• The Editor

How Do You Keep Your Glass From Breaking?

By Jay Baruch, MD

@JBaruchMD


Several months back, a colleague passing through the emergency department stopped by to say hi. We hadn’t seen each other in a while, and he asked how I was doing. “I’m great,” I said. He shot me a cockeyed, don’t bullshit-a-bullshitter look. “Really,” I said. He stepped away, conceding a grin that I read as either suspicion or deep worry. He couldn’t know that at that very moment, without forethought, I had launched the “I’m doing great” project.  What did that mean? My ER shift could be running off the rails, but if someone asked, “how are you?” my response was going to be “Great.” If I felt frustrated or angry, tired and hungry, I’d say “the shift is fantastic.” I embarked on the “I’m doing great” project acutely aware of an undeniable obstacle standing in the way of its lasting success. I’m not an optimistic guy. I’m prone to a thorny inner life that distrusts blanket cheeriness. The glass isn’t half-full. It’s not half empty, either. Instead, I want to know why that glass is filled only halfway, and what could cause it to be emptier in the future. So I was shocked to stumble upon the simple joy of saying, “I’m doing great.” If we rigged the pain scale to physician wellness, I sat at a solid four. I was a moody creature at home, fighting lousy sleep and a fogged head that wouldn’t lift after overnight shifts. I couldn’t dig out from the academic responsibilities that are usually a source of joy. More health problems and less writing time. Starting more and more emails with “I’m sorry for taking so long to respond, but…” Regular exercise, a critical part of my mental and physical health for decades, reduced to strategies for gaming my Fitbit. When my colleague asked how I was doing, his curiosity was sincere. But not for a moment did I confuse his graciousness for an invitation to be dumped on with my emotional baggage. The “I’m doing great” project pivoted on two realizations. First, when I listen to the devastating, hard-luck problems facing my patients in the ER, I’m reminded how extraordinarily fortunate I am to own the problems I have. Secondly, as I’ve grown older, I’ve become less intolerant with venting, when it veers towards complaining, as a social act. When I was younger, I mistakenly believed speaking out was an act of courage. But I was often left exhausted, disappointed, and feeling lesser of myself. As a physician-educator responsible for brilliant and insightful EM residents and medical students, I know that authenticity is critical to the “I’m doing great” project. They become suspicious of medical educators when critical issues—such as physician wellness, difficult conversations and working with uncertainty—are oversimplified and don’t mesh with their complicated experiences. So there’s no place for sarcasm or snark, which can undermine the entire enterprise. Even if I don’t feel great, I have to commit to the project. There’s a decent chance I’ll feel better. In my n=1, it’s going, well, “great-ish.” Not completely great, but not nearly as bad as it could be. A particular run of ER shifts threatened to sink the “I’m doing great” project. There was zero chance of faking it. But I mustered the commitment to say “I’m good.” Before I might have said “eh,” or “could be better” because we all could be better, right? Now, I’m debating whether to rename this enterprise to the “I’m doing good” project. Grammarians will point out that it should read “I’m doing well.” Such quibbling would irritate me until I’m no longer feeling great or good or well. Besides, whether I’m doing great is irrelevant to the goals of the project. It’s about finding personal strategies to endure and hopefully thrive in non-sensical times in medicine. It’s not about learning to see the glass as half full, but rather, fortifying myself so I can be the best possible glass.

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