The Art of Medicine
Resilience: 1. the power or ability to return to the original form, position, etc., after being bent, compressed, or stretched; elasticity. 2. ability to recover readily from illness, depression, adversity, or the like; buoyancy.
Resilience. The high-profile buzzword comes up frequently in and around the practice of medicine. Workplace leadership encourages “resiliency skills” to help battle burnout brought on by increasing patient volumes, metrics, and documentation requirements combined with decreasing autonomy. Last year, my employer even provided every employee with a book titled Type R: Transformative Resilience for Thriving in a Turbulent World.
Resilience is beneficial when bad things happen to good people. Flexibility allows patients and families to find a way forward when a biopsy reveals cancer. The young man with the golf ball-sized submandibular lymph node, night sweats, and weight loss. The woman who ignored a pea-sized palpable nodule in her breast until it became a hard, fungating mass that ulcerated through her skin. The former smoker who kept clearing his throat for his dry cough and lost more than 20 lbs. Each of these people was surprised to find that he or she had cancer, and each reacted differently to the news. Anxiety. Denial. Anger. Depression. Equanimity. I wonder how much of the response is determined by innate personality traits versus intentional, intellectual choice. Is resilience inborn or a learned skill?
When I think of resilience when facing cancer, I think of Allison. Her course of treatment for her early-stage breast cancer was especially challenging. Although she was a candidate for breast conservation, she elected bilateral mastectomies with reconstruction. After she healed from surgery, chemotherapy was initiated. She completed a few cycles of treatment before the contralateral reconstructed breast became red and hot, and she spiked a fever. She was admitted for infection of the tissue expander that required surgical explantation and IV antibiotics. Sepsis developed, and she was transferred to ICU before the infection was controlled. She was discharged and completed antibiotic therapy as an outpatient. We resumed chemotherapy some time later, but she experienced a hypersensitivity reaction that began as a mild skin rash and then worsened with each chemo cycle in spite of increased premedication and dose reduction. We ultimately switched to an alternate drug that she tolerated well. At the office visit before one of her last chemo treatments, she complained in an off-hand way of calf pain that started after her daily walk. We ordered a Doppler, which of course revealed a deep vein thrombosis. We initiated anticoagulation with enoxaparin sodium.
In spite of this relentless series of setbacks, Allison and her sister greeted us cheerfully at every visit. Many cancer patients get stuck in a cycle of despair, ruminating, “Why?” But when I asked Allison how she maintained her indelibly upbeat attitude, she simply laughed. “I'm like a cork: I just keep popping up!”
Patients like Allison have much to teach about resilience. The past months have been personally challenging for me as I found myself treading a rocky path I never expected to travel. Through a long, bleak, wet winter, I dreaded my alarm on many mornings, but my patients and my work gave me purpose and a reason to get up on time. When I railed against the unfairness of my situation, I reminded myself of the undeserved diagnoses of the people in my care. None of us would have chosen the course before us. Some cancer patients express gratitude for this disease that gives them clarity about life's priorities. I don't have a cancer diagnosis, and I am not yet thankful for my circumstance, but I recognize that my position could be much worse. My new reality has become the impetus for me to try and be and do things that I never thought I could or would.
I continue my own resilience practice. I cannot change my situation, but I can control my response to it. I stopped struggling against the reality and instead chose to sit quietly with the sadness to move beyond it toward acceptance. I find solace in nature and the endorphins released by physical activity. I concentrate on the cool breath of a damp early spring breeze that gently lifts the hair from the nape of my neck and the deafening rush of a waterfall as the sun toasts my skin at the end of a mountain hike. I practice gratitude and mindfulness and hope that this focus on my breath and on appreciating the present reshapes my brain in positive ways. The obstacles I face are small compared with those before my patients, but the lessons in resilience my patients teach are great, and they guide me to my future.