only provides temporary gratification... and leaves you with an empty, guilty feeling. Instead of gossiping next time the stress rises, check out one of these quick fixes for stress relief! Do you have any other quick tips up your sleeve?

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The Power of Music to Relieve Stress

(Trent with clouds, top of Wasatch)

I've been dealing with my own stress issues lately in the midst of my preparation for the American Board of Anesthesiology oral board exam (the final step to getting board certified!). Just last night, I was up for at least an hour at 3 am replaying mock oral exam scenarios in my head, the adverse events that had been thrown at me intertwining with visions of my planned cases for the next work day... along with thinking about the pros and cons of moving to a different house (which is not an item on our upcoming agenda)...?? How the brain works is sometimes a mystery, isn't it?


So during my groggy, coffee-soaked morning prep for work, my ears perked up at this segment on NPR. The featured music group, Cloud Cult, is coming out with a new album. Their music reminded me of something you would hear wafting through the racks while shopping for another pair of brightly colored skinnies at Anthropologie, but the words struck me as rich, inspiring and positive. Two of the band members are married, and a great deal of their inspiration for song writing comes from a very horrible (and obviously stressful) experience. Their two year-old son mysteriously died in his sleep 10 years ago. A lyric example:

What comes will come

What goes will go. 

The wind will blow where the wind is blowing.

Let go of where you think you're going.

We'll never know why it flows where it's flowing.

- from You'll Be Bright

If these people can harness the feelings surrounding such a tragedy to create powerful music, what creative fruits could we bear when dipping into our black bags to manage our (much less horrible) work and life stress? Not everyone is adept at making music, but the act of listening to music can relieve stress and generate a creative flow in other areas.

When I got home from work today, instead of immediately diving into the study books or fretting about what to make for dinner, I popped in the headphones and headed out for a walk. And it felt great! What about you? Do you use music to relieve stress, inspire, remember gratitude? Do you play or just listen? I'd love to hear about it!

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The Case for M&M's

(I always loved the green ones best)

No, this is not a blog post about those little round candies...

In the medical world, M&M stands for Morbidity & Mortality Conference. In other fields or any corporate environment where long-term projects come and go, it can be referred to as a Post-Mortem. Much like an autopsy, medical cases or events or projects are dissected piece by piece to determine the best learning points (either positive or negative) that can be gleaned from the participants' experience.

These meetings are not as sweet as M&M candies, however. In medicine, cases are normally chosen for M&M because they are associated with some sort of adverse patient outcome. In fact, they can sometimes become contentious, bringing out strong opinions about whatever decisions were made by the involved parties.

"But doctor, why didn't you...?"

"Did you consider _____ before _____?"

Depending on the audience, if you are the presenting party standing up in the front, naked and vulnerable and being challenged by your colleagues about actions in the past that you may/may not remember and for sure can't take back, it can be relatively stressful. But if you let go of your ego and look at it from a new angle, M&M can actually be a very useful tool in the process of self-care and stress management.

I came across this 2012 study (Thanks, Whole9!) entitled, Disclosing Information About the Self is Intrinsically Rewarding. The authors imaged the brains of participants with fMRI and found that when they were sharing personal experiences with others, their mesolimbic dopamine systems were activated. Thus, they stimulated reward centers in the brain. So while picking apart our actions when something went wrong definitely benefits our patients, it also can benefit us!

The next time you have to present at M&M, look at it as an opportunity to share important knowledge about your experience instead of as a dreaded "pimping session". If you don't have such an opportunity in place with your current practice group, consider starting one.

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