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”
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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
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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?