A Year of Wonders

Yes, I'm stealing that title from the book I just finished, but I think it's appropriate. In looking back, I completed 10 of the 15 things from my list last year (not surprisingly, the recurring commitments fell off, but I did clean my bathroom more often than I otherwise would have). I am sad I didn’t get to Coors Field, or any field for that matter except my flag football field (another 2 championships baby!) but I wouldn’t have traded the year I had. Here are some highlights:

1. Seven months and counting with an amazing man—God has truly blessed us and I’m excited for the year to come.
2. SUP’ed—Stand up paddleboarding. Didn’t even fall in. Bonus: got to see baby dolphins learning to fish.
   
3. Creative Writing Workshop—this pushed me and encouraged me. I loved it! Everyone should take more classes!
4. Rocked the Ugly Christmas Sweater in an epic way.
   
5. Camp Doc Episode 2—in which I learned to hammock, did a 13 mile hike, had Mass in the car wash parking lot, and did a lot of lightning protocol.
6. One award and another nomination at work. Don’t worry, just when I feel like I’m doing something right, a med student evaluation says, “Dr. Z was usually a great teacher, unless US Soccer was on.”
7. Speaking of which… Cheered the USWNT to World Cup victory (pretty sure it was all me)
8. Zombie target shooting with mom and dad. What? Our family is normal.
   
9. Watched “White Christmas” for the first time. Apparently this is a big deal. Who knew?
10. Trained as a Peer Supporter to be able to respond to adverse events at work.
11. Did my first (and second and third) liquor shot ever (not on the same night). I mean, it only took me a decade, but I felt like I was actually able to enjoy the experience instead of puking on the carpet.
    
12. Lit my birthday cake with a cautery loop. I have the best coworkers.
    
13. Puzzle room victory! Michelle wins for picking the lock.
    
14. Bartender’s choice at a speakeasy.
15. St. Louis trip—the zoo, Kelly’s graduation, MMMHops.
    

Not sure I can (or want to) come up with 16 things to do in 2016, but I do have some goals for sure. It’s going to be a big year.

1. The Camino—my goal is to go outside my comfort zone speaking Spanish, to live simply, and to enjoy the journey.
2. I want to continue to grow in love and holiness with A, who helps me be less selfish and more courageous. And yes, next year will probably involve some event planning, so there’s that…
3. I’m going to re-instate my letter-writing and new-recipe resolutions from last year. Can’t hurt to try.
4. One Rockies game. That’s it, just one. That shouldn’t be too hard, right?

 Happy New Year!!!

Again I say rejoice!

As we wind down Advent in preparation for the birth of Jesus, I wanted to reflect a little on joy. Joy is inherent to the season of Advent; the third Sunday of Advent is Gaudete (“Rejoice”) Sunday. The second reading that day was from Paul’s Letter to the Philippians, which is also known as the “Epistle of Joy” (shout-out Lanky Guys!). Writing from prison, Paul could have easily penned the “Epistle of Suffering” or the “Letter of Judgment,” but he doesn’t.

Instead, Paul writes “I…am praying always with joy”, “I shall continue to rejoice”, “I rejoice and share my joy with all of you”, and “Rejoice in the Lord always! I shall say it again: rejoice!”

What is it that gives him the ability to rejoice in such circumstances? Not in a superficial way or by wearing a mask for some secondary gain, but to have true, deep, abiding joy. Paul identifies over and over again that Christ is the source of this joy, and every other good thing, and that the more the Gospel is proclaimed, in any circumstance, the more cause there is for joy.

Do we live like this? I know I can’t speak for you, dear reader, but I know I don’t. I get embarrassingly bogged down in a very narrow "woe is me" worldview. I count my blessings, sure, but I would venture that the first word used to describe me is not "joyful". In confession last week, the priest reminded me that Advent is a time to let others see the JOY we have in the birth of our Savior, which was perhaps what led me down this path to begin with.

Most of my emotions are so short-lived that I can barely keep track of them, but I’ve felt that peace that comes when I’m resting in the Lord, the security in knowing I’m doing His will. And as many times as I’ve tried to take back the reins, I’ve laughed (or cried) as God shows me His way is better anyway. Take yesterday for example: I had been praying just that morning that God would use the sense of uneasiness I’d had lately to nudge me forward in a direction that would glorify Him. I wasn’t sure where my desolation was coming from, but it hung around clouding the air. I won’t go into all the details, but suffice it to say God brought about some answers in the least expected (and probably least desired by me) way. And so, despite my tears, I knew it was cause for rejoicing.

Every struggle we have in life is an opportunity to share the joy that Paul has in prison. Whatever happens, as long as we think on the things that are good and share the Gospel, we win. It doesn’t mean we’ll always be happy. Even Jesus cried, yelled, and chastised. But I don’t think He ever was without joy.

As we reflect on our Almighty God becoming a tiny, helpless newborn in order to bring us back to Him, may we receive the gift of His joy this Christmas. As we wait with longing for His return, may we rejoice in His victory, in our salvation.

Grateful

For a Church that is home no matter where I am, and a faith that gives me consolation and strength every day. For God’s constant presence in my life.

For a family that is all together in Colorado and actually gets along most of the time. For their constant support and love.

For a wonderful man that makes me a better person and helps me grow in holiness. For the opportunity to pursue my vocation, be challenged, and learn how to love better.

For growth and fulfillment in my job, for mostly healthy kids, and for financial stability.

For all my needs being met—a warm house, enough food on the table, my health, recreation—and much more.

For so many abundant blessings in my life.

I am grateful.

Calling names and being called

It has been said, pardon my language, that the worst thing you can call a man is a coward, and the worst thing you can call a woman is a whore. While you may be able to come up with a greater insult for a specific individual, it seems to be mostly true. It has no doubt been the start of many bar fights and cat fights. But why?

What is it about being called a coward that makes men raise their fists, even when they don’t respect the opinion of the offending party? What is it about being called a whore that makes women bristle, even when they know someone is just being catty? Why is that so much worse than being called stupid or fat or ugly or mean?

I may be reading too much into it, but I suspect it’s because those things go against the very nature of what it means to be a man or a woman. And it cuts to the very heart of our fallen nature. Hear me out.

If we’re to believe countless saints (and I’m inclined to), man (as a species, not a gender) is most fully alive when we become the people God has created us to be. If we remember back to the story of Genesis, we can get some idea of what that looks like.

When God created Adam, He “took the man and put him in the garden of Eden to till it and keep it.” (Gen 2:15). The word for “keep” here is the Hebrew shamar, the same word used when describing the covenant between God and Abraham and how priests would defend the temple. It means to guard over and protect. Then when God gives Adam the animals, and more importantly Eve, these come under his purview to shamar as well. So the responsibility and desire to protect and defend is ingrained in man (gender this time) from the beginning of creation.

What about women? Woman was created from Adam’s very side to be his “helpmate”, a word that I’m sure riles feminists everywhere. But the Hebrew word for helper here is ezer, a word mostly used to describe God in the Old Testament, as one who comes to the aid of, rather than as a subordinate, one who demonstrates power and strength, and therefore has the ability to help. “Therefore a man leaves his father and his mother and clings to his wife, and they become one flesh” (Gen 2:24). From the very beginning, woman was made to give her strength and self to one man, as a visible sign of the creative and self-giving love of God, in whose image she was made.

Now it’s starting to make more sense why we get so worked up by the words coward and whore. They are contrary to our very nature. Not only that, but they remind us of original sin, of us turning our back on God, and I think on some level, even for nonreligious people, that feels wrong.

When the serpent came to Eve, he played on her insecurity that she couldn’t sit back and receive God’s love, but had to grasp it for herself. She had to give up on Adam’s providing for her and do things for herself, in a sense giving herself away to the most seductive bidder.

And where was Adam? Sure as heck not shamaring his wife, not protecting the garden like he was supposed to be doing. He let evil in, and it cost him paradise.

So now, in this culture where masculinity and femininity are under attack and seem to shift with the daily newsfeeds, no one really even knows what it means to be a man or a woman. Yet deep down, we must still have some idea, or those insults wouldn't hurt so much. We know, intuitively, at our core, that men are to protect and defend. Women, children, the truth, goodness, beauty, all of it. And when they don't, when they act cowardly, they are not being the men God calls them to be. They know it, and they hate being called out on it.

We also know, at our core, that women were created to receive love, to bring their special gifts to the service of their loved ones, to trust God to provide, and--if married--to trust our husbands as well. When we start grasping at love or desires ourselves, when we abandon our commitments for the sake of things that are "a delight to the eyes"(Gen 3:6), we lose our dignity as women. We are no longer able to be a "helpmate" to anyone; we lose our strength and power. And when someone accuses us of that, even in a superficial way, we feel it.

So more than not calling people unnecessary names, I hope you take away from this a renewed sense that it is possible to recover our greatness. It is possible to become the men and women God created us to be, and in doing that, we will be fully alive and bring glory to Him. We just have to go back to the beginning.

How to deal with the doctor in your life

Everybody has bad days at work, I won't argue with that. But in medicine, it's a little bit different. We can’t come home and vent our frustrations with just anybody. As part of the training I did this week as a peer supporter, we were discussing coping mechanisms, like talking things over with friends and family. Specifically non-doctor friends and family. The facilitator asked, "What does it look like when you go to a family member, or a friend, someone outside medicine, and they are able to help you cope?"

We all looked down at our papers, back up at her, thought about it. Finally, one of the anesthesiologists spoke up. "It's never happened. I always get blank stares, or horrified looks at what we deal with every day."

We all nodded. No one disagreed.

I’m sure it’s similar with fields like the military, first responders, law enforcement—where they see things the rest of us can only imagine. While any non-medical person could sympathize with a parent or patient yelling at me, an incompetent co-worker, too many demands on my time, or any number of other hassles of the day to day, they can’t understand what it’s like when a kid you sent home to get better comes back horrifically sick and has permanent damage. They can’t understand what it’s like when you have to tell a parent their child has cancer. They can’t understand when making a mistake really is life or death.

I’m fortunate to have two sisters in medicine and a host of friends from residency, as well as supportive co-workers that I can go to when I have a rough day. But the truth is that most of my family and friends aren’t that helpful in getting past those adverse events. It sounds harsh, I know, but it’s true. It’s not their fault, and I know they love us and want to support us.

With that in mind I’d like to offer a few tips for you non-medical people who know and love us doctors (God bless you).

Please don’t be offended. We still love you, and we appreciate that you’re not in medicine because that can often be a much needed distraction (when we want that, you’re the perfect person!). Just because we don’t come to you first about work stuff doesn’t mean we don’t value your support.

Don’t try to understand the medicine. It can be even more stressful to have to explain the jargon and physiology when we’ve had a bad event. The details of it are not as important as the fact that it makes us feel awful, so if we do talk about it (and we may not), don’t interrupt when you don’t know what a word means, or miss a piece of the story. Don’t try to figure out what it was that went wrong and offer suggestions. Just listen and offer a simple, “That sucks, I’m sorry.”

Don’t compare. This one seems unfair, I know, like my problems are bigger than yours. In general, I want to hear about your good days and your bad days. And when I have a story about a crazy parent, go ahead and one-up me with your crazy client story. When I have a co-worker driving me crazy, please tell me you do too, so it doesn’t seem like the worst thing in the world. But when I have a truly bad outcome, it’s just not helpful to hear about how much grading you have to do, or how you had to work through lunch. I still want to be supportive of you, but it’s not the same, and I need you to understand that.

Pray for us. We’re not perfect. We don’t handle stress perfectly. God’s grace is always appreciated.

Sharing stories

I mentioned in my last post the notion of Second Victim for health care providers who have experienced an adverse event. Every physician has been there. Whether as a result of something we did, or as part of the disease course, sometimes patients have bad outcomes. Those patients stick with us, their memories intruding at inopportune times, making us wish for a do-over, making us think maybe we don’t have what it takes.


There’s a certain pressure to be perfect, coupled with stakes of life and death, that make the Second Victim Syndrome almost ubiquitous among doctors. Yet we often hide our insecurities after such an event, not wanting to admit our human frailty, not wanting to be judged. Isolation can become the norm.


The training session that I went to this week for our new Peer to Peer Support Network aims to break through this isolation in the hopes of preventing some of the PTSD-like symptoms that doctors suffer after an adverse event. The program allows doctors the chance to emotionally debrief with a colleague who knows exactly how they are feeling. Sounds kind of touchy-feely, right? But it works.


As part of the training session, we each shared a story of an adverse event in a small group, and the other doctors just listened. It was incredibly therapeutic to open up and to have three faces of complete understanding looking back at me, nodding, knowing. They knew exactly what it felt like to get news of a poor outcome and have to wonder what you could have done differently, if you could have changed the course. They knew all too well that intrusive voice saying, “You’re not good enough. A better doctor would have done this right. You’re going to mess up again.” They know the panic of seeing that patient’s mom again, wondering how she remembers you. And they don’t even have to say anything, because I know they know.


As we shared our stories throughout the morning, you could see shoulders become less tense, faces become less masked, and affects become brighter. There is amazing potential for this program, and it’s exciting. It’s exciting because I think we’re accepted Second Victim Syndrome and burnout as inevitable for too long. We assume that doctors are capable of bearing these burdens silently and still being flawless. We expect the high rates of depression and suicide as a hazard of the job. But it doesn’t have to be that way.


This Peer to Peer Support Network, and others like it around the country, is changing the norms. Isolation and shame can give way to understanding and healing, just by talking about it. And that can make us better doctors, more able to learn from our mistakes, bounce back from setbacks, and not carry our work home with us.

The Second Victim

I recently had at work what we call an "adverse event". These are cases where something goes poorly, either because of an error, or just the natural progression of disease, but everyone feels it. A kid is very sick, or passes away, or is harmed in some way, and it shakes all of us out of our happy pediatric comfort zone. I obviously can't go into details, because HIPAA, but it hit home for me a concept that I wanted to share.

In 1999, when the Institute of Medicine published their famous (infamous?) "To Err is Human", detailing the widespread prevalence and effects of medical errors, a brave physician from Johns Hopkins thought to go one step further. In his sentinel paper, "Medical Error: The Second Victim", Albert Wu outlined the idea that medical errors, and all adverse patient events, harm more than just the patient and their families. He observed that "although patients are the first and obvious victims of medical mistakes, doctors are wounded by the same errors: they are the second victim".

I can feel the cynicism rising up right now: How can doctors even compare their "suffering" to a patient death? Shouldn't they feel bad if they've done something wrong? Shouldn't we focus on the medical errors and stopping them instead of telling doctors "it's okay" after they mess up?

Those are all valid questions, and the answers to the last two are surely "yes", but that's not the whole story. Second victims have symptoms very similar to PTSD, experience higher rates of depression and burnout, and can have impaired performance due to maladaptive coping behaviors, decreased confidence, or fear of making a further mistake. I will attest that these are not theoretical; they are very real. And I think we can all agree that if we can avoid these effects, that's a win.

We are about to launch our own Peer to Peer Support Network at work to help second victims, and this experience has taught me a lot of things that I hope to carry forward..

I've learned that adverse events are going to happen, and that we all make mistakes. Let me repeat that: We all make mistakes. It just so happens that in our job, mistakes can range from forgetting to bring someone a blanket to causing a death, and that's terrifying. We make hundreds of decisions every day in a very stressful environment. We set up our systems to try to prevent as many errors as possible, but you can't remove the human element. We have to learn from our mistakes instead of letting them cripple us.

I've learned that I work with amazing people. One of the nurses I work with found out I was upset about the patient and said, without hesitation, "You know we all stand behind you because we know the kind of doctor you are." The other doctors, who had every right to critique the situation, instead offered their support and acknowledgement that our jobs are very difficult and we all have these days. It makes all the difference in the world to be able to have that support at work, which makes me excited to train as a peer supporter.

I've learned it's important to take a deep breath and remember why we do this. It can be so easy to get caught up in a busy day and miss the small details, miss the opportunities to really meet our patients where they are and be part of that encounter. Yesterday, with this fresh on my mind, I spend a few extra minutes in each room, talking to families, being thorough, not letting the 18 patients in the waiting room get to me. And I could feel it make a difference. I was a better doctor because of it. Hitting that reset button every now and then, without waiting for an adverse event, is crucial.


Finally, I've been reminded that I'm not doing this of my own accord. God called me to this profession, has given me the things I need to succeed, and can decide what to do with me from here on out. And that's okay. I don't have to be perfect, because He is. He is bigger than the adverse events, than the mistakes, than the bad outcomes. He also cares for His children and gives us the tools we need to move forward if we let Him.