Joseph Cramer, M.D.: Push the pause button and take a breath
Pause. Take a breath.
While we are waiting, ponder the power of the pause. It is a temporary equivalent of stopping the world from spinning out of control without us having to get off. Modern devices can put electrons on hold. They have a pause button.
A pause slows the mind and lets the executive part of the brain catch up with the twirling dervish other half.
A true pause is complete peace. It is calm amidst the storm. This break in thought is a brake for the brain to stop perpetual crisis and constant urgency. It arrests the churning wheels of tension to permit the engineer to get aboard our mental train.
We all live on our own train. Some are chugging along pulling great burdensome loads. They follow the path of the rails and head for a proscribed destination. With their heads down, they miss the scenery. They only see immediately in front of them the tracks bolted in place that trap them. Everyone admires them for their hard work, but no one seems to notice there is no joy.
There is a second train. It is more like a roller coaster careening up and down and all around. It rolls on its own inertia without a conductor. In spite of the contrasts, both lives are on autopilot.
They are equally on thoughtless journeys. One is dutiful and dull. The other is wild and crazy. Regardless of the style, someone needs to push the pause button.
The third means of locomotion is a passenger train. It has an engineer. The engineer can make his steam engine go fast or slow. He directs the string of cars to come to a complete stop. He decides which branch of track to take or not take. He blows a loud whistle when there are cows on the track. He can even back up if necessary.
The ability to govern our lives is this engineer. Some call it a will — others say agency, intelligence or choice. That is why a pause is so important.
A brief hesitation is therapeutic. It wakes us up. Either the brain shuts down and prods ahead blindly or it sprints off to save itself and the body that carries it. Any perceived delay in either scenario is assumed fatal. Unfortunately, there is a problem. For the worriers among us, threat centers are set for the highest level of sensitivity. That means that at the slightest hint of any problem, no matter how small, the brain immediately sends out hormonal and neural message of anxiety, fear and the need to escape or put the head down.
In contrast, a pause stops our train from becoming an unguided, out of control roller coaster or a mindless slave. A pause permits all the panic hormones to dissipate. With a halt, there is time to bring order to the sensed urgency. In the tiny seconds we can make choices and prioritize. We can rank our tasks by importance not by randomness of stress or perceived threats. We can look up to see where to go.
There is no better example of the power of a pause than a hospital code. The moment the code blue sounds over the PA system, stress hormones set the trains in motion. The patient’s room is crammed with responders. ICU docs, nurses, residents, respiratory therapists, lab, EKG are all there. People are grabbing medicines, starting chest compressions, pulling in equipment and staring at monitors. There is a need for a collective pause. There is so much commotion that if the patient were to instantly recover, he could quietly slip out of the room unnoticed and escape in the crowd.
Our lives can be a continuous code blue. A pause would let the brain train recalibrate. It lets our internal engineer make decisions. The screaming and the moaning stop.
If our existences become robotic, push the pause button.
Joseph Cramer, M.D., is a fellow of the American Academy of Pediatrics, practicing pediatrician for 30 years, and an associate professor of pediatrics at the University of Utah. He can be reached at firstname.lastname@example.org.
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