SOS Classic – From Zero to Hero

SOS Classics are reprints of Shot’s of Satisfaction that Dr. Frank Gabrin shared as he wrote his works Back from Burnout, Care 101 and Booster Shots. Each shot contains a glimpse of Dr. Frank’s personal journey back from burnout.

Originally published February 9th, 2011 (edited)

Shot of Satisfaction Classic

Each Shot of Satisfaction is related to one of the seven steps in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on your journey to a fulfilling life of caregiving.

Step 2 – EARN your satisfaction. Realize you are responsible for your own satisfaction and that for it to last, you have to earn it.

From zero to hero

Last time, I talked about how, in every area of our life, we must be willing to take 100% responsibility. I also talked about the 3 things that any human can control:  (1) What we do or say, (2) what we fail to do or say and (3) our personal responses or reactions to what occurs (like what others do “to” us or fail to do “for” us). The truth is that we have no control over anything (or anybody) else, only over ourselves.

How can this universal truth make life better for us in the Emergency Department?  Let’s take a look at a typical scenario:

The bus just dropped off in Triage and five squads just showed up in the Ambulance bay.

Are you excited or do you dread what happens next?

It’s the ED, so it’s easy for us to feel overwhelmed. When this happens, many of us look at the situation and quickly see how it looks like we are doing way more than a particular co-worker. Our automatic reaction is most likely to make that person our scapegoat. We feel it is their fault that we are overwhelmed and probably begin to complain to anybody who will listen. “Can you believe how slow she is?” “Look at all the work I have and he just sits there like a slug!”

It’s not surprising that our automatic response is to blame and complain. When we complain, momentarily, we feel better about ourselves. We might even get sympathy from the person listening to us complain. But, in reality, nothing in the department really changes. And because we are taking up time complaining (not to mention occupying the time of the person we are complaining to) the situation is likely to worsen and worsen.

Let it go

We cannot control what the other person failed to do for us. But we can control our automatic reaction to the situation. That co-worker is not our enemy. Our immediate self-pity/victim/martyr reaction is our true opponent.

If we were to stop this autopilot reaction, we could use the opportunity to shine and improve the situation in a heartbeat. If, instead of complaining, we were to stay focused, see as many patients as possible, and take full responsibility for the entire department, we would flow within the process. Others would see how much we are doing and be inspired to help. When we work without complaining, time flies, we see how efficient and talented we are and we all feel satisfaction in a job well done.

We feel bad when we complain and others think less of us for doing so. But, when we rise to the occasion, meet the challenge and smile all the way, not only are we happier and more satisfied, others are amazed and inspired by what we can accomplish.

By taking responsibility for controlling what we can and letting go of what we can’t, we empower ourselves and others to feel better and do better. Which would you rather feel like, a zero or a hero?

TAKE ACTION

Taking responsibility means you have the ultimate power to create your life experience.  This is the only way that you can be the cause of your own happiness and not the effect of someone else’s laziness, bad mood, depression, lack of work ethic or inability to do better.

Try it. Notice when you begin complaining and instead, take 100% responsibility for what you say, do, fail to say or do, and how you respond to the situation.  See what happens when you respond instead of automatically react. This is how you live your life as the cause of your own satisfaction!

 

Go ahead, make your day!

All the best,

Signature

Frank D. Gabrin, D.O

Back from Burnout:  Seven Steps to Healing from Compassion Fatigue and Rediscovering (Y)our Heart of Care

Get your copy today at amazon.com
Get your copy today at amazon.com

 

 

SOS Classic – Walk With Me

SOS Classics are reprints of Shot’s of Satisfaction that Dr. Frank Gabrin shared as he wrote his works Back from Burnout, Care 101 and Booster Shots. Each shot contains a glimpse of Dr. Frank’s personal journey back from burnout.

Originally published March 28th, 2012

Shot of Satisfaction Classic

Each Shot of Satisfaction is related to one of the seven steps in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on your journey to a fulfilling life of caregiving.

Step 2 – EARN your satisfaction.  Realize you are responsible for your own satisfaction and that for it to last, you have to earn it.

Walk with me, talk with me

One of the best attending physicians I ever worked with was a doctor I met when I was still a resident in training. This guy was always running from one task to another. Whenever I needed his attention, instead of stopping to listen, he would say, “Come, walk with me.” He would grab my elbow and hold onto me as we moved to the patient’s bedside and I presented the case.

When he was on duty, the department ran smoothly. People worked harder for him than for anyone else. Everything was good whenever he was working—and he was always working. He definitely got more from life, and more from the people around him. He left a big impression on me, and on everyone he came in contact with.

What was his secret for living a successful, engaged, and meaningful life? Action.



Why aren’t we feeling better?

In the past month or so, we’ve been exploring the ideas of happiness and satisfaction. We’ve seen that the only way we can be satisfied, fulfilled, and happy at work is to reconnect with our pure, uncorrupted desire to care and have that care make a difference for another. 

We have explored the different things in our environment that derail us from executing our primary mission. We have discussed the ways in which we can be emotionally hijacked, and the ways emotional contagions can work against us.

We know that successfully executing the transaction of care, and feeling compassion for another ultimately makes us feel great, because it causes all of the dopamine rich feel good centers in our pre-frontal cortex to light up. 

So why are we not feeling better yet? What is the wisdom hidden in the “walk with me” approach to life?

Now or never

I think Shawn Achor said it best: “You can study gravity forever without learning to fly.” We can be busy our whole day at work, starting IV’s, charting, ordering or giving medications or treatments, but none of this will actually bring us happiness, fulfillment or engagement, unless we get busy with the work of true care.

If you are ready to fly high on life, consider this. Successful people take immediate action to implement their plans and ideas. Unsuccessful people rarely implement anything they learn. Great people rush to action! Small people think about it. This “taking time to process your plans” decreases the chances of getting anything done. If you don’t do it right then and there, it’s probably never going to happen.

If I have not convinced you by now, our only hope of feeling better, and having happiness, fulfillment and lasting satisfaction, is to actualize our pure uncorrupted desire to care. The cure for our disgruntlement and lack of satisfaction at work is to realize that settling for the status quo, continuing to operate in the same old ways, will never turn on the dopamine generators in our brains. 

The simple truth is that if we choose to connect with our desire to care whenever it presents itself, then we can feel good about what we are doing and who we are.

One second makes a difference

Only when we rush to action can we generate meaning, purpose and significance in our lives. 

The moment you take your time to think about it, you disconnect yourself from happiness and engagement. If you don’t commit to action now, you will wait yourself into failure. You will miss the opportunity to feel good, and it might not come around again.

This is one of the reasons we are all drawn to the emergency, where we do not have time to think! The same way that one second can make the difference between life and death, one second can also make the difference between death and life, hell or real lasting happiness.

Don’t waiver

Start your day thinking about what you want, and how you will get it. Then, during every encounter with a patient or co-worker, ask yourself, “What is one thing I can do right now?” and rush to take that action no matter how big or small.

Don’t waiver. 

Remember (y)our power lies in realizing that (y)our thought, (y)our action, can turn things around. In this moment, can you do more than you are doing right now? Then do it! Always be in a place where you can ask yourself about the situations that are presented to you.

Don’t worry about what others are doing- or not doing. Never focus on or compare yourself to others. Their happiness and satisfaction are their concern!

TAKE ACTION

Be on the lookout for opportunities to feel good and create happiness in each and every interpersonal encounter that presents itself today. Make it all about the other guy. Rush to act fast, move fast, walk with me, talk with me. 

“Get ’er done!” Experience your best self!

Signature

Frank D. Gabrin, D.O

Back from Burnout:  Seven Steps to Healing from Compassion
Fatigue and Rediscovering (Y)our Heart of Care

Get your copy today at amazon.com
Get your copy today at amazon.com

 

SOS Classic – The Knowing Doing Gap

SOS Classics are reprints of Shot’s of Satisfaction that Dr. Frank Gabrin shared as he wrote his works Back from Burnout, Care 101 and Booster Shots. Each shot contains a glimpse of Dr. Frank’s personal journey back from burnout.

Originally published July 16th, 2012

Shot of Satisfaction Classic

REFLECT – EVALUATE your results. Recognize what you bring to the encounter. Is your giving care effective? If not, go to step six and begin again.

You can check out anytime you want, but you can never leave

This has been one extremely challenging week. Seriously. I looked up at work a few nights ago, I was standing at the front counter and could see almost everyone. It was quiet, everyone was busy, I could hear only the drone of the machines and buzzers, and I said, “You people are entirely too happy for me! Would someone please smile?” Truth be told, everyone was feeling stress. Even small, seemingly innocent things were bothersome.

 “Truth be told, everyone was feeling stress. Even small, seemingly innocent things were bothersome.”

I am not exactly certain what the underlying emotion all of us were feeling, or maybe we just had been feeling too much this week, but all the tragic sad cases we had dealt with seemed to be taking a toll on our emotional psyche. Then again, even my friends who don’t work in the hospital seemed to be having troubles this week with their own blues. This week it seemed to me as if we all were suffering from a sort of depression or hopelessness, collectively or together.

Mirror Mirror

Ever notice how we feel happy around happy people, sad around depressed people, or even agitated when we are around anxious people? Not long ago I told you about the Mirror Neuron System (MNS) active in each and every human. These specialized brain cells actually sense and then mimic the feelings, actions, and physical sensations of those in our environment. Our mirror neurons cause us to imitate the facial expressions, postures, and voices of the people around us. Different expressions trigger certain moods, the same moods experienced by the person we mimic. The process happens so fast that we have no conscious awareness of it. Emotions are contagious.

As we move through our day, our brains are constantly processing the feelings of the people who cross our paths, taking note of vocal inflections, the look behind their eyes, the stoop of their shoulders, or the spring in their step. Our amygdala can read and identify an emotion in another person’s face within 33 milliseconds and then, just as quickly, prime us to feel the same. Scientists tell us that emotions are so shared that each workplace develops its own group emotion, or affective tone, which over time creates shared emotive norms, that are proliferated and reinforced by the verbal and nonverbal behaviors of those in the group.

Stuck in the gap

As I moved through the rest of that shift at work that night, I was frustrated by what I was feeling, and I knew that whenever I am feeling anything less than my best, my negative feelings will seep into every interaction I have, and limit what happens in those interactions. I knew that I could bring all those around me down. So I bought pizza, hoping it would bring just a small smile to everyone’s face. I wanted to make those I work with feel better. I wanted to make my patients feel better. I wanted so desperately to make myself feel better.

I was actually becoming angry with myself because I just could not snap out of it. I knew that if I could snap out of it, my happiness would infect my co-workers and we would all feel better. But this I could not do, for it seemed as if all I could do, was pout and brood. I know so many ways to feel better that I am writing a book to help everyone in healthcare feel better, but that night, I was stuck. I just could not find the way to walk, “my talk.”

Late in the shift, when the next crew came onboard, the physician told me that they read my article in Medical Economics, and they loved what I said there. I got a terrified look on my face and said, but “right now, I am so not that guy!” She loving looked at me and said, “It’s just because you have worked so many tough shifts. It happens to all of us.” And she is right- IT DOES!  Even with that though, I carried that foul mood home with me, and it lingers in me still.

Those of you who know me have heard me say it a gazillion times: If you do not have what you want in this life, you simply have not done enough work to create it. Well now, it seems my battle cry must change, to “If you are not feeling the way you want to feel in this life, you simply have not done enough work to create it.” You see, I recognize now that whenever I am stuck in this funky place, I have fallen into the “Knowing-Doing” gap.

“Thinking about it, talking about it, day dreaming about it, and even visualizing about it will not create the shift unless we act on it.”

There is only one way out of “Hotel California,” one way out of stuck, one way out of that gap between knowing what’s best and doing what is best, and that way is ACTION! Thinking about it, talking about it, day dreaming about it, and even visualizing about it will not create the shift unless we act on it. We live in the world of action and only when we act, when we walk our high walk, will we create the feelings what we want to feel and the satisfaction we seek.

TAKE ACTION

Step out of the knowing doing gap. Do Something! Do Anything! Just DO. See if the action you perform, the step you take, does not move you closer to the person you really want to be.

Walk your best walk! Then broadcast that happiness and satisfaction you create for yourself to others in your environment. The more genuinely expressive we are, the more our mindset and feelings will spread.

You can change the world, one human encounter at a time. It all starts with you, taking action!

Signature

Frank D. Gabrin, D.O

Back from Burnout:  Seven Steps to Healing from Compassion
Fatigue and Rediscovering (Y)our Heart of Care

Get your copy today at amazon.com
Get your copy today at amazon.com

 

SOS Classic – It Never Ends?

SOS Classics are reprints of Shot’s of Satisfaction that Dr. Frank Gabrin shared as he wrote his works Back from Burnout, Care 101 and Booster Shots. Each shot contains a glimpse of Dr. Frank’s personal journey back from burnout.

Originally published September 7th, 2012

Shot of Satisfaction Classic

 

REFLECT – EARN your satisfaction. Realize you are responsible for your own satisfaction and that for it to last, you have to earn it.

It Never Ends?

In case you wondered what happened to last weeks shot, I have been working quite a bit clinically as of late, and spending so much time on the floor of the hospital emergency department, that it has really cut into my time to be creative and write.

The last shot of satisfaction I wrote for you was about the recent Mayo clinic study that showed 65% of emergency physicians are suffering from burnout. This is essentially seven out of ten.

In trying to make sense of it all by looking at the causes and the symptoms of burnout, I concluded that one of the reasons we as a group (EMS, Emergency Nurses and Physicians) are so susceptible to burn out is because of our huge desire to care, to make a difference and save the day. 

I went on to say that I believe we have become confused about what care is and that in fact we are not caring because, we are so focused on the physical aspects of fixing it, our patients are not feeling our care.

The human aspect of care

Paying attention only to the physical details of what it is we do distracts us from the intangibles of what we are here to do and, at the end of the day, everything we really want from life is actually intangible. Peace, love, happiness, success, the feeling that we are significant and that we are making a difference, all these are intangible, as is the feeling that what we do every day matters. Essentially, what I was and am trying to say is that we have forgotten what it is that we really want from what we do and this is why we are burning out.

Care is, in essence, intangible. To create, provide and deliver the intangibles of care, we must go through a uniquely human and intangible process to be able to generate it. If we do not take the time to execute on the verb called to care, we will not generate the intangible substance of care. Without it, our patients will never feel our care and we will never be satisfied and continue to burn out.

How focusing only on process hurts us

There are three other factors that influence our ability to feel satisfaction from our work in emergency medicine. One is the fact that we do not generally get to see the outcome of our work. We don’t get to see the results. We don’t see the patient walk out of the hospital after they have come to the ER with a heart attack. We get them to the care of the cardiologist in the Cath Lab, from where they go to the ICU and then they walk out of the hospital with a stent and no functional damage to their heart muscle.

But we don’t get to see that and often we don’t get any acknowledgement either, the cardiologist does.We diagnose appendicitis and hand the patient over to the surgeon, who then gets the credit for helping the patient. We diagnose the brain tumor, but only the neurosurgeon gets the credit (as they should) for saving the life.

The second factor is that much of what comes in to us for care has no instant solution, and we really can’t fix it. Chronic medical problems, COPD, congestive heart failure, end stage renal disease, dialysis patients, those who suffer from mental health issues, patients who have been abused, patients who have been raped, patients who are addicted to drugs or alcohol. There is no fixing these things. We do have the technology to make things better, but we really can’t fix this.

The third factor is the fact that no matter how much we do in a given hour, a given shift, or even in a lifetime of the practice of emergency medicine, there is always another patient, another emergency to deal with. It never ends.

All of this can lead to frustration; if we are attached to the physical stuff that we do, if we are attached to the outcome. It can be even more frustrating if we are attached to getting the thank you.

Where to find hapiness

In all that I learned and studied when I did the research for my upcoming book, The Health Care Heroes Handbook, 7 steps to creating satisfaction on both sides of the stethoscope, (this was the working title to ‘Back From Burnout’) it is the work of Dr. Srikumar Rao that I believe shows us the way to true fulfillment and happiness in our work. It is his work that shows us how to love what it is that we already do and therefore, how to follow the lead and advice of Steve Jobs in the quote above, “the only way to do great work is to love what you do.”

Dr. Srikumar Rao is considered a happiness expert. He maintains that the reason we are all so unhappy in our Western world is because we all buy into a flawed mental model of how the world operates. According to Dr. Rao, our flawed mental model goes like this: we think we have to get something so that we can do something so that we can achieve something so that we can be happy. In short, we believe that if “this” happens, “then” we will be happy.

To see the flaw in this logic, Dr. Rao asks us to questions ourselves. “What did I want 10 years ago? What was it I thought I needed to be happy?” If we are honest, we will see that we probably got that “thing” – our degree, the car, the house in the suburbs – and we are probably not much happier now than we were then.

Dr. Rao then then asks us to remember times where we had a blissful, peaceful moment. Maybe we stumbled on a breathtaking scene in nature, a waterfall or a rainbow, or we participated in a joyous moment like the birth of a baby. “Can you remember what it was like to see your child take their first steps or utter their first word?” Dr. Rao brilliantly points out that in these moments that we accept the Universe just as it is. Our habitual wanting of another “thing” drops away and our innate happiness surfaces, and we feel it. Even years later we KNOW we felt it because we can still remember it as if it were yesterday.

These profound moments in our otherwise ordinary lives allow us to feel perfection despite our problems. These moments show us that happiness, satisfaction and success are in the process and not in the outcome. When we concern ourselves primarily with end results, we experience frustration, angst and all the emotions that are the antitheses of authentic happiness and satisfaction.

Investing in the process

The obvious solution is to invest in the process. In life, when we give the process everything we’ve got, our attitude changes. If we arrive at the destination, great! If not, still great! 

When we live this way, every day is amazing. If we want success, we have to step into the process of generating success. If we want health, we need to step into the process of preparing healthy foods and going to the gym, regardless of the number on the scale or the inches on your waistline.

Focusing on the process is where we go from knowing to doing. This is where real change occurs. It is the only place where we have to power to be the cause of something new or different or better! 

I believe that in Emergency Medicine and Nursing, it is in our best interest to let go of our outcome orientation and surrender to the intangible process of generating and delivering true care for our patients and each other. For only when we are focused on and in the process of caring, will our patients feel our care. This is the true measure of our success. 

Finally, I would like to quote Steve Jobs once again:

“We’re here to make a dent in the universe. Otherwise, why even be here? We’re creating a completely new consciousness, like an artist or a poet. That’s how you have to think of this. We’re rewriting the history of human thought with what we’re doing.”

TAKE ACTION

Life is like a lab where we experiment with different sorts of creative processes until we find the one that works for us, the process that fulfills our desires and results in happiness.

Try this experiment this week, surrender to the process of generating and delivering true care. See if this is not the only real cure, we on the front lines of medicine, have access to.

  1. GET PRESENT – for just that moment stop thinking about anything else
  2. CONNECT – make an energetic connection with good eye contact or touching their shoulder- hold that contact just a little too long
  3. FOCUS – on them, imagine what it is like to be them, find real empathy for their situation and stay in the empathetic place until you actually feel their pain and discomfort
  4. COMPASSION – feel your own compassion for them, feel your desire to care, to make a difference, to make it better for them today
  5. ACT – from your compassion, say or do something that will change things for them.

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Frank D. Gabrin, D.O

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SOS Classic – Did you shed a tear?

SOS Classics are reprints of Shot’s of Satisfaction that Dr. Frank Gabrin shared as he wrote his works Back from Burnout, Care 101 and Booster Shots. Each shot contains a glimpse of Dr. Frank’s personal journey back from burnout.

Originally published September 14th, 2012

Shot of Satisfaction Classic

 

REFLECT – EARN your satisfaction. Realize you are responsible for your own satisfaction and that for it to last, you have to earn it.

Were You Moved to Shed a Tear Today?

Did you see any of the TV coverage around the 11th anniversary of 9/11? What I saw was so powerful. Especially all the talk of heroism, the firefighters, the police, the volunteers, the victims themselves, stories of those who put the needs of others in front of their own, in front of their own lives. There was danger, there was difficulty, things were chaotic and unpredictable, but none of that stopped those heroes from doing whatever they could do to save a life, to help, to make it better somehow. Those brave men and women jumped into the chaos without any regard for themselves. That’s powerful. That’s what moves us. That’s what inspires us all.

In the middle of a crisis

So much has changed in these United States since the twin towers fell. The economy is bad. People are out of work, or working jobs that don’t pay all that much with less benefits than they had before. Depression is at an all time high in our country and that is why we are seeing so many people who are thinking about or threatening to kill themselves. Others have turned to alcohol or drugs to numb the pain and end up in our care as a result. Others are anxious, some are somatizing. Many can’t afford their medicines or the co-pay to see the doctor and a trip to the dentist is absolutely out of the question. All of this means that you and I are busier than ever as we function as America’s Safety Net providing care at all hours, to all comers.

It just so happens that I was working in the Emergency Department on the anniversary of 9/11 this year, we were scheduled short and I was the sole physician and I had no midlevel to help. I was told that I saw nearly 60 patients in the 12 or 13 hours that I was on duty. It was a wild and crazy night for a weeknight. Some of my patients were really very ill. Some were injured badly. It would have been difficult under the best of circumstances.

But it was in fact September 11th, and those of us on duty, standing ready to care, found ourselves in circumstances that were less than ideal. Our unit coordinator had car trouble and had to call off so our charge nurse had to take on that role as well. We were already short one nurse, but another called off, and we had to close not one, but two patient care zones. As if that weren’t enough, as we were all working so very hard to do more than we thought we were capable of, our computer system crashed.

Stepping up

We were smack dab in the middle of our own crash and burn situation. As each hit came, no secretary, down not one, but two nurses, and finally no computers, I looked up and asked “Really?” “Seriously?” “Is this really happening?” While no booming voice came down from the heavens to confirm the gravity of our situation, the answer was clearly yes, it is. With all that we did not have, we we still had to do whatever was necessary to help those who were there, those who came for our care.

As I looked around at the staff I was working with, I saw nothing but heroes. One thing all of us emergency types have in common is that we love stepping inside the emergency, inside the worst case scenario for it is in these times that our roles become crystal clear. I was slow to start, still stuck in “really- no computer” moment, my charge nurse was quick to re-direct me: “Yes really, What I need more work and less talk doctor! We can do this.”

It is in these desperate places that we find the way to become more than we usually are and somehow work together, almost as one, anticipating each others needs and moves. We manage to execute flawless teamwork. “Can I get you a cup of coffee doc, what do you need, how can I help? I got you set up to suture in 9, and here is the EKG, along with an old one for room 2.”

Joining together

No only do we care for our patients, but suddenly we care for each other. I had some very deep, profound and meaningful experiences with my patients and my staff that night, as a matter of fact, that night is one of the most memorable moments in my career. Sir, you are having a heart attack, but the cardiologist is already on the way to get you to the Cath lab. “You will do just fine. Mrs. Smith, your son has appendicitis, and we are going to have to go to the operating room right away. Mr. Taylor, this headache your mother is suffering is not a simple headache, she has some bleeding in her brain, it is very bad, she may not survive. I would like you to be at the bedside when I tell her what is happening and what her options may be.”

“Mr. Jones, we have found some very complex and unusual things on your CAT Scan and in your blood work. I’m sorry but it looks like this is a large cancerous tumor that has wrapped itself around your liver and your intestines. We will have to move you to one of the bigger hospitals that are more equipped to get you through all of this.” I held his hand as he cried and ask if he was going to be all right. I did my best to paint the ugly picture for him and offer him hope and I promised him that I would see to it that he would be in the hands of the very best care available.

Surrendering to the process

We all left that shift feeling good about what we had done. We had created satisfaction for ourselves through doing our very best to care. What can we learn from times like these? That when all the distractions fall away because of the intensity of the situation, we automatically focus on the work. The secret is to disconnect the work from the “results” and the “things we just don’t have.” Then suddenly what we are doing is meaningful and full with purpose. We feel connected to each other and our mission. We carry each other. We are totally invested and engaged with the work and we surrender to the process.

As a doctor I know that all I can do is bring the two ends of a broken bone together in alignment, and that is really all I can do. I have to then allow the patient to move through the healing process, over which I have no control. I can deliver the shock to the fibrillating heart, but that’s it, I have to wait and see if the heart responds and then energetically reorganizes itself into an organized rhythm. I can repair the skin once it’s been cut, but the healing and the scar are out of my control. The results in reality are not up to us. The results are not our responsibility. Our only choice is to invest in the effort, do our best and surrender to the process.

TAKE ACTION

Give up your illusionary sense of control. Give up your sense of accomplishment. Give up your attachment to the outcome or the results. Do what the universe puts in front of you today. Give up what should be, what it should look like and above all, do the work with happiness.

It is time we all surrender to the healing process. I promise, you will feel better and will find a way to make others feel better to.

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Frank D. Gabrin, D.O

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Cure vs. Care

Watch the fourth and final video in the four part series on
Dr. Frank's Personal Journey Back from Burnout.

“He who distributes the milk of human kindness cannot help but spill a little on himself.”
– James Matthew Barrie

Care exists within the “interpersonal interaction between two human beings.”  We have gotten so far away from that in medicine and nursing, that we go through our jobs getting the history, doing physical exams, getting the blood work, the imaging, the test results, starting the IV, and giving the medicines.  It is as if everything has become so methodical, mechanical and robotic, that many times, we don’t know anything about our patient.  Many times we do not even know their names.  We stay aloof and detached.  We know what room they are in and what their problem is, but we have no idea who they are.

We Came to Care

I believe that each and everyone of us came to these jobs and these positions on the health care team because we have an intense desire to care and make a difference! If we don’t make the effort to get to know and connect with our patients, find a way to empathize with their situation, then we are going through our days as if we are making widgets.  We can’t possibly draw any sort of satisfaction from our day if we are only making widgets.

The only way I know, that we can draw any satisfaction from what it is we are already doing, or create satisfaction for our patients, is to actually connect to our patients, make the effort to step into their shoes and feel their pain as if it were our own.  It is only from this vulnerable and painful place that we can truly treat them with human dignity, respect and mindfully generate compassion for them.  This intangible space is indeed the only place that care exists.

If we want to draw satisfaction from our jobs as givers of care, if we want to feel significant, to feel that what we do matters, to feel that we are making a difference; then we must shift our focus from the physical tasks that we perform to the intangible space where kindness, compassion and the milk of human kindness exist for it is only in that place that we will find the satisfaction we crave.

Take Action

No one can give us the satisfaction we want.  We will have to earn it for ourselves.  We will have to focus on those intangibles within our reach if we ever hope to realize our potential and attain our goal- the feeling that comes from knowing that our care for another made a real and tangible difference in their life.

You can read more about the generation and delivery of true care in Care 101Back from Burnout or Booster shots, all available at Amazon. com.  You can also check out my blog, Shot of Satisfaction at Clear2care.com.

Care, Make a difference and change (y)our world!

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Frank D. Gabrin, D.O

Get your copy at amazon.com.


Danger! Danger Will Robinson!

“At work and in life, in the final analysis, we all want the same things; we want to be happy with who we are and what we are doing in this world.”

– Dr. Frank Gabrin

 

When we lose it at work

It was insane at work this week.  So busy and the patients were so sick!  One night when I arrived, we were working a couple of nurses short and the staff was complaining about everything and anything.  You know the standard greeting- Turn around and call off while you still can!  It’s bad. it’s really bad.  I smiled, put my things down, logged onto the computer system and wow! They weren’t kidding!  It looked awful!

I grabbed a few charts and got busy trying to put a dent in the workload that lay ahead of us.  Soon however, I started sounding just like my staff.  I began to complain and added my voice to the choir singing about the negativity in our environment.  They just keep coming!  Look how they are backing up in the waiting room.  We have no rooms to put them in.  Another squad, really?  And then the police showed up with a belligerent, loud, aggressive and threatening patient. Our modern day equivalent of the saber tooted tiger.  This patient was high as a kite on drugs and my crackerjack staff bent the rules, the very rules that are designed to support us when the department is stressed and overburdened and I “lost it!” I lost my temper! I was ticked off and livid!  I was so mad I scared myself!

Why do we lose it?

Why does this happen to any of us?  Why do any of us lose it?  Most of the time it is because we are not getting our way, things are not going our way or, we are not getting what we want.  I was acting like a two year old having a temper tantrum.  This was not the me that I want to be.  Worse yet, I’d just written a book (Back from Burnout) about creating happiness and satisfaction for ourselves and others at work and in life.  Clearly, I was not following my own advice.  I was not walking my talk.

So what exactly happened to me that night?  I was emotionally highjacked!  But how did I LET THIS HAPPEN?  It’s because I was being careless with myself.  I was not paying attention to my own thoughts.  Instead I was on autopilot and not mindful.  It was because I was not being consciously aware of what was going on inside me that as a result, I allowed myself to default (on my self-responsibility—)  and let my human physiology, my animal like neuroanatomy and neurochemistry, run the show.  Because of this I reacted automatically rather than having made the conscious choice to formulate a conscious, thinking and caring response.

Our uniquely human hardwiring

To understand why this happens to us, we can take a look at our uniquely human hard wiring and and overlying operating systems.  There are basic “physiologic programs” running just under our conscious awareness which are built into our human physiology.  These are necessary because our physical five-sense system brings our brain way too much information for our brains to process and interpret without them.

As nothing is more important to any organism than its own survival, it makes sense that all of this sensory information comes directly and indirectly into one of the oldest and ancient primordial parts of the brain: the amygdala, a tiny piece of our brain, about the size of an almond.   The primary function of the amygdala is to sort through all of that sensory information coming into the brain, looking for anything in our immediate environment that might harm us. It is a danger detector and it functions much like the robot on the old TV series lost in space: Danger! Danger, Will Robinson!

The amygdala is part of the limbic system, which is considered to be our reactive and feeling brain.  While our cerebral cortex, the prefrontal and frontal lobes, are often referred to as our thinking brain, in contrast, our limbic system is responsible for the emotional experience of our lives. Good and bad.

This tiny and ancient piece of our neuroanatomy is in constant and close communication with our five senses and our internal organs, including our adrenal glands. It’s responsible for the dry mouth, rapid heart rate and tense muscles in our freeze-fight-or-flee responses to danger. This system is also physically responsible for our physiologic, autopilot, emotional reactions in our interpersonal encounters with others.

In our modern high tech world, this internal automatic system of ours is responsible for our feeling stressed. This is why I lost my temper.  This is why we all loose our composure. While necessary in situations of actual physical danger, this ancient piece of our present day neuroanatomical physiology does not always operate in our best interests, especially when our challenges and choices are more complex than fighting, fleeing or freezing in reaction to the danger of a saber-toothed tiger that just entered the department with the police.

Emotional hijacking

At work, when the volume and the acuity of patients are high, we are short staffed and the challenges seem to be getting steeper and more cumbersome, we can start to physically feel the stress of our environment because of the biochemicals that flood our system as a result of our amygdala and limbic system’s interpretation of the environment as dangerous.  When we are so hyper-stimulated by our environment, we often start to feel like we are losing control.

Under conditions like these, our limbic system is hyper active-ated and we can find it oh so difficult to “keep it together.” This process is automatic, physiologic, biological and mammalian. Modern-day stressors activate the system, and cortisol, adrenalin and other chatecholamines are generated. When the amount of stress reaches a critical point, even the smallest challenge can trigger an automatic reaction, an amygdala reaction, a knee-jerk reaction, where instead of caring for those around us, we react like a jerk.

This automatic, physiologic process, running just under our conscious awareness, is human and none of us are immune to it. Social scientists in the past decade have named this process emotional hijacking.  The reality is that we are constantly being hijacked by our own physiology.  A piece of our brain that is about the size and shape of an almond is working against us and our efforts to be better, do better and feel better. The high catecholamine states generated by our amygdala actually diminish function of the higher cortex, where the power of our free will and “con-science” resides.

Taking control

This is precisely why I consistently need to remember and use the R.E.F.L.E.C.T. format I developed so I can wake myself up, stay conscious, stay in control, and engage my free will so that I do not allow my automatic physiology to take me over:  Remember why I came here and what I want.  Earn my satisfaction, Formulate my plan and free myself from agenda, Look to see if I am the cause of something better or the effect of another’s bad mood or situation, Evaluate my success- am I creating satisfaction? If not, Circle Back to the beginning and apply the steps again. Take Care of myself.

Practicing our seven-step framework is not, let me repeat, IS NOT a natural or automatic thing; it takes real effort. Having a knee-jerk reaction, losing our temper or engaging in any of the negative behaviors that go along with it—complaining, avoiding others, judging others, feeling entitled, gossiping, manipulating—ALL OF THAT is automatic.  Falling into one of those reactions requires no conscious effort and does not really engage our power to choose, to exercise our free will.

In our day to day, we are not in a position to control our environment or the amount of stress it will induce in us.  The only control we do have, if we are looking for happiness, satisfaction or fulfillment in our jobs and lives, is the ability to control our own thoughts and behaviors.

The reason heroic effort is required to put our R.E.F.L.E.C.T. framework into practice is that it pushes us against and beyond our nature, our automatic operating system and hard wiring; our physiology. Executing the framework successfully requires us to use our free will by using the thoughts in our mind, using our conscious awareness to change the chemistry in our frontal and prefrontal cortex.

The downfall of complaining

The opening for my emotional hijacking the other night happened when I allowed myself to complain.  If we want to live the high life that I talk about in the book, Back from Burnout, we can never indulge in our natural desire to complain.  Complaining is automatic, and requires no conscious effort on our part. Complaining, however, has to be against our personal set of rules if we want to do better, live better and be better.

Complaining actually engages our amygdala and limbic system…… complaining turns the system on and makes it even more hyper-vigilant.  Whenever we feel the urge to complain, we should already realize that we are in deep, deep, trouble and apply the first step of the R.E.F.L.E.C.T. process; Why did I come here and what do I want?

We all want to feel good; good about who we are and good about what we are doing in our world.  Complaining creates a reality for us that is in direct opposition to our goals and desires. Complaining makes us and those around us feel bad.  When we feel the urge to complain, there is a way to use the thoughts in our mind to change the chemistry in our brains and our bodies.  Just by stopping and remembering what we really want, we can then choose, by using our free will, to turn the complaining upside down and begin to be constantly on the lookout for the good.

Activate with a smile

Simply forcing a smile on our face will start the brain about the task of creating feel good neurotransmitters called endorphins.  If you have to, put a pencil in your mouth.  It will force a smile and keep you from speaking your complaints.  There is always a duality in every reality we face.  Everywhere we look there is both good, and bad.  The reality we are facing is actually neutral, and our experience of that reality depends solely on what we choose to connect with; the good or the bad. The trick is to look past the negativity, the problems, the chaos and find what is good, wholesome and pure.  We can choose to focus and to attach ourselves and our energies to what is good.

Our personal choice to extract the good from our environment is not an easy choice, it is a difficult and even sometimes painful choice.  Without using our free will to make this choice to get what we came here for, we will automatically see and connect with the bad and we will complain and lament to all around us  This will strengthen the bad and amplify our misery, our discontent will grow as our lack of satisfaction expands.  Compassion fatigue will set in and slowly progress to the emotionally dysfunctional state of professional burnout.

See the good

Our brain, our physiology, our amygdala and limbic system will automatically connect with what is negative, dark and dangerous.  The only way out of this operating system is to know that there is always good right in front of us, in every situation, and to make the effort to see the good, connect with the good, enhance and amplify the good, so that we can do good, be good and feel good.  This is our only opportunity to “do it” differently.  This is what keeps me going.  This is how I used my last emotional hijacking to reconnect myself back to what I really want from myself.

When we make the choice to extract the good from every situation then our experience of our reality changes and we see and experience only the good.  We do not need to fight against the negativity of those around us, we need only feed and add our energies to what is already good in others.  In other words, if you want the darkness in a room to disappear, all you have to do is turn on the light!  Do what’s right.  Care and share.  Go the extra mile.  Be extra-ordinary.  Pick up the litter or clean up the mess in the break room.  Smile instead of scowl.  Give someone a pat on the back, tell them what a great job you think they are doing under these circumstances.

When times are challenging and we are working so hard and nothing is happening, when we can’t seem to rise above the chaos and the pain, it is our human nature, our automatic physiology, to become frustrated, angry and complain, to become a victim. But if we really want to change our negative experience of life. If we really want to come back from burnout. If we really want to live the high life, we have to feel all these automatic human emotions and take responsibility for revealing our potential through our god given gift of free will and find a way to connect to the good….. ANYWAY!

It is our job in every encounter to find the good, grab onto it, hold onto it, and then milk it for all it’s worth, squeeze every last drop of goodness out of the situation until we can walk away with a smile on our face.  This is what will generate our personal satisfaction and fulfillment.  This is what will create satisfaction for others.  This is our only hope and our only choice:  To remember when we are confronted with the negativity and everything seems bad, that the good is there too and it is our job to extract it, amplify it, expand it and enhance it until it outshines the darkness.

This is how we can reconnect to our initial pure uncorrupted desire to care and make a difference, to ease the suffering, calm the pain and make things better for another.  This is how we can create quantum levels of personal and professional satisfaction and fulfillment for ourselves and those we care for.  This is how we can get what we really want!

“The true secret to high performance and satisfaction—at work, at school, and at home—does not lie in external rewards. It is based on the deep human need to direct our own lives (autonomy), to learn and create new things (mastery), and to do better by ourselves and our world (purpose)!”

– Daniel Pink, Author of Drive

Take Action

Remember why you came here in the first place!  Remember what you want!  Connect with your primary mission to care.  Understand that our coming back from burnout is dependent on realizing that nothing about our reality is going to change- it is going to be exactly the same.  What is going to change is the way we perceive, work with and deal with it.

We will have to take on the mantle of responsibility to use our ability to see our reality in a different way.  Until we can learn to do this consistently we will never be able to feel satisfied, happy or complete.

Nothing will ever be ideal or perfect.  We know that no matter what the circumstance, there is the potential to feel good at the end of every encounter.  Taking responsibility for revealing our potential, to use our free will, to make the conscious choice, to earn our satisfaction for ourselves, to reveal our potential to create what we want, by using the R.E.F.L.E.C.T. framework to see it differently, we can work with it differently and choose to make things different and better for ourselves and others.

This is how we change our experience of life.  This is how we feel our own power.  This is how we create meaning and significance.  This is the way back from burnout.  This is real liberty, and the freedom to pursue happiness.  This is the high life.

Care, Make a difference and change (y)our world!

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Frank D. Gabrin, D.O

Shot of Satisfaction
Antidotes for Burnout and Compassion Fatigue
Thursday, December 17, 2015
A Pot of Gold

Each Shot of Satisfaction is related to one of the seven steps back from burnout in the process of REFLECT. My hope is that, by sharing with you how I apply these steps in my daily life, it will help you on … Continue reading