Tahmeena Ali is a wife, mother, writer and family physician in White Rock, BC
In medical school, we learned the components of the cardiac cycle. Systole: contract; diastole: relax. Essential dance partners. But one partner always garners the spotlight. The scene stealer in an echo report is the volume of blood contracted—the ejection fraction. The star of the blood pressure—the systolic. The key measurement during exercise—the pulse rate. All measures of action—pumping blood to places.
Medicine, and life, share that action bias. I interrupt patients mere seconds into interviews because it is hard to stay passive. Even when time is not money, I am pulled towards perpetual efficiency.
“You are obviously in a hurry, doctor.” The patient comments as I stand up and gather the laptop under my arm.
Yes, I am in a hurry. But why? I am running on time. In this setting, I am paid by the hour, not by the patient. And yet… I find it hard to pause. Stop. I sit back down and open the laptop.
“I’m so sorry. No hurry. What else can I answer for you?”
Twenty years of fee-for-service medicine has given me an attention deficit and hyperactivity problem. A twitchiness if I’m idle. I was never taught rest and recovery. It was systole all the time. A few minutes between patients means time to check a few labs; reply to an email; review text messages; teach the medical student. At lunchtime, a sandwich at the computer while charting and writing consults is the norm.
We go like this—for months and years—in a work culture pushing us beyond our limits. When my mom passed away at the beginning of my family medicine residency, only one person—my family medicine advisor—suggested I take some time off. There seemed to be so many reasons to just soldier on: not burdening my colleagues with extra call; not wasting my precious elective time making up my pediatrics rotation. For the first time in my medical training, the hospital was the last place I wanted to be. Instead, I wanted to cry on my couch, look at old photo albums and listen to sad music. Of course, that experience becomes the measuring stick that perpetuates the martyrdom complex many of us develop.
“My mom died on a Wednesday, and I was back to work on Monday. And you are requesting time off for a sibling’s graduation? What is he graduating from, Harvard?”
We continue the cycle of trauma as we model it for the learners alongside us.
Ejection fraction is the only value I can think of where normal is 60 per cent. It’s essential for about 40% of the blood in the ventricle to remain at the end of systole so that at the end of diastole – the pause to allow refilling – there is enough blood in the ventricle to actually pump. Since we try to squeeze out everything we have to give, is it any surprise that our metaphorical ejection fraction is floundering? We need to put ourselves on a collective beta-blocker to slow everything down. Faster does not mean better—for us or for our patients. Each day needs moments of diastole. We are so chronically burnt out that many of us have forgotten what healthy feels like. Like the patients who are dazzled by their ability to climb stairs again without shortness of breath after their heart failure is treated; they forgot what healthy felt like.
Rests are necessary in medical treatments and in nature. Breaks between chemotherapy and radiation treatments. Vaccination doses. The pause between inhalation and exhalation. Sleep at the end of each day. A blink of an eyelid.
I am starting to take lunch breaks. This is a new practice for me. After I finish with my morning patients, I stop doing all clinical work. No more labs. No consult letters. No email. No UpToDate searches. No eating and typing at the same time. I close my office door, watch an episode of The Office on my laptop, and laugh out loud. During slow parts, my twitchiness returns. I find myself reading—a few emails, a few texts or playing a game of Wordle, but I resist (most days).
My transformation after a restorative lunch break is nothing short of miraculous. It is like the repeat echo report after a year of beta-blockers and an ACE inhibitor. I am renewed. I complete the pile of lab results and To-Do’s that felt overwhelming before lunch faster than if I had hammered through it all before lunch.
Science has conquered so many diseases. We created a safe and effective vaccine against a novel coronavirus in a matter of months. How about turning that science towards ourselves? We are physicians with actual hearts. Despite our mass fantasy, we are not robots with mechanical ones. Once our hearts stop beating, that’s it. There is no reset switch. We seem to operate under delusions that the MDs behind our names stand for “master [of] death,” forgetting that our hearts beat within the mortal bodies of physicians. One day, your heart will beat and fill for the last time. Will all your moments be systole or will you make room for some diastole?
Dr Manhar Verma
Reflections of a doctor’s life especially a Family Physician in terms of Systole/Diastole. Beautifully written. This is coming from a retired anesthesiologist.
Sorry, I meant 4-5 days per month.
I ran a family medicine practice for just short of 50 years. I managed another great interest of mine, completely non-medical. This required around 4-5 days per week. While I pursued this for around 43 years, I had the sense I was being somewhat irresponsible toward my medicine. In hindsight it actually helped my ability to practice medicine.