Letter from the Chair: Wilderness = Wellness

by Taylor Haston, DO, FACEP, MPH, MS, DiMM
Chair, ACEP Wilderness Section

Greetings friends, fellow adventurers, wilderness seekers, colleagues and coworkers. I know it has been a while since our last communication, which was right before our meeting at the Scientific Assembly in Boston this past October. I suspect many of you were not able to be there in-person, and y’all were missed, but I remain hopeful more of us will be able to connect again in-person this October in San Francisco at ACEP22. I sincerely hope everyone is taking care of themselves and finding time to get outside and feel the natural healing that takes place in the great outdoors: from the most austere environments like a quiet trail shared only by a line of marching ants or a foggy mountain top at sunrise to the more comfortable and familiar spots you see nearly every day like your own backyard. Perhaps less exotic, but your backyard is still a very acceptable definition of the great outdoors, whether filled only with lightning bugs and crickets serenading you as the sun sets after a long, chaotic day at work or maybe it’s filled with the laughter and shrills of your kids running around before dinner on a Tuesday night. Bottom line, the wilderness wins, and it probably looks quite different to each of us, all in varying seasons of life and careers. In my opinion, I think that is one of the most unique and fantastic qualities of our section, of what brings us together. I believe we all recognize that even while on varying walks of life, or crisscrossing trails scattered about the mountainside; we all meet at the top at some point. It’s less important if we reach it at the same time, rather more important that sooner or later we will all get to the same place and usually our goals and aspirations are fairly similar. The ‘endpoint’ so to speak might be the summit of that big, majestic mountain with countless trails leading to the top, or maybe it’s back to the campsite, back to the first trailhead, back to the beginning. Keep in mind, it’s not the destination, but the journey… and we are certainly on this journey together.

I hope everyone can relate to that, because at the end of the day, I believe we as the Wilderness Medicine Section of ACEP have very similar goals in our lives and careers; we actually recognize the importance of slowing down a bit and going outside, taking a big deep breath of fresh air and spending some quality time with the queen herself, our beloved Mother Earth. We understood the assignment when they asked: “what is your life fuel? What is your wilderness as wellness?”

I want to share something with all of you. I certainly hope it will resonate with at least one person at minimum, as the whole point of sharing is to hopefully impact and help someone learn from your experiences, whether mistakes or successes. (Plus, only you can decide if your experience was in fact a mistake or a success. Sometimes the best successes come from what we initially might think are huge failures.) I want to give full disclosure here and be very transparent to all of you reading this messy transcription of my thoughts: my peers, colleagues, mentors, mentees, coworkers, friends, role models and those who qualify as family. This has been a difficult season for me. I never thought I’d actually feel burnout. I thought: ‘Nah, that’ll never happen to me, I’m too tough for that; I don’t need as much sleep as ‘they’ do... I mean, I’m always pretty happy and never really have a problem with energy, I can help out my colleagues, I can take on another project, I’m not traveling anywhere right now anyway because of Covid, I don’t have kids, why not?!’ Well, before I knew it, I had taken on far too many projects, I failed to say “no” again and again, and I basically lost sight of what the core of my practice is: helping others. Now, to be clear, I never stopped taking care of others; I always had everyone else’s best interest before my own and my patient care never wavered, at least not intentionally. But, as the truth would have it, (I know y’all already know where this is going, I know, it’s obvious, it’s the car crash you see coming yet continue to keep watching) one cannot take care of anyone else without taking proper care of themselves. Classic. Mistake.

I sat at work one day in early February, staring at the wall, eyes glazed over, feeling absolute overwhelming anxiety and exhaustion, but partially blunted with head-to-toe numbness. I took a sip of coffee, then a sip of energy drink, ate a Sour Patch kid hoping that sweet-but-sour-surge jolting from my parotid glands would suffice and ultimately deliver the ‘kick’ needed for me to get up and see the angry row of patients waiting for me along the halls of the ED. Still moving in a foggy slow-motion, I recognized my aching muscles and almost tricked myself into thinking I had gone on a nice afternoon run with my dogs that day. But I quickly remembered I hadn’t been outside, nor had I run my pups. Rather my muscles were merely aching from lack of sleep. My next thought I was trying to process was how I hadn’t exercised or really been outside in weeks, maybe months, and then I looked at the computer and saw I still had 300+ charts to sign. Almost simultaneously, one of the nurses, likely feeling overwhelmed and anxious herself, snapped at me asking if I was going to see the new patient, a 2-month-old with an oxygen saturation of 80% on room air. As I got up and hurried over to that room, I could feel the angry line of hallway patients staring at me like I had 7 heads; and so, my 16-hour shift began. (Yes, 16 hours. And yes, it was my fault. Yes, I did this to myself. Yes, I agreed to work the extra 6 hours in the Peds ED before my regular overnight Adult ED shift, because well, they needed help… we were busy and it’s the 47th wave of Covid. I thought, ‘I can help, I should help, I’m not doing anything else, I can’t say no, it was my12th consecutive shift, most of which were 16 hours, but by now I was already on a schedule, it was fine, it was like a normal day…’) Well, a few lessons to take away here. #1. You can actually say no. #2. You cannot take care of anyone if you are not taking care of yourself. #3. It might have actually been better to have 7 heads that night.

Sometime that next day, I got out my phone and pulled up my trusty Google search page. Yes, I’m here to admit, I actually googled “BURNOUT.” (‘Who even does that?’ I thought…) The Oxford Dictionary describes the verb as: ‘ruining one's health or becoming completely exhausted through overwork.’ Merriam-Webster says it means: ‘to cause to fail, wear out, or become exhausted especially from overwork or overuse.’ (They weren’t wrong.) Then I proceeded to look up “what are the signs of burnout” and here’s what I found: sense of failure, apathy, feelings of defeat, detachment, loneliness, loss of motivation, anxiety, increasingly negative outlook, and decreased satisfaction and sense of accomplishment. I looked up about 8 more sources, read them all and then realized I checked all the boxes. I could barely believe it. How did this happen to me? How had I gotten so behind on so many things? How did I end up with so many things on my ‘To Do’ list that just looking at it made me feel nearly paralyzed? And even more astounding, was how had I managed to literally cut out the parts of my career and day-to-day life that provided me joy, professional fulfillment, and rejuvenation?

What kind of Wilderness Medicine Section Chair and self-proclaimed ‘Ambassador-of-all-things-Wilderness-and-Wellness’ gets lost in this mess and gets it all wrong? I did. Embarrassing? Yes. Absolutely. I must admit, we embody and educate others about the importance of this very principle all the time. We scream it from the mountaintops and speak to our so-called ‘expertise’ of the wilderness and innate respect for the great outdoors and all things nature. Our relationship with nature, speaks not only to our view of medicine in general, but also paints a picture of our scope in the world of wilderness and austere medicine. Why are we even needed as resources to help educate, protect, serve, support, and potentially provide medical care in the first place?

Talk about full circle, right?

It would be easy to blame it all on Covid, sure, it’s a global pandemic, right? But we all know that’s a cop out at the end of the day. Covid certainly played a role, no doubt, but it was my mistake to ignore my physical, mental and emotional health. We must have accountability. At the end of the day the only person we can truly blame is ourselves. (And Covid…JK.) It was indeed a huge error to neglect my personal well-being. It was a lapse in judgment to forget about my work-life-balance and the necessity of self-care; to forget about everything I talked about in the last newsletter: about the wilderness and how it wins, how it provides a healthy renewal of our mind, body and soul and keeps us in check and keeps us balanced; how the wilderness and our respect of the great outdoors makes us better clinicians, providers, supporters, colleagues, friends, family members and coworkers. The wilderness undoubtedly makes us better humans, and that’s something this crazy world needs more of right now. There’s no denying that statement. So yes, I wasn’t wrong last year when I said ‘the wilderness wins;’ because indeed it does.

We are a profession. We are a community. We are resilient. Tough. Strong.
We are coworkers. Friends. Mentors and Mentees. We are family and we are heroes.
We know grit, as well as pain. We know both happy miracles and harsh realities.
We are more alike than we are different. Stubborn. Determined. Hard-working.
And usually, silent.

I’m sure there’s a consensus; it’s hard to feel like your struggles are validated or even worth mentioning when your profession forces you to be acutely aware of other people’s struggles, your patients and their family members for example, which you feel are obviously far worse than your problems. However, sometimes, more frequent than not, it is in the silent moments we are struggling. And oftentimes we never utter a word about it. Let’s change that. Normalize the conversation. Recognize that more people than you probably realize are struggling in the same ways you are, also feeling burnt out and empty.

I want us, not only as a profession, but as a section – the ACEP Wilderness Medicine Section – to recognize that more than likely, based on statistics alone, one of your coworkers, neighbors, boss or friends, is burned out and struggling silently and alone. Normalize asking for help or reaching out. Communicate, be present, listen, and invite them on the hike again, even though you already asked 12 times; because that next time might be the perfect nudge that they need to start digging themselves out of burnout and regaining balance in their life. When I realized the depth of my personal burnout, I worked to reprioritize my life and regain that highly sought-after work-life-balance. I had to reach out to people and admit my faults, and you would be surprised by how many people mirrored what I was going through in their own lives. I was truly astounded. Easily >95% of everyone wrote back or responded by sharing what they went through recently, or their burnout story; what happened to them and how awful it was. I couldn’t believe that all of these people had been quietly struggling, while things seemed perfect and status quo on the outside. This was a big eye-opener for me and further proves that we really are all fighting secret battles that most people know nothing about, and there is a strong chance that the person to your left, and to your right, are struggling too. I hope that we can truly lean on each other, our members, our very own Wilderness Medicine Section, to lead by example in a movement to normalize our common struggles and improve mental, physical and emotional health through the wilderness. After all, it’s the great outdoors, Mother Nature herself; I think that’s the piece of magic that can ultimately lead us all back to a healthy work-life-balance.

The Wilderness; our life fuel, our therapy. The Wellness of our community; our profession, of each other. How does wilderness look to you? What about wellness? What do they feel like? Can you touch them? Smell them? Is it just a feeling? An experience? Is it a routine? What about a conversation? A place?
Are they similar?

Remember, we are surrounded by the tiny details and inexplicable miracles in the sky; the mountains and oceans and the landscapes that leave us in awe and keep us connected. This is the wilderness. These feelings and experiences are our life fuel. They pick us up and keep us going, they ground us, they keep us feeling as ‘normal’ as possible during very abnormal times. They keep us childlike in the best way, they pique our curiosities and help connect us with others as well rediscovering ourselves. The wilderness gives us hope, strength, common ground, and a reason to keep fighting through the hard shifts; it ultimately brings us back ‘home.’ This is how our movement will create positive change and become palpable throughout our organization and our profession. It’s really quite simple: 1) wellness equals happiness, 2) the wilderness equals wellness, 3) and happiness is contagious, the end.

I challenge each of you to be leaders in our profession of emergency medicine, as well as our awesome Wilderness Medicine section. Continue to show our colleagues why the wilderness is important and how it directly correlates to wellness. Be brave and unwavering in this movement to turn the tables and help each other rediscover and remember why they became EM physicians; to help improve our workplace happiness, our mental and physical health, our awareness of and communication with each other, and to be the best we can be professionally, as well as personally. Most importantly, to be happy.
Share the secrets of the wilderness with others. Work on conservation in the small daily habits. Take someone on an adventure. Show others why the wilderness is magic, why wellness is necessary, and why at the end of the day, this is what it boils down to: Wilderness = Wellness.

So, what is your wilderness as wellness?

Tell us a story. Draw us a picture. Sing us a song. We want to hear about it. Maybe your wilderness as wellness will impact someone else.

Stay safe out there, please email or post in EngagED if you have any ideas or thoughts to share, we all want to hear! Our sincerest thoughts go out to our friends and colleagues in Ukraine, and in other parts of the world facing unimaginable challenges and struggles. We hold tight to hope, to a future of peace, happiness, laughter and wellness as 2022 progresses. Here’s to doing the very best we can in a sometimes-challenging world, remembering to stay humble and kind, normalizing asking for help, checking in on each other, maintaining awareness, talking less and listening more, showing respect and understanding silence does not always equal strength. Be vigilant of your mental health, take a deep breath, move your body, take another deep breath, compliment a coworker, call a friend, hug your family (human or animal) and go outside. Experience nature. Be curious. And while we’re at it, go ahead and take another deep breath, it’s good for you, I promise. Be responsible and prepared. Make good choices. Laugh. Cry if you need to, but then, please, laugh again. Lead by example and try to remember that we are all more similar than we are different: mostly stubborn, struggling at times and steadfast at others, maybe strong, maybe silly, sometimes sad, sometimes stoic – and if we are silent, take heed, because perhaps that means we need a subtle nod or a gentle nudge to show us someone cares and we aren’t alone, maybe we need more support. Remember to get outside. Seek out that life fuel, seek out your wilderness, look for the ‘spark’ and continue to fight for it because that’s what keeps us going, that’s what provides our wellness.

Thank you for everything you do to keep the world in motion, conserving and protecting the great outdoors, and providing more opportunities to find our wilderness as wellness.

#wildernessaswellness
#whatisyourwildernessaswellness
#lifefuel
#liveyourlifefuel
#acepwildernessmedicinesection
#acepwildernesssection
#acep22

Cheers,
Taylor