“Life moves pretty fast. If you don’t stop and look once in a while, you could miss it.” — Ferris Beuller (character from “Ferris Beuller’s Day Off” [1986])

Editor-In-Chief, Chester "Trip" Buckenmaier III, MD,  COL (ret.), MC, USA

Chester “Trip” Buckenmaier III, MD,
COL (ret.), MC, USA

I have commented numerous times within this column on the daily stressors that federal medicine providers face within our large health system. Although considerable job stress can be attributed to unwieldy and/or unnecessary bureaucratic nonsense that seems to plague the system, the fact is that medicine tends to be a stressful occupation, even in the best of circumstances. Some stress in any complex occupation is probably necessary to focus the mind, clarify purpose and motivate positive action. I believe many people who enter the healthcare profession do so because of the deep sense of purpose and accomplishment the stress of caring for another ill or injured human being can engender. This response to stress actually has a term, “eustress,” which means beneficial or good stress. Psychologists look at eustress not as a stressor type but as psychological response to a stressor as a positive challenge as opposed to a negative threat.

Personally, I can think of many instances throughout my career where I have been greatly stressed by my medical profession but have responded with intense feelings of personal satisfaction and general well-being after the experience. Eustress appears to be a component of our psyche that pushes us to achieve, improve and overcome. This positive and motivational stress is likely a key ingredient in all of human accomplishment. Keeping this positive stress in moderation, like so many things in life that are positive (food, sex, iPhone, etc.), seems to be the key to prevent eustress from becoming the health-corroding condition of plain old life-threatening “stress.”

Considerable evidence shows that excess stress is detrimental to physical well-being and general health. Following an acute stressful event, a cascade of changes occurs within the nervous, cardiovascular, endocrine and immune systems of the body in response to stress. In the short term, these changes might be beneficial, in that they mobilize the body’s energy stores for immediate use in the acute response to the stressor (i.e., “I need to run from this lion!”) and divert energy to organs that are usually needed to respond generally to stressful situations, such as the brain and muscles (i.e., “I need to be more alert for lions in this area.”). This is all well and good, if you are briefly being chased by lions but not so healthy if this response is prolonged by exposure to some constant uncontrollable stressor.

Problems related to or exacerbated by stress include heart disease, asthma, obesity, diabetes, headaches, anxiety, gastrointestinal problems and even accelerated aging. Belly fat or central obesity provides an example of how chronic stress translates into disease. Beer bellies have a strong correlation with cardiovascular disease. Chronic stress leads to excess cortisol secretion, which has been associated with increased abdominal fat distribution.1 If my own beer belly is any indicator, I appear to handle my own stress poorly (probably by enjoying a few too many beers).

I would imagine it was easier managing life stress when it was more compartmentalized and obvious (i.e., “I should avoid the area where the lions are to circumvent the stress of being chased and eaten.”). Unfortunately, the realities of complex modern society have all manners of stressors that are far less obvious and less direct than an attacking lion: daily traffic, endless emails, iAnything, overscheduling, manuscript deadlines, meetings, travel, work, family, my teenage daughters, other teenage boys (argh!) and myriad other intrusions into my otherwise tranquil psyche. No, I do not want to return to the simpler times of lion avoidance, but the convenience of our modern society appears to come at some cost to our health. Fortunately, we can do something about this stressful situation.

The most obvious answer would be to avoid stress altogether by moving to a mountaintop for a lifetime of quiet contemplation. Sadly, this is inconsistent with most folks’ financial status, but, while such a scene makes an excellent opening for a martial arts movie, it contributes little to a productive life that is meaningful for your fellow human beings or family.

A productive and meaningful federal medicine career, I would argue, necessarily includes a hefty dose of stress. As Theodore Roosevelt put it, “There has never yet been a man in our history who led a life of ease whose name is worth remembering.” Although stress might be unavoidable, we do have some control on how we decide to respond to stress in our daily lives. We can choose to be optimistic about stressful situations, particularly at work, and see them as eustress opportunities to further personal and professional goals. We can identify those situations that are always and routinely stressful and adjust our lives to compensate.

I am routinely subjected to the stress of insane Washington, DC, traffic. Occasionally, I enjoy the commute on my Indian Scout motorcycle, which turns the drive into more of an adventure than drudgery. I recall those motorcycle commutes when I am forced into the car cage, which reduces my anxiety and lowers my blood pressure. When required to commute by car due to weather or work issues, I listen to audiobooks (U.S. Grant’s memoir presently — recommended) while traffic rages around me, and I learn new things in the process, despite the inevitable maddening traffic jams. I strive to hold my morning exercise time sacred against my workday responsibilities, because I know a morning workout enhances my outlook and productivity all day. Weekend sailing is another effective means for alleviating the stress of the workweek. I also try to leave work at work whenever possible; this goal, as my wife will attest, I am least successful at. The actual strategies developed by an individual in response to stress are not nearly as important as recognizing stress generators and working on personally effective tactics to manage that stress.

Life does, indeed, move pretty fast as the young protagonist in “Ferris Beuller’s Day Off” so eloquently proclaims. We should pause and look for opportunities to turn stress into eustress. Apparently our health and possibly our lives depend on it. We also should pass this wisdom on to our patients so they understand the impact of poorly-managed stress in their own lives; to help them, as Ferris would recommend, stop and look around at their lives, and not miss it.

1Moyer AE, et al. Stress-induced cortisol response and fat distribution in women. Obes. Res. 1994 May, 2 (3):255-62.