when the system isn’t changing fast enough · when the system isn’t changing fast enough how...

When The System Isn’t ChangingFast Enough

How one community emergency physician got to the end of her rope… and held on

Katerina Tsapos Parmele, MD, FACEPCalvertHealth EM Director of Wellness

Class of 2000

And then life happened…

MeditechPatient satisfactionscores

KidsAiling parents

Single coverage night shift

Husband

Metrics

Keeping up with literature

MeditechPatient satisfactionscores

KidsAiling parents

Single coverage night shift

Husband

Metrics

Keeping up with literature

MeditechPatient satisfactionscores

KidsAiling parents

Single coverage night shift

Husband

Metrics

Keeping up with literatureDEATH

MeditechPatient satisfactionscores

KidsAiling parents

Single coverage night shift

Husband

Metrics

Keeping up with literatureDEATH

Shifts: 4 3 2

(Perk of Emergency Medicine)

Depersonalization

Compassion Fatigue

Will this be my life?

WEAK

Small Community Hospital, 2016

Awareness first, then eventually solution.

WEAK

If I felt like this, how did my colleagues feel?

(Cue Righteous Indignation)

January 6, 2017

A great leader has your back

January 6, 2017

“What can you offer?”

“I want to help doctorswith their own wellness”

…The moment one definitely commits oneself, the providence moves too. All sorts of things occur to help one that would never otherwise have occurred. A whole stream of events issues from the decision, raising in one’s favor all manner of unforeseen incidents, meetings, and material assistance, which no one could have dreamt would have come his or her way…

Whatever you think you can do or believe you can do, begin it. Action has magic, grace, and power in it.

-W.H. Murray (1951)The Scottish Himalayan Expedition

January 6, 2017January 9, 2017

“We need a Physician Wellness Champion”

+/-

+/-

+/-

+/-

?

New Age Hippie Mumbo-Jumbo?

Show me the Science!!

What is Meditation?• Brain quiet time• Thoughts are acknowledged, observed, then

”released”• Usually involves a repetitive action, like a “mantra”

or focus on the breath• May involve sitting, laying, standing, walking,

running, or a different repetitive activity (yoga, tai chi, qi gong)

You’re not doing it wrong

https://images-na.ssl-images-amazon.com/images/I/71qAyI%2BzpUL.jpg

What is Mindfulness?• Immediate here-and-now physical and emotional

self “snapshot”• Awareness of emotions, feelings, sensations

– No attempt to control• Non-judgmental• A stepped-back, objective observation• Being “in the moment”

https://siyli.org/uploads/general/thumbnails/conquer-your-emotions-by-being-siyli.png

Why is meditation healthy?

Fight or Flight Vs. Relaxation Response

Fight or Flight• Amygdala becomes activated• Signals hypothalamus• Epinephrine surges

– Acute rise in heart rate & blood pressure, bronchodilation, gluconeogenesis

• Hypothalamic-Pituitary Axis becomes activated– Hypothalamus releases CRH (corticotropin releasing hormone)– CRH stimulates release of ACTH (adrenocorticotropic

hormone) from pituitary– ACTH releases cortisol from adrenal glands

• Chronic stress = chronically elevated cortisol

Chronically high cortisol is bad• Results in shorter telomeres, shorter lifespans• Increases risk of diabetes and hypertension• Weakens immune system• Increases adipose fat deposition• Results in atrophy of hippocampus (memory center)

Meditation works to oppose “Fight or Flight”

Relaxation Response• Stimulates the parasympathetic system• Decreases blood pressure and heart rate• Provides negative feedback on amygdala• Stimulates hippocampus• Results in longer telomeres• Improves immune function

Binaural Beats and Entrainment

https://www.binauralbeatsmeditation.com/wp-content/uploads/2014/01/how-binaural-beats-work.jpg

“Frequency following response”

https://www.lifeimproving.com/wp-content/uploads/2014/02/brainwaves_chart.jpg

January 6, 2017January 9, 2017

January 22, 2017

Dear Fellow Colleagues,

Did you know that Monday January 22- Saturday January 28 is officially "Emergency Medicine Wellness Week?" Me neither! I was not even aware that such a thing existed!

I thought...

The patient always comes first!Using the bathroom during your shift is a privilege, not a right!We can work harder, faster, longer, because if we don't, we're WEAK!Sleep? Emergency providers sleep?A power bar is a good food option, right?

We shouldn't talk about our struggles because we're SUPERHEROES! LONE RANGERS! COWBOYS!

Why not? Can’t hurt, it has binauralbeats meditations, and it’s free

January 6, 2017January 9, 2017

January 22, 2017January 26, 2017

Sense of Purpose

Ikigai

My Ikigai• What I love

– Adrenalin & adventure– Endurance multisport– Food & cooking & family– Travel (Mediterranean)– Motivating & helping

others• What I can get paid for

– EM physician– Public speaking– Coaching– Running a Wellness Retreat

Center?

• What the world needs– Wise, balanced & badass

emergency physicians– Health, longevity, vitality,

sustainability– Love & open-heartedness

• What I’m good at– EM physician– Endurance multisport– Healthy cooking (ie Greek)– Motivating/inspiring others– Creating

Where to start?(What’s bugging me the most?)

I need to help other docs

Some Remarkable Things Started Happening…

Some Remarkable Things Started Happening…

Summer 2017

October 7, 2017

October 30, 2017

December, 2017

February 2018

Meanwhile, I kept meditating

And Remarkable Things Kept Happening

But beyond Badassery

Remarkable Things Continued Happening

I started to remember why I went into medicine in the first place

Same night schedule, more on my plate, but I was recovering

System change? … still waiting

March 15, 2018

But then

March 17, 2018

MeditechPatient satisfactionscores

KidsAiling parents

Single coverage night shift

Husband

Metrics

Keeping up with literature

MeditechPatient satisfactionscores

KidsAiling parents

Single coverage night shift

Husband

Metrics

Keeping up with literature

MeditechPatient satisfactionscores

KidsAiling parents

Single coverage night shift

Husband

Metrics

Keeping up with literature

March 30, 2018

+/-

+/-

Shame

July 27, 2018

There is a crack in everything.That’s how the light gets in.

-Leonard Cohen

The show of support humbled me.The entire world opened up.

The possibilities became endless.

(Armor is heavy)

An open heart is an open mind-Dalai Lama

An open heart is an open mind-Dalai Lama

Say YES

September 15, 2018

September 29, 2018

October 15-24, 2018

December, 2018

February 8, 2019

February 13, 2019

February 14, 2019

Lessons to keep me BalancED• I need to care for myself in order to care for others.• There is courage in vulnerability.• Shared experiences are powerful. I am not alone.• I need to put down my armor and be open-hearted.• Follow flow– let it move me through the ED and life.• Listen to my curiosity and follow my Ikigai.• The Universe has my back.• I need to manifest my Intention by speaking it out loud.• I can not just wait for change to happen- I must act for

myself and for my colleagues.• Meditation brings clarity and peace.• Finally, I need to remember to…

CalvertHealth/Alteon Emergency Physicianswho helped make this possible

Marion ColburnStephanie Dabulis

Drew FullerJulie GoldrichFulton Lukban

Ali MohammadiChris MorrowChad Smith

Concetta Weibe

What’s YOUR Ikigai?

kathyparmele@gmail.com