Lessons from the Mountains

And we're back...  Back from our family vacation.  We definitely hit the ground running this week.  Between work shifts in the ER, shuttling kids to activities, and planning the last few weeks of summer, the operations tempo of the house seems to be set on 1.5x speed.  That is what was nice about being away on vacation - none of the normal day-to-day things really mattered.  Physically extricating ourselves from the daily routine allowed us to put all of the chaos of daily living on pause for a week.

When you travel there are certain places that have a greater impact than others.  This year our family took two, week-long vacations.  The first was our spring break trip to New Orleans.  And most recently, we returned home from a visit to Denver.  The New Orleans trip was fun.  We explored a new town and enjoyed the tastes of Bayou food.  But in the end, it was just that - it was a good time away in a unique place, but I was glad to get home.  New Orleans was fun, but there was nothing really compelling that made me want to stay.

Denver on the other hand was a bit different.  We spent a week in the mountains.  Our schedule and logistics didn’t afford prolonged outdoor wilderness hikes.  But we filled our week with a number of opportunities to enjoy grand vistas, drives through the mountains, cool mountain creeks, and much more.  The highlight of the trip was a drive over a mountain pass that brought us to 11,000 feet elevation - where the tree line meets the mountain shrubs.  Every twist of the road through pine forests and along cascading mounting streams brought us further and further up to the summit of the pass.  And when we reached the top, we were met with a majestic vista.  It was a combination of vastness, grandeur, and simplicity.  Everything else - the cares of work and life, seemed so far away.

As we were driving back to the airport to come home, we had to drive down out of the mountains and through Denver.  At this convergence of the Great Plains and the foothills of the Rocky Mountains, I found myself looking back at those mountains.  There was an “otherness” that was wrapped up in that landscape – something distinct from my normal life on the flatland.  I noticed feeling a sense of melancholy - a sense that is leaving a part of myself there.  Though my mission set was now to return a rental vehicle and get my family and all of our stuff on the airplane, I did have a profound desire to turn around and go back.

There was something in those mountains that felt right, contrasted with the welling anxiety of returning to the frenetic life at home that we call normal.  I know cognitively that merely transporting my existence out of my present circumstances and into an idealized portrait isn't the answer.  The cares of this life tend to follow you regardless of your geography.  But looking back at the mountains I sensed (albeit just a fleeting glimpse) that there was some sense of wholeness, contentedness, and peace that I was leaving behind.

So, what are the practical take-away points (other than vomiting a bunch of nostalgic feelings onto the page)?  Here are the things that I am trying to remember as I reintegrate into my normal life.

Know your priorities and orient your life accordingly

I spend a lot of time thinking about, reading about, and listening to others talk about identifying and orienting toward your intentions and priorities.  But somehow in the daily, hand-to-hand combat of life I seem to find myself captive either the tyranny of the urgent or the perspective of the immediate.  I tend to forget about priorities in favor of necessities. 

While on our trip I unexpectedly was able to reconnect with an old college friend that I hadn't seen in almost two decades.  As we sat and talked, we were able to reminisce about days gone by, share our current life journey, and discuss the triumphs and struggles that we both face in our daily lives.  It was encouraging to hear his perspective and step back to reflect on the trajectory of my life and career.  I was reminded of my own struggle to find the delicate balance between home life, personal ambitions and the demands of a career in academic medicine.

I have said many times in the past that medicine is a jealous mistress.  It is a demanding career – not just because of long work hours, but also because of the intense sense of concern that we as physicians assume for the wellbeing of our patients.  Layer on the academics and now you have the additional demands of teaching, writing, administering, and researching.  In the midst of all of this it is easy for career to rise to the top of the priority list.  All other pursuits (including family) then take a back seat.  In our work, we are striving for accomplishment, significance, and legacy.  And while work is good and important, at the end of the day, when it comes to individual accomplishments and efforts, institutions have a short-term memory.  A year from now, your boss won’t remember the extra shift that you picked up last week or that you stayed late to complete a project.  But you will!  Your family will!  Knowing your priorities doesn’t disregard the importance of work.  It just means you bring your efforts in line with what is ultimately important.

Make room for rest

One of the easiest things to do is to feel overwhelmed by the crushing weight of all of our responsibilities and the demands that others place on us.   In response we tend to attempt to work harder, work longer, and work faster.  We fall prey to the trap of thinking that we can do it all.  But we are not omnipotent.  We have not been designed to function well by burning the candle at both ends.  While we can (and should) work hard, we were made to operate most effectively with seasons of rest.  There is profound physical, psychological, and spiritual benefit from stepping outside of the melee daily, weekly, monthly, quarterly, yearly to rest.  The surest way to burnout is to neglect rituals of rest. 

This is an unnerving prospect from time-to-time.  Ambition calls for action.  Accomplishments, the things that we find rewarding, are often kinetic.  I find that when I sit down, my mind is racing with ideas of what I need to be doing next.  But that thought stems from the misguided illusion that somehow I am in complete control of my life and circumstances - the idea that my effort is the requisite cause for what happens in my life.  But if the emergency department teaches us anything, it is that we are ultimately not in control.  Serious accidents, sudden illness, that fatal diagnosis - they come when we least expect and are out of our control.  We can even approach this idea of rest from a theological perspective.  We are created, not the creator.  We are finite, not infinite.  We are dependent, not independent.  And while God has charged us with working in our environment, our paradigm of work without rest belies a lack of acknowledgement and faith that he, not me, is ultimately in control and will provide.

I have had seasons in my life and career where I have been better about rest than others.  In medical school I made a commitment to take Sunday off completely from all school and studying activities.  It was my day of rest.  Now, with a 24/7/365 job where I am expected to work weekend shifts, and having an active home life with my kids, rest looks different.  But the principle is the same.  As uncomfortable as it is, the most effective way to run is to carve out periods of rest.

I've been back in the routine for a week now - whatever routine means for an emergency physician with a haphazard clinical shift schedule.  The temptation is going to refocus on the frenetic and lose focus on the lessons of the mountains.  And while routine and busyness is in one sense normal and good, it is also important to keep our sights oriented on our priorities, and carve out times to rest.  That is the lesson of the mountains.