Friday, March 9, 2007

Bears and Teddy Bears

Yesterday, during a busy day in the emergency room, one of the nurses asked me "How come you're not getting stressed out?". I thought about it for a minute and replied "I used to get stressed out, but I was the only one who seemed to notice, so I gave it up.". I think she thought it was a funny idea, giving up getting stressed out, but I was serious. I remember when I first started working on my own as a doctor, and how I would get stressed out if the clinic was super busy and running late. The only problem was that it didn't seem to make the day any better, so I gave it up. These days I realize that stressing about what is beyond my control is not only a waste of energy, it's unhealthy. So, I avoid stress until I need stress.

Stress is a clever adaptive response. The idea is that faced with a terrible situation your body has a mechanism to get really ramped up really quickly so you can fly into action. I like to think of it as an adaptive response to fighting bears, when a bear lumbers out of the woods in front of you, your body acts to give you the best chance of survival. Some people call it a fight or flight response (as in should I run or should I fight the bear), it's more scientific name is a sympathetic response (as in I have sympathy for those people who have to take on these bears). Your adrenaline rushes, your pupils dilate, your heart rate increases, your body redistributes blood flow, all of this to help us react quickly and effectively in order to survive.

As an adaptive response to bear attack stress is very effective. In medicine, the bear is a difficult airway, or a profusely bleeding patient, or someone in cardiac arrest. In these situations a stress response is useful and called for. It speeds up your body, focuses your mind, allows you to act without regard for personal discomfort. A stress response to a real bear can be lifesaving.

What is not a bear in medicine is an overcrowded emergency room, a grumpy colleague, or a poorly run clinic. These are the false bears of medicine, the teddy bears if you will. If you allow yourself to be convinced that they call for a stress response, you have been fooled. In these situations the stress response in maladaptive, because it does not affect outcome of the situation.

Prolonged stress responses are unhealthy. They modify how your mind and body function in very real ways. For instance, a stress response diverts blood flow away from your digestive tract in favour of vital organs and muscle, disrupts sugar metabolism in the body, and changes the way we focus on multiple versus single tasks (all useful for bear fighting, not useful on a prolonged basis). On an ongoing basis, in response to pretend bears, these responses make you feel sick.

When I am having a crazy day, when the patients are waiting to long, when everyone is grouchy, when one more person says 'How long do I have to wait?!?' when I am already going as fast as I can I think to myself this is not a bear, and I save my adrenaline in case I a real bear is hiding in the next exam room.


Nancy said...

Great post! I've been wrasslin' too many teddy bears lately, gotta mellow out again.

Anonymous said...

You, I would definitely enjoy working with. My motto is: I don't get excited unless it is life threatening and IF it is life threatening I don't get excited because then I am way too busy too be excited. Works for me every time.

And if you are going to wake me up in the middle of the night, you better be DND. Not a hangover "I need to be rehydrated", or a hangnail, or wanting cough syrup, or wanting to tell me why you think your aunt got cancer twenty years ago, DND!

And another thing, I hate it when an ebriated person pukes on my shoes at 0300h after threatening to punch me and then I have to pull the tazers out of their rotund hairy naked belly.

Sweat pants are not a fashion statement.

mike said...

Add a little romance by sending this personalized "I Love You" teddy bear greeting with his/her first name. You don't need an occasion . . . Just choose the teddy bears color and treat (lollipop or toy pinwheel).

Tuan Ahamed Cassim said...

lol.. its amazing to hear that doctors think scientifically always in a way which benefits both of the patients and the doctor..!

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David bone said...

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