Knowledge is gained by gathering data, where wisdom
is earned by going through actual life experiences.
- Master Jin Kwon
Five years ago, when I decided to move to Manhattan, I had a very different vision of what the next five years would look like. I had just published my first book, Back From Burnout; Seven steps to healing from compassion fatigue and rediscovering (y)our heart of care. I had researched and come to know everything that could be known about empathy, compassion, physician wellness and resiliency. I knew that compassion was the cure for what ails us in healthcare.
But knowing something intellectually and knowing it “internally” are two vastly different things. Knowledge is intellectual. Wisdom is internal and unshakable. Wisdom is knowing something within every fiber of our being and it is earned when we move through actual, challenging, and all consuming life experiences that teach us about the very nature of our existence.
On the other side of the stethoscope
It's been almost three years since I last blogged about professional burnout and compassion fatigue and quite a bit has happened to and for me since. In latter part of 2015, I suffered through a catastrophic, nearly fatal illness. It lead to many months of me being on the other side of the stethoscope unable to care for myself.
I was hospitalized for three months and had multiple endoscopic procedures. When I was discharged home, I was still incapacitated for another five months. Friends came to my rescue. They shuttled me to and from doctors appointments, cleaned my clothes, my bathroom and my apartment. They helped me answer the mountain of mail and deal with bills, disability and health insurance. I can’t count the number of souls that helped me, prayed for me, sat with me, cried with me, cared for me and encouraged me through those dark times.
I did get well enough to go back to work, but for the next year, I had horrible chronic abdominal pain and digestive issues. I worked with many high powered specialists at one of New York City’s most prestigious health care systems to find a solution. None was obvious. I felt that I’d exhausted all my options. This pain consumed me and as a result, I felt my life was in ruins.
My world shrunk. I did not want to be social at all. I was actually embarrassed by my continued failing health. My illness had taken nearly everything away from me. My finances were a disaster. Insurance is great but I still had overwhelming medical bills and my savings were exhausted. My marginal health did not allow me to exercise and I could not eat in a healthy way. The pain was unrelenting and almost always present. It got to the point that I would fast just so that I would not have pain. My excitement and optimism about my future were eroded.
One of the few things I had left was my work in the ED. Even though I was in terrible pain and unhappy and depressed most of the time, it was by methodically moving through my six step process of delivering true care to my patients that the neurochemistry in my own brain would change and I would find temporary relief of my own pain and problems. My work of caring for others in the ED was the only thing that sustained or fulfilled me during this arduous time in my life.
I resigned myself to the idea that my health was not going to improve. I was just going to have to find a way to live with this illness and the pain that came with it. I let go of the idea that I would find a solution. I decided to create a “new normal” for myself and figure out how to best manage my situation. I would create the best possible life within the limits imposed by my poor health.
It was only after I had let go of the idea that I would find a solution that, when I least expected it, the solution found me in the Emergency Department at the small community hospital where I was working.
Compassion in action
I was caring for a patient who was having intense abdominal pain that was the result of a complication from a previous surgery. Let’s just say it was easy for me to empathize with her, to feel her pain as if it was my own. I did not really know how to help her, besides simply relieving her pain with powerful pain medicine, so I called her surgeon.
I had never met him before. He happened to be in the hospital and offered to come and help me evaluate and treat her. He was “old school” so when he came to the ER, he came looking for me. As he shook my hand and introduced himself, he noticed that I was hurting. He asked me why and it was clear that he was not letting go of my hand until I told him.
He listened intently, When I finished, there was an uncomfortable silence. Then he said, “I don’t believe you have to live this way. Have your records sent to my office and I will take it from there”.
Long story short, a few weeks later he took me to the OR. When I woke up from anesthesia, all my pain and discomfort was gone. Turns out all of my physical suffering stemmed from scar tissue, gastric adhesions and a hernia where the feeding tube once was.
He had used his hands to break apart the scar tissue and adhesions and then he fixed the hernia. Seems simple and logical right? Not so. If it was logical, my other doctors would have figured it out long before. It was because of his years of experience in taking care of patients with gastric bypass, gastric balloons and gastric bands that he had the wisdom to know what could possibly be wrong with my stomach and to figure out how to fix it.
None of my high powered, extremely knowledgeable doctors at that prestigious tertiary care center in Manhattan could identify the problem. They went as far as to tell me I was a hypochondriac. It is so clear to me that those highly published world renowned physicians were masters of the technology capable of saving my life, but they really did not have the capacity to truly care for me.
I know now that my healing was born in, and is a direct result of, this humble general surgeon’s empathy for me. His compassion and desire that things be better for me was the medicine that ultimately set me free from my physical pain and suffering. Because of his compassion, my world opened up and, once again, I could see that anything is possible.
Before I moved through this life threatening illness, I knew intellectually that practicing compassion was actually in my best interest as a physician. The wisdom I have come to know to the very core of my being is that compassion is hard wired into our human physiology and that compassion makes us and our patients better.
Compassion can't fatigue
Recent research in the neurosciences teaches us that the neurochemistry of compassion actually enhances us all as humans. In those powerful bedside experiences dopamine, serotonin, oxytocin, neuropeptide X, GABA, glutamate, endorphins, endogenous opiate peptides, endocannabinoids, as well as many others, bathe our prefrontal cortex and other structures involved in our own pleasure response. This process actually augments all of our human capabilities when we do that hard work of generating compassion for others.
Our physical strength is enhanced. Our spatial perception gets better. Our ability to calculate and diagnose is sharpened. Our immune system is strengthened and our own experience of compassion for others feels incredibly good in a deep visceral way.
The best news is that we can use mindfulness to train ourselves to be compassionate and give compassion in any circumstance whenever we want to.
I know deep in every fiber of my being that compassion can not fatigue and compassion fatigue does not really exist. What we've previously thought of as compassion fatigue is really empathetic overload. It is when we mindfully move past the natural process of affective empathy through to cognitive empathy and into the state of compassion that we erase all of the emotional exhaustion and pain that we naturally feel when we are exposed to others’ pain and suffering.
We are hardwired to care. Our care for others is rooted in the survival of the species and survival of the self, two of the most ancient and primal aspects of the human condition. It is in our own best interest to care for others, for it’s in this way we heal ourselves as well.
The best way to accomplish this is moving through the six step process of delivering true and genuine care thus generating compassion for our patients and their families right at the beside. This will change everything for all of us and free us from the bonds of professional burnout we are all feeling to some degree today in modern medicine. This is the cure: Physician heal thyself!
It has been roughly three years since my last blog on caring for others. I feel like I have come full circle. I’ve come home to myself. Now I am ready to share both the knowledge and the wisdom I’ve learned with you.
I’ve created a new website that is easier to use. Check out drfrankgabrin.com and take a look at the new short videos containing insights about care gleaned from the latest research. You can also sign up to download a copy of the True Care Process as well as two of my other books Care 101 and Booster shots. I’ve also created a private facebook group where we can discuss the concepts and share our insights and experiences with each other. In the future, you can expect to see and experience more short videos that use cutting edge concepts to help you discover the world of mindfulness and how you can use it to enhance your own career.
It is time for all of us to come together and get serious about physician wellness, happiness and resiliency.
Until next week, go care, make a difference and change (y)our world-
ED PHYSICIAN HAPPINESS AND RESILIENCY
This Week's Action
“The difference between try and triumph is just a little ‘umph!’”
We are all looking for satisfaction at work. Sometimes we think we know why we don’t have it. We might feel the reason is because our patients have a sense of entitlement or they don’t appreciate what we do. Maybe we feel our co-workers are not team players. Or maybe we feel expectations are too high and it’s impossible to meet everyone’s demands.
No matter what we think the problem is, it all boils down to one single thought: We believe our lack of satisfaction is the result of someone, or something, we routinely encounter which is less than ideal. Moreover, we want someone (other than ourselves), to change, or fix, those less-than-ideal “someones” or “somethings.”
Our thinking tells us that if those undesirable circumstances were removed or changed, we would instantly have job satisfaction. But perhaps it’s our way of thinking that needs to be changed.
Picture yourself standing at one end of a giant rainbow. At the other end is a pot of gold. You want the satisfaction contained in the pot. Now imagine there is a large fence between you and the gold. Did your satisfaction disappear?
No. It’s still there, but now you have to do something to get it. So would you give up and go home? Or would you scale that wall gladly, knowing there are riches waiting for you on the other side? Odds are you would because the fence is simply a challenge – not an impenetrable barrier blocking you from satisfaction.
It is similar for us at work. We want to care for others. This is why we are here. This is also where our satisfaction lies – much like the pot of gold at the end of the rainbow. Those less-than-ideal people and situations are our fences. We need to see them as opportunities for us to get our satisfaction.
We work in an environment where we have plenty of challenges. We can’t control others. Nor can we change them. The only thing we can change, and it is not easy, is ourselves. When each of us works towards changing our thinking, seeing our challenges as opportunities, we begin to change our world!
Today, and every day, dig deep, reach into your soul; find a way to see the obstacle in front of you for what it is: a challenge. See it as the fence you must scale in order to find a way to care, to make a difference.
With this mindset, you will have access to unlimited amounts of job satisfaction. You will become empowered. You will have scaled the fence and found the way to care for another, and you will get some real and lasting, good old-fashioned, satisfaction.
All the best,
SOS - Shot of Satisfaction
Dr. Frank Gabrin
I am a practicing emergency physician and two time cancer survivor whose frustrations and triumphs on both sides of the stethoscope have lead me to transform my medical practice and my life with just one word: Care.