Homeostasis

Homeostasis (from Greek: ὅμοιος, homoios, "similar"; and ἵστημι, histēmi, "standing still"; defined by Claude Bernard and later by Walter Bradford Cannon in 1929 + 1932^[1]) is the property of a system, either open or closed, that regulates its internal environment and tends to maintain a stable, constant condition. Typically used to refer to a living organism, the concept came from that of milieu interieur that was created by Claude Bernard and published in 1865. Multiple dynamic equilibrium adjustment and regulation mechanisms make homeostasis possible. - Wikipedia

It is funny that a word which literally means "to stand still" requires so much activity and effort. This word now seems to always evoke memories of lectures from biology and physiology. I think of all the various tugging interests & insults - and the elastic reactions to all of them designed to keep us "in place". Baroreceptors. Ion pumps. Vasodilators. But if I stretch my thoughts a little I can expand it further to bring back memories of my education and research in physics and astronomy too. The beautiful equilibrium of hydrostatic forces that balance the sheer destructive expulsion of hot plasma from a fusion reaction with the ever present, stable and somewhat comforting force of gravity trying to hold it together. Then at some point, some infinitely thin membrane, these two find harmony and a star is born. A spherical, glowing mass of matter and energy warms our planet for millions of years, seemingly static. An entire universe of opposing forces balanced both within our bodies and without - all maintaining a sort of homeostasis. Peace.

I am thinking about this more and more lately, mostly in passing, as I have been closely scrutinizing the extreme disequilibrium I am finding myself in these days. Not so much my blood pressure or anion gap. I am not thinking just of the existential being that I am but also of the essential one. My life in residency these last several months has truly tested the limits of the inner person and its ability to react and balance the intrusions that medicine has made. The work hours. The increasing responsibility. The patient's continual need. The failed decisions, both medically and personally. The continual evaluation. The sacrifice of so much that I am.

Without the time or energy left over at the end of the day to neutralize these many debts on my soul I find myself going further and further into some sort of psychologically mortgaged state. One where I have stretched myself daily to absorb and store all the perturbations to my life with the hope that at some later time I will find some time to balance them. For every attempt to stretch myself, take responsibility for an important decision and live the repercussions I need some time to reflect on the deeper meaning of how this is changing me. Who I am. In residency you get very little of that time and it is spaced so far apart. I am lucky that I recently had a few days this month to allow me to return to the natural world and reflect a bit. Recharge. Realize that this is not all I am and remind myself that my value extends beyond the narrow person I have been for the last 12 months. I drove for hours, walked for hours and just sat for hours amidst the most beautiful places I could find and sensed some warmth return to my skin and deep inside. I am left thinking about my inner psychological and spiritual homeostasis and wondering how I can better manage this battle for  the coming year. This last year in residency, my intern year, has taught me that I don't have the resources to absorb the coming two years without a better mechanism in place to maintain balance. I feel I have been becoming thinner, more translucent. There seems to be less substance to my life and who I am because I am so narrowly focused on the tasks of learning Emergency Medicine and being a physician. I feel sad that there is so little of the larger aspects of what I had hoped a physician would be within this training. It does not focus on the human but on the process of metabolizing. It focuses on lab results, legal pitfalls, a complete differential diagnosis, the proper work-up, adequate antibiotic administration, resuscitation. All important, but all only part of the human need and there is so little room for anything else.

I see now more than ever that I am made up of so many little parts, not just one large one. I wish I were. I see people for whom medicine is their life and they are happy to be in a world where they can live 100% of what they are every day. Sadly I am not that way. I get to express maybe 30-40% of what I am every day here in medicine, which is more than I have found in physics, astronomy, philosophy, photography or anything for that matter, but it has come at such a huge cost. I miss time for my cello, creativity, art, writing, thoughtful reflection, meditation, simple being. I find occasional outlets. My writing is rushed and poorly thought out as I squeeze it in at the end of a night, but it is something. I have never had the time to return to it, edit it, rethink it, erase it. My cello rarely gets a few scales played and some very halting and poorly remembered tunes from when I was able to take lessons. I no longer find the contemplative space for real creativity. My goal for the coming months is to find a way to include this, some of it, back into my life. Otherwise I fear, like a stellar furnace, I will run out of hydrogen prompting one force to overwhelm the other and all homeostasis to come unhinged. I will eventually shrink and cool and end up a dead ball of matter, dense with medical knowledge but without any heat or energy to give to the universe around me.