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Wellness Section Newsletter, January 2011

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circle_arrowFrom the Section Chair - Wellness Section Newsletter, January 2011
circle_arrowFrom the Newsletter Editor - Wellness Section Newsletter, January 2011
circle_arrowPhotograph by Lori Weichenthal, MD, FACEP - Wellness Section Newsletter, January 2011
circle_arrowA Call to (Wellness) Arms! - Wellness Section Newsletter, January 2011
circle_arrowA Wellness Story - Wellness Section Newsletter, January 2011
circle_arrowPhoto by Lori Weichenthal, MD, FACEP - Wellness Section Newsletter, January 2011
circle_arrowWellness in Haiti - Wellness Section Newsletter, January 2011

From the Section Chair - Wellness Section Newsletter, January 2011

Lori Weichenthal, MD, FACEP 

Happy New Year to you all! 

This newsletter will hopefully reach you all soon after the start of the New Year. This time of the season is a time of introspection where we look at the past and make plans for the future. For the section, the past year has been great. We sent out two newsletters filled with great information and had an increased presence at Scientific Assembly. The Wellness booth that is sponsored is association with the Well-being Committee was as popular as ever and the morning guided meditation sessions and noon yoga offerings meet with increased enthusiasm. Comments that members shared regarding the meditation and yoga offerings included: “Deep gratitude, loved it: Thank you for the guided yoga, it was a great break; Thanks to whoever came up with the idea of a meditation room and made it happen; and Hope we have it at Scientific Assembly next year.” 

Still, as we look to the New Year, there is always much to look forward to and to accomplish. At our annual meeting, members brought attention to many areas where there is still work to be done. We continue to support the work of the Task Force on the Aging Physician that looks to address the challenges of our colleagues as they come to the end of their careers and look for ways to transition to other work or retirement. We also seek to reach out to young physicians and residents to support them in making wellness a part of their career planning early. We are working with the Well-being committee and individual residents and residencies to help develop a curriculum on wellness for young physicians. 

Also of increased importance, is a plan to address the needs of physicians who deploy to difficult situations throughout the world. Increasing numbers of physicians are being deployed to disaster situations through the military and volunteer situations. The work they do is great but the degree of support they receive in regard to pre-deployment preparedness, situational support and debriefing on return from deployment are varied depending on the agencies and situations that they are faced with. We look in the New Year to create a list of resources for members who are involved in such situations to deal effectively with the stresses related to dealing with international disaster. 

Finally, we look to continue to support your contribution to the wellness section. It is only through member involvement that this section can exist. We encourage you to lend your energy to aspects of the section that interest you, including but not limited to: Involvement at the annual meetings; contribution to the newsletter; help in creation of a resource list for those deployed to disaster situations; and/or development of a wellness curriculum for young physicians. We are also open to new ideas on how, we as a section can support wellness in our members. 

In this New Year, we wish you all the best and, if you have some extra energy to give, we invite you to get involved and support the wellness of others, like you, who are working on the front line of emergency medicine.     

Feel free to contact me by e-mail. If you want to talk, I'll be happy to give you my phone number.

 


From the Newsletter Editor - Wellness Section Newsletter, January 2011

Sarah McCullough, MD, FACEP 

Wellness…we are the wellness section and we toss the word around a lot but what does it truly mean? You can Google it, look it up in Webster’s dictionary, or ask an expert. And if you do so, you will find that there are as many definitions as there are sources to access or people to ask. One description that I particularly like is, “a healthy balance in Mind, Body, and Spirit which results in an overall feeling of being well.” This definition suggests that wellness is multi-dimensional and that these different aspects must work together in an integrated manner. Another factor that I believe is important is that one environment or activity that might bring a great sense of wellbeing to one individual might bring great distress to another. 

Staring down the barrel of a 300 Win Mag with a prize elk in the site might be the ultimate experience for some while for others, attending a week long silent meditation retreat might be the time when mind, body and spirit come into balance. For others, either of these experiences might sound like pure torture. Ultimately, I think that we each must discover what wellness is for ourselves. Having said this, it still helps to have a road map to examine our own present state of ease of dis-ease. 

Let us focus on the body first, as this is the area that tends to get the most focus in our society when we talk about being well. Certainly, being physically unhealthy can limit a person’s sense of wellbeing, especially if it prevents them from doing the things that they want to do. This being said, a physical insult can occur and with time and adaptation, an individual can still return to a balanced state of well-being. Having a heart attack can make you feel unwell and limited, but focusing on things that can help to prevent future heart attacks, such as dietary changes, exercise and stress management, may bring you back into balance where you feel at ease and empowered again. A motor vehicle accident that causes paralysis of part of your body may initially create a great sense of dis-ease, however, over time and with adaptation to your new physical state, a sense of wellness and balance may return. 

Whereas the physical aspects of wellness are very concrete, the mind and spirit dimensions are much more nebulous and perhaps, in the end, more important. The mind is the aspect of intellect and consciousness experienced as combinations of thoughts, perception, memory, emotion, and imaginations including all the unconscious cognitive processes. The mind is powerful and frequently, we pay very little attention to it and allow it to rule us. Our thoughts jump from one idea or memory to another and can become very disturbed thinking about something that occurred in the distant past or pondering something that might occur in the future. When well focused and fully present, our mind can be our friend and allow us to sort through facts and come up with solutions to problems. We do this when we are faced with critically ill patients but it also presents in our daily lives. For example, when you or a family member receives a serious medical diagnosis such as cancer, it is the mind that is called on to collect the facts and arrange for a plan to deal with the problem. If you are able to do this successfully, it can create a sense of ease even as you face physical illness and discomfort. 

Finally, perhaps because it is the most difficult to define, there is the spiritual aspect of wellness. The spirit is technically defined as related to the non-corporeal substance contrasted with material body; it is the animating or vital principle in the individual. The physical well being can be lost, the mind may not be able to sort it all out but the spirit may remain. A good example is my friend’s mother-in-law who suffered from dementia. She had experienced several falls and thus her body was not well and her mind was such that she frequently would not remember people that had been deeply important to her but, when she would open a present at Christmas or on her birthday there was such joy in the process, like that of a small child, that you knew her spirit was still present and engaged. Perhaps she is an example that when nothing else is left, the spirit can still be present and so perhaps may wellness. 

I expect that each of us would like to feel well. We must remember in the process that it is more than just physical health but involves a mental and spiritual component. We must also remember that it is not necessarily something that just happens, but that it requires some thought and effort. Start by defining your own wellness. Then use your body, mind, and spirit to achieve it. 

 


Photograph by Lori Weichenthal, MD, FACEP - Wellness Section Newsletter, January 2011

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A Call to (Wellness) Arms! - Wellness Section Newsletter, January 2011

We are looking for members who what to become involved in several important projects. They include:

  1. Developing a resource list for members who have been involved in deployment to disaster and other stressful situations
  2. Creating a wellness curriculum for residents and young physicians
  3. Providing personal insights into wellness for the section newsletter
  4. Recruiting a speaker for the wellness section meeting at the San Francisco Scientific Assembly, October 15-18, 2011.

If you are interested in being involved, feel free to contact me by e-mail. If you want to talk, I'll be happy to give you my phone number.

It is only through member involvement that this section can be successful. 


A Wellness Story - Wellness Section Newsletter, January 2011

Written by an anonymous section member 

I woke up yesterday at 6:15 am and jumped out of bed to start my day. As I walked to the kitchen something wasn’t quite right. I felt a little lightheaded and needed to touch the wall to steady myself. I figured that I had just gotten up too quickly, so I decided to forego my morning run and rest a little before I had to get up at seven for some morning meetings. 

When I got up at seven, I was still not feeling right and in fact was feeling a bit worse. I was now nauseated, lightheaded and off balance. I went ahead and got dressed for the day but as I did so, I checked my pupil size in the mirror, assessed whether I had a pronator drift or not, and began to generate a differential diagnosis for my condition. I also decided to ask my husband to drive me to my meeting as I was feeling dizzy and knew I shouldn’t drive. My husband looked at me a bit strangely but loaded me into the car and we headed off. 

Not far from our driveway, a voice of reason suddenly sounded in my head. Why was I going to a meeting when I could barely walk straight and had created my own differential that included diagnoses that ranged from benign positional vertigo to glioblastoma? With much relief, at my request, my husband u-turned and headed home. 

Then began the dilemma of what to do next; first, we called my primary care physician. Unfortunately, he was out of town on vacation for two weeks. His staff recommended going to an urgent care. I really didn’t want to do that; what would they do for me? What tests could they order that would rule out all the things on my differential. My husband wanted me to go to my own ED to be seen. That idea petrified me. I didn’t want to appear silly if nothing was wrong with me and at the same time, I didn’t want one of my colleagues to diagnose me with something life altering. I suggested to my husband going to the other major ED in our town but even this idea did not appeal to me. I know that, similar to the institution I work at, the other hospital ED is overcrowded and has long waits. Would I be willing to tolerate the wait (being the patient person that I am)? Would they be as concerned about my symptoms as I was or send me to fast track for being weak and dizzy? Perhaps I should just go back to bed and sleep for awhile and I would wake up feeling fine. My self-administered neurologic exam was okay, right? 

Finally, my husband (also a very patient person) took the decision out of my hands. He called my boss, told him what was happening and asked if he would meet us at the ED. Twenty minutes later, with my husband’s help, I stumbled into the department in which I work and was escorted to a room. I was both mortified and scared. I still couldn’t decide if it would be worse if there was nothing wrong with me or if there was something wrong. 

I got into my gown as instructed and then my boss arrived.  He examined me and said he thought we should run some tests including an MRI/MRA. I agreed, not knowing if I was speaking as a patient or a colleague.  He then asked if it was okay to give my case over to another faculty member as he was not truly working in the department at the time. By this time, I was okay with the idea. 

So, I got an IV, was hooked up to the monitor (which peeped all of the time due to my relative bradycardia), blood was drawn, and an EKG performed. Through it all, I was treated with great professionalism, kindness, and courtesy. I had always known that the nurses, physicians and ancillary staff that I worked with are a great group of people but I had never seen it from the patient perspective before and it made me proud to be a part of such great team (although I was still embarrassed to currently be the patient).

And then the hard part began: The wait for test results and for the MRI/MRA to be performed. Over a few hours of waiting, I suddenly had a clearer understanding of why patients peer out their doors every few minutes or send their family members to the nurse’s desk. Although I had brought reading material, I was too dizzy to read (even after 12 mg of Zofran) and my husband and I tried to make light of the situation and keep up a conversation, but it was clear that we were both worried and after a while, we became quiet; No TV or radio to distract us, just our own thoughts and worries. 

Finally, they came to get me for the MRI. It was a surreal experience to be wheeled through my own department on a gurney; quite a different perspective from the patient’s perspective but also very awkward. I wasn’t sure whether to say hi to people I knew or to pretend I wasn’t there and I had a sense that they felt the same way. 

Then the experience of the MRI; I had earplugs placed in my ears and then pads placed on the sides of my head and then into the tube I went. I am not a claustrophobic person but the bumps, bangs, whistles and hums that the machine made were a bit disconcerting. I now have a better understanding of why people refuse the test even with sedation. I chose to focus on a mantra and deep breathing and the test was completed without incident. 

And then back to the ED to wait some more. Finally, the news we had been waiting for; all the tests were negative and I would be able to go home. Then, a little more waiting and I finally got to walk out of the ED, a little more steadily that I walked in. 

Clearly, there is more to the story: Follow-up visits, further testing, etc. However, I am recuperating at home and feel I have learned some valuable experiences as an ED patient. So, kind of like “All I Ever Needed to Know I Learned in Kindergarten” by Robert Fulgrum, I have made my list of “The Things an ED Doctor Can Learn by Being a Patient.” 

  1. Denial is not just a river in Egypt and for ED physicians, the river is deep.
  2. It helps to have a loved one who can think clearly when you clearly are not.
  3. A caring boss is priceless.
  4. So is having a great group of people to work with who you can trust to care for you when you are the patient.
  5. Waiting is a stressful experience. Remember to check in with your patients and let them know what is going on.
  6. Chances are, someday you will be a patient too. Treat your patients as you would like to be treated.
  7. Life and good health are precious. Enjoy them both.

 


Photo by Lori Weichenthal, MD, FACEP - Wellness Section Newsletter, January 2011

Tulipsphoto

 


Wellness in Haiti - Wellness Section Newsletter, January 2011

Cameron Jones, MD 

One of the most challenging aspects of relief work is personal health. When faced with unexpected challenges, difficult living environments, poverty, and sometimes overwhelming sickness, how can the relief workers themselves stay healthy and focus on those whom they came to help? Many of us involved in medicine have the desire to travel overseas and lend our skills and knowledge to those in need. I am no different, and I am lucky to be enrolled in a residency that allows a bit of freedom for its residents to pursue interests outside of the hospital. I was able to set up a trip to Haiti in September of 2010. A country in need even before the earthquake, my experience in Haiti certainly changed me for the better, making a lasting impact on my world perspective as well as shaping my goals as an emergency physician. I learned many lessons, not only in medical care, but also in how to cope and deal with the many stressors of relief work. 

The first hurdle that I encountered was my own expectations. Haiti was decimated by an earthquake on January 12, 2010, and any infrastructure that may have existed prior to the earthquake was destroyed in a matter of minutes. Over 250,000 people lost their lives, and life essentially came to a standstill for those in the country. In preparing for my trip, I imagined getting off the plane, arriving at the hospital where I was to work for 2 weeks, and diving in, getting right to work. On the contrary, we arrived mid Friday, the ED was essentially empty from the morning rush, and there was little to do. The hospital in Carrefour where we were working is run by Seventh Day Adventists, and much of the hospital had a skeleton crew on Saturday. Sunday was not much different, as the Haitians viewed this as a day for rest, and the hospital was not very busy. There is no functioning EMS service in Haiti, so the ED is a much different place, lacking the constant influx of patients we see in the US. So while I expected and prepared to jump off the plane and start working in this country of so much need, I was frustrated and angry that these expectations were not being met. 

I believe that one of the main challenges that relief workers face is unmet expectations. We work so hard to prepare for a certain goal or mission, that when we actually arrive in the country, we are frustrated and caught off guard if what we actually end up doing is different than what we prepared for. We form in our mind a vision of what we will encounter, but that vision may be drastically different from reality, specifically if you are going to an area where you have never been before. I had never been to Haiti, and the devastation that I saw, even 8 months after the earthquake, was shocking. It is important to prepare as much as possible for your trip, physically, mentally, and emotionally, but realize that what you may encounter when you actually arrive at your destination may be drastically different than what you prepared for. Realize that while an experience may not be what you expected, this does not mean that it still won’t be significant, one that has its own benefits. While I did not begin my time in Haiti as I expected, the pace of the first 3 days allowed my team and I to explore our surroundings, familiarize ourselves with the hospital and clinic, and meet and establish relationships with our translators, all of which proved to be an immense benefit during our trip. 

You want to do all that you can to set yourself up for successes on your trip. Most likely, if you choose to do international relief work, you will be traveling to a destination that is highly different than your current living situation in the US. You may have to sleep outside, deal with extremes of heat or cold, not have access to running water, eat freeze-dried food or canned meat, or perhaps deal with all sorts of strange wildlife and insects. While it is important to test your boundaries, it is not smart to intentionally place yourself in an environment where you will not be able to function. You will be stressed with your work, as practicing medicine in a low resource environment is taxing, so being able to “recharge” while you aren't working is immensely important.  

One good way to make sure you have plenty of energy is to travel with good friends. I was lucky to go to Haiti with Rais Vohra, a toxicologist and attending emergency physician at UCSF Fresno, and Daniel McAtee, a parametric in the San Francisco bay area. Each day we would work our hearts out in a hot, stuffy emergency room, encountering all sorts of problems, from malaria to urinary retention, and each night we would spend time together, processing our days. We would call these times together “office meetings,” going up to the roof of the hospital to work through the stresses of the day. Just like working in the ED in the US, our days were filled with highs and lows. From treating sexually abused orphans, to watching a haitian grandmother slowly succumb to a severe intracranial infection, everything we encountered was highly emotionally charged, challenging our ability to deal with grief, happiness, and understanding. Without each other to lean on throughout the day, the trip would have been much more difficult. The experiences that I had with Rais and Danny were unforgettable, and established a bond that will continue far beyond this initial trip. 

Along the same lines, in order to stay “well” during your travels, it is important to take time to recuperate. Take a day to travel to a local site, see the country you are visiting, do something separate from your regular work. Rais made a contact with a local Haitian medical student named Dol, and we were able to go with him and tour the city of Port-au-Prince, visiting his school and his home. Exposure to a larger area than the neighborhood of our hospital really hammered home the extent of damage and hardship that still faces the country. Even 5 months after the earthquake, it was estimated that 95% of the rubble from the earthquake remained uncleared. Ruined buildings are everywhere and there are still over 1 million Haitians living in tent cities not designed to withstand the test of time. While this tour with Dol was overwhelming in many ways, getting out of the emergency room for one day was a welcomed break, and allowed us to continue working hard for the remaining time we had in Haiti. 

There are many stresses and challenges that face you if you decide to do relief work. You are choosing to place yourself outside of your comfort zone, both personally and professionally. I can tell you from experience that the rewards of making this decision are great, and you will be changed as a person and a professional forever. Having flexible expectations, traveling with friends, and taking time to recuperate and enjoy yourself are just a few lessons that I learned from my first trip to Haiti. I look forward to many more visits, as there is still much work to be done, and many more lessons to learn.

 


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