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
So, resilient people can feel afraid. Fear keeps you safe. You know…fight, flight, or freeze.
reaction of a normal person to an abnormal situation. Look at what is distressing you. Focus on your breathing. Let the millions of thoughts going through your mind run their course. Give it time, but try not to dwell on the negative parts too long. Make a plan for how you can handle the situation and work your plan.