The Body Keeps the Call

Bottom Line:

• In-house call present an opportunity for learning about myself.
  
• Two powerful concepts help me make sense of its impact:
  

1. The Brain as a Prediction Machine – It constantly anticipates what will happen next based on past experiences—sometimes creating a distorted, subjective reality if left unchecked.
   
2. We Are Not Mind and Body; We’re a Mind-Body – The idea that mind and body are separate is a false dichotomy; they are deeply interconnected and influence each other in every moment. 

A Saturday 24:

Call takes a toll. Perhaps one day I'll tell some of the stories from the days and nights I've spent doing my best to keep people safe inside hospital walls, but suffice it to say that beyond the clinical challenges, being "in-house call" has been a personal training and battleground for me. It pushes me in ways I never would have imagined being pushed. And it's how I frame and reflect on this challenge that leads me to either learn from it and grow OR allow unconscious forces to cause compensation, poor habits, and being pushed off what the stillness inside me knows is the path I'm meant to travel. It is simply a stimulus. A major, major stimulus. Just like lifting a heavy load in the gym. If I can learn to have some body awareness and lift the load with good form, there's the possibility of strength gains. But poor form, inadequate recovery, or ignorance manifest in many other forms has the potential to cause real damage.

This past Sunday, I got home after a long in-house 24-hour shift and felt so excited and so good despite minimal sleep. I was home! I was with my people again! As the day wore on, I began to feel more and more like a clenched fist. I could vaguely feel the haze of wanting and control distorting my perception, but on that day, I couldn't see it clearly. Reflecting now, I see how I wanted it to be a perfect weekend day with fun and good behavior. I wanted to make up for my being away from the three people I loved the most by showing them in every moment how much they meant to me. I didn't want to see any signs that my being away for a full day, after what was already a busy week, had any negative impact on my two boys' growth and development. Not surprisingly, I became more reactive and less fun as the day wore on. I tried to get my youngest son, who was fighting a cold, to sleep during quiet time by lying with him. But the little goober wouldn't sleep, so neither did I. After nearly an hour of trying to control the uncontrollable, I left his room frustrated. I went and got some exercise. But there was little that was healthy about my approach as it was just a habitual response and attempt to cover up the exhaustion I didn't want to allow myself to feel.

The day was a series of such blunders and weird internal narratives. It was only after some sleep and slow recovery that occurred over the course of a couple days that I was able to reflect with much clarity on what had happened.

I learned a lot from this last weekend. I've learned so much from the countless call shifts I've taken over the past 13 years. I wish I was a skilled enough thinker and writer to sum it all up succinctly, but I'm not to that point yet. So what I hope to do today is really pretty selfish. I want to help myself remember the absolute importance for me to not forget how two concepts I've learned a lot about over the past couple of years can help me understand the potential impact call has on me and act in a more skillful way while both on call and post-call. I hope that you might find some personal application for the concepts I discuss as well, as I believe they are quite powerful and have wide-ranging applications in their ability to help us reinterpret ours and others' behavior in an interesting way.

Concept 1: The Brain as a Predicting Machine

I was first introduced to this idea in Seven and a Half Lessons About the Brain by Lisa Feldman Barrett. The basic idea is that the brain's primary job is not to react to the world, but to predict what is likely to happen next based on past experiences. This idea is rooted in neuroscience theories of predictive coding or predictive processing. The way I remember her explaining it was that your brain issues predictions and checks them against the sense data coming from the world and your body. If your brain has predicted well, then your neurons are already firing in a pattern that matches the incoming sense data. That means this sense data itself has no further use beyond confirming your brain's predictions. By predicting, instead of going through the process of collecting the sensory data first and then reacting, you act with greater efficiency. But you see the potential downside, right? When your predicting brain is right, it creates your reality. When it's wrong, it still creates your reality. Yikes! It might seem like we all sense first and then act. But neuroscience is showing that sensing actually comes second.

How does this apply to being on call? What I believe my brain starts to do is predict that I always have to be doing something. Rest is not an option. Whether it's my conscious decision to make sure I'm prepared for the next case by doing a good chart review, talking with the team about the plan, and setting us up for success in any other myriad of ways OR it's unconscious and involves being woken up multiple times to go take care of women who are screaming in pain or emergent cases in the operating room, the result is the same... my brain is always predicting that there's more to be done and I have to just keep on going. The story my brain tells is that deep rest or relaxation do not serve me on call. Sadly, what I believe I'm beginning to realize happens is that I bring this same call-brain home with me, and even when what I most need is rest, the very subjective reality my brain creates for me is one of invented reasons to always do more.

Concept 2: The False Dichotomy of Mind and Body (i.e., we're not mind and body; we're a mind-body)

All that we are, it all works together. What we think of as separate, perhaps we just don't understand fully, yet. To get at this, let's use the analogy of our minds and bodies being like the software and hardware of a computer, but with a twist. What my understanding is evolving towards based on the science and my own experience is that the software reprograms the hardware, and the hardware shapes the software. Just think about the way that feelings have physical signatures, the way trauma and chronic stress are often best treated with somatic modalities, or simply the way that anyone with any semblance of self-awareness has experienced the way that movement (walking, swimming, dancing, whatever) has the power to change our mood and thoughts.

This is a fascinating topic to me, and I love the work of folks like Drs. Dan Siegel and Antonio Damasio among many, many others on the topic. But how does it apply to call or perhaps to all of us out there who are trying to take care of our kids, patients, or others in need? The following are a couple key nuggets I hope to bring with me and retain greater awareness of going forward:

• If I'm not taking care of the physical inputs, like sleep, I can't just will myself to have a positive outlook (i.e., have complete control of my own mental game). I'm not going to use the lack of sleep or whatever other physical input I might have neglected as an excuse to be a grumpy parent. But I won't have unrealistic expectations for myself and hold on to a bunch of "shoulds" regarding how I feel. I'll know that I just am where I am based on the decisions I made to address or ignore my body.  Resisting reality is energetically costly, so I think this nugget may help me accept where I am a little quicker and perhaps enjoy some greater energy.
• Hopefully, I'll learn more and more to let my mind rest even amidst the chaos of being on call. This is training. I can do this in so many ways. The big ones that jump out are: 1) to not add to the challenge by demanding more of myself on stressful shifts than what is being asked, and 2) to come back to my body as a place to find my own groundedness even when my mind feels like it's being pulled in multiple directions.
• In the ways listed above, I hope to build healthy resilience and increase the distress tolerance window in which my mind-body functions effectively.

Alright, that's what I got for you today. If nothing I tried to put to words landed for you, my apologies. I ain't got the prettiest words, but I know someone who does... the poet David Whyte. Here is a link to his Substack with an excerpt from a poem that captures Concept 2 very well: https://davidwhyte.substack.com/p/body. I highly recommend his books of poetry and essays.