Kaizen and the amygdala

Our history as humans from thousands of years ago, is still having an effect on how our brains are working.

Thousands of years ago, when we met a big bad wolf in the forest, we had not time to think. So for the purpose of saving our life, our basic brain structures, our amygdala were helping to shut down all other brain functions including our thinking processes, our sexual desires our need for approval, our creativity, and made us fight or flight, run for our lives or try to fight off the danger. The fear for the wild beast had successfully triggered fear and an appropriate reaction for our survival. Since we were not very fast or strong comparing to the beasts preying on us, it was best to learn where it was safe and to really go and explore the unknown. Major changes were readily triggering our amygdala, shut down all our higher brain functions and got us ready to run or fight.

Now if we have to sit for this very important test or we face a major change in our life, our amygdala tend still to respond in such a way. We want to lose weight, but diets are difficult, exercising demands time and causes us to have sore muscles initially at least and instead of effectively going towards the change, our fear sets in and we are in a run or fight mood. Our higher brain functions shut down and no change tends to happen.

Now small incremental changes in what we want to achieve, tends to bypass this primitive response. If we start with one snack less per day, we may not lose a lot of weight in the first week, but we see that change is possible without too much effort and we are encouraged to take the next step. Or for exercising, instead of enrolling a program of half an hour for five days a week, which is very likely to fail we then start with doing a few minutes of exercise every day. No trigger of fear, no trigger of amygdala no run or fight response, no shutting down of higher mental functions.

Good stories from students

I want to share with you two amazing stories of medical students who had spent almost 7 weeks in the pediatric wards. I asked them to share their worst and best moments in these wards. 

Story 1 

    The first story was the worst experience of one of the students. A child with a chronic kidney problem had been admitted. The child was very ill. The mother had not brought the child to the planned follow-up after the initial diagnosis and most likely that lack of proper follow-up was one of the main causes of the quite critical condition the child was in. The child needed to be transferred to the high dependency unit and the doctor in charge had asked the parents in a bit of an angry way: "Why did you not come for follow-up. Look how ill your child is now; we need to transfer him to the high dependency unit". This had left both parents in tears. My student had stayed a bit with the parents but was not trained on how to deal with this difficult situation.

Comments on story 1

     My student had observed an instance of poor doctor communication. The child was critically ill and instead of providing empathetic support, the doctor had just induced lots of guilt feelings in parents who were trying to cope with the critical illness of their child. The parents were shaken and my student as a bystander was shaken by the event too. 

    We had an interesting discussion on how each of us felt the communication could have been better. We  agreed that in the acute phase of the illness, there was no point in putting too much stress on errors from the parents. Rather, a doctor should describe the condition of the child and reassure the parents that we will provide the best possible monitoring and care for their child. We should be perfectly clear on the fact that the condition was critical but we hope that the child would recover with the care provided. Later, much later, when the child will be recovered and be ready for discharge we can stress to the parents the importance of attending follow-up in the future, in order to reduce the chances of the same complication happening again. 

    We discussed also what could have been said to the parents while they were crying. It is quite essential to allow the feelings to flow and handing some tissue paper to the parents and not say anything may be appropriate. If we want to say something, it may be good to express our understanding for their sadness and our understanding that it must be really hard for them.We discussed also the importance for all doctors to not be afraid of their own feelings. Anyhow, these events can help us to reflect and help is in the long run, deal with our won emotions better 

 

Story 2

The second story made me really happy. The second student shared his best experience. He had clerked a four year old boy who was very much interested in a cartoon, the student knew well. At the end of the encounter the student had given to the patient a figure that he had owned since quite long and he felt really good about it. 

Comments on story 2

I really enjoyed hearing this so much. This part illustrates that it is in giving that we receive. Something I myself struggled with for long to fully understand. The student was giving a material thing, and he received a good feeling in return.  This was so important to him, that he had selected this as the best experience of the 7 weeks.

I believe thoroughly in random kindness and the value of giving. I think oftentimes our parents and our teachers are planting the seeds of kindness in our souls and hearts. But it is only through our experiences and the reflection on our experiences that these seeds manage to blossom into wonder flower of a long term dedication to selfless service. 

Many thanks to Nor Athirah Binti Azlan and Ahmad Izham Tasnim Bin Mohd Satar for giving permission to share here their personal stories.