Latest / The Hidden Load: For the educators and leaders in medicine who hold everyone up. / Unclenching the Wheel: White Knuckling and Practical Mindfulness
Transcript
- Santina Wheat: Welcome to the hidden load for the educators and leaders in medicine who hold everyone up. We will tackle the hard topics and help you conquer your chaos and get to calm all by starting to acknowledge and remove that hidden load. This podcast is a space for us to name the things that are common, but not normal. Each week, we'll look at the invisible weight you're carrying and explore practical coaching-based tools to help you find more calm, better boundaries, and a sense of purpose that doesn't require you to run on empty. I'm so glad that you've carved time out for yourself today. Let's get into the episode. Welcome back to The Hidden Load. I am your host, Dr. Santina or Tina Wheat. Now I want to take you back to a moment earlier in my training that I have never forgotten. As a younger physician, someone I respected looked at me while I was navigating a demanding clinical rotation and said something that really stuck with me and cut to the core of how I was operating. They said, Tina, you are moving through training like you're holding on to a steering wheel during a severe rainstorm. What does that even mean? Well, it meant that I looked visibly tense, that I looked like a driver who was white knuckle gripping the wheel at 10 and 2, staring through a blurred windshield, bracing for every potential slip, and hyper-vigilantly. Trying to avoid every possible accident. Now, at the time, I probably laughed it off or even defended myself. I don't exactly remember. But as the years have passed, that image of white-knuckling the steering wheel in a rainstorm has stayed with me. Maybe I've been thinking about it a lot as I have been doing more driving over the past couple of years. Because if I am being completely honest with you today, every once in a while, life still gets exceptionally busy, both at home and at work. And I find myself right back in that exact same posture. I find myself going through my clinical day, my administrative meetings, and even my evening routine at home as if I'm holding onto that steering wheel for dear life. You know the feeling, don't you? You're moving through your day in a state of constant bracing defense. You're waiting for the next patient to decompensate, the next inbox to drop, the next schedule conflict at home to erupt, or the next administrative emergency to derail your evening. And as you're doing this, your shoulders are up around your ears, your jaw is tightly clenched, your breathing is shallow and trapped in your chest. And your fingers are literally locking up with tension over every micro task. And here's the diagnostic truth about white knuckling through life. When you drive through your day like that, you unfortunately overreact to every single hiccup that comes your way. When your nervous system is already operating at maximum tension, a minor traffic delay, a routine charting error, a late patient, or a spilled glass of milk at the dinner table. Does not feel like a minor inconvenience. It feels like a catastrophic skid on an icy road. You react with sharp frustration, intense irritability, or deep exhaustion. Not because the hiccup was huge, but because your system had zero open capacity left to absorb. Let's look at why we do this. Why do high-achieving physicians, educators, and leaders walk through life with white knuckles? Well, of course, it is because medicine trained us to do it. In our clinical training, hypervigilance is an adaptive survival skill. It makes sense when you are managing an ICU patient, taking trauma call, or running a busy labor floor. In those scenarios, we must be acutely aware of every potential slip-up. It is what keeps our patients safe. In those moments, heightened threat perception is absolutely appropriate. The problem is that our brains don't know how to turn that threat detector off when we step away from the bedside. And so what that means is that the acute clinical threat has an appropriate high vigilance, rapid action, patient-saved. But then there's also the systemic misfire of the chronic administrative threat, inbox, meetings, home logistics. You have the same fight or flight cortisol spike. And that leads to physical rigidity and exhaustion. And so we start treating a routine administrative email with the same neurobiological threat level as a code blue. We treat our home schedule, our kids' extracurriculars, and our daily task lists like we are driving through a blinding torrential downpour. Now ask yourself: is it worth it to go through every single day feeling like you are driving through a rainstorm? I'll tell you, I don't think so. Living in a perpetual state of heightened threat drains your biological energy. It inflames your body, it fries your patience, and it destroys your ability to feel joy. We cannot walk through every year of our career and our personal lives with our nervous system set to emergency alert. When you realize that you are white knuckling the wheel, how do you actually start to relax? How do you unclench your jaw? How do you drop your shoulders? How do you loosen your fingers and keep moving forward safely in our everyday lives? It is one thing to slow down when you're driving on an actual highway. The rain eases up and the sun comes out. And it's clear that we can relax again. But how do you do that in the middle of a 24-patient clinic block or even a chaotic family evening? This is where we have to talk about mindfulness. Now, let me be completely a hundred percent honest with you. I have never been the person who believed in mindfulness. In fact, for years, anytime someone brought up meditation, mindfulness apps or wellness breath work in a faculty meeting or a conference. I inwardly and maybe even exward extra ex externally. I inwardly and maybe even outwardly rolled my eyes. I pushed it away. I thought it was a bunch of hooey. I thought I certainly don't have time to sit on a cushion for 20 minutes and hum when I have 50 emails to respond to, three meetings to prepare for, and patients to see tomorrow. So if you are listening to me right now and you also think mindfulness sounds like fluff, I totally get it. I was sitting right in your seat. But if I, a skeptic who used to dismiss it entirely, can convince myself that it is not HUI, I hope you will take it as a sign that it might actually be able to help you too. Mindfulness doesn't look the same for everyone, and it does not mean sitting in a quiet room for an hour. Mindfulness, in its truest form, is simply the act of lowering the perceived threat level in your body so that you can loosen your grip on the wheel. Here is what practical real-world mindfulness actually looks like for a busy leader. One might be the two-handed sip of water. Sometimes mindfulness is taking a single moment to have a sip of water in between patients. And I don't mean taking a sip while typing an inbox reply with your other hand while reading a lab result. I mean stopping for 10 seconds, putting both hands on the glass or water bottle, or one hand on the counter. and one hand on the glass, taking a sip, swallowing, and just feeling the water. It is a 10-second pause that signals to your brain, we are safe right now. Another option is the focused box breath. Sometimes mindfulness is taking one single focused deep breath between clinic rooms. Whether it's box breathing, which is my personal favorite, inhaling for four seconds, holding for four seconds, exhaling for four seconds, holding for four seconds, or even just a slow, deep belly breath. It physically forces your parapet sympathetic nervous system to drop your heart rate and loosen your shoulders. And the last one I'll share with you is the midday environmental reset. Sometimes it's stepping away from your desk for a five minute walk during your lunch break to get fresh air. It might be spending three minutes journaling on a notepad, or even recording a quick audio note on your phone while walking to your car to get the mental clutter out of your head. Each of us will find the specific micro reset that works for us. The goal isn't perfection. The goal is awareness first. And then after you have the awareness, it can be followed by a deliberate unclenching. Now, if you lead a team, supervise learners, or manage an apartment, how you grip the steering wheel directly dictates how your entire team drives. When an attending, program director, division chief, or other leader walks around white knuckling every hour of the day, when they are visibly tense, reacting sharply to minor hiccups, and operating in constant crisis mode. The team absorbs that threat signal instantly. White knuckle leadership radiates a threat, the team operates in fear, and this leads to higher error rates and skyrocketing burnout. Whereas steady hand leadership with unclenched jaw, pauses before reaction, allows a model of a calm in the storm. When you white knuckle your residents, your staff, your team, they start whitenuckling too. They become afraid to report mistakes, afraid to ask questions, and they are perpetually braced for panic. But when you have the courage to loosen your grip, when you model taking that breath, when you walk into a busy clinic day and say, things are busy right now, but we are just going to take this. One patient at a time, calmly and safely, you lower the threat level for the entire room. You create psychological safety simply by choosing not to panic. And I want us all to choose not to panic. With that in mind, here is your Monday morning challenge for the week. Sometime this week, when clinic is hectic or your home schedule is overflowing. I want you to perform a physical body audit. I want you to take five seconds and check in. Are your fingers locked tightly around your pen, your phone, or your coffee cup? Are your shoulders up around your ears? Is your jaw clenched? Does every muscle in your back hurt? When you catch yourself white knuckling, don't judge yourself. I just want you to notice it. Then I want you to execute just one micro reset. It might be that you unclench jaw purposefully. It might be that you intentionally drop your shoulders. It might be that you take that two-handed sip of water or take one deep box breath or belly breath. This will help you start to loosen your grip on the wheel. The storm outside may still be raining, but you do not have to always drive through it with white knuckles. Thank you for joining me for this episode of the Hidden Load. If this reflection spoke to you today, please share it with a colleague who might be holding on to their steering wheel a little too tightly right now. I want us to lighten the load together. And if you happen to be at The AAFP C O D or FMX, come say hi to me. I will be presenting and even coaching for AAFP members. And if you come and find me and tell me that you're interested in working with me, I have a special deal for folks that I see there. I am Dr. Santina Wheat, and I look forward to seeing you next week. Thank you for listening to The Hidden Load. If today's conversation spoke to you, I would love for you to share it with a colleague who might need to hear it too. It's one of the simplest ways we can start shifting the culture of medicine together. And remember, your time spent reflecting here matters. You can earn free CME or CE credits for listening to today's episode through the Pinnacle app. You'll find that link in the show notes. If you are looking for one-on-one coaching support or want to dive deeper into the resources we discussed today, let's connect. You can find information on how to reach me in the show notes. don't forget to hit subscribe so that you never miss an episode ⁓ and leave me a rating so that others can find me too. and take care of yourself because you deserve to be held up too. And I'll see you next time.