Four clicks. That’s all it took. Four additional clicks were added to the process of putting in a post-op order after surgery, arriving without any warning or explanation. Eleven seconds of additional work on top of the tripling of the time taken to complete paperwork my way out of the operating room, necessitated by the advent of EMR. That’s all it took. Why? Why did we have to add this duplication of stuff that was already accounted for? Four clicks, and I was literally enraged.
Four additional clicks pretty much define the “micro” in “microstress.”
All of my reserves were depleted. There was no room for, well, anything else. I like to think of myself as possessing three distinct, finite “spaces” that encompass my daily lived experience. Time space is easy: how many minutes I have over the course of my waking day to accomplish whatever it is that I need or want to accomplish. Brain space is a little more complex: the amount of “carrying capacity” I have in my brain for the combination of accessible information storage and “computational” power to apply to the memory I am carrying in my RAM, so to speak. Lastly is emotional space, the most complex of them all. This describes where I am on the proverbial “happy <-> sad” scale, my emotional resilience (how likely I am to be able to withstand negative events or vibes), and my emotional carrying capacity or empathy.
In my mind, I see these three spaces as buckets, each a particular size at any given moment, and each filled to a level that corresponds to whatever state I find myself in and the world around me. Time space is mostly fixed; my bucket can never hold more than 24 hours’ worth of minutes. I only get to determine how many of them I’ll be awake to use. Both brain space and emotional space are more elastic. Some days, it seems like I can bring up any fact or notion I’ve ever acquired and then work effectively to carry out whatever task I’ve been presented. The brain space bucket just seems a bit bigger sometimes. So, too, the emotional space bucket. There are days when I am just feeling on top of the world. I’m happy and happy to spread my joy. I can withstand the emotional currents, both internal and external, that buffet each of us as we sail along. My emotional space bucket is as big as a swimming pool on days like this. On others, it is quite the opposite; each tiny bit of negativity goes into a bucket that shrinks with every passing minute.
Until four additional clicks, four tiny drops cause one or two or all three of my buckets to overflow.
That’s when stuff gets dicey, when the buckets overflow. It’s rather rare that you wake up with huge buckets, with all of your spaces sitting there and all kinds of volume available like so much space on a hard drive, and something comes along that floods them, producing what we might call “acute stress.” Chronic stress is what brings most of us down. The accumulation of tiny microtraumas, little moments of tension, discord, or anxiety over time. A continuous flow of tiny drops filling up your buckets.
My mom isn’t doing all that well in her retirement facility, a situation that produces a chronic drip that fills all three of my buckets. A kind of background stress. I barely know it’s there most of the time, but that’s a part of why stuff like that is so insidious and therefore dangerous. Unlike the tsunami that will ensue when Mom eventually passes away, the daily drip, the microstress of having her be unwell slowly fills my buckets and leaves less room for everything else.
We each live our lives in a constant state of filling and emptying our buckets. “Burnout,” the inability to roll with the mundane, occurs when one or all of our buckets are so full that a single additional drop affects us as if it were that tsunami above. My buckets were so full from microtraumas like my mom’s situation that the surprise addition of four clicks after surgery brought me to a place of injury no less hurtful than if I’d gotten there all at once; once there, it doesn’t matter if it was four drops or a veritable shower of challenge or trauma. Either way, you’ve entered the burnout zone. I knew I was close; the “empty space” above the water in my buckets is where patience and empathy live, and I’d been short of both. As it turned out, the surprise addition of four clicks on top of the other clicks it took to complete paperwork my way out of the operating room was at least one drop too many.
Understanding burnout, stress and stressors, and how it affects each of us means understanding that the breaking point is often a tiny drop into a bucket filled to the brim, with no space left above to breathe.
Darrell E. White is an ophthalmologist.