An Ounce of Kindness

Author: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UT Southwestern Medical Center / Parkland Memorial Hospital) // Special thanks for meaningful feedback to: Mike Weinstock, MD; Manny Singh, MD; Jamie Santistevan, MD; Brian Zink, MD; Compton Broders, MD

I worry for my colleagues… I worry for my profession

At the bedside we navigate an encyclopedia of intermingled diseases and life stories with circadian whiplash – spinning and whirling to meet paramedics arriving with the critically ill, twisting and turning incongruent stories, whittling and pounding our own needs for food, rest, release… a necessary evil?

Tired

The kind of tired where you can’t sleep

There are consequences when changing day for night and dawn for dusk; when the doctor becomes the patient, the implications can’t be ignored

Depression, cardiovascular disease, anxiety, insomnia, metabolic syndrome, substance abuse – are the prison guards really that different than the prisoners – can we really blame the lifestyle for the disease?

We welcome a worsened quality of life, a distance which spans like a canyon, driving us from families, friends & colleagues as we try to forget the 3 year-old struggling to breathe, struggling to understand how caregivers did not give care, struggling to reconcile how there will be no football games, no college, no children of his own, no old age…

We accept this, but…

We should not

Burnout is a symptom, and we are high-achievers. We lead the pack.

There are so many theories…

Lack of purpose and empowerment

Flawed, overburdened systems

Trying to squeeze the last drops out of a lemon

For primary care is overwhelmed

Some specialty care is not interested

Don’t pass Go… Straight to the ED

Limited resources. Boarding. Waiting rooms like a bus station – we are forced to MacGyver:

Communication barriers, we’ll figure it out

An overwhelming cognitive load, nice challenge

An incomplete procedural kit, no problem

Labs/radiology on break, we apply the mantra that clinical judgment trumps all

Decisions made on limited information. We are juggernauts juggling javelins

Despite all – patient advocacy still stands

With exponential advances in expertise… and volume, we have become masters of troubleshooting

Street-smart, hard-shelled, but with a gentle core within – the clues of struggle apparent

Just listen and observe… it’s not hard to see

The harshest critics of glass-windowed emergency physicians are not only our peers… but ourselves

An acceptable miss rate of zero is our target. Our true ‘dark side’; striving to see natural light from our fluorescent prison…

We are multilayered roses, each with unique life stories and passions, with grit/resilience only a partial answer

As we seek to balance being true to our patients, while being true to ourselves – we return to our roots

Striving to be kind to our colleagues. To be kind to our patients. To be kind to ourselves. To show an ounce of kindness

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