Work-Life Balance Collision: From Doc to Mom and Back

When a family member becomes critically ill, we as physicians can experience a traumatic collision of our work life and personal life. In Dr. Maneesha Agarwal’s FIX17 talk, she shares her experience of dealing with a family medical crisis when her daughter became sick with recurrent febrile seizures, and how the stress of being forced to be the medical interpreter to her non-medical family members was incredibly painful for her. Drawing from her experience, Dr. Agarwal offers advice on how to provide support to colleagues who may be undergoing a similar life trauma.

Watch the full FIX17 talk below!

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I Did Nothing

She came up to me and said, “You saved my life.” I remember meeting this woman while I was walking my dog in a woody park near my home and I was taken aback.  She didn’t look like someone who should be dead, she was young and vibrant and out for a hike. Then she added details.  She had an ectopic pregnancy. She came to the ED in shock. She was frightened.  She was right- I did take care of her.  I remembered her coming in with nearly no blood pressure, with low belly pain and a positive pregnancy test.  In the days before ultrasound, this was enough for me to advocate for her to go to the OR with OB.  They took her, and we were right, she had a ruptured ectopic. And clearly, she had lived.

So as it came back, I then remembered and said, “I did nothing.” Meaning I did nothing unusual.  Two large bore IVs, some intense phone calls, the pregnancy test, a physical and I remember standing by her head and whispering in her ear nearly the whole time to explain everything.  Because she was scared.  And this was the worst day of her life and it was the right thing to do.

We say that a lot, my friends and I.  We have a habit of meeting people on the worst days, or nearly the worst days of their lives in the Emergency Department.  We stand there, shoulder to shoulder and just do the right thing. We give them the moments of care and humanity that mean so much at those horrible times.  But to us, it is a day at work.  It is what we do.  And because we make such a difference often each day, we are dulled to the impact.  And so, we say “It was nothing.”

Last week I had the worst day of my life.  My parents’ home went on fire and the second floor, where my brother lived was destroyed. My brother was home and died in the fire.  My parents were away on vacation and as news trucks and fire engines filled the entire block with ambulances and police cars it fell to me to call them and tell them their only son had been killed.  It fell to me to find my sister as she walked from where she had been able to park the car and have her collapse and keen outside of the camera shots of the news cameras.  It was, by far, the worst day I ever had.

Through this all, two of my brother’s friends, both off duty from NYPD, were by my side.  They flanked me as I spoke to the police (someone died, so the area was a crime scene), the arson investigators (they were able to tell me the fire started from an electrical short in an extension cord) and the medical examiner who came to the scene.  All of these people were incredibly kind to me.  All of these fine first responders were stalwarts of strength. I wanted, needed to see the inside of the house.  I needed to see where he had died, which had been burned to charcoal beams.  There was no light, water from the fire hoses was dripping and puddling everywhere. There were holes in the floor of the second floor.  The policemen at the scene took flashlights and lanterns and took my sister and myself around our childhood home safely.  In the dark, dripping silence at 1am we walked around the basement, gathering small things important to our parents, we walked around the first floor doing the same and they guided us up the stairs to see where our brother had perished.  When we thanked them when they came to the wake for my brother, they insisted they were doing nothing.

The next day forty people friends and families gathered to clean out the front of the house so that when my parents returned they did not have to see the fire’s destruction as their first view of their home of the last thirty-seven years.  Cousins just showed up.  When I went to the house at 10:30, where we planned on meeting at 11am I already found a crowd of his friends working hard, with power tools boarding up the windows that had been blasted open by flames, cleaning and gathering debris.  When I thanked them they said they said, “But it was nothing.”

The next day when we brought my parents to the house we found the ceiling bulging with water that had collected creating a dangerous setting.  Rather than having my father stab the ceiling with a kitchen carving knife as he first wanted I called a friend from long ago.  He lived not far and has been a fireman for about 30 years.  He has risen to a rank that now mostly has him pointing out directions from outside the burning house, but he knows his way around the inside of a burned house as well.  I told him the issue and He said, “I’ll be there in ten minutes.”  We probably had not spoken in at least a year.  But he was in my home in full gear, with all he needed to help keep that spot safe, taking down half the ceiling in the process.  When I thanked him he said, “but it was nothing.”

So, I’m reflecting on “nothing”.  Nothing seems like a lot more than I thought before this horrible day.  All of those people in those acts of nothing helped pick me up from desperate depths.  I leaned on them and they held me up.  They kept my family safe.  They allowed me my pain and helped me to keep going.  I can’t thank them enough for all their “nothings.” I realize that their “nothing” really means “Nothing more than decent people would do to help someone in great need.” or maybe “Nothing more than touch your soul when it is truly exposed and help it to heal with the love of humanity.”

So next time when someone thanks me, rather than saying “It was nothing,” I might just say “I’m glad I was able to help.”

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On Being Average

68% of us are statistically “average.” Whilst being an average weight or height may be acceptable, no-one wants to be an average parent, have an average income or be an average doctor. What does average actually mean and what are the implications for our patients?

Are you average? When it comes to who we are physically there is a simple bell shaped curve that describes the population within which we exist whether that is people from “our” socio-economic group, age or even profession. What height is the average American woman? What size shoes does she wear, excluding those fabulous ones seen in the sales but just weren’t the right size but you crush your feet into because, well just because….

And then what about how much coffee or alcohol you drink? Where do you fit into the curve? Because there is a curve for that. Does the barista at the local coffee shop know your order and is that because she likes you or that you are funding her college fees? What is average? Some of these things we are dealt by nature and can’t really change, like height or shoe size but some we have issues about and may want to change or hide like weight or number of sexual partners. Why though? What is it about average that we don’t like?

What then does it mean to be an average physician.  Because, for the simple statistical reasons 68% must be average physicians. That’s what bell curves and standard deviations do to statistics however we gather or measure the data. We all know some amazing doctors and some poor ones but actually the rest are probably…average. But who wants to be looked after by an average doctor?  Not me! So, most of us would push harder, stay later, study longer to improve our standing in the group and move above that average. Which is good, of course? But here’s the thing, we should all do that. And  if we all did that the whole bell curve would shift to the right and…we’d be right back where we started again; better healthcare but we are still average.

So, what does average actually mean as a physician? Is it a bad thing or is good, good enough?

A chief of mine loved aphorisms: sayings that explain things. One of his favourites was “the enemy of good is perfect.” Good, is average really. The enemy of average is perfect. As a phrase it probably came from nowhere in particular but Voltaire is certainly credited with its popularisation.

“The enemy of good is perfect.” How does that make you feel? The psychological literature would suggest that there are two responses to this. The first view is that it doesn’t really make sense, because surely excellence, that quality of being better than average, is about striving towards perfection, isn’t it? Shouldn’t it be, “the enemy of perfect is good?” Surely perfection, that excellence we seek, is defined by the absence and avoidance of error. And yet Spicer and by extension Voltaire didn’t say that, they said “the enemy of good is perfect,” which is different. What does it mean to accept good rather than perfect?

Does our view of average come from our self-criticism? Who wants to be an average parent, an average lover? We recognise we may have flaws but does that mean you are no good? Is the opposite of perfect, failure? Or is there value in that?

Now when it comes to making mistakes there are those of us who actually are VERY happy to list all our mistakes. We are ALL about mistakes. We firmly believe in the Imposter Syndrome and firmly believe that Drs Dunning and Kruger were looking directly at us when they wrote their paper. Some would wear “average” almost as a badge of honour itself. Some of us actually want to be average. We never think we are good enough and that everyone is better than we are. Dunning and Kruger had something to say about that and it probably isn’t what you think it is.

So who cares if we are average? Does it limit your ability? Does it predict your future performance? And what actually is performance about? If one member of a team is excellent, does that guarantee excellent performance? Conversely, if none of the team is excellent does that preclude excellence? What is our perspective and is that the most important view? I think we have the wrong idea what excellence is; excellence in care is NOT what you think it is. What it is, is actually liberating and inspiring….

Watch the full FIX17 talk below!

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