New Year's in my home state of Kentucky is a time of togetherness, optimism, and cabbage.
For some, eating cabbage is as strong a tradition as resolutions and countdowns to midnight. In fact, my Appalachian grandparents, usually not superstitious people, always ring in the new year with cabbage on the table. "Coleslaw, cooked cabbage, however we can have it," my granny Barbara Adkins told me. "The more cabbage you eat, the wealthier you'll be!"
This tradition takes an inexpensive staple food and instills it with a magic quality. Something overlooked throughout the rest of the year suddenly promises new beginnings, just by adding a bit of mindfulness and imagining a more prosperous future for ourselves.
As residents and fellows, our plentiful staple food is clinical experience. Though our time and money are tightly limited, we are endowed with a bounty of interactions with patients, mentors, and learners. These experiences can make us more understanding, teach us knowledge and skills, and illuminate how much we do not know. Conversely, at times clinical demands also threaten to inundate us. When the volume of work, grief, and our own shortcomings begin to run together, residency can become a blur of stress and uncertainty. For some, it becomes difficult to summon the energy to serve their patients’ needs, much less to improve their emergency department, residency program, or our broken healthcare system.
In the new year, perhaps we can renew our resolution to find the cash in the cabbage, and bring your personal passion to every shift that you can. Some of my co-residents do this by teaching medical students. A simple suturing lesson for a third-year medical student turns a resident’s tedious laceration repair into a rewarding teaching exercise. Others of you are critical-care-bound residents frustrated by obsolete hospital protocols for cardiac arrest management. Producing critical care research or investigating how these protocols are written can be the first steps in turning misguided dogma into evidence-based patient care. Perhaps you can reduce your own burnout and improve wellness for the next class of residents by making scheduling improvements to a particularly taxing rotation.
I try to remain optimistic by keeping my eyes open to my patients’ social challenges and considering how I can address them. For example, this summer I attempted to prescribe buprenorphine to an incarcerated patient, only to be told it was the detention facility’s policy not to give buprenorphine. This motivated me to write EMRA policy in support of equitable healthcare for incarcerated patients, particularly in support of mental health and addiction treatment. At ACEP21, your EMRA program representatives voted to adopt that policy. Now, in efforts to change detention facility policy or in cases where patients do not receive the addiction care they need, policy leaders and advocates can cite the opinion of EMRA, the largest and oldest independent resident organization in the world.
This December 31, many of us will be working. The ball may drop while you’re running a trauma or placing a central line. But I hope at some point you have time to reflect on the past year and renew your commitment to finding the magic in the daily grind, like my family in Eastern Kentucky eating cabbage on New Year’s Eve with hope for a plentiful tomorrow.