A Fresh Look at Resiliency in Medicine, Self-Assessment Part 1

We are starting out 2024 with a series taking a fresh look at resiliency. Last week, I gave both an overview demonstrating how resiliency is better seen from a system view and a framework. The model developed by Dr. Kemia Serraf of Lodestar Trauma-Informed Coaching provides a beautiful analogy of a dam to this systemic process of resilience. This week, I’m offering a look at a couple of the components, taking a bit of creative license, and walking you through a self-evaluation process. Grab your pen/paper - or digital note-taking device.

The reservoir created by the dam represents a dynamic look at our hardiness made up of two components 1. the capacity 2. the water level.

The reservoir's actual capacity increases and decreases more slowly over a lifetime and are influenced by the positive side of supported stress, or eustress, which grows your adaptability. It can also fill up with silt and other things under more harmful conditions. Awareness is key. Most of us in medicine developed extra-large capacity reservoirs along the way (much like our bladders 😂) , and some of you had pre-existing large-sized containers. The awareness gives you some context to intentionally engage or avoid tasks when you’re able. What is your current capacity (not how full you are)? Thinking back to various points in your life, has your ability to take on activities, projects, roles, etc., remained relatively steady, increased, decreased, or varied up and down?

The water levels represent your ability to fully bounce back from stressors and take on the day's tasks. The fuller it is, the more easily it is to function optimally.  It changes more rapidly and can vary throughout a given day depending on the inflow and outflow. It relates to your bandwidth. The most significant influencers of the water levels are the rivers and tributaries upstream that are filling the reservoir and the spillways downstream that are draining it. These represent the resources that fill our buckets and the things we pour ourselves into that utilize the water in our basin.

Right now, what is your water level?  Are your energy stores close to 100% abundant? Is there adequate supply, and it’s staying steady in the middle? Or is the level down under 20% in the danger zone? (Okay, yes, I picked an arbitrary number for the warning based on when my car’s fuel light comes on. But hey, I’m not a civil, mechanical, electrical, or architectural engineer 🤷‍♀️.) How quickly are your levels fluctuating? I like to think of the basal evaporation rate – just existing in this world, there will be some naturally occurring losses. Also, there is rain, little external unplanned low-level energizers. Both may affect our adaptability but are not in our control and play negligible roles for the purposes of this analogy.

Ideally, we would construct a self-sustaining steady state of equal inflow and outflow to keep the water at an ideal level. However, this is real life. At times, we will experience crises where the natural state is to throw open all the intakes and outflows to maximally meet immediate needs and mitigate damage.  Occasionally, we will have very slow, calm times when the water is almost brimming over, if not a bit stagnant. However, we will mostly remain in between. Suppose your depth of resilience is below a desirable level. In that case, you have two options. You can tend to the upstream tributaries and rivers to increase water flow, or adjust gates and spillways downstream to decrease the outflow or do a combination.

We want to be able to meet the current situations and activities as our best selves while maintaining water levels for those unexpected challenges that we know will appear. (This is like keeping the trauma bay clear in the ED, or aiming for 20% free rooms in L&D as inductions are considered). Next week, we will take an audit of our rivers and spillways to see if there are corrections we want to make immediately and any that we want to make proactively for future preparation.

Until then,

Have a joy-filled week!  Tonya

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 Original post 12/2022, updated 1/2024