Dear Everyone:
I had a lengthy, commiserating missive composed for today. I wrote extensively about the impact of chronic toxic stress, and the challenge of navigating the melancholy, exhaustion, and apathy that seems to be taking up permanent residence for so many of us.
I then spent 5 minutes last night watching the news and another ten scrolling through discussion threads online. Any additional commentary at this point feels like a deliberate recycling of pain, and there is little value in that.
Coast to coast, everyone I work with is digging deep for yet another push and feeling like they’re coming up short on resources, on empathy, on energy, on hope.
And no one really knows what to do.
While it beats the alternative, the problem with getting older is that at some point you look up and realize that everyone is pretty much winging it.
Me: Hello. I’d like to speak to an adult.
Life: You are the adult.
Me: No. Seriously. Get me a grownup.
Life: Seriously. You ARE the adult.
Me: .…
Me: I would like to speak to an adultier adult…
So, in the spirit of acknowledging that no adultier adult is coming to fix all the things, I scrapped my solemn missive in favor of a story best filed under “doctors make for odd farmers.” I hope a lighter touch may provide gentle assurance that although our interactions look a little off and feel a little off, we can still choose to engage in ways that support and hold space for each other’s processing.
Humor helps.
Connection Mitigates Trauma.
You are not alone.
~~
August, 2021
Farm life carries a unique set of challenges and loves reminding my husband and me that we, in fact, know almost nothing about almost everything.
On the upside, life on a farm accustoms you to death in ways that are equal parts hard and instructive. We do our best to safeguard the sheep and goats and cows and hens and cats and dogs and so.many.children in our care, but it is the nature of Wild Things everywhere to eschew safety. Boys break bones whilst launching themselves off bikes and into space. Turkey chicks waddle into the ever-ready mouth of an otherwise resting German Shepherd. Guinea fowl flap hysterically into the pond, only to learn they can't swim.
Vigilance is necessary.
Last summer during evening rounds, we stumbled upon a chicken who’d opted to roast itself half to death in the eleventy-billion-degree August sun rather than seek the accessible, ample shade and water mere feet away.
Flopped over, eyes closed, agonal breathing.
I took one look and thought: “Damn. We were just a couple weeks from harvesting him, too.”
My husband took one look and thought: “Damn. I can save him!”
~~
As physicians, we learn early to keep our inner monologue, inner. We actively hone this skill and know it to be particularly important in high intensity situations where decisive action is needed.
Turns out this is also a high-value talent when running chicken-codes.
Me out loud: “Honey, you are a wonderful cardiologist. But that is a DEAD chicken. It’s a shame, alright. Tag it, bag it, and move on.”
My inner monologue: “Wait. What am I watching? What are you doing? You’re coding a dead CHICKEN! One we were going to kill and eat a week from now, anyway. Are.You.Kidding.Me. I still have hours of work, kids who need dinner and bed, and a literal metric ton of laundry threatening to bury us alive. Toss the damn thing on the burn pile and move on, Goldstein!”
The Husband (out loud): “He's just overheated, let’s give him a soak. Maybe he's only mostly-dead… we’ll give it a try. Won’t take long!”
His inner monologue: “Today was hard. This year was HARD. I need this win.”
~~
If you’ve never seen a city-boy-doctor-turned-farmer resuscitate a chicken, I can truthfully report you’ve missed out.
As he raced, chicken in arms, to the barn and turned on the hose to soak the bird in a feeder bowl of fresh water, I sat on the hard ground making supportive-spouse-sounds while excavating the recesses of my memory for college-freshman animal biology tips.
Dunk. Dunk. Sternal rub.
Experimental lifting, manual flapping, and pouring of water under the wings.
Dunk. Dunk. Sternal rub.
Me out loud: “I think chickens have some kind of counter-current conduction that helps them cool. Hold the feet in the water.”
My inner monologue: “It’s non-responsive. Its respiratory rate is two. This is insanity. I wonder where we fall in DSM…”
Me out loud: “What? Oh yes, honey. He definitely is perking up!”
Dunk. Dunk. Sternal rub.
Experimental manual beak opening and throat massage.
Dunk. Dunk. Sternal rub.
Him out loud (to the Chicken): “Open your eyes, buddy! Open your eyes! Live Dammit, LIVE!”
My inner monologue: “Sigh. That chicken is dead. But my husband awfully cute…”
We ran Chicken Code for somewhere between 30 minutes and forever, and in the end my husband’s heroic efforts trumped death. The mostly-dead chicken lived.
I named him Lazarus.
~~
The takeaway?
Our processing may look a little … weird … for a while.
And humor helps.
Thing have been very hard, for a very long time.
Exasperated though I was by the disruption of my work and plans, I understand that the processing of bad outcomes and patient loss - always hard - has been compounded by the extended pain of unbearably toxic years both in healthcare and the very fabric of American life.
This isn’t just a pandemic punctuated by confused messaging and inadequate scaffolding. This is a Tridemic: Covid19, Violence – racial, social, and political – and Isolation.
There is a cumulative and compounding impact of the pain we are experiencing individually and collectively. And it isn’t just the Events that are causing harm – the chronic Exposure is wreaking havoc, too.
A foundational truth of pharmacology, learned by every student in the first year of medical school, is the dose makes the poison. As we move collectively through the unrelenting, inescapable toxic stress of these times, the profound harm of chronic exposure is becoming increasingly evident and make clear the need for better rules of engagement with each other.
We can begin by acknowledging the toll this has taken on us personally, then acknowledging that in every encounter we are interacting with someone who is also carrying harm. This truth becomes even more evident when considering that data suggest most of our population was already carrying some combination of childhood, community, racial, historical, institutional, and intergenerational trauma even prior to the Tridemic.
Whether we’re talking about recognized and named Traumatic Events, or less well-defined but no less harmful unrelenting Exposure, all of us are carrying places of harm. Primary, Secondary, Vicarious – we have all been injured by the pandemic, the violence, the unrelenting toxic stress, and the isolation.
That harm demands one of two things: Mitigation or Discharge.
~~
Chicken revival was, at least, micro-mitigating.
Exasperated though I was, I understood my husband was processing a very hard day as a physician in a VERY hard year. When asked later, he noticed that my presence, nonjudgement, and encouragement (a testament to keeping one’s inner dialogue, inner) probably helped more than did the successful outcome.
Everyone I talk to feels brittle, embattled, and exhausted. We are hard-wired for threat detection, and right now those threat detection systems are sensitized, primed, and ready to discharge.
In the absence of mitigation, trauma will discharge disguised as behaviors that further amplify harm and drive disconnection: Anger. Aggression. Apathy. Avoidance. Disdain. Disengagement. Self-injury.
Mitigation is better.
Fortunately, there is no terminal degree required for engagement in trauma-responsive, trauma-mitigating interactions. The skill acquisition is available to anyone willing to learn and practice.
Sometimes trauma-responsive engagement looks like getting curious rather than reactive to behaviour we perceive as overblown, disrespectful, or disengaged. Sometimes it means extending our pause, tending our breathing, unclenching our jaw, and saying, “May I ask for some clarification? how can I best support you right now?”
Sometimes it looks like monitoring one’s inner dialogue, noticing the unspoken needs of the person we’re with, and sitting on the hard ground while thinking, “Yep. This looks a bit unhinged. And I know it’s been so, so hard. I’ll hold space for this because you matter to me.”
We trauma-mitigate when we slow down and self-regulate. When we get curious and allow others to tell us how they’re making sense of their experience without judgement. When we actively listen with the intent to connect. When we respect that trauma always involves loss of control and choose to respond with transparency and restoration of agency.
We are hard-wired for threat detection. Fortunately, we also are hard-wired for the antidote to harm: Connection.
You say you want to revive a dead chicken? Ok. I’m here with you. What do you need? How can I best help?
Connection Mitigates Trauma.
~~
If you're struggling or exhausted or angry like never before, you are not alone: Same-Same-Same
Connect with someone you love. Connect with someone who listens well.
Make space for others to connect with you. Practice listening deeply.
Laugh and Play
Extend Grace
Cultivate Gratitude
Your sleep matters more than you can possibly imagine, and rest is not a reward.
Stay hydrated
And hold fast to this foundational truth: We can fix anything but dead
Even a mostly-dead chicken
More soon,
Dr. K
~~
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