Posted by: boxcarintl | January 25, 2008

Emotional Resilience


There’s plenty to be reactive about in Medicine these days. Most of us arise in the morning recognizing we are already behind from the day before. Traffic is bad. The physician parking spaces are filled with suspicious cars that couldn’t possibly all belong to doctors. Elevators are slow. Charts have taken flight into distant niches where a critical review by agents of the insurance industry is being conducted. When we finally get our hands on them, they are incomplete. Computer systems are complicated and time consuming. Distractions, pages, text messages and telephones are unmerciful in their persistent presence. Nurses are absent, or seemingly unaware of anything relating to our patients. Other physicians are absent or seemingly unaware of anything relating to our patients. Patients themselves fail to be appropriately cooperative and appreciative of our noble efforts on their behalf. They occasionally refuse to get well in the way we want them to. Money is tight, schedules are tight, spouses are cranky, and our children have wandered off into their own living without leaving behind a trail of crumbs by which we might find our way back into their lives.


Medicine, on the one hand, is a thinking business, and we are all aware that there is a certain level of cognitive ability, or intelligence, that is necessary to master the science of our craft. Medicine is also an emotional business, and we are not nearly as sure-footed in the arena of emotional skills, or emotional intelligence. Yet it is our emotional experience, our level of emotional reactivity or non-reactivity, that sets the tone for the way we feel about what we do all day long. For example, we may hold the impression that we have made an astounding diagnosis from a set of confusing, vague and challenging clinical symptoms. A single criticism, whether it is about accuracy or the lapse in time or the quality of the delivery of this news, is enough to deflate a personal sense of achievement and trigger emotional reactivity. We may express that reactivity in a variety of ways, including initiating an immediate confrontation, and somehow the whole of the day becomes tarnished by this single emotional event.


We know well how to exercise our intellectual muscle. But how do we begin to train the emotional muscle that will bring greater ease and satisfaction to our days? How do we learn to create enough inner space to manage our own emotions in this often stormy and emotional environment?


The mastery of emotional resilience is purposeful and in a certain way may be guided by the intellectual processes that have served us so well in the mastery of the science of Medicine. Surprisingly, the use of mathematics may be one of the simplest and most effective ways in which we might develop emotional mastery. Do you remember, long ago or perhaps this morning, being told to count to ten as a way of creating enough distance from an event to “cool off?” There is a science behind that old adage. Our reactivity is in part moderated by a biochemical event that persists from somewhere between 5-7 seconds. If we can engage the cerebral cortex in its realm of mathematics or some other complex processing, two things occur. First, there is a diversion, or a non-reactionary pause, that is created while the biochemical process dissipates in its own natural way. Secondly, we deflect the inner conversation that bolsters our outrage, or reaction, and thereby interrupt a second or third or endless volley of biochemical emissions triggered by our thoughts themselves. The completed event itself has no impact on our experience one way or another. It is our thoughts about the event that would and do sustain the state of reactivity if permitted. Instead of spinning our thoughts in search of evidence to support our perceived disturbance, we place our thoughts into the realm of the analytical, and it is from that part of our brain that high level behavioral choices are available.


Anything works. Counting to ten is actually an option. Reciting a formula from physics or chemistry will create a detour from the limbic system to the cerebral cortex, if one is so inclined. Musical scores, a complicated piece of poetry, the first lines of the Declaration of Independence can work. Conquering a new language a few seconds at a time can fill the pause and deflate the reaction. The choice is entirely personal, as long as it draws thought into the arena of the analytical brain. The pause itself may have value in interpersonal interaction, for it serves as a declaration of mindfulness, of being thoughtful in our response, and thereby elevates the conversation for everyone involved.


A method that I personally use, and one which I feel amplifies the value of this pause, involves an analytical assessment of the person or situation before me. I create an inner challenge to define three things about the person that I find endearing, or that makes their reaction understandable. If we regard each person or circumstance from a place of good will and respect, there is a shift in our thoughts. As thoughts shift, we become alternatively informed at an emotional level, and our emotional responses shift in kind. Even the fierceness of what feels like a personal attack can be re-framed with a positive focus, if we are willing to open our evaluative mind to that possibility. I remember being told, as a child, that I was stubborn. This was not a parental compliment. It was, pure and simple, the inflamed words of a completely exasperated parent. I believed for many, many years that I was simply stubborn, ornery, and willful. My inner conversion as a young adult re-framed this quality so that I began to regard myself as a woman of conviction. As I reflect on my behaviors during that time of changing my mind about myself, I realize that I began slowly yet consciously to maintain fidelity to the things I truly believed in, and that I began to allow other issues that I might once have argued about to benignly pass by. In the same way, we can interpret an emotionally charged remark or unruly circumstance seemingly directed toward us as a personal attack. Alternatively, we can bring a re-understanding from our rational mind into an assessment process that results in a different opinion about any given set of details or words, and we can simply allow them to pass by. A patient who appears angry may then be honored as frightened. An uncaring nurse may then be understood as overwhelmed. A verbally violent family member may be acknowledged as grieving. A stubborn woman, as a fine and humble example, may be compassionately re-considered as a woman of strong conviction.


There are lofty and noble goals for cultivating an emotionally capable physician population, and I agree with those noble goals. Physicians are automatically designated as leaders in a medium marked by complexities and urgencies. We have the opportunity, and the personal and professional responsibility, to participate in the creation of a coherent, effective and balanced medical culture through the intellectual and emotional intelligence we exhibit. We are not only observed as leaders, but our behaviors contribute in a substantial way to the kind of environment that exists around us. We are the way-showers. If we are hypercritical and reactive, we invite a duplication of those qualities as cornerstones of our daily environment. If we have the habit of “flying off the handle”, we had best learn to duck. There will be flying objects in the air. If, on the other hand, we model collaboration, cooperation, and the skillful management of our internal emotions we impact the collective in a positive way, and the culture of our daily living evolves in a more honorable and purposeful manner. We infuse our work with respect, compassion, sincerity and service. We will not have to duck our heads in fear of flying objects nearly as often.


The enhancement of our personal lives through the mastery of emotional intelligence is of equal and utmost importance. The experience of what I often refer to as “living in low growl” is exhausting, depleting, and produces a sense of endless discouragement and frustration. The joy inherent in a profession of human service such as Medicine becomes buried under a prevailing sense of anger and despair. A new way of managing our inner emotional climate and our relationships through increased awareness and the acquisition of personal tools not only increases harmony in the workplace and our profession as a whole, but it also provides a kinder and more graceful way of being for each of us. Consider the residue of a harsh interaction. It is often filled with remorse, a sense of ill will, and a criticism of self or others that might hold us hostage. We carry these emotions and our attitudes into the next activity and encounter in our lives, often with poor results and a deepening of our negative experience. When we manage emotional triggers with skill and wisdom, there is no residue. Rather, we experience a sense of good will, of having been present to a challenge in a graceful and caring way, and that warmth and caring plays forward into the rest of our day. The positive experience deepens, and the quality of our lives rises. The quality of our lives is important, not just because of our role as physicians in service to humankind, but because each of us has the intrinsic right to lay claim to a life that is fulfilling and peaceful. We have the right to retrieve our innocence and our fundamentally caring nature from the rubble of our thoughts and reactions. We have the right to be in service to our own well being in the same way that we are called to be in service to others. We are invited to participate in the creation of our own multi-level health, appreciation, clarity, and creativity. It is within our power and authority to release fear, emotional stress, and anxiety. In that relief, we are also freed from the experience of self-remorse and regret. We liberate the emotional energy that is engaged in wrestling with disturbance and upset, and it then becomes available to sharpen intellectual discernment, promote personal satisfaction, and to create happiness. I am profoundly interested in happiness.

It may seem as though the current times in Medicine are too troubled, that we are too troubled, to make any changes that will ever make a difference. It may even seem impossible to make personal changes, given the flaws and faults of the organizational culture that currently shape our days. It would be much easier, of course, if the system could magically improve without any personal effort or expenditures. Given, however, that the world appears to continue to do what it does without regard for our preferences, our option lies in the realm of how we choose to relate to what it is the world is doing. We can relate to this large, chaotic world with disturbance and upset, recognizing that the quality of our lives is impacted in a suboptimal way. I believe in magic in a different way. The great chambers of the metaphorical human heart has its own inner intelligence that is, at its minimal description, emotional intelligence. That is where the magic of change resides, and we all have access to that inner wisdom. Perhaps there is no need for actual change at all, but rather only a reconstitution of a more original formula for our lives. The skills and tools of emotional intelligence are discoverable and can be implemented with practice and purpose to create resilience and lift the quality of our lives in positive ways. I believe that we have earned the right to bring the same level of caring and compassion to ourselves that we feel called to extend to others. The tools of emotional intelligence can teach us to shift in thought and action and that will move us toward an easier and more kind way of life as we continue to go about our good work.