Industrial Athletics

The medical community here is Europe was rocked by a news story this week about a doctor in the UK who died while 'On call' the medical term for 'on duty.'However, rather than detail the life, struggles, and accomplishments of the doctor in a fitting tribute to somebody who literally died waiting to help people, his physician colleagues used the event to claim he was the perfect example of why doctors should have limited working hours.It is said that politicians never waste an opportunity to turn tragedy into something they can use to promote their political aims and some in the UK medical community certainly abused his corpse for that.The headline read: 'Doctor dies from exhaustion working second job.'Along with about 3 paragraphs on how 'unsafe' it is for doctor to work long hours or multiple shifts when it comes to patient care as well as calls to make it at least unethical and hopefully illegal for doctors to work more than 1 job.Down in paragraph 4 or 5, text which most people will never ever see, much less read, like the page 2 results of a Google search, it casually mentioned that 'high levels of alcohol and fentanyl' were found in the doctor's system on the post mortem examination.I am guessing that had far more to do with the death than working a second job…The doctor in question was reported to be an anesthesiologist. So he was certainly trained and tested on the interactions between alcohol and opiate medications.Here is a brief summary for the non-medical folks:Alcohol and fentanyl (fent) are synergistic, they are both depressants. Alcohol has been used as an anesthetic since the earliest recorded history. Alcohol works by the same chemical mechanism in the same part of the brain as benzodiazapines, barbiturates, and ketamine. Fent + alcohol is the same as Fent +midazolam or fent +thiopental.These types of sedative and opioid 'cocktails' are used in medical practice, most often by anesthesiologists, though also dentists, emergency doctors, surgeons, and even paramedics (I was first trained how to do this procedure as a paramedic and so were all the other paramedics at the agency I worked for at the time. I went on to set up and help teach educational programs and protocols to use procedural sedation, before I ever became a physician,) to sedate and anesthetize patients. (Anesthesia is just a higher dose of sedation for increased effect.)These combinations are also used in palliative care and lethal injection for execution and assisted suicide. (I am not making a moral argument for these activities, I am only stating facts.)Whatever the totality and the stress of life circumstances that led to this doctor to use and most likely become addicted to alcohol and opioids, he most certainly knew how dangerous these medicines are individually and certainly together.He played a dangerous game and lost.If you are a role-playing game enthusiast, it is fair to say he TPKed (total party killed) himself.For the video gamers, like is always set to hardcore mode. You get one life, when you die, you lose everything and the game is over…Eustress, distress, and coping mechanismsEustress is considered 'positive' or 'good stress' in that it is stress that causes you to work harder, try harder, and generally motivates you.By contrast distress is stress which causes a person pathology, anxiety, depression, social impairment, etc. Because culturally, we generally only ever talk about distress, we often just refer to this as 'stress' or 'being stressed.'Just as there is good and bad stress, there are good and bad mechanisms to cope with that stress… (Aptly named positive and negative coping mechanisms.)I am not writing on how best to deal with your stress today, I am simply stating facts.Negative coping mechanisms are the most common and the most effective at dealing with distress. Not because they are beneficial, because they are easy.The partial list includes smoking tobacco products (cigarettes), alcohol abuse, drug abuse, participation in physically risky behaviors such as extreme sports, and hypersexual activity (both in quantity and freakiness.)They are considered negative because they relieve acute stress, but cause physical harm, damage or destroy social relationships, and are addictive. So even if your distress stops, the behaviors continue.By contrast, 'positive' coping mechanisms can all be summed up by saying 'work more…'In fact, 'volunteering' or physical hobbies, such as exercise, crafts, etc. are all work…They do not have nearly the addiction qualities of negative coping mechanisms, and rather than distract or damage, they build a person up (strengthen) mentally, emotionally, and physically.However, because they require investment of time and money, which cuts into rest or 'down time' as well as creating additional commitments, and very often increased financial burdens prior to any appreciable effects, the positive coping mechanisms are less often used, compared to the instant distraction and gratification of the negative mechanisms.I am not here to preach to youNegative coping mechanisms are often immediately effective. They are also immediately dangerous and harmful. Normally when talking about coping mechanisms the speaker/writer, tells you not to do them, they are bad, stop it at once…(As if an addictive behavior masking your psychological pathology is so easy to quit or avoid…)I am neither a saint nor a fool and so I simply say to you: If you are using negative coping mechanisms, it is the sign you need help. Seek out help.If you are using positive coping mechanisms and caring for your health, keep doing the voodoo, that you do, best. Maybe reach out to those negatively coping around you with support rather than antipathy and derision…Take care of each other.Now that we covered that…Time for the main event…Work hoursLet's start with some background history…Throughout most of human civilization, up until the very recent past of about 40 years ago +/- a few, most work was physical. There were always accountants, clerks, teachers, and other 'white-collar thinking' jobs, but there were an extremely limited number of them.From ancient times to industrial times, whether you were a doctor or a scribe, you were paid for the physical work you did. For the most part, that remains true today. Except today, you can do a lot of that work sitting on your ass. Like me typing this…During the Victorian era in England, wealthy people who did not have to physically work propagandized they had a right to their life of leisure because unlike the 'underserving' or 'working' poor, they had 'earned' their (often inherited, generational) wealth, by doing some sort of activity which they enjoyed, helped them pass the time, or otherwise optionally helped them acquire more wealth. Having never had to work hard in their lives, they had an extremely skewed idea of what it means to 'work hard.'To these people of means, anything that caused them to break a sweat and necessitated retiring for second breakfast, tea, or a nap, was considered 'hard work.'As you may imagine, that definition of 'hard work' is very different from a farmer or laborer awake at the first light of dawn, eating a couple thousand calorie meal, with chronic pain from prior years or decades of work and both acute and chronic work related injuries and illness, like low back pain, black lung disease, etc., in order to make it until lunch (if they got a lunch) for the purpose of having just enough time to consume more calories, so they could continue to work until quitting time.From their first job…This is compounded in modern times by the 'gig economy,' where people are earning so little compared to what it costs to live, many, if not most, have 2 or 3 jobs to barely earn enough to pay their expenses, with not even an emergency savings.That means these people are working in excess of 60+ hours a week, with a large portion of that being physical. Nobody seems concerned about work hour limits, safety, etc.In some professions it is even more extreme. I am from those professions. Many of my patients and friends have bestowed on me the title of 'doc' because the medical care and advice I provide comes from living the same life they did/do. With the same demands. I am very proud of that honoriffic.But from this description, you may have noticed, poor people work fucking hard. They even work themselves to death from exhaustion…Nobody gives a shit about their health, stress, or 'well being.' They simply work to survive.I was there…Where were you?My first taste of 'hard work' was during my high school years. As I have detailed ad nauseum, I started my 'training' by working in a high school program for poor and dumb kids who were 'not fit for college' because my family had no money.The basic shifts were 24 hours. When not at the FD, I had to attend classes in school, I played in the marching and jazz bands (I hate fucking jazz, I was voluntold to be involved) as well as the wind ensemble (Concert-style band for kids who could actually play an instrument), an a cappella choir (kids who could actually sing), various school musical theatre productions, from Phantom of the Opera to Guys and Dolls, and had martial arts training 3 times a week for a couple of hours, including Kendo, Iado, taihojitsu, and ninjitsu.My mom described my life as 'eating, sleeping, or performing some sort of activity.' (Welcome to Gen X kid…)That's when I got a taste of working my first disaster…I was at home, hanging out with a friend, when the Plectron (a special radio device to call firefighters at home, prior to cell phones, pagers, or the internet…and tell them to get to work for a big emergency.)I instinctively looked out the window. Not expecting to see anything, but it seemed right at the time…I saw some storm clouds, they didn't look like any other storm clouds…But we were definitely in for a storm…I was grossly mistaken…It would turn out to be the worst storm in the recorded history of the region…As I drove my family's car (I was 16 years old at the time) to the fire station, I stared to see trees and powerlines fall behind me. The rain coming down in sheets I could barely see in front of me. I made it to the fire station.When I got there everyone on duty and many of the trucks were already gone. I didn't know what to do standing there by myself, so I waited. A few moments later, one of the most senior firefighters arrived as did another of the newer ones.The senior firefighter looked at us 2 and decided we were a crew. Moments after that, a message I did not even think possible came over the radio…'Due to the destruction of the storm, firefighters in the area are instructed to go to any fire station they can reach, not their appointed station…'I didn't even have time to take it all in when another radio call came specifically to us…A neighboring municiple fire department called and said there was a house on fire and gave the street, they said they could see the building, but because of downed trees and powerlines, they could not physically get to it. They asked if we could help and try to get to it from our end?Normally fighting a structure fire requires the simultaneous, coordinated actions of about 25 firefighters. We had 3. Two of which could still be described as rookies.So we did what firefighters do…We geared up and rolled out…Not knowing what we would or even could do, but we will see when we get there…A trait I have never lost and it pisses off most of my physician colleagues...When we got there, we found the roof of a residential house on fire, probably because of a lightning strike or downed electrical wire. So we hooked up the hoses, and sprayed wet stuff on the red stuff we could see…Until the fire was out. With special help from the wind and pouring rain…For those of you who have never work firefighting turnout gear before, it is heavy to start with. At the time, without the self contained breathing apparatus, it weighed in at around 50 pounds. I weighed in around 110, and highly likely closer to 105. (22.6kg, 49.8kg, and 47.6kg respectively.)Now I was also soaking wet, and very well aware at just how heavy saturated turnout gear feels when you add another 8.24 pounds per gallon of water…(0.98kg/l)And it doesn't dry for days…I spent the next 72 hours going from one emergency call to another. As went responded to or returned from a call we met other units, other firefighters, we were transferred from unit to unit, call to call as needs determined. At one point the most senior lieutenant set up a whiteboard at the fire station to keep track of who was where and on what truck. The dispatchers were so busy, they just relayed calls to him and he assigned resources as were available.The most sleep I got in that 72+ hours was the 2-3 minutes it took for us to physically drive to the next call. Laying on the floor of an ambulance in wet turnout gear and getting to close your eyes and not move for a whole 3 minutes before performing physical labor, is a luxury many will never know…It can really feel like forever…When it was over, I remembered the physical weight lifted off of me, as I took off that wet gear and placed it in the gear dryer. I drove home…Though I don't remember the drive. I am lucky I didn't fall asleep behind the wheel. I don't remember eating anything than candy bars from the vending machine at the fire station. Usually on the way to the next call.I walked in the door of my family home, exhausted, soaking wet. I took 2 steps and collapsed. Striking my chin on the marble table in front of the couch. I went unconscious. Whether from my physical exhaustion or the blow to my face, I didn't feel it. I just remembered hearing the crack.My parents being the caring people they were apparently heard me snoring, so they figured just best to let me sleep where I fell.Plus at I had to be back at my normal fire department shift at 8am the following day.That was my first taste of working a disaster. It would not be my last. There would be many more and as I type this 2 wars. The later of which, I worked 90 days straight a few km behind, but well within artillery and drone range. I was even chased by an FPV (first person view drone) with an explosive, which was rather stressful, and obviously I escaped without being hit, but it was close.The industrial safety folks certainly never taught me about drone warfare…The Ukrainian Army didn't teach me what to do prior to the event either... I got an 'atta boy' and the advice, 'do more of whatever you just did…'Its damn hard to run after working for 3 weeks with no day off and on call every moment not 'working.' Especially now since I am 50+ years old.But I will say…Running from a drone hunting you to kill you is motivating stress. That counts as physical exercise, a positive coping mechanism, but I wouldn't call it exactly 'eustress…'(disclaimer: my humor is not simply 'dark.' It is essence of pure blackness…A positive coping mechanism.)A term I learned after working another disasterWhile working as a paramedic in Southern Louisiana, my unit was dispatched with more than 20 others, to a massive motor vehicle collision that took place on a highway bridge. Like many of the bridges on Interstate 10 in Louisiana, this brings was miles long. There were more than 50 cars involved, and as I heard on the radio traffic on 'the way in' (to danger) some of them caught fire and there were living severely burned patients in addition to the blunt force and penetrating trauma.At one point we were notified by radio, we were to exit the motorway at the last exit before the Atchafalaya Basin Bridge (18.2 miles/29.3 kilometers long,) then re-enter the motorway going the 'wrong way' against traffic.It was a surreal feeling going the wrong way down a freeway but even more weird was we saw no traffic coming towards us. Though I saw ambulances in front of me going the same direction and ambulances behind me in the mirrors following us…It would take me multiple pages to describe what happened when we got there, and I will probably type out that story one day, but today, what is important is what happened after.Walking up and the debriefAs some quick information, when working for fire, EMS, or the military, sometimes you cannot physically drive to the location you need to get to. You drive as close as you can, then carry your equipment on foot the rest of the way. Your equipment is all the equipment you 'might' need. It easily weighs in the 10s of pounds/KGs. It is made more difficult when fatigued, walking over uneven ground, in snow or mud, or when looking for landmines and unexploded ordinance as you walk.During this debrief I first heard the term 'Industrial athletics' by the company safety executive and guru, when talking about the out-of-shape, medics who were unable the task of walking up though 50+ crashed cars with some burning, and needed to be cared for by other responders.It was also the best disaster debrief I was ever involved in, because instead of just telling each other how awesome we were and what a great job we did, like happens after most disasters, we talked about what didn't go well and what we could do better. (With some pointed comments about paramedics who were physically unfit to do the work that was needed and taking up resources to take care of them in addition to the disaster victims.)An industrial athlete is a worker whose job requires high physical demands, using strength, endurance, flexibility, and coordination across long shifts much like a traditional sports athleteI never thought of myself as an athlete. Not when I played little league baseball, not when I was part of the dancing marching band, not as part of my martial arts training, not when I was a professional classical dancer. Never once when I was a sailor or contractor for a military.I simply had a job or a task to do, and I had to be physically able to do it. Since I was on the smaller side (shorter and usually thin) than most men, the hardest part for me was always worry I was too small, but never too big or overweight…It never occurred to me that some people were physically unable to perform their job and discovered that at the moment of truth when doing that job could mean life or death for somebody else.Today I am in nowhere near the physical shape I used to be, but I have proven I can still keep up and run from a drone if I need. Though it takes a much bigger toll on me than it used to…By contrast to fire, EMS, professional performing arts, and the military, working in hospitals and clinics as a doctor is not even describable as physically demanding. Even when walking 14+ KM in a shift in an emergency department or standing at a surgical table for hours…Sure it can be tiring. It may even make your muscles ache a little, but it doesn't drain every ounce of energy and leave you in pain or sore for days after…Maybe if I live another 10 years it will, but today it still doesn't.Train like you fight, because you will fight like you trainI have written about the need and style of training that is grossly lacking in the medical profession before. But today I will look at it from a different perspective…Did you ever physically train to practice medicine?I don't mean did you train how to use equipment or do a procedure, I mean are you physically and mentally able to perform the job as circumstances call for?A training mantra in the fire department is 'you don't train until you get something right, you train until you cannot do it wrong!'That applies to medicine too!One of the things I discovered in ballet is when you first start, it feels wrong. The basic posture feels like you are about to fall forward. The foot and arm positions require extensor muscle strength, muscles you probably never exercised or even thought to before.Then, through practice, you build your (exercise) technique until it feels wrong to do the movements any way except the proper way. A dancer is as much of an athlete as any sports person. Physically strong, flexible both physically and mentally, and from repetition and building muscle memory, a dancer does not concentrate or even feel how their body moves or positions. It simply does. With the mental focus being on the music, the other performers, costume changes, and all the other things that is part of the job, but not physically your body.Your endurance is trained too. Yea, it hurts to practice so many hours a day. It hurts to when you don't practice and stretch the muscles. There are injuries and days practicing with injuries.Nobody cares that you are hurt. Nobody cares that you are tired. Nobody even cares if you are stressed, afraid, or however else you feel.You know you are properly trained when you can perform the task without noticeable effort and make it look so easy anyone can do it.And I am not just talking about being a dancer. The very same is true for firefighters, EMS workers, sailors, soldiers, et al. Aka Industrial athletes.'If I wake you up in the middle of the night and ask you to identify an EKG rhythm, you will be able to do it and tell me the treatment from memory.'Is what my paramedic instructor said to our class during the cardiology segment.He drilled it. Like a drill sergeant. To this day, I can wake up from a dead sleep and there is nothing about a cardiac emergency I do not know or cannot recite, whether it is physiology, pathophysiology or medication doses for adults and pediatrics.Because it was trained until it was as much a part of me as walking or breathing.Endotracheal intubation was the same way…Doctors do not train like that…and it shows…You can see how nervous and unsure of themselves they are. You can see the in their hesitation to make decisions or call for help from others before even trying.The older ones, the ones who worked in places where quantity and acuity was high, with 90+ hour a week residency training, they are medical athletes…Medicine and their treatments are a part of them. They calmly do the job, effortlessly, even when they are woken from a dead sleep on the couch in their on call room. They make it look easy…Remembering and writing this, I am just calling bullshit on a doctor dropping dead from overwork.I have written about my Navy boot camp experience before, and anyone who has been through military basic training knows what it is to be tired…Because sleep deprivation is an intentional part of the training…Who among you military veterans has not fell asleep standing up?I did…Waiting for chow. I was in line, waiting my turn and the next thing I knew, the people serving the food woke me up and told me to catch up to my company.Who among you war veterans has not slept through a rocket attack or explosions?I have. I have been dragged from my bed still asleep by coworkers after working 21, 18-24 hour days in a row as rocket artillery fell.Today if an explosion doesn't shake the walls, I am not waking up for it. If it hits me, I won't know. There is a peace in that realization.How many of you firefighters or EMS workers haven't worked a 48, 72, or 96 hour shift, where you got your ass handed to you by calls, and never slept a wink, but still did your job? Including driving a multi-ton motor vehicle?You might die from a car accident, but from exhaustion, because you 'worked too hard…'I am not going to run a marathonFor all of you running psychopaths out there reading this :) The first guy to do that died at the end of it…He wasn't wearing track shorts and a tank top either…He had fought in a battle that lasted all day, wearing plate armor, holding a sword and a shield almost as tall as he was first…You know…as a warm-up…After fighting in a battle according to his training, running in full kit another 26 miles to stop the city from burning itself in a scorched Earth military tactic, he embraced the suck and lived up to his job description 'and all other duties as assigned…'But if you are a marathon runner, you did train for it! You can do it! You have done it!and you didn't die from exhaustion afterword…Because you trained and conditioned yourself to it.Just like there are crazy people in the military that train and condition to load up on gear and march or run equally crazy distances.Even during a 2 to 4 hour ballet performance, after practicing 12-16 hours a days every day…That 4 hours is an easy day…Might as well be a vacation…My US physician colleagues…How many hours a week did you work in residency? 90? 100? 110? How many days off a month did you get? 1? 2?You were trained! You were conditioned! You can perform with excellence! Even if you are woken out of a dead sleep.Here in Europe, there is a 36-40 hour maximum week, depending on the country. The worst week I ever worked in Europe was 60 hours…Meanwhile doctors here complain they work too hard, its unsafe, bad for their well-being, and not only are supposedly 'equally' trained and certified as my US colleagues, (What a fucking laugh…) but now claim that a colleague died in his sleep in an on-call room from exhaustion, with no more than 60 hours on the clock that week?I'm not buying it…His colleagues said 'he always looked tired…'Yea…no shit…abusing alcohol and opioids makes you look tired…That is literally the whole fucking point of depressants…The hard part of the jobFirefighters, soldiers, sailors, EMS providers, are all likely to have a colleague die on the job in their career. Honestly, I lost count at 5.One of the toughest things is to pack up their stuff from work and send it to the family…To see their shoes in the apparatus bay where they left them, before stepping into their boots. To roll up their sleeping bag on the bed across from you.It is an act of almost religiosity…You are the first person to touch their 'things' now they are gone. To see the pictures of their friends and family they hung in their locker to see every time they went to get their stuff.You remember jokes and hardships shared.You realize it could be you not going home, having your stuff packed by colleagues.You make every effort to protect their 'good name' and make sure the picture of the mistress or lover isn't sent home to the wife or husband…You ditch the porn collection and/or sex toys as if it never existed…Anything at all that could cast your newly deceased comrade in a negative light disappears without a trace…It is a solemn and sacred duty…What it is not, is an opportunity to get a political win by claiming your freshly dead colleague died of exhaustion to try to get a raise and more time off…I don't care that the doctor died from a drug and alcohol overdoseI do care nobody seemed to notice how bad of a state he was in and intervened…More importantly, I care that some selfish and pathologically greedy fuckwit instead of giving a eulogy the deceased person's family could be proud of, used his dead body and grieving family as a way to get something for themselves by misrepresenting the facts.I care that whatever reporter researched the hell out of his death and reported it, didn't make him look like a fine upstanding hero, and published his name and picture on the internet so he will look like the exhausted, drug and alcohol abuser for all of eternity now. Not having the human decency to just say his death was tragic and leave it at that, instead of creating a public spectacle and scandal.Now every time somebody Googles his name or story, there will be no mention of his successes, his contributions, his family, or all the people he helped by his practice and work.There will be an exhausted drug and alcohol abuser…Whose death is not attributed to whatever demons haunted him…But not being fit enough to do his job. A job he gave his life for…Doctors don't need more money and time off in EuropeThey need proper training and conditioning.They need to stop being bullied, mobbed, and ostracized. They need to stop being sexually harassed. They need to be able to get help without losing their license to work. They need a class on how to treat a fallen colleague and his family and legacy.They need to learn to have some human decency instead of using a tragedy that ends in a dead body as a means to slake their own greed.They need to learn what hard work really is…If for no other reason than to empathize with patients who face struggles they seemingly can't even imagine.