Full disclosure here: I am not an expert or pundit on the topic of “resilience in medicine” (a term which I am not a big fan of), nor will I be able to quote a bunch of stuff from the literature like RCTs and the like.
Honestly, I am just a physician who has spent 20+ years in the ER, had a few leadership roles along the way (which makes for a mildly robust LinkedIn profile), and nurtured some wisdom too. I think that is enough.
Currently, I am happily a volunteer medical director and primary care doc at an outreach clinic doing primary care. I also do some PRN telemedicine work. Yeah, you may have noticed that I am not really in the ER anymore and that is true.
However, this transition has given me a new perspective on my ER career and I think enough corridor cred to at least pull this essay off. Beyond medicine, I am pursuing other vocations. Many who know me may not realize that I have been playing drums for about 40 years.
Okay, now that the formalities are out of the way, I shall begin my theoretical discourse, or, er, diatribe :-)…
Honestly, I am just a physician who has spent 20+ years in the ER, had a few leadership roles along the way (which makes for a mildly robust LinkedIn profile), and nurtured some wisdom too. I think that is enough.
I think all of us have been seeing resilience thrown about since the Pandemic. I am sure it has been talked about before but wasn’t on my radar.
Please allow me to delve into my experience in medicine and try to describe what I believe resilience is and why hospital administrators cannot teach it. If that sounds good, please read on. If not, no worries, please move on to another post.
Imagine you want to see the peak of Mount Everest, but you are not a mountain climber. Now, I understand that helicopters, to my non-aeronautical self, can’t hover at 26,000 feet and beyond, but for the sake of this post, let’s say that they can. And yeah, this analogy is simple, so keep your comments kind :-).
Climber 1 spends a couple of months and a crap load of moolah, goes to various basecamps, tries a summit attempt and fails, but returns alive and intact, and overall spends a lot of time at high altitude, doing a lot of climbing, and pretty much feeling good.
Climber 2, on the other hand, does some leisurely trekking but takes a helicopter into basecamp; gets treated for acute mountain sickness – luckily no HAPE or HACE for you ER junkies; followed by this magical helo lift to the summit: wearing oxygen, all suited up, sweet selfie on the summit, a little frostbit too, and then quickly flown back down to basecamp. Done and dusted, sweet!
Both climbers return together to Kathmandu and share a bunch of stories at a local pub over a beer or two. Climber 2 still feels sick and honestly wants to go home. He has been there for only a couple of weeks. Climber 1 on the other hand is pumped, physically feeling good and grounded, save for a couple of discreet bouts of acute gastroenteritis in recent weeks. She is still remembering the frozen body of the climber in a brightly colored suit. She is also looking forward to going back home.
Who is more resilient? I would argue Climber 2. Why is she more resilient? Well, she spent a ton of time acclimatizing and climbing. Like a mountain summit, the effort made to become something greater than what we had been before – to wholly transform ourselves – is what gives us the rock-solid physical and emotional fortitude, regardless of what is thrown our way, that epitomizes resilience. There are no shortcuts to attain this. And it may take a lot of attempts before we achieve our own personal summit.
Physicians go through their own Everest summit attempts. These are the crucibles of med school, internship, and residency. Not everyone makes it. Some drop out in school, others in internship, and others later on; and for several reasons. I don’t believe that there is no way anyone can teach this type of resilience to survive the crucible. Sure, you can be taught some preparatory skills and you can acclimatize. But ultimately, we have to jump in and go through it. Other fields like nursing and advanced practice health professions, for example, have their own. I can only speak to mine.
I earned my grit. I didn’t take a course called Grit 101 and got a certificate that says I am grit-certified. I worked my butt off to get into med school. I can’t recall all of the sacrifices I had to make, but given that writing this essay is a bit of a therapy for me, I can vividly remember friendships and even true loves that were left in the wake of my medical training journey.
But the crucible did not leave me unscarred. I was physically attacked yet externally uninjured, and had to go back to an ER shift; like literally back to it after picking up all the debris of broken computer screens, chart holders, and others things from the floor, and trying to make sure my MA and nurses – my people – are okay and unscathed. It’s not OK. I say this with experience and it absolutely sucks.
I earned my grit. I didn’t take a course called Grit 101 and got a certificate that says I am grit-certified.
Whether right or wrong, I did what I had to do at the time to survive and succeed: I wanted to be exceptionally well-trained and be the best I could be for my patients. That compass included the memory of my late grandfather, a surgeon whom I idolized.
There was no “light at the end of the tunnel” for me until very late when I clawed my way, hand over hand, out of this physically and emotionally challenging experience of internship and early residency. There was a lot of darkness, and even more beyond the initial darkness, but I got through it.
Coming through this I felt confident, strong, knowledgeable, and in many ways, tempered like a steel blade – atoms locked into a position of great strength and flexibility through a process of heating, forging, and quenching… I began to become more balanced too and increased my connections to others. I found new loves and eventually the love of my life. I survived, and in many respects thrived. My experience is probably different from yours, but it’s mine. Weirdly, I feel like it’s a superpower.
In Part 2 next week I explore different perspectives between clinicians in the trenches and leadership, trying to see both sides. I also suggest some Manhattan Project Tom Hanks Captain Sully Hudson River ass-kicking solutions.
