Taylor Swift, Australian Siri, and an Open Road

I recently had the opportunity to drive for eight hours. I haven’t driven that many hours straight in a long time. Though I was dreading it, I ended up having a fantastic time: I memorized Taylor Swift’s new album, I made a dent in the list of podcasts I’d accumulated, and I discovered a lovely bakery right off the highway that I will plan bathroom stops around whenever I make this drive again. But, as I said, I dreaded the drive, so I rented a maximally comfortable car. And the maximally comfortable car I rented also happened to be fast—sneaky fast. One minute, I was singing my brains out to “I Can Do It With a Broken Heart,” the next, I was looking at the speedometer, shocked to find I was cruising along at 95mph. “Oh s#%&,” I thought, lifting my foot off the gas (but not slamming on the brakes so as not to draw the attention of any highway patrol that may be up in the distance).

Luckily, with all the comfort and speed, the car also came with ApplePlay, so I could rock out to Taylor Swift while having Apple Maps up for navigation. My Siri is Australian, and every so often, he’d give me the heads up that a speed check was ahead. It happened enough times that as soon as I’d hear him interrupt Taylor, I’d start lifting my foot off the gas, assuming I was probably going too fast anyway. I made it through all eight hours, well, 16 hours if you count the drive back home without a ticket.

It was so easy to cruise right along in that car; I got used to barreling down the highway at 10 - 15mph (okay, 20mph) over the speed limit. It made me think of the pace of life that I’ve just become used to. I think many people in medicine have become used to this pace. It’s compounded by the world outside of medicine cruising along at breakneck speed, information coming at us from all angles, whether we’re ready for it or not. We write our check-boxed to-do lists on the backs of our census and race to complete as many things as possible before signing out, lest we have to hand them over to the skeleton night crew. Our message baskets are overflowing, and we have to task switch among answering patient questions, sorting out prior authorizations, and figuring out whether the labs flagged as abnormal are things we actually have to do anything about. Email inboxes are much the same: messages from the medical school, messages from colleagues about a patient, messages from colleagues about non-patient things, all-staff emails that only apply directly to me about 20% of the time (but I have to skim them at least to figure out whether the particular message is one of the 20% or the 80%), messages about educational opportunities, messages about my N-95 testing being overdue. It’s so easy just to cruise right along, running rounds, writing notes, tackling message baskets and inboxes, putting in an Amazon order during the walk to the car (and then putting in an Uber Eats order right before pulling out of the parking space). We get home, eat dinner, zone out for a few hours, sleep, and then start cruising again the next day. This pattern carries on pretty well for me for about ten days, maybe 12. After that, though, I crash. Hard. I start throwing pity parties for myself while driving in for shifts. Instead of ordering something reasonably healthy on Uber Eats, I think, “Screw it,” and order something that will give me comfort while I’m eating it but make me feel awful shortly after that. And, of course, I’m going to bundle a pint of Jeni’s ice cream with that Uber Eats order, one that I can eat while zoning out before bed (and all but assuring my sleep will be rubbish that night). Basic tasks like putting away clean laundry fall by the wayside, cluttering up my bedroom (and my brain). Text messages go unanswered, and calls from life-long friends go straight to voicemail. And then I’ll get up and cruise along the next day, over and over again, until I have some time off.

I don’t see the crash coming because I honestly think things are going just fine. I’m getting things done, putting in my time, checking off boxes, and seeing my work yield results. But what if there was a speed check throughout my day or even in the middle of the week? If I only assessed my drive by measuring the time between when I started driving and when I got to my destination, the car may have been falling apart on the way, but I’d have had no idea. If the only time I check in with how my pace feels is when my alarm goes off in the morning and when I fall back into bed at night, I may be careening towards a miniature episode of burnout and never know.

In medicine, it’s easy to charge ahead at breakneck speed because that’s likely how we tackled acquiring the knowledge necessary to do these jobs we love in the first place. The pace has gotten us this far, so it seems the only way to do what we do. But like all habits, it works for us until it doesn’t. If I’m pushing myself at a pace that’s only sustainable for a week and a half before I devolve into a heap of couch rotting, maybe it’d be better to do a few speed checks so I can let up on the gas before the laundry pile falls over, the scale starts creeping up, or my friends begin to ask whether I’ve become a Buddhist and joined a monastery. I can use my Australian Siri to set an alarm at 2pm every day, prompting me to assess my pace and see if I need to let off the gas for the rest of the afternoon. I can block off fifteen minutes on Thursday mornings to review the first few days of the week and see what adjustments I need to make so I’m not entirely gassed for any upcoming days off. No driving Maseratis down dead-end streets. No Aston Martins driving straight into ditches. T. Swift may be learning a thing or two about speed checks. And if it’s good enough for her, it’s certainly good enough for me.