65. Bouncing Back After a Tough Case

• Perhaps you made an error. Maybe not. Either way, it creates a sea of guilt, shame, and embarrassment. It rocks you to your core. You become more susceptible to catastrophic types of thoughts, such as “I should never have gone into this field.” Some will respond by adjusting their behavior, striving to feel safe by avoiding these situations or similar cases.

• Revisit your purpose and find an anchor point to shift yourself back. Why are you practicing emergency medicine?

You need something to anchor to that’s stronger than your fear of failing and that’s stronger than the pain you’re experiencing from not performing up to your expectations.

• Having a bad outcome is integral to the practice of medicine. Expect it to happen. Consider in advance how you might react emotionally to a bad outcome. And then come up with a process to navigate yourself through those choppy waters, so you can continue to perform during the remainder of your shift.

• There are different paths that people take after a bad event. Some will become an expert in the area where they had a failure. For others, it will become an albatross that never leaves. Many find ways to utilize these difficult outcomes and turn it into something positive, such as learning how to stay in the moment, avoiding complacency, or perfecting technical skills.

What is the voice that would speak to you, to temporarily shift your attention away from your own heightened emotions and negative thoughts about what just occurred and towards some semblance of being more present-focused?

• We have to find a mechanism to process the experience, draw lessons from it, forgive ourselves, and move forward with a sense of hope. On the other side of forgiveness is the full presence, trust, and confidence that we need going forward to ensure that the next person has the very best that we’re capable of giving. Should we encounter the same situation saddled with fear, guilt, and uncertainty, this extra distraction will have a negative impact.
• You must take steps to earn the right to forgive yourself. Do not deny or repress the emotional reaction to the experience. Allow the emotions to come up and don’t judge them. As you continue to process the experience, the emotional intensity will drop, and it is at this point that you can begin to consider the deeper intellectual processing of what happened.

It is important to forgive yourself, because suffering incessantly will not serve your next patients to the fullest of your ability. Lingering doubt and fear will manifest as hesitancy or heightened emotion.

• Every experience has the potential to make us better or worse, depending on what we do with it. Ask yourself, “What do I need to do differently in the same situation next time? And who can help me? Or how do I help myself?”

• Since the first reaction is primarily emotional, what is needed is empathy, understanding, and support. You are not yet ready for logic, reason, or a cognitive approach to what you should’ve done differently.

Don’t repress the aftermath. What someone needs in the immediate aftermath is emotional support to at least begin to create a tiny bit of space to step into that next moment with as much of your full capacity back that you can muster.

• Bouncing back implies that you’re back at your original place. The goal should be to get to a place that is elevated from where you started.
• If we earn the right to forgive ourselves, adapt to the experience, move forward, and make space for this thing in our life that we cannot undo, these adverse outcomes can become something that propels us to a higher level of performance.
• When processing a bad outcome, one can draw comfort from the notion that there is purpose in it.

Deep down in the grand scheme of it, you will be able to re-engage because there’s reason enough to do so that’s stronger than how this feels. Knowing that is what frees one to keep battling, to keep persevering and going forward.

• Early on, your emotion is still high, you’re still experiencing doubt, and you only hear negative self-talk.
• Share what happened and how you’re feeling with your team. Draw strength from the people around you. Allow them to support you and to look out for you.
• Have a mantra that you say as you step back into work. Tell yourself that in spite of your emotions, your patients, team and students command and deserve your full attention. Your mantra should be about inspiration, duty, and calling.

Ignite a bit of emotion that is equal and opposite to your shame, guilt and fear.

• When you have an effective process, you no longer have to have fear. You have peace of mind knowing exactly how you’ll proceed in the event that something bad happens.