What is gratitude? Webster’s Dictionary defines gratitude as the following: the quality of being thankful, ready to show appreciation (asamonitor.pub/3SPtiAL). How did gratitude end up in my practice as a physician? How has gratitude helped me cope with the daily challenges of practicing anesthesiology, critical care medicine, and hospice/palliative medicine? How has gratitude allowed me to appreciate being part of the care of my patients? Well, the story is a bit complicated. This article will not resonate with some readers; however, other readers may find a similar path with gratitude that contributed to their own resiliency.
If one had asked me 15 years ago to write an article focused on gratitude in medical practice, I would have said no. Now, I feel I should have written this article a long time ago, as gratitude (along with other things) has been one of the strategies that has allowed me to stay more resilient. For the reader, I am boarded in anesthesiology, critical care medicine, and hospice/palliative medicine. Having all three of these boards and being a member of our medical school’s ethics committee only means that my days of practicing medicine in an academic medical center are never boring. All physicians practicing in the United States have been through interesting times. For me, a global pandemic with an airborne pathogen, being a critical care intensivist during that pandemic, being an anesthesiologist and intubating patients during that pandemic, the death of professional colleagues from the virus, shortages of resources at work, colleagues and patients with very “short fuses,” etc., have been challenging these past several years. The burnout and cynicism rates being expressed in many medical journals (and seen in real time in our fellow colleagues and ourselves) reveal an alarming issue within our profession. I’ve been aggressive with finding ways to control and mitigate my own feelings of burnout and cynicism. Gratitude has been a valuable part of that process.
After much debate, I decided that I did not want this article to be a literature search on gratitude with peer-reviewed articles (though these articles do exist and, in my opinion, they can seem rather ambiguous). Rather, I wanted this article to represent what this physician has done to find calmness, resiliency, and appreciation for practicing medicine. From the peer-review standpoint, cognitive behavioral therapy and mindfulness have shown some success in mitigating stress, anxiety, and depression (Am J Health Promot 2020;34:929-41). I’ve tried both but neither seem to help me acutely when I am having the “bad day.” These opportunities can be helpful after the fact, either later at night or on the weekends when I can sit quietly and reflect on the events of the past week. I have been seeking tactics that help me in the here and now – real-time strategies in managing the acute bad day.
Through my research and reading, I learned that all humans are programmed to focus on the negative. From an anthropological standpoint, our brains have adapted a characteristic referred to as either “negativity bias” or “negativity effect.” The book “The Power of Bad” suggests that our ancestors were always anxious and under constant treat of attack (The Power of Bad: How the Negativity Effect Rules Us and How We Can Rule It. 2019). Given this constant threat, those ancestors who remained prepared and vigilant seemed to be those who supposedly survived and thrived. As a result, this “negativity effect” from our ancestry was conserved into our current neurobiology. This fact can help many to understand why anxiety and nervousness are common and universal reactions to events in our daily lives. In addition, this can account for the negativity focus on all the bad things that happen when our day does not go so well. Many humans fundamentally tend to favor the negative unless they are trained to do otherwise. I had to train myself to focus on gratitude rather than the negativity effect when I have a bad day.
My early efforts to manage my growing burnout and cynicism with working in a hospital were focused on peer-reviewed research, books on work-life balance/time management, TED Talks, and Harvard Business Review articles. I felt (and still do) that work-life balance did not exist, and I appreciated other authors and speakers for finally confirming similar thoughts. I see that the current psychological terminology is trying to reframe work-life balance into the concept of work-life harmony. Current reading content about work-life harmony requires changing how one specifically responds to daily events, and the practice of gratitude was a method suggested in the literature for providing some personal and professional resiliency. In real time, I find that gratitude does not hold up to the challenges of the day. I could see the benefits of using gratitude, but I needed to find a way of making gratitude more permanent/having a stronger presence. The more I read, the more the teachings of stoic philosophy kept emerging in the literature and in various books. Maintaining permanence of gratitude is part of the fundamental teachings of early stoic philosophers. The three best-known stoic philosophers are Epictetus, Seneca, and Marcus Aurelius, and their teachings are widely available. My interest in stoic philosophy and gratitude strengthened further when learning that many admired Silicon Valley CEOs, U.S. military generals, U.S. Secretaries of Defense, leaders in industry, admired world leaders, etc., practice elements of stoic philosophy and gratitude every day. At the time of writing this article, elements of stoic philosophy and gratitude have provided me better work life harmony than I have had in the past. However, I must admit that I am continuing in my own personal and professional improvement (I’m a continuous work in progress).
One of the fundamental elements of stoic philosophy centers on the Latin phrase “momento mori,” which translates into the following: “remember that you have to die.” The story behind this phrase suggests that the subordinates of Roman generals would continuously say to each general, “momento mori” during military campaigns and military processions in Roman cities. The phrase was meant to keep the military leaders humble and remind each of them that all great leaders will die. Momento mori reminds each of us that one cannot escape nor control death. This phrase could be considered morbid, but not to me. It reminds me that when each of us is born, we are born with a death sentence. Managing the death and dying of patients in my own practice has actually helped me to be more aware of my own life, my mental/physical well-being, and the time I have left in this life. It’s my own momento mori moment that helps me refocus on what is important. By reminding myself that my time is limited and that this life will end, suddenly the pressures of daily life in the hospital do not seem to be so burdensome. This fact allows me to show gratitude/appreciation for being part of the care of my patients. The “bad day” that used to persist all the way up to bedtime now has impermanence and fades away quicker than in years prior. Momento mori provides permanence to my gratitude each day. It helps me to focus on the things that I can control rather than the things that I cannot. If I cannot control the issue, then I do not spend time focusing on it and I move along. My gratitude has more strength to endure throughout my day.
For me, at the time of this writing, aspects of stoic philosophy and gratitude have resulted in the following professional benefits: greater appreciation for being part of the care of patients and more resiliency for getting through the challenges of the day. The benefits I have seen in my personal life are: more emphasis on relationships with family and friends, less road rage, growing interests in hobbies, improved biometric data (via a WHOOP band and Apple Watch) with better heart rate variability, improved sleep quality, leaner body mass, and less anger during the day. I now appreciate being part of the care of my patients. I am a better physician. My burnout and cynicism are managed, but not gone. It’s not a revolution, but rather an evolution of my current circumstances. Although some may disagree, the thoughts I’ve discussed here may offer others a path that allows for acute management of the day that does not go so well. This is how gratitude became an aid for harmony in my professional career.
Leave a Reply
You must be logged in to post a comment.