From January 22 through January 28, 2017, the American College of Emergency Medicine (ACEP) will be hosting its annual Emergency Medicine Wellness Week, a national effort intended to promote and celebrate the value of physician wellness in our specialty. As part of this effort, the CORD Resilience Committee has created a two-part series of blog posts highlighting wellness and resilience. You can read Part I here.

Part II: How was your Day …?

Joshua Schiller, MD

Assistant Program Director

Maimonides Medical Center EM Residency Program, Brooklyn, NY

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A woman stands before her colleagues in a darkened room and recounts her experience as a patient who just had a C-section for the birth of her last daughter.  Being an ER physician, she watched her post-operative condition deteriorate on the monitor until she finally called the OB attending herself to get taken back for surgical exploration.  On the way into the OR, she turns to the surgeon and says “Please don’t let me die, I’ve got a little baby to take care of.”

 

Despite the large number of people listening in the room, her voice holds everyone so tightly that no one is moving and there is not a single sound.  Tears are streaming down faces, and with the applause at the story’s conclusion, there is an almost palpable sensation that this crowd was brought closer together.

 

What is it that creates community, and why is it so important?  An essential part of society is the need for its members to share their experiences.  It can be a profoundly simple process—to speak and to listen—in gathering those around us together, whether they be family, friends or work colleagues.  Its importance of a shared experience is multi-focal.  It assigns context to what we do, offers an exchange of knowledge, and perhaps most importantly it provides a sense that we are not alone in what we do.

 

We all know the practice of medicine can be relentless, and ironically merciless for the practitioner.  In the field of Emergency Medicine, our place of work can feel like an amoral meat grinder.  In addition, there are few places where there is more drama of the human condition played out in one room.  Often, the ER can be an endless parade of patient care and disposition, with almost all of our customers having a miserable day. A couple of shifts and we find there is little in the way of decompression from the daily tragedies.

 

Oftentimes, the recovery process starts when you sit down with a colleague over a beer or loved one at the dinner table, and talk about the day.  You transport back into the stressful burden of the ER, and in the telling of the story, you travel the arc of confronting conflict and finding resolution.  The path towards the work day’s conclusions may bring variable levels of drama, depending on the nature of the story.  A “quiet day at the office” has its own ER version (however rare), and may not yield much in the way of a ‘great story’; as much of the literature on narrative suggests a need for conflict, crisis and resolution.[1]

 

However the simple process of recounting the day’s events can provide the storyteller with perspective and context.  As well, there perhaps is a natural inclination to focus on more troublesome or provocative aspects of a recounted day, which we know in the ER can occur with high frequency.  Consequently, the narrator relives the moments that make up the story and, in doing so, gains understanding in thought process and ultimately in course of action.  Inherently, the story then culminates into what James Joyce characterizes as the epiphany of the narrative, i.e., the point at which events appear new, or seen from an entirely new perspective.[2]

 

So what starts as a means of blowing off steam may actually become a process of learning as the story is being told.  The narrator can place his actions in a larger context of societal constraints and expectations, and may better understand how the course of events proceeded.  And this is not solely experienced by the teller; in fact the audience may be provided more powerful insight as they bear witness to the tale.

 

Listeners are compelled by stories’ intrinsic narratives, enabling them to imagine the situations as if they were theirs. In this way, listeners who are doctors can reflect on the principles that drive their practice.  Perhaps more importantly, the inherent loneliness so common among doctors lessens when hearing a story in which one is familiar with the setting and can empathize with the characters.  As a result, the plights of practitioners and patients alike are given the mantle of humanity that can so often be lost in the emergency room.

 

Storytelling is, fundamentally, the sharing of one’s experience with others.  It is an ancient ritual that not only brings the teller closer to his colleagues, but taken collectively also forms a narrative of how medicine takes its place in society.  So when you walk out of the ER after a long stressful day, pay attention to the stories that may be stirring inside you.  Then let the world know about them.

 

[1] Burroway, J. Writing Fiction: A Guide to Narrative Craft. 3rd ed.  New York: Harper Collins; 1992: 39-40.

[2] Langbaum, R.  Moments of Moment: Aspects of the Literary Epiphany, ed Wim Tigges (Amsterdam: Rodopi B.V; 1992) 39-60.