I am an emergency physician, a member of a specialty whose foundation requires a complete renunciation of routine. It's one of the vows we take before they teach us the secret handshake.
No week can be reliably expected to be like any other before or after it.
[The only exception: You will inevitably encounter a patient allergic to every analgesic except for a specific intravenous narcotic - "I think it starts with a 'd'" - that is a guarantee.]When I entered the field, I found the rejection of routine to be one more sexy differentiator for a specialty attracting misfits, mavericks and pioneers.
It brought to mind many cliche euphemisms as I thought affectionately of what it signified to be an ER doc.
- It felt like being the punk rock specialty of medicine.
- It felt like being a "made man" in the mob.
In reality, it made a hodgepodge of nerdy students of science feel dangerous and bleeding edge, as if their risk averse choice of a safe career in medicine was somehow offset by their dangerous choice of specialty.
I've always wondered if there's a comparable status specialty among accountants.
You employee compensation folks are the Iron Maiden of Pricewaterhouse Coopers!
This long digression is laying the groundwork for a brewing question: what if the job characteristic that made me feel tough and special is now something I no longer value?
The darker side of emergency medicine: we practitioners are familiar with the data that rotating shift work (especially nights) are bad for your health. There are associations with both increased risk of cancer and increased rate of developing risk factors for cardiovascular disease.
But someone's got to take care of grandpa when he comes in with a stroke at midnight and someday I could be that grandpa, so night shifts aren't going away any time soon.
The desire for routine seems biologically based. To grossly oversimplify (in lieu of reviewing the neurobiology), for millenia humans processed light sensitive input to the brain to set our internal clocks. Shift work upended what evolution had slowly designed.
Twenty years into a career based on shift work, my biological needs are lobbying hard to take precedence over my career needs.
After all, I can only get by on my youth and good looks for so long before I start paying a price with my health.
There are other appeals. Those days that I feel most productive are the ones where my day has a template:
- Wake up and exercise immediately - bodyboarding, cycling, sit ups and pushups or weights.
- breakfast with wife +/- kids, read the latest New Yorker in a pool of sunlight
- 2-3 hours on the laptop being air quote productive
- scheduled call to a friend or unscheduled call to a parent
- family lunch
- afternoon spent helping kids with homework
- sneak in a 30 minute installment of TV series I'm watching with my wife
- family dinner
This quotidian routine works wonders for my soul. I sleep well, eat well, feel fit and others experience me to be less moody when I engage in it.
At this stage of life, this misfit feels ready conforming to a routine.