bad call – Resilient Responder

December 13, 2016

Introspection or Rumination? What Does the Cow Do?

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?

Leave a comment below. Follow me and I will let you know when the next blog comes out.

Thanks for reading!

December 9, 2016

To Be or Not to Be…Resilient, That Is

Sometimes to understand what something is, it helps to look at what it is not. So let’s talk about what resilience is not. It might be a little surprising.

Being resilient does not mean you never get angry. People get angry. It is a normal, natural response.

Resilience does not mean you never feel depressed. When bad things happen, you feel bad. Your mood gets low. It happens.

Resilient people can feel anxious. Sometimes anxiety is good. It keeps you sharp. Sometimes it comes from anticipation of change, wanted or unwanted. (See the last post for how to manage change.) It is often the fear of the unexpected.

So, resilient people can feel afraid. Fear keeps you safe. You know…fight, flight, or freeze.

Being resilient does not mean you never cry. Come on. You know you have wanted to, but didn’t want anyone to think you were a wimp. God made tear ducts for a reason and it wasn’t just to keep your eyes clear of debris.

Being resilient does not mean you have to always be smiling. (Cue Pharrell Williams here…or NOT.)

Resilience does not mean you get along with everyone all the time. Some people are just not fun to be around. You know who they are…..

Being resilient does not mean you always agree with everyone, even your admin. You might even argue with them or get angry (see number 1).

Resilient people do not “suck it up, buttercup.” They know that doesn’t work anyway.

Ok…can’t think of anything for number 10.

So, what do resilient people do when they experience 1 through 9? They live through it. Duh, right? What I mean is, they pay attention to what they feel. They recognize it is a normal reaction of a normal person to an abnormal situation. Hey…we get some really abnormal stuff in our job!

The trick is to look at the reason you feel the way you do and decide what you want to do about it. Sometimes, there is action you can take. If you disagree with your admin, offer them an alternative solution. They might not take your advice, but at least you are not passively complying. You are being part of the solution rather than the problem.

If you are depressed, angry, sad, or anxious; cut yourself some slack. Again, normal 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.

Resilient people do not push their feelings and emotions down and ignore them completely. (See #9). They know these are normal and let them come. Then they carry on.

What are you doing that is not resilient? What do you want to do instead?

Leave a comment below. Follow me and I will let you know when the next blog comes out.

Thanks for reading!

December 6, 2016

Change on Your Terms

How do you like change?

If you’re like most people, you’re not crazy about it. Some change is good. Some not so much. It can even be painful if it means you have to lose someone or something you love. There are times when the status quo is preferable.

But, change happens whether we want it to or not. So how do you manage it without it overwhelming you?

So far, we have talked about two dimensions of resilience: determination and endurance (Taormina, 2015). Another part of resilience is adaptability.

Adaptability helps you cope with unexpected or unpleasant situations by keeping you flexible and resourceful. You are able to adjust to the changes you experience. You make purposeful efforts to change the way you think about your environment so that you feel more comfortable with the outcome.

You know what? You may be more adaptable than you realize. Have you ever been married? You had to adjust to having a new person in your life. Have children? That definitely requires adaptability!

The thing is, these are changes that you want…usually. You probably initiated them yourself. You might not even have thought of it as a change that would cause you stress because it was generally a positive experience.

So what do you do when change is forced on you?

Well, if it is change at work you could quit. That would certainly be the easy way out, but it is usually not the best response. After all, if you’re like most people, you need the job. (And you probably like the job, at least before the changes.)

What if it is a change in your family? Someone becomes seriously ill, or has a chronic illness, or has died leaving you extremely sad with an empty place in your heart. That one is especially hard because it is more personal!

Believe it or not, you can adapt to this change too. Really, you say? Keep reading.

Adapting to change requires changing the way you think about it. That is how resilient medics cope without losing their minds. Instead of looking at how the change has inconvenienced you, find the ways it will benefit you. If you cannot find a personal benefit, how will it help in a broader sense: your agency, your family, your finances, etc.

What can you contribute to the overall mission that will make the transition smoother? How can you be a part of the solution?

Use change for your personal growth. Use it to help you become the best medic, and person, you can be. You can be an example for other, less resilient, medics and maybe help them find a different way to look at change too. Your adaptability is another way to help someone else while you are helping yourself.

What changes have you experienced? How did you adapt?

Leave your comment below. We would love to learn from your experience!

Taormina, R. J. (2015). Adult Personal Resilience: A new theory, new measure, and practical implications. Psychological Thought, 8(1), 35-46. doi:10.5964/psyct.v8i1.126

December 1, 2016

Endurance: the Strength You Have Inside

In an earlier post, I talked about the dimensions of resilience: determination, endurance, adaptability, and recuperability (Taormina, 2015). Each of these are important aspects of understanding how you can live with and manage the stress this job causes.

I want to talk about endurance today. Endurance means getting through hard times, unpleasant situations, or difficult problems without giving up. You do this all the time.

What about that bad trauma? It may seem hopeless and it certainly is not pleasant, but you don’t quit in the middle and say “it’s not worth it”. Right? No, you endure. You get the job done and do everything you can do to get that patient to the definitive care he needs.

Then there’s the cardiac arrest. Maybe it is a child or a parent. It reminds you of something personal and you really don’t want to have to think about it. So, you push those thoughts aside and work that code to the best of your ability. You give that patient every opportunity possible. Maybe it works and maybe it doesn’t, but you did your best. That is what matters. That is endurance.

What gets to you is giving in to the negative thoughts that almost always arise. You wonder if there was something else you could have done. You tell yourself you are a black cloud, especially if you are having “one of those days.” Or, maybe, you blame someone else. They didn’t do what they were supposed to do. Usually, though, when you really look at it, you know everything went as well as it could under the circumstances.

You are not what you do. Does that make sense? You are not what happens around you. You are not the cause of all the bad calls you got today or any other day.

What you are is a person who, unfortunately, had a bad run. Nothing you could do about that. You just happened to be the available and closest truck to the call. If you could predict where the next call would be, you could go the other way. But it doesn’t work that way. (Oh, for the crystal ball!)

How can you turn those negative thoughts around? How can you give yourself the benefit of the doubt? It is okay to review the call. That’s how we learn. Just don’t dwell on it. If you did make a mistake, own it and learn from it.

Odds are you did just fine. Odds are you do just fine every day. You endure because you can. You endurance-athlete-runner DO have what it takes.

Give yourself some grace and remember who you are: a person who has dedicated your life to helping other people. That is a very noble and worthy person to be.

What have you needed to endure lately? Leave a comment below! I would love to hear from you.

Taormina, R. J. (2015). Adult Personal Resilience: A new theory, new measure, and practical implications. Psychological Thought, 8(1), 35-46. doi:10.5964/psyct.v8i1.126

Introspection versus Rumination

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