I staff the psychiatry team within the University of Iowa Health Care’s Emergency and Trauma Center. After spending 50 hours a week in this environment for the past four years, I’ve seen a lot. Fortunately, I’ve been trained through medical school, residency, and my time as an Air Force flight surgeon to remain composed despite stressful situations. The same holds for all the physicians and nurses across UI Health Care. They are wonderful teammates.
During life and death situations, we rely on compartmentalization—a psychological defense mechanism in which conflicting thoughts and feelings are isolated from each other in our minds. In critical care situations, you want your physicians and nurses focused on the task at hand rather than the emotional aspects of what is happening or could happen.
I recall a recent day in the Emergency Department, where three very critically injured patients presented in succession. Each needed an entire team, over a long period of time, to be resuscitated. When the lifesaving interventions were finished, there was no time to debrief, discuss, or process emotions. There were more patients that needed to be seen immediately. I looked at my peers and they were numb. I asked if they were OK, and they said, ‘I am fine’ and went on to see the next patient in need. They did so with grace and expertise. I was amazed at their perseverance and commitment, and I was witness to compartmentalization at its best (for the patients, at least.)
In recent times, it seems that stress levels have greatly escalated. I see teachers and professors on the frontlines of our national mental health crisis. I hear from clinicians, faculty, researchers, and teachers asking the same questions, ‘Can I keep up this pace for 20 or 30 more years?’ I am convinced that our reliance on compartmentalization has reached its limit for the roughest days. I fear pushing off the sadness and grief we experience in our important work can cost us mentally and physically in the long run.
This begs the question: What can we do differently on some of our roughest and saddest days? I certainly don’t have all the answers, but I can offer some guidance.
When those worst of days are over and the time is right, I undo the compartmentalization and allow my grief to come through. I set aside quiet time (e.g. on a walk without headphones) and allow for true emotion and mourning to happen. I sense how difficult the day was for my patients, their families, and my teammates. This helps, and some weight comes off my shoulders.
Then, I move on to reflection. I think about two concepts introduced to me by Tippie College of Business Professor Amy Colbert. The first is eudaemonic well-being, which occurs when we have a strong sense of purpose and contribution from our work. I remind myself that our work as clinicians, teachers, researchers, and so many jobs at the University of Iowa are serious, life changing work. This kind of work always comes with good days and bad days.
The second concept I learned from Colbert is human sustainability: the ability to maintain physical and mental health without subverting growth and impact. Even on the roughest days, I can say I was able to do some good, to ease suffering to some degree, or to teach something useful. Usually, I am able to learn something myself that makes me a better doctor and teacher. If you look for it, the roughest days allow for personal growth.
In actively trying to apply this guidance, I have learned that while letting grief in can be an enemy of effective compartmentalization, more importantly, it allows joy, happiness, and growth opportunities and the fulfillment of our work to come through as well.
Cover image by Artem Kovalev.