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War Stories
Like a lot of people, I spent time online during the pandemic-induced isolation looking at things I probably would not have otherwise heeded. One of the more memorable was a lecture by Prof. Marshall Duke of Emory University, who presented a talk on his studies of resilience in childhood. I found a good summary of his work online. 1 “Two decades ago, researcher Dr. Marshall Duke asked children a set of questions to help explore the role of story and ritual in U.S. families. His questions centered around family stories such as, “Do you know where your grandparents grew up? Do you know the story of your birth?” Far from just an interesting pop quiz on family history, his team of researchers found that the capacity of children to answer these questions predicted the children’s sense of control over their lives, self-esteem, resilience, and their belief in the strength of their own families. Dr. Duke went on to explain that when we chronicle the stories of our family, we build resilience and give children and teens both a strong identity and a sense that they belong to something greater than themselves. In his research, Dr. Duke identified a type of family storytelling that is especially helpful for building resilience and called it the “oscillating narrative.” As opposed to stories that detail straight paths towards either victory or destruction, oscillating stories are full of ups and downs, complications, accomplishments, growth, setbacks and strengths. Oscillating stories might be complicated but they don’t lack focus. They have one important thing in common – they consistently communicate to kids that though our family has had ups and downs, we have unique strengths and we stick together.” I had the good fortune to grow up in a family that told stories, often repeated by different members of the family, and some written down in various forms, so I had never really thought about what that might have contributed to my worldview. As I have pondered the question in the past couple of years since hearing the lecture, though, it occurs to me that our lack of storytelling as adults might also be a problem. Many of the medical organizations I belong to have emphasized physician “wellness” in various ways. While each organization has its own motivation and approach, most seem to incorporate various forms of didactic training to improve the individual’s ability to cope with the stresses of medical practice. I have not seen reliable data about any program’s effectiveness, but the continued findings of widespread burnout on surveys suggest we aren’t denting the problem much. One key question is—are the stressors leading to burnout new or old ones, perhaps intensified by the way medical practice has changed? If they are a mix of old and new stressors, which is my considered opinion, what did we do in the “olden days” that made burnout less of an issue? Or was it really just less talked about, not less prevalent? I was in a conversation recently when the topic of physicians killed in one-car accidents, came up. I am personally aware of at least two instances where there is reason to 1 Walsh, Erin. Building Resilience: Your Family Stories Matter. 2 April 2020. https://sparkandstitchinstitute.com/building-resilience-family-stories/ 2 September 2024. consider the “accident” was really suicide, and am aware of at least two other instances of overt suicide. Interestingly, none of these four instances were brought up in the conversation, and I did not contribute “my cases” to the discussion. Suicide is clearly the most extreme form of burnout, by I also know of more than a dozen instances where problems of substance abuse was a manifestation of burnout. Fortunately, we have an organized program with a track record of success in helping physicians with these issues. But as I think about what has changed and what might help, it occurs to me that we don’t tell “war stories” the way we used to. When I was young, doctors often congregated in the lounge or dining room and socialized some. True, most of the conversations were about sports, the weather, or other commonplace topics, but it was not unusual for someone to share a current or previous war story about a problem patient or a difficult family. Solutions were rarely offered, but one war story almost always led to one or two more in a similar vein. In retrospect, I now wonder if we weren’t building resilience in each other just as Dr. Duke found in the children he was studying. My father, a career Army officer and combat veteran, often said he did not like to share his war stories, because someone else always had it much worse. But he did, in his own way, tell war stories, as did most of the people he associated with. So, the war story is a way of processing a negative experience. Sharing war stories is a way of letting people know they are not alone. But war stories don’t need to be about war. I was recently visiting with friends who are educators, one of whom just retired. She was telling a story about one of the last essays she graded, which filled her with hope for that student, but this was in the context of a general dismay about the changes in teaching during her career. This prompted the sharing of at least two more “war stories” from two other educators, validating the feelings of the first one. Finally, I had a conversation the other day with a nurse I had known at the hospital. He is now approaching retirement, and commented, as is common, about “things going to the dogs.” But as he got specific about things he missed about the “olden days” he listed the prolonged on-the-job training, which was locally called an internship, that he received when he first started his nursing career. This lasted a year, during which time he had ready access to seasoned, experienced nurses, who were expected to teach him how to actually do the things he had been taught in school. He noted the cadre to re-start a program like this was gone, just as he had left the hospital for the outpatient department. The informal conversations, the war stories, then, may be just as important as formal training for building resilience. Could one solution to our malaise be having lunch together? It may seem simple, but as the examples cited suggest, not simple-minded. As Walsh noted: “Remember, research tells us that reminiscing about the everyday details of our family histories and narrating current events helps bind us together. It offers protection and builds resilience to get through this challenge and many more to come.” What is true for birth families is likely true for work families, too. December 16, 2024 |
Further Reading
Advisory Report on Burnout, part 1 Health care worker burnout has become so prevalent, the US Surgeon General has issued an Advisory Report on immediate steps needed. Ensuring Resilience Unintentional injuries during hospitalization have reverted during the pandemic to levels not seen in years. Authors from CMS and CDC opine about what should be done about it. Individual Resilience Fear is a normal response to threat, but how do some people develop resilience in the face of it? On Resilience Regret Regret is a universal emotion. Although we try, avoiding regret is not possible, and our desire to do so creates costs to everyone. The Stress Continuum The stress continuum was developed by the military, but is applicable to all healthcare organizations. |