Stop Triaging Your Life
I first learned about the art of triage watching MASH with my parents growing up.
I also learned about the critical timing of one-liners. Both followed me into a career in pediatric orthopedic surgery, which I practiced for 21 years. Triage is a process to assess the relative conditions of patients and prioritize treatment accordingly. This rations finite resources like operating room or surgeon availability based on patient need.
In medical school and residency, there was actual training in triage. Sometimes this teaching was formal, but more often it was the informal decision-making of what needed to be taken care of next.
After training, triage became the natural way of approaching all things medical, not just the patient in an obviously emergent situation. Do I need to interrupt this patient’s visit for a phone call from the ED? Is the patient in the ED more emergent than my clinic? Which of these patients in the ER has to go to the OR first?
But without realizing it, I started applying triage thinking to my life.
Is this errand urgent? Does this bill have to be paid today? What housework has to be done today? What can wait, what can’t.
I started to “conserve energy” in my everyday life, just as I’d do when on call, gradually decreasing my activity to what “has to be done”.
Clutter built up and was left, as it wasn’t urgent. Bills got paid, sometimes late. Errands got done, but frequently to save my energy or be available to the ER, patients, colleagues, they didn’t get done in what I might call a timely fashion.
And then I applied it to my free time. Packing for vacation was always rushed and last minute. Dinner was picked up from take-out on the way home. Did I have time to exercise? Could I go on a walk when I might get paged? Did I have the energy to reach out to friends or make plans to get together? Or with family?
Gradually this triage habit resulted in my life shrinking into shallow times of survivor mode, familiar to anyone who has done a surgical residency:
get up, go to work, come home, eat, sleep. I lived months of my life like this, holding out for the happy release of vacation, where I would finally let myself be, enjoy, experience.
The times when my “to do” list was left at home and forgotten about. But all too soon, the vacation would be over and I’d fall back into my home habits.
I didn’t even really notice this pattern until I realized I was triaging my own health.
At a conference 6 years ago I bent down and twisted to place something on the bedside table. As I did so, I heard and felt a “ckckckckckckct” in my right knee. Meniscal tear, I thought. As the knee pain started and it swelled over the next 24 hours, the diagnosis was confirmed. I wasn’t too worried. I knew what it was. Over a few months, the pain and swelling receded. Oh, it’s healed, I thought. But the pain and swelling, along with a new symptom, catching, would periodically recur. Ok, I thought, it’s not healing. I will have to take care of that at some point.
But since I could still function, I triaged it to the back burner.
Until I could not walk without pain. Until my knee was swollen all the time. Until my MRI, which I’m sorry I looked at, showed severe arthritis.
While the knee was periodically bothering me more, I started to have severe pain and swelling in my right thumb. My dominant thumb. Again, I became my own doctor, triaged the thumb to not-urgent, felt I knew what was going on as it would swell and the joint seemed mildly unstable.
But still, I could work. Not urgent. Triaged as I kept working.
By the time I sought the expertise of a hand surgeon, there too was arthritis, requiring a fusion. By the time I got the fusion, other joints in my right hand and now left thumb were aching from overuse. Finally, urgent and unavoidable, I had to stop practicing due to arthritis affecting multiple joints in my hands.
It was no longer possible to ignore my own needs and keep going as I had for years.
The physical limitations made it impossible to continue to practice medicine. I finally paid attention to what my body needed, seeking medical care but also resting more than I was used to each day. If my body felt tired, I took a nap. I let go of the mental stress associated with working and relaxed into just being each day. I started doing things like reading for pleasure and education. I traveled with friends and made new connections. I immersed myself in being the patient, the person, not the doctor. I changed my diet. I started meditating. I took time each day to feel gratitude for the simple moments of living a life without the pressure of “should,” “must,” “have to”.
After this period of resting and being, I started to wonder about being active again in the world. Ten years previously, I had taken a life coach training and that role started to interest me again. The training had given me a new perspective and many tools that allowed me to recommit to my career at the time. Even as a doctor I had always thought of myself as a facilitator of healing and now I could facilitate a different type of healing. I could find a new way to relieve suffering. Letting my life evolve in response to its changes. And finding a different place in the world.
Triage has its time and place. It is an extremely useful mindset when needed. But like the Emergency Room has its place in the hospital, it is not the whole hospital and triage can’t make a life whole.
Stop triaging your life. First, recognize when you’re in triage mode. Then become present. Ask yourself “how does my body feel”? If you don’t know, that’s an indication you need this. Start with your big toe. Can you feel the floor or your shoe? Try meditation or a gratitude practice. Start with just 5 minutes a day if you need to.
Take a walk in nature. Do something you enjoy and invest yourself in it fully by not doing anything else at the same time. Revisit old hobbies where time loses meaning. Maintain or strengthen your social connections. Make time for the people and things that make life most enjoyable to you, ideally every day.
Make your whole life a priority.