Resilience Strength through unity

if i say the word dog

what’s the first thing that comes to

your mind if you’re like me

or many others you might think pet or

furry animal or

something along the lines of man’s best

friend these are by convention some of

the most common ways dogs are seen in

our society

now not as commonly dogs might be seen

as food

in places where it’s common to eat them

or as employee

where they work in law enforcement as

guard dogs or as therapy animals

in some places it might be normal to

kill dogs

in the name of science whereas in others

that would be a total

crime now the all these different ways

of looking at dogs are known as

discourses

which are narratives or constructs about

a certain topic

there are discourses on virtually

everything we know

from rainbows to fruits to racism

justice and even pickles discourses are

a product of language

and they’re shaped by the words that we

say to each other eventually

what happens is that the most powerful

discourses drown

out the quieter ones and this shapes the

cultural norms of our society

and the structure of our institutions as

a whole

that’s why if i told you that i owned a

slave you would think that i’m a

criminal

but if i did the same thing two or three

hundred years ago

you would just shrug a shoulder and pass

it off as normal discourses

shape society and i want you to think

about the word resilience

what are the first things that come to

your mind when you hear this word

whatever your thought is i want you to

hang on to it for just one moment

while i tell you about medical school

coming into medical school i knew that

this would be a long journey to becoming

a doctor

in our clinical years it would be normal

to expect anywhere from eight to 12-hour

days

followed by long nights of studying

after we got home

and this too would be on top of

extracurricular work

keeping in touch with families friends

research and also somehow squeezing in

our hobbies too

much like military training i knew that

this would demand a lot of hard work

perseverance and dedication

all this this constellation of effort

that was expected of us

was branded to me and many others as

resilience

now most commonly in our society

resilience is seen

as this ability to show strength in the

face of adversity

to show toughness in the face of

difficult circumstances

and to recover through challenges i want

to tell you that those aren’t the only

ways of looking at resilience

three summers ago i did a research

project where i was looking at

resilience in the medical world

i wanted to look at the narratives that

exist about this topic

what kind of language was used to

describe resilience

and then eventually how did that

language and those narratives

shape the cultures and institutions that

we saw in the medical world

and in society at large in my research

i came across four key discourses three

of which very closely related to

something known as burnout

perhaps you’ve heard of that dreadful

state of mental and physical exhaustion

lack of motivation and excitement and

this total sluggishness at work

that’s burnout no one wants to get to

that stage

but it’s a sad truth that more than half

of all medical residents

end up experiencing burnout at some part

of their training

this is a problem and we need to do

something about it

now let’s talk about the discourses i

discovered

the first discourse described resilience

as self-care

to be resilient meant taking on the

individual responsibility

of being your own hero knowing that life

would be tough

it would be important to nurture

yourself and to be well

the second discourse described

resilience as

prevention to be resilient meant using

resilience as a buffer

against these inevitable stresses you’d

expect in your training

resilience was a way of preventing bad

things from happening

the third discourse described resilience

as

competency this meant that being

resilient was a professional

responsibility

it’s your job to be resilient that’s

what doctors do and they need it because

it’s a tough career

now all three of these ways of looking

at resilience self-care

prevention and competency had the

pattern of relating to that thing i told

you about earlier called burnout

naturally i then wondered resilience

seems really crucial to my success

and it seems like it’s my individual

responsibility to make sure i have it

am i doomed if i don’t and what can i do

to really ensure that

i nurture my resilience that same summer

my resilience was tested like never

before

and it was time to find out one early

morning

in june of 2018 i was on my way to work

when i saw police officers outside my

neighbor’s house

it turned out that their son who’s my

friend was the innocent victim

of a car crash just a few hours ago and

was ended up admitted to the icu

in a nearby hospital we frantically

packed our bags and rushed to the

hospital as fast as we could

and when i got there i was fighting back

tears

as i saw everyone else shedding theirs i

saw my friend’s

lifeless body attached to a ventilator

being pumped with medications whose

names i had never heard of

when i realized how he presented there i

knew that statistically

he had less than a 50 chance of survival

but i didn’t share this with anyone

because i knew i didn’t want to scare

them

i remember the nurse came up to me and

said hey you’re the medical student

right

i’ve been a nurse in the icu for 20

years

and i have never seen anyone survive an

accident like this

i’m so sorry hearing this news

and knowing these facts was not easy and

truth is

i had a tough time finding my place

between the two hats that i wore

on one side i was the medical student

trustee a knowledge translator

who’s explaining the science of what was

going on to his family and friends

i remember speaking closely to doctors

and nurses

attending family meetings and reassuring

everyone when his vitals would change

on the monitor i felt like the one who

had to keep himself together for

everyone else

yet behind all of this i was still a

human being

and a friend before i was a medical

student

i felt deep sorrow from what i saw and i

was trying to make sense

of my own pain as i shouldered everyone

else’s hurt

i felt out of place to seek the same

comfort

for myself i remember his younger sister

asking me how come you’re not crying

oh wait you’re the medical student you

have to keep yourself together for

everyone else

i remember going home to a younger

brother who yelled at me for not

answering the phone

him not knowing a clue what i had just

gone through that day

i remember receiving texts from friends

who asked me how are you

i could only tell them it’s okay as i

sat with my cat in my lap

in the basement behind closed doors

shedding tears all alone

it was so ironic that i was surrounded

by so many people

yet i felt so deeply alone during this

time

my friend was declared dead the next day

and life

quickly became a blur after that i was

dazed for a long time

and it took the rest of that summer to

really reorient myself before i started

the next year of medical school

this was such a strange place to be and

so ironic that as i served as a

caretaker for others

i became blindsided to my own humanity

it was not easy getting through this but

eventually i did

but all that happened since then was not

an easy journey i don’t see death the

same

and i definitely don’t see resilience

the same

what i realized in those moments is a

reflection of what i learned during my

research that summer

the discourses that become the most

common

drown out the quieter ones and this

leads to something called unintended

consequences for us medical trainees

the unintended consequences of seeing

resilience this way

has been the creation of a macho culture

in medicine

one that says burnout is almost

inevitable because that’s just

how the system is 26 hour shifts are

okay

sleepless nights are okay and being

tough

in the face of death is needed because

it’s our job

i get it we’ve crafted these as noble

qualities

worthy of applause and admiration but

they carry lasting effects on medical

trainees and learners

i imagine our discourses and the systems

they’ve created

have something to do with that burnout

should not

be the norm but most importantly i

wonder

what can we do about this during my

research

i came across a fourth small but very

important

discourse about resilience it described

resilience as a cultural norm

it said rather than resilience being

solely an individual

responsibility it should be part of a

broader cultural practice

one that promotes a unified approach to

well-being and a shift in the forces

that lead to burnout in the first place

rather than saying you need to take care

of yourself

on your own it says we’re in this

together

so let’s build systems that keep you

well so that you can serve

humanity now remember when i asked you

when i say the word resilience what kind

of things come to your mind

i imagine cultural norm and collective

efforts aren’t the first words that you

thought of

and that wasn’t the case for me and

that’s okay because this is not

the most common way of seeing resilience

but i do think

it’s an important one and my hope is

that we can all work

towards strengthening this way of seeing

resilience

with those around us and in our

workplaces i know that our world is

moving incredibly fast

and wellness should be a priority for

all of us in the face of death

in the face of a demanding education and

in the face of a lifelong journey of

learning

and discovery with highs and lows and

everything in between

i’m now learning that resilience is so

much more

than just self-care preventing burnout

and

meeting a job description i’m now

learning

that medicine and our world at large

need to normalize and promote a

culture in which we support each other

where

our macho mentality is perhaps coupled

with our shared

humanity because resilience is so much

more than a tool to combat difficulty

it is a value that we all deserve to

hold as a collective

and while culture change is hard i also

know that it is

absolutely necessary and that begs the

question

how do we achieve it dr anthony sushman

spoke very wise words at the

international conference for physician

health

he said that in order to change medical

culture we have to look at three

seemingly paradoxical things

first he says to make big changes we

have to start small

have a snack day on fridays and set

basic ground rules

normalize seeking support and being open

and honest and use our voices to speak

to power

these small changes can have a ripple

effect in the systems around us

number two he says to find an answer we

have to be willing to not know

humility is so important in life and

life will always be full of uncertainty

so we have to fight the pressure to find

an answer

and instead take small steps towards

finding it

and do that together understanding that

this is a shared responsibility

not an individual one and number three

he says in order to feel good

we have to feel bad because the first

step towards experiencing change

is loss so helping people manage their

loss and their grief

is so important in building a culture of

unity

and support he also said that we need to

stop being skeptics

and believe that change is actually

possible i remember our vice dean once

telling us

with her fingers pointed like this you

guys

need to use your voices to change the

system

don’t ever feel that your voice is too

small to make a difference

when you see something wrong speak out

loud about it

complain about it challenge the

narratives that you see

in the world around you to make it

better i remember a surgeon once told me

that the ultimate chronic disease is

life itself

the inevitable outcome of which is a

lonely death

and i get it there might be some truth

to his words but for someone who likes

discourses

and language and knows the power that

those two can have on the world around

us

i like to rephrase his words as follows

i say that the ultimate gift we all have

is life itself and our resilience is

nurtured

through every single day in which we

live at best

together to change our culture

we have to act differently and to act

differently we need to change the

discourses

around us you can change the world

and language might be the first small

yet most powerful step

towards doing that thank you