A: Hey guys. Welcome back to the podcast. I'm Amanda.
L: I'm Laura.
K: And I'm Kendra.
A: And until we get to 500 reviews, I'm being very annoying and requesting you to scroll down right quick and hit five stars. We're approaching 10,000 downloads and we're still under 20 reviews. So it's time guys. We need to share it with our friends, and if we have more reviews, then it'll be easier with the algorithm for people to find.
This time, I'm excited because it's a story that I try to remember as much as I can. And I think it really pertains to people that work in healthcare. And it is the story of The Star Thrower. K, you wanna tell us what the book is about?
K: Yeah, sure. So this came up actually recently. Lately, I think, in our shop the waiting room is so devastating. You work your entire shift, and then you leave. And like, did I make a dent in the waiting room or anywhere actually that I step foot in, and like, why am I here?
So this story was actually published in a collection of essays in 1969. Loren Eiseley. Is that right, A? Eiseley?
A: That's how I say it. I don't know. It's E I S E L E Y if somebody out there knows. Please correct us, but we're gonna say Eiseley.
K: Okay. It's a collection of essays in a book called The Unexpected Universe. In it, there was an essay titled “The Star Thrower,” and it's been adapted into various iterations. But the story essentially goes something like:
An old man goes down to the seashore, and he sees a little boy picking up starfish- one by one- and throwing them back in the ocean. As he approaches, he asks the child what he is doing. The child tells him he's saving starfish. The tide is going out. It's a hot day, and they'll dry out and die otherwise. The old man kind of scoffs a little bit, and he points out that there are thousands of starfish along miles of coastline. This little boy can't possibly think he can make a difference. The little boy quietly leans down, picks up another starfish, and throws it in the ocean. Then he turns to the man and says, I made a difference for this one.
L: I love this so much. So Colin Beavan, PhD. We're gonna link his website in the show notes. He has some suggestions for when things seem futile. Some of our favorites, as I read these, I use every last one of these to help myself stay sane and actually enjoy my work. Realize that there's a difference between the world not changing fast enough and you being useless. So put that another way. Imagine how much worse things would be without you and people like you. What would the world be like? What would our country be like without an emergency department? Where would people go?
Everyone's overwhelmed. Everyone. Yeah, everyone's overwhelmed, but there's no place to go in the middle of the. Right. There's a place to go to sew your arm back up or get his spinal tap.
A: You can't even go to jail where we are. They bring him to the ER when you're drunk.You can't even go anywhere when you're drunk except the ER.
L: So instead of focusing on how bad the problem is, focus on how amazing your allies are. I love this because there are no better people than who work in healthcare, in my opinion. And, in the emergency department, we endure a lot of trauma. We endure a lot of stress, but we also have a lot of fun. And the people there are just special. They're special and, and many different kinds of special. But focusing on how amazing the people who are helping you are is just crucial. And, it reminds me of what I've heard Amanda say lots of times. I think I've heard you say this lots of times, but look for the helpers. And when we are the helpers, that's that much more to.
A: That's credited with Mr. Rogers. I don't know if… I haven't Googled it to verify that fact. But that's how I always hear it, that Mr. Rogers says, look for the helpers when in times of chaos.
L: Yeah. So we're not in this alone. We have, we have amazing teams and coworkers.
Realize that anger, fear, and frustration will burn you out. And you're like, yeah, duh. I know. What we offer to you though is that those are actually optional. Clearly we have circumstances beyond our control, but there are things that we can do to mitigate anger, fear, and frustration for ourselves.
And if we remember why we are doing what we're doing, that's one way to help us mitigate that. But this is something that work with our clients a lot on, is how to keep those negative emotions from consuming us. Because, I don't know, maybe you guys haven't ever had this, but I've certainly felt consumed by each one of those in the past. But learning how to manage our brains and learning how to be intentional with our thoughts really can make a difference for those things and help mitigate burnout.
A: One thing I use a lot with our clients is that I totally get while you're angry and frustrated. I had so much anger and frustration too. But the second I realized that all of that anger and frustration wasn't getting Care Bear Stared into the people I was angry and frustrated with… and it was only destroying me…that's kind of a huge realization for me. That like, oh, this isn't serving the purpose that I thought it was. It's only serving to make me massively burned out.
L: Right, right. The people that you're angry with or frustrated with usually are completely unaware or don't care. And so you're only, we're only just hurting ourselves.
Take care of yourself. Many of us abuse ourselves for the sake of our work, and then wonder where our energy went. Treat yourself like a well valued agent of change that needs to be taken care of in order to function optimally. We've used that quote before, but you know, you're a very valuable resource. I'd probably say you're a priceless resource, and you've got to take care of yourself. You've got to pay attention to your sleep. Pay attention to eating some healthy food and making sure you get enough water. And go pee more than once every 12 hours when you're at work. Take time to process the things that are happening at work, and process your stress in a way that it doesn't harm you more down the road.
It is okay. It's okay to work hard, but we want to always be pouring from a cup that's full. We don't wanna be like scraping the bottom or becoming a stump. Like in that Giving Tree episode we talked about, we don't wanna be that stump.
Count your blessings.
A: I have a story on this one. I used to, in the midst of, you know, back when I was harboring all this anger and resentment and all that. And was, I mean, in a funny way, but was uh, complaining a lot. One of my partners was like, you know, all of these problems: overcrowding, the night shifts, the public distrust, bureaucratic issues. He said, these are all the same problems that my father dealt with working as a police officer. Except for he made a mere fraction of what we're making and was dodging bullets at the same time.
And I was like, oh my God. Okay, well, nevermind. I'll go see the next patient. I know. Yeah. It's just, you know, we have a negativity bias, and it's why it's so important to acknowledge that. And then give equal airtime to the other. Like, just on purpose you're going to have to look for the good also. Yes.
L: And, it is totally okay to feel frustrated and angry and even fearful. But, like she said, we have to give equal air time to the good things that are happening.
A: Because if you don't on purpose, look for it. You'll never see it, is the problem.
L: No, I know. Do you guys know that song, that Jason Mraz song “Look for The Good?” Have you heard that song?
A: I'm sure I have, but I don't, I don't recall it off hand.
L: Okay. We'll have to link the music video to that too, because that is one of my favorites. And he's just like, yes, you have to look, because it's. It really is all around, and it only makes us feel better to look for it, right?
A: Right, yeah.
L: Okay, so create boundaries. Boundaries are good people. You can be a giver. You can be generous. You can be hardworking, but you can burn yourself out. Or make yourself into the stump of the tree, The Giving Tree, unless you create good, healthy boundaries. So take some breaks from all the problems, you know. Ask people not to text you when you're off work unless it's an emergency. Conscientiously spend time with people outside of healthcare, and really try to be present with them. Find other things to talk about. You know, whatever it is you wanna talk about. Preferably not the news. I'm gonna like, you can talk about the news if you want. You get to do you. But I'm gonna say that if you're struggling with burnout, something uplifting, ideas, plans for your future, planning a trip, a book that you've read. There is a great website called The Good News Network.
If you guys aren't familiar with the Good News Network, I make a habit of checking The Good News Network every day. ‘Cause there's awesome stories that are just good. And making time to talk about these other things on purpose will help give us the rest that we need before we go back to work.
And accept that it's appropriate to feel sad and frustrated. It's totally okay and natural. We deal with so much tragedy and stress and suffering in our work, and it transfers onto us. It is okay. Amanda, did you have something to say about when you were burned out about this?
A: You know, I would not only feel bad, but then I would feel bad about feeling bad. And if I, the old equation is pain times resistance equals suffering. Like if it was okay to feel sad about something horrible that I just witnessed, without all the judgment about it and trying to avoid it and buffering and all of that sort of stuff. I could have just processed the original sad thing and left the rest of it behind, you know?
L: Yeah, yeah. So we're, we're human. We come with a spectrum of different emotions and they are all essential to our human experience. Cause we're not gonna feel our highest highs, our most joyful moments unless we also have had that contrast of sadness. Just take it in and process it. And recognize it. And embrace it, and it's okay.
The biggest takeaway in all of this is to just limit your concern to your sphere of influence. So you are in control of basically you. Yeah. The waiting room is overrun with patients. Yes. That's happening everywhere. Yes, there's a staffing crisis, also happening everywhere. Yes, society has ills that cannot easily be solved. And that's part of the reason why I switched to doing mostly peds after I burned out, was. I mean, there's still social ills, but I felt such deep sadness about some of these social ills. But you don't have to switch to mostly peds ‘cause truly it is still there. And in with the parents now too. But yeah, these can't be solved easily, and we're not gonna be the ones to solve them. But we can offer support, we can offer kindness, and we can make a difference for our individual patients.
And we don't have anything to do with the fact that this other stuff is beyond our ability to fix for everyone. And we are all fixers. If you're in medicine, you probably have that nature. You wanna fix stuff, you wanna help people. And that may be part of the frustration. It's definitely part of the frustration that we feel, but it doesn't mean that we're not doing anything. We need to focus on what we're able to do and all that that good is.
A: Yeah. I love that. And that leads me into this, is to just remember that you're not seeing the full results of your work. I was kind of talking about that feeling of that you're not doing anything, not accomplishing anything with one of our clients. And I mentioned this whole story to her and she was like, you know, now that I think about it. There has been times when many years after I saw a patient, they came back and they were like, what you said that day made a difference. But you know, you're not usually thinking about that. And you're not seeing the results in real time of your work.
So a couple studies that we will link to, there's a study by Christakis and Fowler, where a single act of kindness can affect up to three degrees of separation. So not only the person that you helped, they tend to go on to help somebody else and somebody else. And according to David Hamilton, each recipient of kindness, on average, tends to be kinder to five more people as a direct result of that. So that means that if you get three degrees of separation, and each one is kinder to five people, your single act of kindness can affect up to 125 people. That's exponential goodness that you will never bear witness to, but it exists nonetheless. So, you may think that you're not making a difference ‘cause you don't see it, but that does not mean that that is what's actually happening. And I like to think about it in the same way of like the slightest change in a boat's rudder has a huge difference over time. But you would never notice it in the moment.
So we come back to the original essay. Eiseley’s Star Thrower isn't a childlike character at all. It's actually a weathered solitary man who rises before dawn to save the living starfish. And all Eiseley sees initially (that's the author) is futility. There's starfish dying all over the place. Beachcombers are snatching up shells with living creatures in them to ultimately sell in their little, like, beach stands. Octopi are getting tossed up on shore. Vulnerable hermit crabs are getting snatched and eaten by seagulls. All he originally sees is death and futility.
But there's something about stumbling upon this solitary Star Thrower that sticks in his brain, and it doesn't let him. Like he can't escape it. And later that- I can't, I don't, I don't remember in the essay if it's that night or the next day or whatever- but it strikes him that this Star Thrower is the anti chaos in a world of chaos. And that's why he sticks out from everything else. And just thinking about it. And the difference that this one guy is making, he becomes compelled to help him as well. And when he does that, it strikes him that eventually they'll be joined by others also. And then little by little by little, the anti chaos will slowly grow stronger.
And so, the whole purpose of this story, or at least what I take from it, is, yeah, there's a bunch of chaos out there. That's not your job. Your job is to just keep shining your light in the darkness. So, the people can find you who can help, and let the rest take care of itself. I used to get so overwhelmed with, you know, the medical system's broken. Yeah, and? You know what I mean? That's not taking away from the little bit, the person who I- even if it's one person. The one person who I was able to help today, or even one person this week, it's all additive. It doesn't diminish that. Right? So we wanted to end this, kind of, with encouraging words from each one of us because we know what it feels like to be where you are.
I mean, I felt this way a lot,and a lot of our clients do. So I'm certain that some of you who are listening also probably have been in this spot where it just, everything seems futile. But I just want you to remember that you are making a difference. And on the days that you don't have much to give, it's enough.
Allow yourself to be human. The world doesn't need you to martyr yourself. It really doesn't. It just needs you to be you and to pace yourself and to do your little contribution. So that means rest when needed, play when needed. Spend time with your loved ones. Recharge. And then when you're recharged, make a tiny difference when you're ready and then take a break and recharge again. The whole point of all of this is that there will always be more starfish, but there's only one you.
L: Oh, that's awesome. I would just like to say that if we struggle with burnout, there is no better way to alleviate that than to learn how to see the meaningful work we're doing one by one with our patients and their families. And unfortunately, when our thoughts are focused around, we're not making a difference. And we have these feelings of frustration and burnout. It leads us to be able to make less of a difference. And so, if we can think about, I have the potential to make a difference in one person's life. Each shift, I can make a difference in one person's life. These people who come to us are generally, well, at least some of 'em are in crisis actually. Any of the ones that make it back to the department anymore are probably, like, really in crisis, but…
A: Oh, the olden days.
L: Yeah. But people in crisis are craving connection. They're craving the feeling of safety, and we are able to help steady them as much as the situation allows. And that is making a huge difference for people. And, if we can hold onto that thought that, hey, I am making a difference in this world. Even one person, it is making a difference. Then our burnout is gonna lessen, and we will be able to make a difference for more people.
All the good, all the really transformational good that happens in the world generally happens one human being to another human being. And we see that in coaching all the time, that when we can offer tools and words of encouragement, that it really can be transformational for that individual. And the same can be said. In a lot of ways, we are coaches for our patients. And we can help them on their way, and not only to just live, but to have a more meaningful life.
One of the things that I really love to do. I actually love peds psych patients. And I, because I find that when a teen comes in and is suicidal, often times that is a crisis moment where I can make a connection. And feel like I could make a small difference. And it doesn't mean that they're, you know, gonna grow up and be Gandhi or whatever. But, but we can make some positive energy start flowing. And if enough people do that over time, we will we'll see change on a grander scale. But there's no better people than you, you amazing physicians, to make that start. So, but like we said, don't be The Giving Tree. Pour from... I'm so traumatized about that. I always have been. But pour from a cup that's overflowing. And if you don't know how to get that overflowing cup, we can help you. But don't hurt yourself. Make yourself whole and abundant. And we actually, I feel like when we offer kind words to people, we do increase our own abundance that way. So keep up the good work people. You're amazing.
K: Definitely. I would agree to that statement and raise you one there, Laura. I would say. When we were talking about that, instead of focusing on how bad the problem is, focusing on how amazing our allies are, I know that I struggled. I knew burnout had set in. I didn't really, maybe I was in a little bit of denial. But really what kept me on for probably, I don't know, six months to a good part of a year, was my amazing colleagues. And you know, there's something about going through trauma or just being in the trenches with someone. And just the unique people that the ER calls to its service because I believe we are all called. Special ER people are called to service. And we're so special that we, there's really, really a colloquial bond there. And so that, that's really what actually kept me from quitting or walking away for such a long time. Until my soul started to crumble, and then I was like, eh.
But I will say one of the things that I noticed too is…I'm passionate about medical missions. And so I've been on multiple, multiple missions trips. And when I started going, I think I felt that way. We'd go to these third world countries. We go to these small villages, and we come with as much as we could carry, bring, pack, all the things. And it was just never enough. And I remember, the first couple of times that I would come back to the states, I was always so discouraged. Cause I was like, we need to bring twice as many and twice as much next time. And we would, we'd bring twice as big of a group and twice as much stuff, and we would go through it. And I'm like, oh my gosh, we need twice as much. And then I started leading, taking teams. And I will tell you that the teams that we took, it really didn't matter.
I started to realize that there will always be a need for help, wherever it be. Outside the US, inside the US, there will always be a need. But it's just amazing when you gather together an amazing team that is unified with one mission and has the same passion and the same heart working for the same goal.
You start to realize that, wow. How fortunate I am to actually be in here in the trenches with these people. We're doing what we can, and then you almost become. Your focus shifts to like celebrating them and how amazing they are, and it's reciprocated. It comes right back to you. And they are like, we're so glad you gave us this opportunity, all this stuff, whatever. But really, that was a shift or a pivot for me that I would come back almost revived and recharged. Not to mention, when you go and volunteer your time for a week and work in the trenches with people and just see as many people as you can, they're so grateful. So it does, it fills you up. You, you come back so tired and weary like physically, but your soul and your heart, and your brain and your mind is full. You've just been poured on and loved on and so much gratitude. That, that it really does catapult you, until the next time, to really keep going.
So we are honored to be colleagues with you, all of our listeners. We know what it's like, and you know, if anything that we could share with you in closing it is that you are the one. The one that does make a difference. And what you do matters and everything that you give every single day is enough.
So thanks for joining us today. We do want you to know about an amazing webinar series that we've started. It is topics that came from you, what you wanted to hear more about. So join us on Wednesday, March 29th at 12:00 PM noon central time for “What's the ICD-10 Code for Injury Sustained in a Dumpster Fire.” This will be a fun time, including tips on how you can thrive in the crazy circus that we all work and a deeper dive into how we can manage the frustration of working in healthcare. Use the link in the show notes to sign up, and we'll see you there.
So until next time, you are whole. You are a gift to medicine, and the work you do matters.