Volume 44

June - 2024

Cover: Distressing Drawstrings

In the relentless rhythm of life, there exists an undeniable urge to rush the process of healing, to mend the broken pieces with haste and urgency. Yet, in our fervent attempts to sew the wounds of the soul, we often overlook the profound importance of allowing time its sacred space—to breathe, to grieve, and to heal at its own pace. Like hastily stitching a broken heart, the well-intentioned efforts to expedite recovery may inadvertently inflict deeper wounds, stifling the natural course of healing and denying the soul the solace it seeks. As Rumi eloquently reminds us, "The wound is the place where the Light enters you," highlighting the transformative power of embracing our vulnerabilities and honoring the sacred journey of healing. Just as a flower requires time to unfurl its petals, so too does the heart demand the gentle embrace of time and patience, to unravel the layers of pain and find solace in the tender arms of acceptance. For it is in the quiet spaces of introspection and solitude that the soul finds its sanctuary, where the echoes of grief resonate with the whispers of hope, and the healing balm of time soothes the wounds of the spirit. As Khalil Gibran poignantly observes, "Out of suffering have emerged the strongest souls; the most massive characters are seared with scars," a testament to the resilience born of embracing the depths of human experience. Thus, let us heed the gentle whispers of time, granting ourselves and others the grace to heal, to grow, and to bloom anew amidst the gentle embrace of patience and understanding.

Stoicism in Emergency Medicine

By: Jonathan Warren, MD

Understanding how to improve wellness in emergency medicine is a difficult topic. For one, it is incredibly personalized and dependent upon the stressors that we confront on a daily basis, which are frequently beyond our control. We do not decide on the patients presenting to the ED, the severity of their trauma, the interactions with our coworkers, the bills and breaking refrigerators at home, or the additional tasks our bosses assign to us. 

This is where changing our mindset to improve where we can and accept what we cannot may help. Stoicism embraces this philosophy and seeks to develop self-control and fortitude as a means of prevailing over our self-destructive tendencies. The core is focusing on what we can control, accepting what we cannot, and viewing challenges as opportunities for growth. Utilizing this philosophy is not a new idea. In fact, it was recently explored by Dan Dworkis (one of our previous contributors) in the ACEP Wellness Guidebook, but how can we really put this into practice?

1. Focus on Control:

1. Much of what we confront in emergency care is beyond our control. Did the IV blow right when you were about to push that life-saving medicine? You cannot control that, but you can control the next steps. Shift your focus away from the stressors that present themselves as you dwell on the difficulties you are going to face, and instead focus on how you can provide the best care for the patient moving forward. The outcomes may be beyond your control, but you can continue to lean on your algorithms, protocols, and training. This will allow you to remain calm and efficient. 

2. Acceptance and Adversity 

1. A key tenet in stoicism is acceptance of those things beyond our control. By realizing that not all outcomes are changeable, you are allowed the space to focus on your personal response to the outcomes. Managing your emotional state allows you to reduce the emotional toll and maintain mental health. 

2. Beyond this, overcoming adversity or viewing it as an opportunity for improvement is another core tenet. You may develop a mindset of post-traumatic growth when practicing acceptance, which may lead to greater psychological resilience and job satisfaction. The more often you practice this, the more likely you are to improve your resilience to future situations. 

3. Focus on Virtue

1. Stoicism highlights and emphasizes the prioritization of ethical practice. Having guiding principles of beneficence, non-maleficence, autonomy, and justice, just as those that were ingrained in medical school, provides a support structure upon which to fall back on when confronted with adversity. If you are holding these virtues as a priority when making patient focused decisions, then you will continue to be acting in the best interests for both yourself and the community. Beyond this, upholding these virtues will allow you to maintain professionalism even in the highest stress environments. 

4. Emotional Control

1. At times our emotions and stress may rise up and provide a foil to the calm center we are trying to develop. It is important to strengthen and have techniques for providing emotional control as an emergency medicine provider. Many of these may be mindfulness techniques or acute stress management techniques such as Box Breathing. Techniques like these allow us to take a step back and realize that while stress and other emotions are natural and may happen, our response to them is entirely within our control. (For more techniques on stress management see Volume 35). 

Practicing Stoicism within our day-to-day jobs may be difficult, but by embracing a focus on control, acceptance, virtue, and emotions, providers can navigate any challenges within this demanding field.

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Mcconnell Springs en plein air

I'd always painted inside as a therapeutic outlet, but in the Las year have taken to painting solely outdoors. Combining my love of the outdoors with painting has been an absolute game changer in wellness and burnout prevention.

When I wake up in the Morning

Inspired by the joy of waking up next to my wife every morning. Being able to create and learn something everyday takes my mind off of stress and burnout.

Waterfall

The composition of this photo truly stands out to me. The way it captures the high mountain peak, packed with snow that is melting downward, forming this beautiful icy waterfall. Once again, I was able to capture this particular photo in just two days off between work. A 36 hour turnaround trip. Just enough time to leave the stresses of work, reset, then come straight back for another shift. Sometimes my psyche can't wait for a scheduled vacation. So I use any time I can get to decompress, even if its just two days off to rejuvenate myself for another night in the Emergency Department.

Streetlights and Busy Nights

A moment of calm and stillness away from the hustle and bustle of a busy Tokyo street corner.

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This Months Featured Artists:

Sahar Asif

I'm a Year4 Resident in Emergency Medicine at Aga Khan University Hospital, Pakistan. I believe I was attracted to this field because of its abstract nature and sensory feast it offers. I've always been drawn to nature and have enjoyed writing, drawing and photographing content related to it. Being a resident EM I get to enjoy medicine in an abstract, randomness and versatile aspect of medicine. No two patients are alike the same way no two art pieces can be.

In this perpetual dance between science and soul, I find my purpose illuminated—a healer, an artist, and a seeker of beauty in the most unexpected of places."

View more of their work on instagram.

Jon Gaddis

My name is Jon. Prior to EKU's Emergency Medical Care program, I'd always taken an interest in fine arts. I currently work as a paramedic in the Emergency Department (I'm also a current student), and my sense of peace has always been tied to outdoor pursuits; those interests led me to volunteer as a Wilderness Paramedic for RedSTAR in Kentucky's Red River Gorge - which had been a source of inspiration for some of my more recent artwork. The experiences I've had over the years in emergency medicine and the lessons I take from it compliment all areas of my being; I am always learning and growing from them. My art (primarily traditional acrylic on canvas) and my interests across the many disciplines might capture some of the moments on my journey, or reflect upon them. I have found great joy in painting and it has translated positively in all areas of my own life - and hope you can find joy in your own art. View more of their art on Instagram.

Jeff Audjie

I've always rapped and recorded music since I was 12. Recently started experimenting with a more melodic sound. I also enjoy working out and working on side businesses/hustles.

Hear more of their work on Instagram

Dan Abellera

7 Year Emergency Room RN. See more of his work on Instagram.

You can learn more about the artists featured in this and other volumes at our contributors page!