Physicians are under stress. I recognize this feeling. When a patient unexpectedly died and I was subsequently sued, I experienced a level of stress unlike any I had previously known. Worse than medical school, worse than residency even. I came through, but it took effort.

I’ve thought intermittently about exploring ways here to care for ourselves when we’re under intense stress. Now, however, the need is urgent. COVID-19 is heating up across North America. Physicians, nurses, and other healthcare workers are deeply worried. Some are in the midst of an overwhelming surge, others are preparing for the surge. I’m feeling that stress as tense muscles and a tightly coiled mind. Maybe you are, too.

In the course of my lawsuit, I became acutely aware of the way my body expresses deep, persistent stress. Like many of you, I became a ninja of stress mastery through medical school and residency. Nonetheless, my body felt different in litigation — chronically tight across the neck and shoulders, tense around the chest, taut in the legs and lower back. Ready to fight or flee at any moment, I suppose.

That would be fine, except for one thing. Chronic stress is associated with elevations of cortisol, epinephrine, and norepinephrine. In the context of acute stress, those elevations are functional — they initiate increases in our heart rate, respiratory rate, blood pressure, and blood sugar which prepare us for quick action. Chronic elevations of the stress hormones, however, leave us sore, sleepless, hypertensive, and inflamed, and cortisol suppresses our immune function. Since I need a clear mind and optimal immune function right now — and so do you — we’re going to have to do something about that.

I don’t pretend to have all the answers to managing deep stress, but I have a few, and I’m sure you have others. Let’s crack those open over the coming weeks. We’ll manage this pandemic better, and as a bonus, we’ll create a repository of wisdom for all those other times when physicians experience chronic stress, including adverse outcomes and malpractice litigation.

Let’s start today by simply identifying four domains we might attend to as we try to keep our equilibrium in a trying and traumatic time. As you read through these descriptions, you may wish to ask yourself what one thing you are doing or would like to do to support your health in that domain. Feel free to insert your thought in the comments below. Your idea may be just what someone else needs to hear.

Four Domains of Human Life and Health

1) Physical

This is the domain most of us think of when we contemplate improving our health, and it’s an important one. Like all other living beings, we are masters of physical homeostasis. The dark side of this mastery is that once we get into a state of persistent high stress, it can be hard to get back out again. But get out we must, for the sake of our vascular, renal, gastrointestinal, endocrine, immune, and brain health. In coming posts, we’ll hear from an expert in this domain.

2) Emotional

Emotions enrich our lives. However, when difficult emotions emerge fast and furious, it can be tempting to suppress them. Short-term, that’s not necessarily all bad. It permits us to compartmentalize, which supports our capacity to do what has to be done in the moment. In the long run, however, it doesn’t serve our health to bottle up so-called “negative” emotions indefinitely. Eventually, the effort required to do so hardens us and can result in an incapacity to move past the negative emotions and fully experience the positive once again. Which is a shame. Because the positive emotions can put us into a virtuous, joyful, parasympathetic cycle, just the place we want to go.

3) Mental

It may seem strange to separate “mental” health from “emotional” health. For our purposes here, though, I want to make a distinction between them. In particular, let’s distinguish thought from emotion. As I’ve mentioned before, one of the central tenets of cognitive-behavioral theory is that frequently, the nature of our thoughts shapes our emotions. Consequently, a change in our thoughts can often alter our emotional state. For that reason, attention to curating our thoughts can benefit our emotional health, and, I would argue, our physical health, too.

4) Spiritual

If this term sets off alarm bells for you, I hope you’ll stick with me for a moment. I use the word “spiritual” to refer to that side of ourselves that perceives — by whatever means — that we are connected to something much larger than ourselves. For some, the spirit expresses itself in the language of the world’s religions. For others, private ritual is where it’s at. And others yet find their connection in nature, meditation, service or family. Whatever inspires awe in you — genuine reverence for the web of life — that something is what I’m talking about here. Only you will know what it looks like; whatever it is, it is potent in times of stress. Furthermore, the injuries I described in my last post are often injuries to the spirit — they disconnect us from our sense of our place in the universe — and will require spiritual healing. Becoming attuned to this side of yourself can serve as a warm-up for the healing we’re likely to require.

Of course, these are not the only domains of health, but I think they are central, and all the others connect to them. In these very stressful times, I invite you to check in with yourself regularly around each of these domains. Your time and energy may be limited — mine are — and yet you may find that a few minutes of some particular activity — drawing? running? laughter? — benefits you in multiple domains. If that’s true, make a mental note and lean in.. I hope to post more often than usual over the coming weeks, sharing the insights and wisdom of others as well as things I’ve learned and wonder about.

Please let me know your thoughts, too.