On Not Becoming Jaded

One night a coworker in the emergency department, who also aspires to be a doctor, asked me if I was worried about becoming jaded as I worked in health care. I answered confidently that I wasn’t worried about becoming jaded, my hope for humanity waning, or burning out like so many medical professionals do. He was skeptical, but I am certain of only that one aspect of my future.

Defining Jaded

Especially late at night when most patients are tired and grumpy, the drunks roll in after exhausting the bars, and the patients held for mental health evaluations decide to spend the early morning hours holding yelling matches that involve nonsensical accusations against staff, it’s easy to see how one can grow tired of working in a hospital (and specifically the emergency department). In medicine, we take care of everyone, even if they’re jerks to us, because the fundamental principle of health care is that we serve all people.

Not so long ago I was greeting patients in the waiting room at the emergency department. We had around 20 folks waiting for rooms, the rooms weren’t changing over, and the wait times for many were over 2 hours. That’s a recipe for an unpleasant experience as a greeter, and the recipe was rich that night. I had a parent repeatedly insult the staff, including me, and ask why we hadn’t brought her child to a room yet. That was annoying, but manageable. What got to me was when she stormed up and demanded to know why we brought back “a drug addict” (her words, not mine) before her child. Her argument was that her child had a bright future while that person was a lost cause. Of course, I couldn’t tell the hysterical mother just how awful it is to watch a person go through withdrawal shakes and then seizure. That’s something you can only understand once you see it. I couldn’t tell her about the alcoholic who came to us one night shaking so badly he couldn’t drink water from a cup. I couldn’t tell her how he had looked me in the eye and told me he wasn’t human anymore. That mother was choosing to believe him, but I knew that that patient was human even if he didn’t feel like he was. That angry mother in the waiting room clearly had never seen a person beat an addiction—winning the daily fight to not give in to a drug or alcohol for years. I have.

It’s not the job of medical professionals to pass moral judgment. Sometimes we are weak and tired, and we do judge our patients’ life choices. But if we were to slip into a world where we used our personal morals to decide who should receive care, we would betray the heart of medicine. Medicine was never meant for only a select few.

In my view jaded is another way to describe losing empathy. There are many presentations—impatience, anger, and hating work to name a few. These feelings come when we are too tired and too worn out to see patients as humans. They come when we no longer find joy in the small things about the job that are awesome. And jaded becomes the norm when we give too much. It’s easy to work hours no one else would dream of working when you’re in health care. Each hour is rewarding because we help someone feel better, but the hours take a toll on the giver.

Considering all the above, how am I so certain I won’t become jaded?

  1. My empathy comes from selfish sources, so I don’t expect that it will fizzle. The first source is curiosity and the second is a love for stories and puzzles. Each human has a story. Each sick person is a puzzle. The curious mind can’t help but wonder about the story plot and the answer to the puzzle. These two factors are some of the main reasons I veered down the medical path in the first place.
  2. I know that I’m brave enough to step away and recharge as well as to shake things up when caring for patients under specific conditions becomes wearisome.

How do I know I am brave enough? Paraguay. While living in the land of Guarani, I cultivated an ability for self-reflection and the bravery to face fears because they were required to survive the Peace Corps. Paraguayans also showed me the value of letting yourself be still. In America, we are so determined to be productive we schedule every moment. I think running around all the times makes everyone miserable no matter what their profession. I also think those who become jaded forget to reflect and change. They fail to see that their job is draining them until it’s too late and, then, they lack the courage to change their work so it’s fresh again. It comes down to the best professional advice I was ever given. When I asked a presenter in one of my undergraduate classes how she knew when it was time to leave a job (she had an awe-inspiring, lengthy job history) she said, “You’ll know. You know when it’s time to leave.”

She was right. We do know when it’s time to mix things up. The hard part is taking the steps to act upon what we know. But, if we do take those steps, then jadedness can never catch us. The moment she gave me that advice, years ago now, I promised myself I’d be strong enough to change my course whenever I “knew” it was time. That strength sent me to Paraguay and brought me back to Vermont. So, no, I’m not worried about becoming jaded. I’m just excited to see where my adventures in medicine bring me.

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Human Side of Medicine

Not so long ago I worked a code (cardiac arrest = patient’s heart stops and they neither have a pulse nor are breathing) in the field. The patient was middle-aged and had a complex medical history. The patient’s father, visiting from out-of-town, found him unresponsive, started compressions, and called 911. We did all we could—did compressions, ventilated, pushed epinephrine and other medications, and analyzed for a shockable rhythm. As we worked the father knelt at his son’s head. The patient’s fiancée sat outside the house. As it became clear that we were not getting our patient back, my crew chief reviewed, outload, all we had done. She asked us if we could think of any other interventions we hadn’t yet done and then she engaged the father, explaining why we were going to stop resuscitation. Once we had stopped she went outside to talk to the fiancée.

As heartbroken as the patient’s family was, they were calm when we stopped CPR. They had seen us sweat over their loved one, try everything we could, and ask for suggestions. We included them in our decision to stop our efforts. We lingered after our care was done to answer questions and offer condolences. This call showed me how it is within the pauses between action that we connect with our patients.

The human side of medicine comes through when we take time to ensure our patients understand what is happening and our plan for treatment. It comes when we include our patients and, when appropriate, their family in decisions about their care. And it’s completed by taking a moment to share their feelings, whether of relief after a successful procedure or sorrow after the loss of a loved one, before we scurry on to our next case.

Amid medical histories and assessments of signs and symptoms that lead to differential diagnoses it can be easy to let the presence of a disease or condition consume our attention. We can focus so intently on the disease that we forget humans bear the illness. But, below the clammy skin and wheezing is a person with a family and life experience just like you and me. And, what the patient will remember from their time during the flurry of a medical crisis is how someone treated them. It’s the offering of a kind word or an act of kindness on the worst day of someone’s life, not just the hope and likelihood that we have a cure, that defines good medicine. I try to remember to take advantage of the pauses by offering a blanket or bit of conversation to my patients. There aren’t always many pauses in my day, but when there are I don’t like letting them go to waste. It’s in the shared moments between points A and B that we build our humanity, but we must be attentive or we’ll miss the opportunity.

In Arlington Cemetery

This summer we held a memorial for my grandfather in Arlington Cemetery. His name will be on one of the niches in the columbarium. He was in the Navy and served in the Korean War. The service was short and concise. I think its precision and simplicity was well suited to my grandfather who was a high school and college math professor and liked things to be just right but not conspicuous. The chaplain was empathetic and caring and the soldiers who performed the flag ceremony were on point. As we said our formal goodbyes a trumpet’s song floated in the air above us.

My grandmother used to comment how they enjoyed when I visited because I’d sit all day and laugh as my grandfather told stories. He was a particularly gift storyteller with the dry wit that ignites my science-loving and logic-focused brain. He told stories of the Navy (usually when he and his comrades were causing trouble), his struggles as a student (he went for a doctorate in math but didn’t finish his thesis because of a disagreement with faculty), or his adventures as a teacher (he had many years of teaching from which to draw).

In EMT lingo, my grandfather had an “extensive cardiac history.” When I called my grandmother after hearing of my grandfather’s passing she told me, “The EMTs who responded to my call were wonderful. You do good work.” She said that even though they couldn’t get him back. His heart had stopped and he had no cat-lives left. When my grandfather died, I’d been volunteering as an EMT for several months.

I’m still and EMT and I also work in an emergency department. An interesting thing about providing emergency medical care is that your mission is to lessen pain and ward off death, but you end up seeing a lot of both. You end up being there when medicine meets it limits and the time of death is pronounced. I sometimes wonder what the EMTs at my grandfather’s death thought. I wonder how they ran their emergency call. What did they do to make my grandmother feel like they’d done the right thing? I hope the families of my patients have the same impression when we determine it’s time to stop CPR.

I used to visit Arlington National Cemetery periodically when I lived in DC. I like cemeteries because I enjoy walking the tombs and imagining the histories of the people they memorialize. Now when I visit Arlington, I won’t have to invent my grandfather’s story because I know it. I’m a product of it. I think of him often, partly because I wish he’d send me some of his math-genius as I continue my medical studies. Mostly, I think of him because he is one of the few people I know who successfully and completely built a life he loved. His only unfinished business is the family he left, especially his wife, but we’ll join him again one day if afterlife exists. Until then, we’ll keep making stories worth telling just as he always encouraged us to do.

Photo Credit: Mary Lou (family friend)

Christof

There’s a guy, Christof, in my neighborhood who collects returnable bottles from the recycling we put out on the corner for the city each Friday. One day when my father was visiting me, he struck up a conversation with Christof. One of Christof’s daughters went to college and the other didn’t–Christof joked that the daughter who finished college doesn’t have a job while the other one does. He collects bottles to help both of them.

I don’t often drink anything that comes in a redeemable bottle, but since chatting with Christof, my father started saving his seltzer bottles…he drinks a lot of seltzer. My father brings the bottles to my house (even though I live about 2 hours away) when he visits so I can give them to Christof.

I work nights, so it’s challenging to put out the recycling before Christof passes. One morning I saw him, though, collecting from the neighbors. As he walked by, I ran out and asked him to wait a moment. He paused, a smile lighting his face. I handed him 2 huge trash bags of bottles I’d squirreled in the garage for a few weeks. He thanked me a million times, wished me a blessed day, and was on his way.

At first, I thought my father was ridiculous for saving bottles for Christof. But, that morning when I saw Christof’s face after I handed him our bags of bottles, I realized that my father was right. We can get so caught up in all the big things we should do that we do nothing. Christof reminded me that it’s the small things that add up in the end. And, luckily, life is full of small things.

Determination: 2 Girls, 1 Hill, 1 Tree, and 1 Ladder

As children, my friends and I spent hours wandering the woods. We lived in rural Vermont in the middle of hills covered with sugar maples. One of my best friend’s families made maple syrup as part of their living—they collected their sap using draft horses. And it is with that friend that this adventure took place.

Far up on one of the hills behind her house, maybe a 40-minute hike across a river and bushwhacking through the sugar bush, was a monstrous tree. It was a Pippi Longstocking tree, a tree of wonder and stories. It was the most perfect tree for a tree fort you can imagine…and the branches didn’t start until 20 feet above the ground.

Those high branches spread out in such a way as to almost make a floor. My friend and I thought that if only we could reach those branches it would be the best thing in the world. We dreamed of hanging a hammock from those taunting limbs and eating a picnic up in the canopy. We thought about our future tree fortress on many occasions, staring up from the ground, until one day we contrived a plan.

Her father had a very tall ladder—one of those aluminum ones that has two sliding parts so it can get even longer than it appears at first.

We started in the morning. She took one end of the ladder and I the other. Those ladders, though hollow, are not light. We discovered this not long after crossing the river and starting up the hill. We also realized that zigzagging through trees was a lot harder when you are attached to another person by an 8-foot, stiff ladder.

We stopped occasionally. We argued about the best way to go through the trees. We sweated and got scratched by brayers.

And, after what seemed eons, we reached the tree. We lay the ladder against it, expanding it to its full length. We observed the ladder. We were scared. It was so tall and the ground wasn’t even. Surely, we’d fall if we climbed it. Surely, if we fell we’d die. We talked about climbing the ladder. About falling. About how amazing it probably was up there. “Fine, hold the ladder,” I said. And I put my foot on the first rung. I was shaky. It was high. My heart pounded. I got about 6 feet above the ground. I paused. The ladder felt wobbly. I wasn’t sure if I should keep going.

Slowly, carefully I reached the top rung. The branches were still overhead. I’d have to grab them and then swing my legs up and hang sloth-style to get up in the tree. I stood at the top of the ladder a long time. My friend first shouted up that if I wasn’t going to do it I should come down so she could. Then she suggested that we not do it at all.

I grabbed the branch and I swung up. “This is awesome!” I said, sitting and staring down at her on the ground. She joined me, with the greatest care because the ladder was unsteady, especially without someone holding it.

We sat up in the tree until we got hungry. The only reason we ever left the woods was because we were starved.

Some people will tell you your dreams are impossible. Don’t bother with them. Someone else will help you carry a ladder.

Defining Friendship

On my EMT shift the day before my birthday, the dangerous topic of religion came up for some reason while we were reviewing the ambulance (something we do at the beginning of every shift) to make sure we had all the right supplies. Like most careful Americans, we ended the religion conversation before we needed to say much about our personal beliefs. It was amusing to contrast the politically correct nature of the conversation with my experience in Paraguay. In Paraguay, religion is not a topic that’s avoided and people have no problem asking you if you’re catholic (the dominate religion there). I went to Paraguay with almost no religious experiences (and most that I had had were very negative)…but Paraguay brought me up to speed on their version of being catholic. And they changed my view of religion forever (though they didn’t convert me).

As I wrote when I was in Paraguay, the Paraguay I know is Catholic. That means that to my Paraguay friends the entire world is seen through the lens of Mary, Jesus, and the saints. A lot of what Mary and Jesus and the saints talk about is how you’re supposed to treat other people. Paraguayans put people, especially family, first.

A little after 9pm on my birthday I got a video message from one of my families in Paraguay. When I say family, I mean I spent every weekend with them. I went to church, out shopping, and to soccer games with them (in Paraguay, soccer is the equivalent of all sports in the US combined). I went dancing all night with the daughters, studied English and history for hours with the son, ate many dinners and lunches with them a week. I showered at their house when my water was out. I was in both daughters’ weddings…

My whole family was there in the video message. First they sang “Happy Birthday” in Guarani…then it was “Happy birthday Jett. May you have a blessed birthday and many blessed years ahead. I hope you’re having a wonderful time. Send us a video, Jett, so we can see you…We miss you Jett. When are you coming back Jett?”

It’s so nice when you realize that the people you think about all the time also think about you. And as my family’s familiar voices and happy words sunk in I thought about friendship. Even friendship is defined using a religious metaphor in Paraguay. And, with the topics of religion and friendship on my mind, it seemed fitting to share (again) one of my favorite stories about both:

Overheard in Paraguay: Friendship
Repost from October 19, 2015

We sat in a half circle around the grill. The men were cooking large slabs of meat, ribs and some unidentifiable cut, for the mother of the family’s birthday dinner. The husband of one of the birthday mother’s daughters sat by the grill passing one can of beer among the men there. A nephew walked up to the daughter’s husband. The husband was around 30 and the nephew was about 11.

The husband hugged his nephew first with one arm and then the other, squeezing him. The nephew squirmed, and they both smiled. The husband held the nephew at arm’s length and put on an almost serious expression. “Will we always be friends?” the husband asked.

“Yes,” the nephew said.

“Even when I am old and you are my age?” the husband asked.

“Yes, even when you are old and I have kids,” the nephew said.

The husband smiled and pulled the nephew into another hug. The nephew pulled away again and they looked at each other, the husband still squeezed the nephew’s shoulder with one hand.

“Even when you are in Heaven and I am old we will still be friends,” the nephew said earnestly.

The husband laughed. “And I will look after you from Heaven.” They hugged again. “And, when you come to Heaven, we will be friends in Heaven. We will be friends forever.”

The boy nodded and ran off to find his playmates.

Happiness Comes from the Heart

Being a pre-med post-baccalaureate student, I take a lot of classes with humans that are 8-10 years younger than me. These young people are a dichotomy of vibrant energy and self-doubt. We are on same footing as we struggle to memorize microbes and how p orbitals shape molecules, yet we are not even in adjacent life chapters.

It’s nice to be a witness, rather than a participant, of the soul searching that comes with learning how to be an adult. I once was an 18-year-old too, but I’m glad that era is behind me. I know my young colleagues will come out just fine without any help. But, there’s one thing that I wish I could tell them so they wouldn’t have to go through the trouble of discovering it themselves. It’s simple but, alas, it’s something only experience can teach us: happiness comes from within.

I think many of us get lost in the weeds when it comes to happiness. We jump from shiny thing to shiny thing. We assume the next great object we possess will fill the holes in our soul. We look to family, friends, and partners thinking they can save us. We search for other’s approval of our look. We act based on strangers’ opinions, hoping that society will label us as “cool.” And as we skip and hop between all these outward forces, our emptiness expands until our core seems more like a beach ball than a rock. Hollow.

It’s not the doldrums, the pits, where the quest for meaning beyond ourselves drives us, but to stagnant waters and ships with limp sails. And, while some of my young lab partners might learn quickly that they are the only ones who can make themselves happy, many of them will take years to realize the truth. I’m not sorry for them. I know their journey will have many fun days and explosions of wonder. But, if they are like me, they won’t find peace until they understand that joy originates inside and spreads from there. I don’t wish the restlessness of the road upon anyone, but it’s a road we all must wander at some point.

While others might make our lives brighter, we’re the only ones who can decide if we’re going to let in the sunshine or draw the curtains. I hope that when the going gets tough and the days seem dark the young folks around me take the time to look inward. There are many things beyond our control, but our emotions and how we respond to the world do not fall among them.

Are you lonely?

“Are you lonely?” is America’s version of the boyfriend question. I thought the coupling obsession was a Paraguayan thing. But, now that I’m back in the US, I realize I was mistaken. It’s also an American thing. Maybe it’s a human thing. Regardless, I’ve gotten a lot of practice justifying why I’m single. So, let me tell you…

…there is no reason why I’m single. I just am.

I know it’s hard to believe that a person can be happy just being. But, try to imagine it. Consider, for example, that I can go hiking on the fly and not wait for a soul. I could move anywhere and would only need to bargain with my future landlord and maybe the visa office. I can (and do) eat when, what, and where I want and don’t feel even a hint of obligation to coordinate with anyone.

Perhaps you’re thinking something like, “Fine, Jett, you’re busy and independent…but really you’re just waiting for the right guy. You’re lonely, but you forge on propelled by the dream of the prince who will sweep you off your feet one day.”

If something like that is on your mind, I must ask: Doesn’t that argument seem archaic? By now we should all know that princes only live in fairytales. They aren’t real, but metaphors for love and good fortune. I don’t need the metaphor. I’m not looking for someone to fend off the dragons. I do that just fine on my own.

Don’t despair, you’re partly right. I’m busy and I have great friends. But that’s the whole point. If I lived my whole life as I am—doing good work, engaging in hobbies, and enjoying friends—then I would have an awesome life. You see, my life’s not on hold. I’m not working toward finding that perfect man. I’m just living…and I also happen to be single. I’m not worried about love. Why should I? It’s spontaneous and stubborn. It will do whatever the heck it wants. Just like me.

I might one day stumble upon someone to be my partner in crime. I might uncover a person who makes me happier than I already am. If I do, I’ll marry him. I also might not find such a human. Either way, the trajectory is grand. I realize that many believe that singletons need to be saved. But let’s remember that when we, you and I, were taught about the American dream it was never said that it could only be dreamt by two.

Thanks for your concern about my emotional well-being. But, the better question is “What do you do?” I assure you the answer is interesting. I have a lot to say about me and my doings. And don’t worry, I’ll let you know if me becomes we.

Raising the Boiling Point

When I tell my grandmother all the things I’m doing she usually says something like, “Just hearing about your activities makes me tired.” This comment always makes me wonder why we all have different thresholds of activity before we become overwhelmed or burnt out and disinterested.

Hypothesis

Interest is to productivity like salt is to water.

Water on its own boils at a certain temperature, but after dissolving salt in water the temperature at which it boils is higher. This is because the intermolecular forces between the molecules are stronger when salt and water are mixed than between water molecules alone. In other words, it requires more energy to boil a pot of salt water than it does a pot of fresh water because the little bits that make up salt water are more strongly pulled toward each other than the tiny bits that make up water are pulled together.

I believe interest acts like the salt when the water is productivity. If you dump some interest into your productivity pool, you’ll achieve a higher production rate than you would if you just do things without figuring out how they are interesting. I define interesting as something that is thought-provoking, relevant to my interaction with people, useful in the activities I do, and/or helpful in reaching my goals.

So what?

Productivity is not set in time nor does each person have their own unique productivity rate. We each have varying productivity depending on zillions of factors like time of day, enjoyableness of what we’re doing, and how many things we have on our mind. But, what I’ve found as I take each step on the doctorhood quest is that if I can convince myself (or already am) interested in something I can focus on it a lot longer and accomplish a lot more in less time than I can if I’m apathetic about it. I can cut the time it takes to do something sometimes by half if I can think of a way to find it interesting.

That’s what I did with first semester physics, specifically kinetics. At the time, I’d been battling squirrels. Squirrel rapscallions were decimating my garden, and though I truly hated those rascals, there was nothing I could or would do about it. I wasn’t going to kill them–I didn’t have the heart. However, kinetics equations such as those used to describe projectile motion gave me a tidy solution. Kinetics can be used to describe how far, fast, and high you throw something. I imagined (even though I’d never, ever actually throw a squirrel) that all my projectile equations related to chucking squirrels. The metaphorical “strike back” was enough to ease my anger over my garden crops being stolen by squirrel thieves and gave me the source of interest I needed to learn and excel in physics.

Side note: Once I got started, I didn’t need the squirrel metaphor…physics is actually pretty cool all on its own.

Test

I think it’s a powerful observation and a testament to the power of the mind that you can trick yourself into being interested in something and by doing so improve your ability to learn about that thing. If you can dig deep and find a fragment of something that sparks your imagination and curiosity even the hardest and most tedious of tasks goes more smoothly. Don’t be believe me? Next time you’re doing something that absolutely must be done even though you hate it, try to find something about the task that is interesting and worthwhile. Focus on that as you do the task. My guess is that you’ll find the whole process slightly more bearable and that you’ll also finish sooner than you normally would have. Challenge: Prove me wrong.

The Do-Good High

Did I tell you I’m an EMT? I’ve been running for about 5 months. Long enough to have learned a thing, maybe two. Let me tell you about the do-good high.

There’s a certain kind of person who becomes an EMT and sticks with it. Hint: It has nothing to do with your age, background, or future.

It boils down to what I call the “do-good high.”

There are EMTs who want patient experience so they can then become nurses and doctors. There are others who like sirens and driving large vehicles with lights. Many EMTs want to give back to the community. Others like the satisfaction of saving lives. Whatever the reason, the thing that makes all EMTs the same is that they get a thrill from doing good.

Whether it’s helping a little old lady after she’s fallen or bringing a person back from the dead through CPR, the folks who stay in emergency medicine are there because they’ve caught the do-good bug. When the alarms go off at 3 a.m., waking you from a dead sleep, and the dispatcher comes over the speaker: “56-year-old male, vomiting and diarrhea…”† I think a normal person would choose to go back to sleep. Not an EMT.

The EMT answers the call. Why? Partly it’s our duty to put on our uniform and leave the station as fast as we can, but there’s also something beyond obligation that makes us go. Even in the grossest of circumstances, like when we pick up that vomiting and pooping man and sit with him during the 30-minute ride to the hospital, we helped turn a bad night for him into a slightly better night.

The feeling you have sitting in the back of an ambulance as the sirens holler and you hustle to your patient is something like that of standing on the start line of a giant race. Your heart goes just a tad bit faster and your mind zips through the possible scenarios that could unfold once you arrive at the scene. Then you reach your patient and a calm descends upon you. There’s a human in distress and what’s ailing them is your puzzle to solve. You might be the one who saves their life. But even if you aren’t called upon to be a hero, you can ease their distress by helping them breathe or reassuring them as you go to the hospital. Seeing your patient’s face relax or their color return after you help elicits an adrenaline rush that starts in your center and spreads out to every corner of your body. It’s a high like that from scoring the winning goal or beating a chess genius at their own game, but it’s better because it lingers. This rush and joy that rapidly overtake you after helping a patient is the “do-good high.” All EMTs get it. It’s what keeps us coming back.

 

†Fictional dispatch that captures the essence of a typical call. HIPAA and other privacy measure prohibit sharing patient information.