You have a patient with respiratory distress, tripod position, BP 220/116, breath sounds diminished, chest pain, diaphoresis, SpO2 88% on room air…classic CHF. You immediately apply CPAP, NTG paste, start an IV, 12-lead, 15-lead. You are on the way to the ED! The patient seems to be improving. You keep monitoring him during transport. His SpO2 is 95% with CPAP. The BP is 200/98. No obvious STEMI on the ECG.
You run through the protocol. Have you missed anything? Is there anything else to look for? Can’t think of anything so you continue what you’re doing until you get to the hospital.
When you transfer the patient to the ED bed, you notice he does not move his left arm. In fact, it is flaccid. He has no history of stroke. You checked. On the scene, he moved all extremities equally because he initially tried to keep you from applying the CPAP. He used both hands at the time. He stood and pivoted from the chair to the stretcher without appearing to stumble.
It must have started during transport. How did you miss it? Great! Now the medical director will want to see you. Just what you need.
So begins the cycle of thinking. What did I do wrong? Did I do anything wrong? Should I have done something different? How did I miss that stroke!?!
Introspection versus Rumination
Two four-syllable words that have deep significance for resilience. One is helpful and the other not so much.
You ruminate when you think about something over and over and over…..
You focus on the bad things. You think about what went wrong. You worry about what someone will say. You worry that you’ll get in trouble. It is rarely productive. You ponder, mull over, cogitate; but never come to any helpful conclusions.
Cows ruminate. Yep. They have four stomachs. When they eat, they chew their food, swallow it, and it enters the first stomach where it begins to be processed. Then the cow
regurgitates some of the contents and chews on it again. Yuck! I guess the cow doesn’t mind, though.
Rumination for us is similar. We have a problem. We “swallow” it for a time. Then we bring it back up and chew on it again. Unlike the cow, this is not always a one-time process for us. Our ruminating can get us into a vicious cycle that is hard to break. We end up thinking negative things about ourselves and our abilities and maybe even our worth.
Introspection, on the other hand, gives us the chance to examine the problem so we can find a solution. It sounds similar to rumination, but instead of focusing on the negative 
parts of the problem, introspection focuses on solutions.
Introspection is productive. Instead of thinking about our self-worth, we work on self-improvement. Rather than focusing on the one thing that went wrong, we remember all the rest that went right.
With introspection we learn. With rumination we make ourselves miserable.
Do you introspect or ruminate?
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Thanks for reading!
December 12, 2016 © 2016 Resilient Medic
I try to learn from every mistake. But at times I find myself getting all teary eyed for no reason whenever I am home alone. Especially in the mornings. Not sure what brings it on. One min I’m just fine & then for no reason at all I get bummed for a few mins. It never lasts very long & it doesn’t disrupt my work or personal life. I don’t think anyway.
Hi Jeff. There are a lot of reasons you may be feeling sad. Getting teary eyed is a normal reaction to that. I am glad you are able to keep working, though. That is a good sign.
You didn’t say how long you have been feeling this way or if you work in some type of first responder field, but please do not feel you have to handle this all on your own. Talk to someone…a friend at work or outside work. If your employer has an assistance program, take advantage of it. There is a lot of help out there. I encourage you to look into it.
Sometimes being resilient means knowing when it is time to ask for help.
Thank you for your response. I am a Medic w/an awesome
EMS service & also a member of my hometown Fire Dept. My wife who is only 45 is dealing w/Breast Cancer again for the second time in 3 yrs. We thought we had it beat but it’s back &
I just had to say goodbye to a very special friend about 2 months ago as well. That along w/my role as a medic just seems like a never ending bad news sometimes. Idk I just know that I react differently to things than I used to.
Jeff,
You definitely have reason to feel the way you do. It is normal. You are normal. It is a lot to deal with.
You said you react differently than you used to. That is not necessarily a bad thing. As we get older, I think we feel things differently. Life has a different meaning than when we were in our 20s. Perspective changes.
With all that is happening, I still think you could benefit from talking with someone. Sometimes it helps to be able to say things to someone that you would never tell your wife or your friends. Things about fear and grief and loss and other things that matter. You don’t want to make them feel bad, so you keep it all inside. Then you get teary-eyed and wonder why. You are trying to be strong. That is noble. That is love.
Just remember that you are supposed to feel sad when you are afraid for your wife and when you lose a friend. You are a normal person having normal reactions to abnormal situations. Add the job to that and it just piles on more stuff.
My guess is you managed the job until your personal life turned upside down. We can separate from things that are not personal. It is much harder when it hits home.
I want to encourage you again to take advantage of your employee assistance program. You may only need one or two visits. You can get stuff off your chest and not have to worry about upsetting anyone. You may be surprised at the results.
Hang in there! I will keep you and your wife in my prayers.