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Monday Apr 24, 2017

Leaning on My Community for Resilience and Recovery

I have signed almost every email since 2009 with the same imperative-as-closing:


This blog post is about a community teaching me a thing or two about expressing love and, by specific application, about resilience and recovery within medicine.

During the past year, my residency program has had a rough go. This initially left us nearly overwhelmed, but we quickly became the recipients of innumerable demonstrations of kindness. Without this outpouring from our community, I am certain we would be several steps past burnt out.

Photo courtesy of Dwight Smith, M.D.

An overturned bus sits at the bottom of a hill. Several residents and faculty from the Cascades East Family Medicine Residency Program were injured in the accident in July.

Just before our new residents were to start their first rotation in July, we went on our annual rafting trip. On the way home, our bus rolled off a gravel road and down an embankment, injuring more than 20 residents and faculty. No one was killed, but many suffered lacerations, concussions and broken bones. Some of the injured are still recovering.

More recently, an alumna was killed in a sledding accident. Stephanie was, among many other things, an incredible woman who founded our city's wellness center and was one of the chief drivers of community development in Klamath Falls, Ore. Stephanie, and the focus on population medicine she helped develop, were important reasons I chose this residency program.

Events such as these force the adoption of new perspectives. Tragedy is not something that just happens to other people. It is indiscriminate, unfair and abrupt. One is reminded that the idea of a fair world is a fragile construct, indeed.

This is when I feel most burnt out: when I no longer have the energy to do what I feel called to do and doubt that what I am doing actually matters. Burnout happens when demand outstrips reserve and you have forgotten how to fill the reserve faster than it is depleted.

This is when I learned to turn to community. I believe that we are most resilient when we rely on our relationships. You see, the only reason the world sometimes seems just and fair is because of the kindness and generosity of those who surround us. The world is just entropy and swirling happenstance, but our community can make it seem somehow persistently good.

Two things happened that afforded recovery to those most affected by our adversities. First, we were reminded of the compassion and kindness our world is capable of. After the July bus accident, those involved had so much food delivered to their houses that many were still eating from their freezers in September. People I didn't even know delivered lasagna to our house. Second, many of these expressions of kindness buffered the demands we faced. This came in the form of covering time for counseling, shift swaps and offers of unreciprocated coverage. The examples of individuals giving what they had in plenty to those who were in need were countless.

Importantly, I was also reminded that sometimes what you give does not have to be tangible to be valuable. Sometimes your intentional and undivided presence is both all you can think to give and all that is needed. When Stephanie died, I was in Argentina on a rotation and had no idea how I would process this news so far from home. My Spanish teacher, whom I had met only the day before, sat with me for half an hour while I told her about Steph. She listened, and then she just sat with me, in no rush to be anywhere else, or say anything else, or do anything else.

These experiences have led me to think about resilience unrelated to major tragedy in a new way, as well, for what is burnout but a constant barrage of inefficiencies and unnecessary barriers depleting reserves and thus limiting your ability to fulfill your professional calling? Specifically, I've been wondering how we can apply the power of community to address burnout.

This reframing does not change many of the known solutions, of course. We should still minimize or eliminate work after clinic, administrivia, lack of electronic health records interoperability, prior authorizations, sudden formulary shakeups and unannounced network changes from innumerable payers. (Need I go on?) We should still push to ensure that the joy and meaning of our work outweigh the annoyances. Mindfulness, meditation and other activities of renewal (mountain biking and backpacking, for example) are still imperative, as is having the time for them.

The experiences of the past year, however, push me to remember that it is not me against my burnout, but rather our community against our burnout. I can and should rely on my community to remind me that the most honest worldview is one that sees kindness and generosity as joyful defiance of luck's callous indifference. Although the world is full of pain caused by the chaos of myriad actors in a limited space, we can buffer the demand we face in times of low reserve. Fate may be cruel, but we can be excellent to one another, and that can make all the difference.

I started writing down life's tiny lessons in 2009. At the moment, I have more than 800 entries, and whenever I re-read the list, I find it silly how often I have to learn the same thing over and over.

No. 824: Burnout happens when the demands on you exceed your reserves. Burnout is addressed when you are afforded the time and environment to replete your reserves.

Nos. 180 and 825: Find joy in kindness; no one has to be kind, but in giving of themselves they find joy and personal satisfaction. It is an example of the best parts of humanity, and is equally delightful to notice as to practice. 

Nos. 274 and 826: The most important currency in the world is time. You constantly spend it, you cannot make more of it, and when you run out of it, you die. Further, it is a universal currency, so when you spend time with someone of any culture, they recognize the intrinsic value of what is being given. Thus, when you do not know what to say to someone who has experienced a loss, consider saying nothing and just giving your time. Being present with someone is sometimes the most valuable thing you can offer.

Thank you for the lessons, Klamath Falls. I promise not to forget them.



Stewart Decker, M.D., is the resident member of the AAFP Board of Directors.

Posted at 10:58AM Apr 24, 2017 by Stewart Decker, M.D.

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