“I feel too dizzy when I try to sit up,” my patient told me after major surgery.
“It’s okay,” I said, “let’s try again in a few hours.
Based on my review, I was not worried about a lingering problem or complication in the patient’s recovery. I felt the patient was already going in the right direction and just needed a little more time.
People recover at their own pace. Often the patient knows better what to do. Some people feel ready to get out of bed and go for a walk in a day or two after surgery, but others don’t. And as providers, it is our duty to understand and respect these individual differences.
This is why many of our prescriptions say:
Increase the dose of this medication as tolerated.
Advance the patient’s diet as tolerated.
Wean off the dose of pain medication as tolerated.
These words recognize the fluid nature of when our body is ready to move forward. The pace should be productive and stimulating, but never overwhelming.
Every provider has seen what can happen when we are not aware of what the body is ready to do.
Give someone too much food before they are ready to eat, the patient may get sick and vomit. Restart home doses of high blood pressure medication too quickly while they are still healing, the patient will feel faint, dizzy, and potentially weak.
If we push patients towards their goals too quickly, these failures often end up slowing them down even further, or sometimes causing terrible, preventable complications.
But despite our patients’ understanding, I wonder if we as providers allow the same degree of flexibility in our own work.
Instead of thinking about the optimal rate at which I can move my career forward, my approach has always been to take responsibility from the start and make it work one way or another. While I know how far I push my patients and the fine line between progress and harm, when was the last time I thought about my own work-life balance in these same terms?
I rarely think or wonder if I’m ready to add more projects to my plate. Instead, I tell myself that I’ll know when I’m approaching a breaking point.
We need to be aware of the stress and the workload that we put on ourselves. Simply applying more grain to run at a level of 110, when the optimal rate is 90, is not sustainable.
By caring for patients, we know people are at their best when progress comes in moderation. In some ways, we need to extend the same view to our own lives. Recovery and growth are two different sides of the same coin.
Advance as tolerated. Increase the dose as tolerated. Sometimes in our rapid growth we all need a little extra time.
Jason Han is a cardiac surgery resident at a Philadelphia hospital.