I've started keeping a journal, the first time I've resumed this activity in a decade and a half.
It brings to mind a 14 year old emptying her emotional life in looping cursive within a Hello Kitty bound book, all while lying in bed speaking on the phone with the cord wrapped around her hand - something out of an old Debbie Gibson video.
[As an aside, I think my kids have little concept of a telephone cord, having only caught glimpses of them on visits to the grandparents.]In my office there is a stack of perhaps twenty journals of various sizes dating back to high school (there were more; the earlier ones were casualties of a fire that claimed our home before my senior year.)
Most of them, in one way or another, focus on the development issue of intimacy vs. isolation in Erikson's framework. Searching for the right partner, and the various dead ends encountered in that pursuit, consumed a great deal of bandwidth during my youth.
The new journal is intended to cultivate insights by logging whether an activity consumes or replenishes energy, and whether it involves a high or low level of engagement.
I returned from a family road trip to find the ER exploding again - high acuity cases, a renewed surge of COVID that is starting to strain resources, and the return of ED boarding (where admitted patients are kept in the ER for hours or days because there is not enough space or staff to care for them upstairs).
It leaves you feeling pretty beat up. Catching up with a young PA I encountered in the physician lounge, I was struck by his waning enthusiasm. He described his summer activities, and then, with a haggard edge to his voice, said, "The only way you can get energized is by spending time away from this place."
It's an interesting phenomenon. In the ER I am usually able to maintain a high level of engagement. By being a plate spinner and keeping multiple workups and resuscitations in play, you need to be attuned to what's going on.
Rarely, you feel a state of flow take hold, where you are able to adjust to every new curveball thrown your way and your team of techs and nurses works as a cohesive unit on behalf of the patients.
Yet even on those days, the shift inevitably leaves you depleted. The amount of energy required to sustain the engagement is greater than what the job replenishes - and over time that's a liability that becomes increasingly difficult to ignore.
As I resume journaling, I am paying attention to which activities permit engagement, which facilitate states of flow, and which replenish my level of energy. It's a process to help identify what I want more of and what I want to reduce in order to fill my buckets.
Comments 2
When I started my anesthesia training it was before oximeters, end tidal gas analysis, bispectral brain wave analysis, automatic bp cuffs and al the myriad of monitors that exist today. BP’s were manual on a spygmomanometer and breath and heart were monitored by a stethoscope taped to the chest. A weird nest of tubes came through a valve mechanism and wound up in a single tube that went into an earpiece which went into my consciousness. The patients vital signs became melded with my consciousness and I listened to every breath, heart beat and pattern that data stream provided. In some ways it was a very intimate experience. The bag which I kept my hand on also provided direct feedback as to the well being of the patient. I could tell with a single deepening respiration or a slight change in HR the patients response to the surgical stimulation and adjust my poisons accordingly I, in some sense became part of the patients physiology. I watched and walked point while he/she slept. Today running an anesthetic without modern monitoring would be malpractice.
Today things have changed. Today we are layers removed from that kind of intimacy. That level of engagement was in itself a reward. It’s still there but far more abstracted by all the intervening layers of technology squirting sometimes data, sometimes noise into decision making. There is another aspect as well. American life seems much coarser and contentious than in days gone by and that lack of harmony or added chaos as a background energy takes its toll. Things feel less solid and more uncertain, hell bent for leather strait into a black hole.
Author
The loss of intimacy has certainly taken its toll.
Patients are not clients, health care is not a widget, and living by metrics makes you a great Olympic sprinter and a potentially lousy but profitable cog in the wheel.
The loss of solidity means that it’s easy to find yourself stuck in tar pits, which (at least here in LA) have claimed more than their share of mammoths and saber-toothed cats, meaning your size and ferocity won’t save you.