“That is a very good question,” said the farmer. “But why did the wise man send you to me? How would I know? He should have sent you to someone who has experienced suffering.”

I think I heard this from Kwai Chang Caine on the Kung Fu TV series: If you raise up hope, it becomes part of your being. If you raise up despair, it becomes part of your destiny.

I recall an uncountable number of times over the years, various folks [consultants, patients, friends, etc.] would ask me how I could work in my trauma center with all the chaos. We lived daily with inadequate staffing by nurses and support personnel, inadequate space [emergency department boarding, plus inadequate capacity], downward pressure from payors mixed with worsening payor mix [i.e., increasing uncompensated care], critical medicine shortages, don’t forget grid locking EMRs, yada yada yada.…

Having done a fair amount of consulting around the country, I had seen emergency departments with much worse conditions than ours. To those asking me about my stressful working environment, I would often echo the farmer’s comment to the perplexed man. I also asked myself, even with focused efforts to fix broken processes, does that mean it’s OK to remain in an environment based on perception?

Buddhist philosophy explains suffering is strongly predicated on one’s perceptions. That certainly doesn’t preclude a poor farmer from moving to a different town with better opportunities or even deciding to become a welder. I was fortunate to have grown up with parents who, despite surviving the Holocaust in Europe during WWII, were able to impart the “hope” part of the hope vs. despair formula to me.

But I also learned to adapt to change, so I began diversifying my career with several successful non-clinical career activities. So I look back with a feeling of gratitude that I was able to avoid having the flame on my cherries jubilee career sauce “burn out.” I am equally thankful for allowing myself to have several other desserts on my plate just in case.

This ACEP News issue has an article on ENT issues in pregnancy. I hope, by making columns such as this engaging and valuable, I can add a bit of fuel to the readers’ flames.