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