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A fresh look at Resiliency in Medicine, Self-Evaluation Part 4

This week we conclude the series of a more robust understanding of resiliency in medicine. This week we turn our attention to early warning systems and a couple of unique and cool components. 


For the past two weeks, we looked at your resources – what you have and what you need that is within your control or influence (this includes the organizational responsibility in this process), and the usage of those resources – the intentionally placed, the demanded, the over-committed, and the waste.


We used the framework provided by Dr. Kemia Sarraf of Lodestar Trauma-Informed Coaching of a dam – with its reservoir representing our resiliency capacity with water levels that vary up and down, its rivers and tributaries bringing the water in, and then the gates and spillways that allow the water to flow downstream where it’s intended.


Another critical component we are looking at today involves those towers you see around large dams. In them reside the spotters that have a broader perspective and give attention to the water level, the barriers and flow upstream, and any issues with gates, spillways, and cracks downstream. They can sound the early problem detection warning to make adjustments. Let's take a moment to walk you through assessing your spotters. Grab your pens.


First, you as a spotter.

What is your personal early warning system? Is it when you react to people or situations out of character? Is it a tightness in your jaw, neck, or torso? Is it dread? We all pick up depletion and exhaustion after the fact fairly well, but we want to catch it earlier. Spend a minute and reflect on what your own tells were in the past. How might you tune in sooner and tend to the upstream and downstream?


Do you know your setups for depletion? When you’re under a deadline, when you’re feeling something is high stakes, when you’ve been on call. What is a proactive approach you can have planned? “Hmmm, this is a setup for my water level getting dangerously low.” This gives you room to anticipate and run through scenarios, similar to a setup for a shoulder dystocia gives you room to think through handling it ahead of time.


Second, who are your objective spotters? We know that a loved one or close colleague is often the first to observe when we are wearing down. Who is it for you that notices a weakening in your ability to recover from the daily stressors at work? At home? Elsewhere? Having a proactive conversation with them will prove valuable. Identify them. Invite them to reach out and speak up. And then be kind to yourself and listen. Don’t ignore or dismiss them.  



Third, what plans can you put in place for that to happen? I’ve talked about Brené Brown’s “gap plan” previously, and it makes sense to have an advanced plan for times your water levels begin decreasing. How will you increase the inflow, and from which streams? Which gates will you close downstream and how, to conserve on critical energy? Take a minute and write out your plan. What can you postpone, delegate, and eliminate? This is especially helpful when crises hit. You know what the essentials are and what has to be sacrificed. How will you manage your mind about doing so without guilt, regret, or shame? How will you talk to yourself? (Think of the supportive dialogues you’ve given friends, family, and colleagues.)


Now for a couple of really unique and exciting components to add to this scenario.


We can cultivate canals between our collective reservoirs to share resources. Limbic resonance is a phenomenon where we share emotional and psychological responses. This is why we smile when we see others laughing or tear up when someone is crying. It’s also why trauma can be experienced vicariously – so we must moderate and build in rest and recovery. Fortunately, limbic resonance is also why having these canals are important. We can also experience vicarious resiliency!  The canals can also be in the form of peer-to-peer support, which has robust evidence in medicine. It takes intentionality and effort. So, let’s be proactive in making those interconnections. Reach out. Discuss. Develop strategies. Cultivate the relationships. Think outside the box.



Now for the surprise component. I mean, it was a pleasant discovery for me as I researched dams a bit more deeply. And I'm going a bit off script and taking creative license with this analogy. But, as you are likely familiar, one of the main purposes behind dams is to generate energy. It does so through something called a Penstock Spillway – as the water rushes through that contraption, the hydrostatic kinetic energy is harvested! And now we are back to meaning and purpose in medicine and all of life. Meaning and purpose is our energy generator! When we have enough reserves to flow into the penstock, we self-generate energy using our resources! How awesome is that? There is so much here to unpack, but I leave you with this idea. We can be exhausted and rejuvenated at the same time - what I'm terming the Penstock Paradox. Ah, the beauty of accepting polarities.


(I’d love to give a shoutout to Dr. Kemia Serraf of Lodestar Coaching who trains coaches in trauma mitigation for this rich analogy and very practical analogy. Her team and other various coaches have also contributed along the way.)


In closing, friends, make time for rest and recovery. It's a key way to maintain your resiliency in any setting - resource rich or poor.  Pay attention to your capacity and water levels, tend to your upstream rivers to optimize flow, ask for what you need from your organization,  adjust your downstream spillways to prioritize your resources, listen to your spotters, and don’t neglect your purposes in medicine and life, which renew your own resources.


Have a joy-filled 2024!  Tonya

The New Year is a great time to consider partnering with me to find joy inside and outside of work - gain clarity, confidence, and balance.  Set up a low-pressure call with me to see how it works and to tailor the strategy to your needs. Click Here.

 Original post 12/2022, updated 2/2024


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