Practicing with Courage in the Age of Fear
It was a combination of unpleasant smells I’d oddly grown to love. Heavy cream, dead fish, rubber, poop. I’d just finished blending cream, whole frozen fish, and vitamins in industrial sized blenders then loading the shakes into giant syringes. Working at a marine mammal rehabilitation center, my fellow volunteers and I tube fed elephant seal pups the stinky shakes then sloshed around in our rubber boots hosing down their poopy pens.
I loved this job. As an eager, aspiring veterinarian looking for experience and recommendations for vet school I spent one day a week caring for orphaned, ill, or injured elephant seals and sea lions.
After a year of service under my belt and training by the technicians, I was trusted with the task of prepping medications for the patients. Then one day I screwed it up. I didn’t double check the concentration on a bottle and ended up overdosing a sea lion. I held back the tears as the veterinarian and technician gently but firmly alerted me to the potential consequences of my mistake. The vet shared with me his triple check policy. Check the label when you take the medicine off the shelf, when you draw it up, and again when you put it away. That lesson was painfully but deeply embedded into my brain and is now a firm habit.
At the time, I decided that I wasn’t cut out to be a vet after all. The fear of causing harm again was ominous and raw.
Thankfully, vet school was in my future and I rode the highs and lows of the experience with unbridled optimism since I knew I’d found my place and people. I was confident that the university knew what they were doing and I would graduate ready to do my job as a veterinarian. Then my senior year on clinics, a faculty member inadvertently introduced me to another fear that hadn’t occurred to me until then.
This respected faculty veterinarian answered the call of a referring vet while a group of senior students encircled her. We could only hear her side of the conversation which was polite and seemingly helpful. She hung up and mumbled audibly to herself, or to us, I was never really sure – “We don’t graduate them that stupid. What happens?”. My fear list now included fear of being stupid. I don’t think she meant to, but she taught this group of vet students to think twice before calling a colleague for advice.
These fears were further reinforced during my internship when I would occasionally hear specialists criticizing the medical decisions of the referring veterinarians in front of interns and vet students. They did this without knowing the circumstances and conditions in which the primary vet was working. Certainly critiquing cases and evaluating the merits of various diagnostic and treatment decisions is a powerful teaching tool when done respectfully. However, in this instance, it added to the ever growing fear list – fear of being judged.
We learn about another big fear in vet school, mostly in the context of keeping thorough medical records. But I don’t think it really starts to sink in until you are in practice, have liability insurance, and start reading those AVMA PLIT newsletters about other practitioner’s mistakes. Slowly but surely, the fear of being sued steps into your life.
All of these insidious fears can add up to the worst fear of them all – fear of making a decision. And that, my friends, doesn’t help anybody.
So let’s switch gears and talk about courage. Courage isn’t about never being afraid when you dive into a scary surgery, an unfamiliar procedure, or an uncomfortable discussion with a client or your boss. Courage is being afraid and doing things anyway. Courage is living with uncertainty and knowing you’ve done your best. Courage is having faith in yourself, your decisions, and your resiliency when things don’t go well. Courage is learning to be comfortable with being uncomfortable.
As veterinarians, we display courage every day. We have little choice. In order to serve our patients we are often called upon to extrapolate, to innovate, to make educated guesses at the best course of action. We don’t always have the option of getting all the answers before we make a treatment decision and sometimes we don’t have the luxury of getting a diagnosis at all. Sometimes all we have to go on are our history taking skills, physical exam acumen, and our experience to draw on the lessons from past cases. Making the call and using your best judgement to help a patient, with the lurking fears of doing harm, feeling stupid, being judged, or getting sued takes a lot of courage.
So how do we cultivate this courage? With practice, that’s how. I’ll share with you techniques that I use, even outside of my professional life, to keep my courage honed.
Most of us don’t like the feeling of being uncomfortable, or new, or inexperienced. But getting comfortable with being uncomfortable is a skill that can be practiced both in and out of our professional lives. It’s also one that is required of all veterinarians, but especially relief veterinarians.
Purposely putting ourselves in foreign environments teaches us how to adjust, cope, and improvise. It exercises our courage like strengthening the fine muscles of balance when standing on one leg. Opportunities for challenging ourselves in this way are plentiful and don’t involve any compromise to safety. Work emergency shifts if this is something that causes you anxiety. Attend a social event where you don’t know anybody. Take lessons in something completely unfamiliar. This type of practice will show us that things rarely go wrong and even if they do, it’s still ok. More importantly, it will prepare us to gracefully handle the unexpected discomforts that work and life will inevitably dish out.
A feeling that sometimes contributes to our discomfort is intimidation. Taming intimidation is a skill, that once again, can be practiced. Take the time to become proficient in a procedure that intimidates you. (For me, this was surgical dental extractions.) If given the opportunity, introduce yourself to someone you admire. Express your opinion with the group, even if you think it will be unpopular. If we’re feeling intimidated by people, it’s helpful to remember that the other party may be feeling the same way – which brings us to empathy.
Exercising empathy will calm our discomforts and tame intimidation. Nothing dissipates fear faster than removing the focus from ourselves. In fact, I would argue that fear is impossible to experience when our attention is concentrated on others. It’s only in self regard that the emotion has any power. Once the focus shifts off of ourselves, the fear turns off like a switch.
Taking command of our fears by learning to be comfortable with being uncomfortable, taming intimidation, and exercising empathy will keep our psyches honed and fit for successfully engaging the opportunities and challenges of our profession.
You may never love the unsavory mixed smells of cream, dead fish, rubber, and poop. But as veterinarians we can learn to embrace the sometimes unpleasant and ubiquitous undercurrent of fear. It defines our courage as we navigate this unique, unpredictable, and special profession.