Maintaining Balance

I’m not much for New Year’s resolutions. They seem to be too easy to break and lead to disappointment. But my birthday and New Year’s are close together, and they do provide convenient markers to reflect on life, health, and balance.

Every day I round in the hospital I find myself discussing healthy lifestyle habits with my patients. Take time to exercise. Eat healthier and eat fewer processed foods. Drink more water. Cut back on the caffeine, alcohol, and soda. Try to control portion size on your plate.   Slow down. Reduce stress.

Do as I say, not as I do.

When working on the wards, nearly every one of these recommendations go out the window.   Busy days go like this: I get to the hospital too early to do a morning work-out (at least, I don’t pull myself out of bed early enough). Once I’m off and running, I have little time to drink fluids, other than my trusty coffee. I frequently eat lunch around 3pm after I realize that I have not eaten or emptied my bladder since arriving at the hospital. I rush down to the cafeteria to grab something quick – whatever is available, along with a bag of chips and another cup of coffee. Lunch is eaten in front of the computer while trying to return pages, write notes and order tests, or return a call about admissions. Walking the halls between rooms I have my head down checking e-mails and responding to things that come up with all of those things I do in my “off” weeks, like global health, administrative, and educational stuff.

Finally after seeing everyone once or twice, talking with consultants, and doing a few family meetings I have my 2-3 hour documentation party, sitting on my backside writing notes and double-checking that I ordered all the tests, consults, and treatments I need to. Often there is a decision at that point: do I go home to put my kids to bed and do notes from 8:30-10:30, or miss seeing them that evening and get home closer to 8:30 (again grabbing whatever is available in the cafeteria for dinner). Whatever the decision, eventually it’s home, sleep (frequently interrupted by brooding about anxieties, mistakes, or slights accumulated during the day). Repeat for 6 more days.

Certainly not all my days are like this, and many people do not work this way. There is a bell curve of efficiency, and I am on the slower side. At the same time, I suspect that several of the unhealthy behaviors I mentioned above ring true for other clinicians, nurses, or really anyone with a very busy job.

With my chronic lymphocytic leukemia (CLL), I have more motivation than many to seek a more tenable balance. But work done as an unhealthy slog through the day takes a toll on all of us. We develop stress-related health problems. We get burnt out. We are unkind to our patients, family, or friends.

I have strived (with variable success) to address and avoid a lot of these stressful and unhealthy behaviors. Below are a few things that have helped. Some of these are easily attainable, others take more work.

Incorporating mindfulness into my day:

This has taken a variety of forms. I try to do short daily meditations at home when I wake up. During the day, I try to do a quick pause before seeing a patient. I try to stop thinking of the extraneous and distracting stuff like other patients, irritation about how slow my day has been, annoying e-mails, etc. For some, the work “meditation” conjures images of super-flexible people sitting in the lotus position or some crazy yoga pose. I can’t even touch my toes, and I was an initial skeptic. But I do find it helpful to take a moment here and there throughout the day.

Connecting with my patients:

Caring for people is why I went into medicine, and I find myself more engaged, empathic, and my interactions more satisfying when I connect with my patients. During that pause above, I remind myself to look at their name. Every day I try to play a game with myself to see if I can find out one personal detail about my patients and connect them to something outside the hospital. It could be a hobby, sports interest, family, job, or historical tidbit. I find that I am less likely to confuse my patients (i.e. Mrs. Jensen – the 78 year-old with CHF in with a COPD exacerbation, and Mrs. Johnson – the 87 year-old with COPD in for a CHF exacerbation). It also helps remind my patients that there is life outside of their illness and the hospital.

Carry my own coffee cup:

After I finish my favorite energy elixir I repeatedly fill up my cup with water (lots of water stations are available on every floor). This also keeps me hydrated, happier, and ensures that I’m getting up more frequently – at least to go to the restroom.

Bring my own lunch:

Since being diagnosed, I have been trying to better control what goes into my body. If I get lunch at the hospital or a conference, I’m much more likely to grab the hamburger and fries, burrito, or other large portion not-too-healthy option along with a cookie or other desert. I’d like to say I regulate myself, but I don’t. Especially when stressed, it is salty, greasy comfort foods with dessert. If I make my own lunch at home in advance, I can control what I bring. Portion sizes are more reasonable, the food is healthier, and it actually tastes better. My go-to lunch has been salad-in-a-jar (recipes and concept here). I have also found that if I bring lunch, I can save the time I would otherwise spend in the cafeteria.

Move around:

Too often I subscribe to the Weekend Warrior method of exercise – nothing for weeks, do a hard work-out, hurt the next several days, then nothing for weeks. In the past, I felt like exercise means a trip to the gym, with sweating, huffing and puffing, and sore muscles. On ward weeks I rarely have time to make it to the gym, which means little exercise. I have tried to alter this perception and adopt the “more movement is good” mantra. I sneak in work-outs where I can, walk up the stairs instead of taking the elevator, and try to move more when writing my notes, maybe at a standing work-station. I also bought a Fitbit this year, which has been motivating. The little dopamine surge when I hit 10,000 steps leads to a private little fist-pump at the end of the day when my energy is otherwise flagging.

Stop checking e-mails!

This one has taken some real discipline. In the past, I was an e-mail over-checker. Waiting for the elevator I would pull out my iPhone and frantically scroll through messages. This inevitably leads to something I feel I need to address “right away.” It is rare that this is true, but it certainly increases my stress, lengthens my days, and takes my mind away from the patients I am caring for. Spending the waiting time taking a few deep breaths, smiling at a patient or colleague, or just doing NOTHING can decrease my stress and lead to a better day.

Write notes as I go:

I always struggle with this one, and frequently an urgent page interrupts this. But if I can put down my thoughts and documentation after each patient, it takes less time, I am less likely to forget something, I am more likely to get my tests and consult requests ordered early, and I avoid the 2-3 hour at the end of the day.

Get home for family:
I do not always make it for dinner, but I try hard to at least get home to spend some time with my boys before they go to bed.

Leave work at work/put off worrying:

I am a ruminator, and this one is particularly challenging for me. I worry about my patients who are sicker. I worry I am letting them or their families down. I feel bad about being short with a colleague, nurse, or someone else around the hospital. I worry that I am spending too much time at the hospital to the detriment of my family. I worry that I should be doing more with some administrative or educational project. I know intellectually that worry and rumination are not helpful – in fact they only slow me down and make the workday longer. Being able to look at worries and ruminations from a larger perspective can make them seem less daunting. This one is certainly a work in progress.

Screens off before bed:

I could spend several hours puttering on the web, scrolling through Netflix, or looking at Facebook before realizing any time had passed. For me this screen time is rarely relaxing. It just puts the brain on pause for a little while, and most often I am surprised and irritated about how much time I piddled away. I also find staring at a screen right before bed leads to more difficulty sleeping, and in the past years, it seems this has been borne out in studies.

Cut back a little:

This was a tough decision, but I needed more time to decompress after busy clinical weeks, so I cut back my full time equivalent a bit. This obviously has job and salary implications and required consideration of the family finances. But I found that it was not necessary for me to work more hours at the expense of my health. Cutting back has also involved choosing additional projects deliberately and saying “no” occasionally (still struggling with this one).

So – as a New Year’s Non-Resolver, I am sharing some of the things I am striving for to better maintain the work/life balance. It is a long list, and many (or most) of these are works in progress for me. I guess my only resolution this year as a Type A goal-oriented person is not to be too hard on myself when I fall short.

If you have suggestions for ways you make the day more satisfying, less stressful, or healthier, leave them in the comments – I would love to hear them.

Brett Hendel-Paterson

Dr. Brett Hendel-Paterson wears several varied professional hats. He is board-certified in internal medicine, pediatrics, and palliative care. He is a med/peds and palliative care hospitalist at HealthPartners Regions Hospital in St. Paul, MN. He also has tropical medicine training with a CTropMed® from the American Society of Tropical Medicine and Hygiene (www.astmh.org), where he is a counselor with the clinical group. He is an assistant professor of internal medicine and global health at the University of Minnesota (www.globalhealth.umn.edu), and he is a codirector of the University of Minnesota Global Health Course.

His professional passions and interests span medical education, palliative care, health disparities, internal medicine, tropical/travel medicine, and immigrant/refugee health. When he is not attending he is active working with the global health track in the University of Minnesota internal medicine residency.

He received his undergraduate degree from Grinnell College, attending the University of Minnesota-Duluth for medical school, and the University of Minnesota for his med/peds residency.

Outside work, he spends his time chasing down his two sons in elementary school, enjoying the outdoors, exercising, cooking, and music. His recent diagnosis of Chronic Lymphocytic Leukemia in the summer of 2013 has required some significant work/life rebalancing and has underscored the importance of caring for patients in an empathic and kind manner in times when many are feeling particularly vulnerable.

2 Comments

  1. James O'Callaghan, MD FAAP SFHM on January 8, 2016 at 4:34 pm

    Brett:

    I enjoyed this column–so many of the points resonated with me. Like you, I figured out that bringing lunch from home was far healthy and saved time in line. By extension, I also started bringing a lot of easy to carry snacks for when I am out and about on the wards: bars, nuts/seeds, etc.

    I also try to incorporate more exercise into my daily routine, like taking the stairs. Here in the Pacific NW, I also try to walk outside between various parts of the hospital (say heading to the ED for an admission) as a way to increase my exercise and grab a bit of fresh air. I recently began using an Apple Watch and find the same dopamine surge (gotta complete the rings!) When I work at Seattle Children’s Hospital, which is only 4.5 miles from my house, I now have committed to riding my bicycle to get to work: a triple win of exercise, free parking, and a chance to decompress both to and from work.

    Jim O

  2. Kari Peterson on January 8, 2016 at 10:36 pm

    Hello, Brent,
    Joni Hagebock shared your wonderful insights with the Somerset staff in her newsletter. Your de-compressing suggestions give me many good ideas. I suppose one can’t sing on rounds, but the long breathing needed to sing are equivalent to slow calm breathing and way more fun!

    Amen to the email checking! I corralled my emailing to 3 times a day. What a difference that made!

    Thanks for the ideas!

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