Wellness POTD: What Do Our Attendings Do in the Winter in NYC?

Happy Friday everyone!

Winters in NYC can be cold and long, but I'm a firm believer there's magic in the city if we search for it a little (too sentimental, I know, but it's true). So for this wellness POTD, I crowdsourced some of our EM attendings for recommendations on how they spend their days this time of the year. 

The question was simple: do you have any traditions, activities, or sightseeing you like to do with your loved ones during the winter in NYC? The responses are humorous, heartfelt, ice skating-infused, and thoroughly delightful. Enjoy.

Dr. Reuben Strayer: "My christmas tradition is to eat birria. My favorite birria tacos at the moment are at El Mexicano Restaurante & Cafe Bar (https://maps.app.goo.gl/ELzrXxUDdYuW7LLG6)."

Dr. Eustace Lashley: "When the kids were younger and wanted to hang with us, we took them to the Christmas show to see the rockets at radio city music hall. Stroll on 5th Avenue and view the displays at Sachs, view the Xmas tree at Rockefeller center. My wife took them ice skating while i watched. The Macys window display was also a hit. Have dinner at a restaurant of my wife’s choice. Now I keep out the city at Christmas 😀😀."

Dr. Eric Roseman: "Ice skating! Bryant Park, Central Park or Prospect Park. And candy cane flavored chocolate bark." (I wanted to clarify if the bark was homemade, to which the response was "def buy, but that would be cute if I made my own.")

Dr. Emily Unks: "Bryant park holiday market is cute. And the nutcracker!! Also going to serendipity on upper east side, featured in my fav rom com ever and has ridiculous hot chocolates and ice cream. Or drinking and going to hawaii."

Dr. Julie Cueva: "Here are some kid friendly activities: ice skating at prospect park (and sledding if it ever actually snows!) Bronx Zoo Holiday Lights, sip hot chocolate and walk through Dyker Heights Lights. We’ve done the tree but they didn’t seem to care too much about it, mostly just wanted to check out the toy stores near by!"

Dr. Laura Gonzalez: "Honestly, my favorite holiday activity is to walk around the various neighborhoods.  NYC is the consummate walking city; you get a sense of the diversity and joy when you walk it and that goes for anytime of the year.  The holidays are even more fun because the decorations are often over the top 😊 Some are color coordinated with tasteful lighting and deliberate designs; others are just chaos - yards with giant blown up santas surrounded by smaller snowpeople, lighted menorahs, and even random left over Halloween paraphernalia.  Gotta love it💕. Also, walking is free, open to all, and good for your health and mind 😊."

Dr. Sneha Shah: "Sundays in Brooklyn in Williamsburg has the cutest holiday pop up called Snow Day in Brooklyn and they have really good cocktails with cute names and very cozy decor!!"

Dr. Lawrence Haines: "I go skiing with my kids. Spend time with family. Go to Miami every year in March."

Dr. Kimbia Arno: "Union Square Holiday Market!"

Dr. David Shang: "I'm depressed during the winter."

Dr. Evan Mahl: "While there are lots of touristy things to do in NYC (Rockefeller Center), for me the winter holidays in NYC are best filled with eating and drinking out with friends and family in clubby and warm restaurants. For steak lovers, I've been digging Hawskmoor Steakhouse on Park and 22nd. The main dining room is an historical beauty, but the best scene is at the bar. They serve what they call the world's coldest Martini and it's a winner. They serve excellent oysters and burgers at the bar, but the steaks are great too. Other NYC classic gems include Gramercy Tavern and Minetta Tavern. If you want to stay in Brooklyn, you can't go wrong with Gage and Tollner (definitely grab a drink at The Sunken Harbor Club, their upstairs tiki bar.)

Lastly, a fun and festive day is always to be had at Chelsea Market on 9th Avenue. It's filled with lots of fun restaurants and shops. It's a great place to sample some oysters and beer at The Lobster Place (their seafood restaurant Cull and Pistol is also great). For meat lovers head downstairs to Dickson's Farmstand Meats; Israeli street food is right at Mizon; Korean grub at Mok Bar; and some of the best tacos in NYC at Los Tacos # 1 (and their seafood taco joint, Los Marisocs). End the day with some sweets from Lilac Chocolate, then bundle up and walk along the Hi-Line.

Dr. Josh Schiller: "Lightscape in Brooklyn Botanic Garden (https://www.bbg.org/lightscape?gad_source=1&gbraid=0AAAAA9p0StKQx9K86zXjBR0IRPNU2mZCt). The lightshow is nice for kids."

Dr. Sabrina Sokolovsky: "I have to think about this because I don't like Christmas very much...My holiday is Halloween."

Dr. Carmen Cortis: "Christmas time is my favorite time of year especially in NYC. It is truly magical here. Since my birthday is on Dec 27, I try to recreate a family tradition my father started for me ever since I can remember. Every year we would go see the Christmas spectacular at Rockefeller center, go ice skating there underneath the beautiful Christmas tree, eat at the Plaza hotel for dinner and then take a ride through Central Park on horse and buggy. I would look forward to it every year and my mom and I still do it every year in his memory."

Dr. Mert Erogul: "We like to gather friends and family for Thanksgiving and make leg of lamb or duck instead of turkey. With the duck you can render the fat and use it year round for frying potatoes. Also everyone knows turkey is so very overrated."

Dr. Myung Bae: "I like Brooklyn Bridge Ice Skating that started last year. Christmas live jazz/bar at the Roxy Bar. Rolfs is a must visit during Christmas, Papillon Bistro is somewhere we go every holiday season, Miracle on 9th Street, and most importantly Petes Tavern."

Dr. Eric Quinn: "Probably Christmas shopping at Macy's herald square."

Dr. Smruti Desai: "My favorite winter tradition is getting the F out of nyc. But realistically hot pot. And snow fights in prospect park."

Dr. Duo Xu: "Traditions: ice skating at Bryant Park, Xmas tree at Rockefeller, Xmas lights at dyker heights, winter wonderland light show at Citi Field. And eat hotpot everywhere lol. I'm kinda excited to see the new bluey exhibit coming out in the winter too lol."

Dr. Danny Novak: "One of my favorite things to do during the holiday season with my family is visit Bryant park for the winter village. There is always great food, little boutique stores, and lots of activities to do for all ages. We also love to see the tree and ice skating at the Bryant park ring during our day out at the winter village! We usually end the day with having dinner at the Bryant Park Grill Restaurant."

Dr. Amy Sanghvi: "Bryant park market. Union square market. A tree I love in the Bloomberg building. Pete’s or paddy’s for the decor. Madison sq park tree lighting. Ice skating Bryant park. Almost always go away for a weekend upstate to try to see snow. The macys windows. I have kids so my list is quite PG."

Dr. Shivani Mody: "The holidays in NYC are my favorite time of year! I love taking my kids to soak up the magic of the season—wandering through the Winter Village at Bryant Park, seeing the Rockefeller Center Christmas tree, and catching the Saks light show. Yes, it’s all a bit cliché, but it never gets old! For date night, my husband and I have our own traditions—watching The Nutcracker at Lincoln Center and grabbing drinks at the Empire Hotel (any other Gossip Girl fans out there?)."

Dr. Kai Wang: "We have gone to the dyker heights Christmas lights and winter village/ice skating at Bryant Park."

Dr. Michael Lamberta: "Finding parking on the left side of the street before it snows… 🤔 checking out the Bryant Park winter market and making mulled wine."

Dr. Eric Lee: "I like ice skating in Bryant Park and strolling the holiday market afterwards. Hot beverage and mulled wine is closest that it feels to christmas markets in Europe. I also like walking down 5th Ave and catching the light show outside Saks. Take advantage of being an EM doc and do all this on a weekday. Don't go on the weekend or week of Christmas."

Dr. Irina Sanjeevan: "This might be lame but my fave thing in winter is finding tasty hot chocolate/teas/ramen/soups to eat haha so usually very food-based activities! Walking around the cold with a loved one and a delicious hot chocolate in hand is my fave."

Dr. Kay Odashima: "For me, it’s all about sharing warm, cozy foods with family and friends. A favorite at home is nabe (Japanese hot pot) or cheese fondue. If I’m going out, I’m game for any place that serves mulled wine. When it snows enough (which didn’t happen last year) we love to take the kids sledding on the little hills at Prospect Park."

Dr. Ryan Lebuhn: "https://freshnyc.com/blog/where-go-best-mulled-wine-or-spiced-wine-nyc"

Dr. Matt Friedman: "Go to Turks and Caicos!! Ok, I'll think of something more local. Frozen hot chocolate at serendipity on East 61st or 60th. Watch the thanksgiving day parade balloons get blown up on the night before the parade on the upper west side. Get Banana Pudding at Magnolias and wander through Central Park with long johns on in case it's cold. Go to 4 and 20 blackbirds for a thanksgiving pie. Matzah Ball soup at the world renowned Second Ave Deli (on 33rd and Third Ave) to offset the frosty weather."

Dr. Jon Rochlin: "When the kids were little, we went to radio city music hall to see the rockettes. We'd sometimes go skating at Rockefeller center. The holiday lights in dyker heights followed by pizza at L&B spumoni."

Dr. Dave Eng: "Snowy cabin weekend in the Hudson Valley with warm cider and board games while watching the snow fall."

Dr. Gary Maida: "At the first semi substantial snow fall in NYC a great Staten Island tradition is to go sledding with the family at Silver Lake Golf course. Hundreds of families fill the golf course sledding on various hills. We then go warm up on Forest Avenue with a famous cheeseburger at Duffy’s! Just call me if you get a summons for trespassing."

Dr. David Lobel: "Light show. When the kids were smaller there were holiday lights at The Bronx zoo, and train show at the NY botanical garden. These are close to Arthur avenue where a hearty Italian meal would follow. These days, the Brooklyn Garden has also started a holiday light show. Photo to follow."

Dr. Jessica Zerzan: "I like a fire. And I will recommend others sit by a fire and figure out how to dismantle the patriarchy."

Happy adventuring in the city,

Kelsey

Wellness: Second Victim Syndrome

Medicine is a stressful career, and health care provider wellness is sometimes neglected within the culture of medicine

Throughout our medical training we have had the opportunity to treat and learn from the patients every day. We are exposed to an extremely difficult working environment and are constantly witnessing terrifying traumatic events that most people never see in their lifetime. 

During the past few months in our emergency department, we have recently seen multiple level 1 traumas, pediatric, and adult cardiac arrests. In this stressful environment it is very easy for medical errors or patient safety issues to occur. It is important that we take care of ourselves, support each other, and to utilize extra help if/when needed.

Today, I wanted to speak about second victim syndrome.  

What is second victim syndrome?

·      The second victim syndrome (SVS) is defined as the Health Care Providers (HCP) who commit an error and are traumatized by the event manifesting psychological (shame, guilt, anxiety, grief, and depression), cognitive (compassion dissatisfaction, burnout, secondary traumatic stress), and/or physical reactions that have a personal negative impact (similar to symptoms of acute stress disorder)

·      Examples: incorrect medication dosages, missed diagnosis, incorrect medical management, accidental harm during a procedure, among several others.

·      These types of cases are unforgettable and can leave lasting emotional scars on providers.

·      After an adverse event, the prevalence of SVS varied from 10.4% up to 43.3%.

·      Almost half of HCPs experience the impact as an SVS at least one time in their career

What are the impacts of second victim syndrome on providers?

·      Anxiety, depression, guilt, sleep disturbances, loss of confidence in their practice, and decreased job satisfaction.

·      Isolation, depression, and suicidality

·      Numerous reports in the literature discuss providers (nurses, residents, attending physicians) who died by suicide following a significant event that led to patient harm.

RESIDENTS ARE AT VERY HIGH RISK!

·      Residents are in the learning phase and are expected to make mistakes during their training given their relative levels of inexperience combined with high levels of clinical accountability.

·      According to one study, the prevalence of fourth-year students involved in a medical error was 78% - compared to 98% of residents.

·      A survey of more than 3100 physicians from the U.S. and Canada found that 81% of those who had been involved in a clinical event (serious error, minor error, or near miss) experienced some degree of emotional distress.

How can we identify this?

·      May display similar emotions and behaviors to those experiencing burn out or acute stress disorder or burn out

What can we do to help each other?

·      Peer supporters, patient safety, and risk management all play a critical role in ensuring the provider has a safe space to recover from the event.

·      While support from friends, significant others and supervisors are important, most providers prefer support from a trusted colleague

·      Receiving support from a colleague from within one’s own specialty offers a sense of shared understanding about the complex nature of patient care. It also normalizes the situation for the affected provider.

·      Projects such as clinical event debriefing and help recognize systems errors, near misses, incidents, etc. They can also be used to help set up peer meetings and services if individuals are suffering.

References

https://omh.ny.gov/omhweb/bootstrap/crisis.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697646/

Second victims in health care: current perspectives

www.ncbi.nlm.nih.gov

Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected ...

https://www.emra.org/books/emra-wellness-guide/ch-8.-second-victim-syndrome/#:~:text=The%20second%20victim%20is%20the,becomes%20traumatized%20by%20the%20event.

Thank you for your time!

Happiness

Today, I’ll be reflecting on happiness. 

There is endless literature, philosophy, and psychology devoted to this one word. I spent a couple of hours this morning reading reading about happiness. A few themes emerged, and I wanted to take a moment to share them with you along with some of my takeaways.

(1) “Experienced” versus “Remembered” happiness

Experienced happiness: the happiness you experience in the moment. Experienced happiness can entail going out to dinner with a friend, enjoying a lovely glass of wine, going to a concert. The moment-to-moment bliss can be nourishing. On the flip side, binge-watching Love is Blind on my couch gives me great joy in the moment, but the next day, I look back and I feel sad like I wasted an opportunity to do more. In general, this term captures the “carpe diem” or “YOLO” mindset. However, being happy in a moment can be different than being happy for a longer timeframe.

Remembered happiness: when you reflect back on a period of time and feel satisfaction. For example: residency. Each moment is challenging and often not “fun.” But you may look back on the breadth of the experience and feel a deeper satisfaction that could not be captured in one single moment. The multitude of experiences culminated into happiness. People often use remembered happiness to measure life satisfaction. 

My takeaway: Framing it in these two categories actually really helped me. Being intentional with each type is important. Moments of experienced happiness will help me withstand the journey of the remembered happiness, so it’s important to prioritize simple pleasures that bring me joy. If I overemphasize experienced happiness, then I might lose sight of my larger ambitions and lack purpose. However, if I only prioritize remembered happiness, I might look back on my life with regret that I didn’t enjoy the process along the way. I think the moments in life when we have jolting reminders of our transience push us to embrace experienced happiness even more. 

(2) The Hedonic Treadmill

This theory is also termed “hedonic adaptation,” and it talks about how people typically live at a “happiness set point.” As positive events occur – like getting a great new job, achieving a longstanding goal – expectations correspondingly rise. Thus, there’s no net gain in happiness. The same theory actually holds true with negative events. Over time, you’ll eventually return to your happiness set point regardless of the stressor. 

My takeaway: I am 100% guilty of this. I remember there were so many times in medical school when I thought, “When I match into residency, I’ll be so much happier.” But with each accomplishment also came a new set of dreams. At times, I’ve forgotten to celebrate my achievements in pursuit of the next goal. I think pushing past the negative life events to maintain the happiness set point shows a level of resilience that is innate to us as humans. But the lack of celebration with the positive seems like a missed opportunity to potentially redefine my set point. However, even more importantly, I think this concept made me realize the emphasis I’ve placed on external sources of happiness rather than internal.

(3) The World Happiness Report

The UN publishes a report each year ranking each country on a scale of national happiness. These results are based on respondents rating their happiness. The survey uses a Cantril ladder – “it asks respondents to think of a ladder, with the best possible life for them being a 10, and the worst possible life being a 0. They are then asked to rate their own current lives on that 0 to 10 scale.”

Finland has been ranked the happiest country in the world four times in a row, followed by Denmark, Switzerland, Iceland, and Norway. USA falls at #19 of 146 countries in 2021, relatively lower than other developed, wealthy nations. One theme noted by analysts is that the top ten countries have “solid social support systems [and] good public services.” These countries also tend to have higher taxes. 

The NY Times article that I’ve linked below tells the story of a Finnish town named Kauniainen, also known as the happiest city in the world. On the surface, is a gloomy weathered town, with stoic residents. However, they cite an Adult Education Center as one of the integral components to the city’s contentment. I remember reading this article when it was published three years ago, and I never forgot it. The simplicity, strong sense of community, and investment in social systems really stuck out to me. 

My takeaway: One of my conclusions is that it helps to have a strong sense of belonging. For my in-laws, they derive a lot of happiness in their church group. For my husband, he finds camaraderie in his cross-fit group. And I realized for me, a lot of my happiness is the strong sense of community that we have at Maimo. I feel happy, grateful, and fuzzy-hearted when I reflect on that. 

References:

https://hbr.org/2018/11/what-kind-of-happiness-do-people-value-most 

https://en.wikipedia.org/wiki/Hedonic_treadmill 

https://www.nytimes.com/2018/03/14/world/europe/worlds-happiest-countries.html 

https://www.nytimes.com/2018/12/24/world/europe/finland-happiness-social-services.html

https://worldhappiness.report/faq/