The lines are down

It's been a rough week and like all rough weeks, there's always a lesson to be learnt (the gold in the rough, so to speak). And I've learnt the value of relationships and communication.

Etched into my memory is one otherwise uneventful night during my undergraduate years. I found myself at a medical careers information evening. The stories were heart-racing. These doctors had been all over the world treating people. They had been the barrier between a patient and an otherwise imminent death. After all the excitement, the speaker said something I've never been able to forget. "As hard as your work day may be, you aren't the one who will suffer the most for being a doctor. It is your family who will bear the brunt of your absence. Your partner will leave cold dinners in the microwave, your kids will be disappointed when an emergency pulls you away from the school concert. Your patients will always come first." The air in the room grew heavier.

This week, I was sitting at work, pondering my career goals and the enormity of my dreams and the long-road to make them a reality. I remembered, sitting in our sauna-like office space, that the person to blame (said in the most thankful way possible) for my love of surgery is now a surgical boss working the dream. Surprisingly, he got back to my message in the same afternoon. After the pleasantries of how life is going, he asked me something that struck a chord. "Are you still writing?" he asked, "because you write beautifully." A surprising message to receive but then it was this boss of mine who snuck a creative piece into the departmental newsletter and who guided me through choosing elective placements and hospitals to select for my internship. It was at that hospital I received multiple scholarships that have reenforced my love for surgery. "Let me know," he said, "where you end up." And I realised that though we used to talk every few months, it had probably been two years since we last made contact.

There are numerous relationships that make up our lives. Our families, our friends, our significant other(s), our work colleagues, fellow hobbyists, commuters on the same journey. We travel through life, our days and our kilometres together. And if we fail to communicate, people get hurt. Sometimes we think we are communicating, but it's really just ineffective talking at each other. On the road, that means car accidents or fried nerves when people swerve in and out of our lane. At work, tensions run high when it's busy and we all forget to be clear in our needs. At home, it can be hard to say what we mean for fear it will hurt someone we care about, or conversely, we use our words to hurt because the people we love most are the most vulnerable to our own pain.

Closed-loop communication is our tried and tested method at work. I'm taking it up as a method of communication in my daily life. At work it goes something like:
Nurse: Mr Smith in Bed 5, who is day 1 after his left hip replacement, currently has a high blood pressure in the yellow zone. I have called for a clinical review. Would you mind seeing the patient and letting me know the plan?
Doctor: Of course, Sister. Is this the man with known severe hypertension? Has he already had his anti-hypertensives?
Nurse: Yes, this is the same man, and yes, he has already had his medications.
... Go see patient ...
Doctor to nurse: I've seen Mr Smith. My plan is the following...
Nurse: Thank you for letting me know, just to make sure, it was to...
It's a pretty basic summary of something that should happen every day on our ward but we all fail miserably in achieving it. We panic and communicate poorly, or we forget to close the loop at the end, or we can't find the person we need to talk to so write in the notes, only for nobody to read them for four hours. And so we all get frustrated at each other because things don't seem to happen. The blame lies with no-one because it lies with all of us and the problem fails to resolve itself. And tensions run higher. Meanwhile, of course, Mr Smith still has that problem with his blood pressure.

Away from work, I've taken to formalising my communications. I'll send a friend a message, "Are you training at the gym tonight? I'll be there at 6:30pm and would love to see you. I'll be training shoulders today." I have this tendency to close the loop with a text at 6:25pm, "running late, see you in ten," and then at 6:35pm, "here, see you soon!" I have no idea if this is wildly frustrating or helpful. My reasoning is simple - I've learnt that the failure of communication is the biggest failure to most relationships. Imagine if my friend was waiting expectantly for me in order to start her training and could have done something productive with those ten minutes? Imagine if it were something more serious than a training session.

Our lives are busy. Our free time is precious. And stress alters our ability to put things in perspective. We start sentences out loud halfway through an internal monologue, leaving our friends perplexed. We send half-messages with the expectation that our loved ones will understand. And sometimes, just sometimes, we start taking our friends for granted. I've been meaning to email my aunts since the new year and still have that sitting in my task list. I meant to call my dad for his birthday a few months ago, but came off nights and forgot the date, falling asleep early in the evening from fatigue. A hand-written letter to my pen pal sat on my desk for so long that I had to write another letter to update her before sending it. As I work, study and train, I know that it is those I care about most who are forced to bend to my schedule.

But those people are the ones who keep me sane. Who cheer me up on the bad days and challenge me intellectually over long chats in the lounge room. It's the warm laughter playing Boulderdash over pizza that make all the stress ebb away. And it doesn't matter if you have 100 friends or ten, as long as there is at least one close friend. I'm lucky. I've got a handful of very close friends. And I realised in this rough week that it's not just that they're there when life gets tough - it's that they're always there. We walk this road to our respective and unknown futures. We walk this road together.

If you value your tribe, your loved ones, make sure you close the loop on your communications. If they send you an open-ended text, reply, even if all you have time to say is, "thanks for the message! Really slammed at work today." If people invite you to their parties, try to go along or at least let them know if you won't be able to make it. And check in to make sure plans are still standing. Sometimes not getting back to you doesn't mean we've forgotten about you - it means we've been swept away by life. It's easy to forget the difference between urgent and important. It's also hard to find the line between life and work when work is 80 hours a week.

When the lines are down, I'll try to pick them up. Because it is the people in our lives that sustain us.

Tips to surviving relationships in residency (Not just romantic relationships!)


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