Resilience 3.0 and Refugee Boats

A lot has been said about the “unprecedented” nature of the Covid-19 pandemic and of its impact on health care.

An Emergency Department perspective on Covid however is perhaps a little more nuanced. While the scale of the pandemic was certainly unprecedented for EDs across the world, the scope of Covid-19 wasn’t. Emergency Departments have regularly dealt with and / or prepared for viral outbreaks – influenza, SARS-Cov-1, Ebola among others.

To me, what is truly unprecedented in both scale and scope is the impact of the cyber attack on the HSE. Never before would we have imagined shutting down an entire network of computers across a national health care system.

As we move into week 2 of the shutdown, this is my perception of its effects on departmental energy levels.

Social energies are up. Replacing emails with actual conversations and a sense of coming together in a crisis are boosting connections.

Intellectual energies are recovering. From an initial feeling of “cerebral nakedness” – not having access to patient records, previous reports, test results or online clinical references – to finding work arounds and coming back to good old fashioned clinical medicine.

Physically, people are tired. This is a labor intensive environment – there is no getting around it. For now at least.

Psychological safety has taken a big hit. The timing of the cyber attack – just as Ireland was coming out of a lockdown that stretched since December – could hardly have been worse. National activity is rising, accidents and emergencies are rising in tandem, Covid measures are still in place – all while the ability of the ED to respond to this surge has been dramatically reduced.

Why am I writing about any of this ? Partly to keep my own note of these events. And partly to explore – how should I / do I respond ? Is my inability to gauge the spiritual energy level of the department a reflection of current conditions – or of me ?

Academics and researchers have written much about resilience. Yet for me, what a world wise friend shared this week is what resonates. Resilience is simply surviving. Surviving 15 months on the frontline facing Covid, surviving this cyber attack, surviving what else may come and doing so with spiritual strength. A spiritual strength that comes from remembering – these conditions too are impermanent.

So coming back to the root question of this reflection – what compassionate wise action can my best self bring to this situation ? I am reminded of a story from Thich Nhat Hanh and the answer emerges – presence and solidity.

“When the crowded Vietnamese refugee boats met with storms or pirates, if everyone panicked all would be lost. But if even one person on the boat remained calm and centered, it was enough. It showed the way for everyone to survive.”

WPW – Week 5 RPR

This week’s surprise lesson for me was experiencing how it can be quite stressful to be kind to oneself. Might sound paradoxical, yet this was my direct experience.

Simple practices – like letting the computer screen hibernate for the 5-7 minutes I have lunch, finishing my shift on time, allowing myself to not eat the fast food brought in by a well wisher and instead have a salad pre-prepared for work… Simple practices of self compassion and self care that should feel easy – but didn’t. Similar to the initial discomfort that comes when (re)learning a skill.

A big positive for the week – recognising this week’s ‘pause’ provided the team with the kind of time and space that nurtures psychological safety. Will this be at the cost of losing project momentum ? Or will individual and team motivation be boosted instead ? We will find out as the new week dawns …

WPW – week 3 RPR

The external growth this week has mostly been in the intellectual and physical energy domains. Notably – delivering the first session of a training program I am offering to ED clinicians interested in quality and clinical audit. And upgrading a proposed ED geriatric referral pathway to a patient flow pathway – shifting the central focus back to the patient.

Diminishing psychological safety at the organisation-ED interface has been the challenge for a second week running. I find myself coming back and taking refuge in the spiritual domain of our work – a purpose and perspective that helps me acknowledge the suffering without it becoming overwhelming.

Serenity to accept what I can not change, courage to make the changes I can, and experiential insight to recognise the difference. Compassion in practice.

A Three Breath Traffic Light


traffic-lightsAs I prepare a resilience workshop, I would like to offer you a simple tool called the three breath Traffic Light.

In essence, you keep an image of a traffic light somewhere easy to find – like your phone or on your desk. Have an alarm prompt you every so often to look at this image.

The Red Light – is to remind you to just stop and breathe.

The Orange Light – to breathe and be aware you are breathing.

The Green Light – to breathe and then go.

While this may sound childishly simple, it’s power can be immense. Neurophysiologically speaking, “stopping” interrupts fear and flight or fight circuits from continuing to spread beyond their origin in the amydala. Becoming aware of the feeling of our breath, strengthens the links between the right and left sides of the brain. Finally when we breathe mindfully and “go” it restores brain function and control to the executive centres in the pre frontal cortex.

Or put simply, it gives us the power to choose how to respond, rather than be driven by subconscious lower brain impulses.

Faced with the breaking point pressures in the NHS as we have been for 3 years, it is worth remembering tools similar to this have helped rebuild inner strength and resilience in children exposed to much worse – the devastating trauma of 9/11. If it can work for them, it can work for us. Will you give it a try ?

Inner Resilience Program

Social and Emotional Learning