All stress, including fatigue, narrows one’s focus. A narrow focus means failing to attend to relevant information and weighting some information too heavily. A narrow focus, then, misdirects sometimes disastrously.
Reflection improves performance and reflection in action improves it sooner. In clinical care many events are singular so that reflection after action helps only with process rather than specific actions whereas reflection in action helps with what one is dealing with specifically. Highly dynamic, time critical events do not lend themselves to reflection in action particularly because they are stressful. What is needed is the facility to step back in critical moments, to disengage.
The patient is dying; disengage. That, friend, is easier said than done.
My belief that I have no control over life and death and that death is destined allows me to disengage. I cannot save those who will die: nothing I do will make a difference. My task then is to see that those who survive do so with the best possible outcomes. There is a central inconsistency here, but inconsistency is human. And I have no wish to debate whether death is destined or not. My conviction is pragmatic: I do not decide life and death so I am free to be as heroic as I choose: I have control of the process, not the outcome.
How do you deal with stress? How do you free your stuck cognitive gears when life is on the line?
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