Part I of II
Some of you may know how to finish this sentence:
“When you hear hoofbeats…”
If you reflexively yelled: “Think Horses, not Zebras”, either you’ve seen House. M.D, you’ve read a book about 1st year medical school, or you’ve been through 1st year medical school.
This aphorism is supposed to remind us junior docs, that when a patient presents with symptoms, the most common diagnosis is most likely (or, rule out the obvious conditions first). Leave the rare ones for the experienced docs to catch. It was first used because new doctors were thought to jump to the diagnosis that was most recently learned, different & flashy. Fair advice – it happens – even to senior docs that return from flashy conferences.
I’d like to just point out what this presumes:
a) Junior doctors have poor memories
b) Junior doctors jump to conclusions faster than their seniors
c) Definitions of rare and common are absolute
d) Rare conditions aren’t obvious
Well, as a junior doctor, my memory is sharpened because I’m acutely aware of my inexperience, thus I’m the least likely to jump to conclusions. In fact, I’m the most likely to hope, for your sake and mine, that it is an obvious & common condition. If I hear hoofbeats, I’m going to look, listen, feel, smell, & measure whatever I can, to find out what’s making noise.
Zebras, Horses or Donkeys – Jumping to any conclusion, is poor diagnostics.
Because I wasn’t so quick to ride the horse train, my comrades in school noted me as the Zebra Hunter… I’ll take that as a euphemism for my undying curiosity & dedication to creativity.
Since then, I’ve had an affinity for zebras, in the literal sense. So when I found the book, Why Zebras Don’t Get Ulcers, I obviously needed to read it. Quickly, I realized Robert Sapolsky is one of mydewdrop people. The book is well researched & dense – 500 pages of stress physiology – written from a meta-analytical standpoint, with wit & humor, from an author who stated opinion vs fact clearly. Done.
To share a slice*, and translate how it tastes to me, is the least I can do.
Let’s just cut to the chase here: Why don’t zebra’s get ulcers?
Because they generally experience stress in short spurts. How do they react to these stress signals?
Remember The 4 F’s – Fight, Flight, Freeze & … Sex.
Stress and the Sympathetic Nervous System (SNS) go hand in hand. We sweat, lung capacity expands, blood shunts to the muscles, away from efficacious metabolism, we have an intense desire to move – or stay perfectly still until the time is right.
Additionally, new research shows that the hormone oxytocin (often associated with child rearing), is also released in stressful events; leading the stressee to actually stay put & take care of others. There are several circumstances where this may be the wisest course of action, from an evolutionary standpoint. It’s been coined “Tend & Befriend”. Could we shimmy it into a 5th F?
A zebra can experience a stressor, do one of the 4 F’s, and it’s either dead or alive at the end of the stress. If it is still alive, it moves on and all it’s SNS signals drop within 30 mins, and it’s back to eating, digesting and playing. It doesn’t spend the rest of the day worrying about the next potential run-in, or searching for meaningful work. Most certainly, it doesn’t develop a stress ulcer.
Our human condition, as opposed to the zebra’s luxurious savannah lifestyle, creates longer term stressors: We are made of minds that weave webs, emotions & goals that drive our actions, experiences of horrific events, as well as the fact that we exist within undeniable socio-economic stressors.
What makes us different from zebras, is also a beautiful part of humanity:
We choose goals, we feel passion, we become motivated, we stand up for what we believe in.
Without the stress of searching for “who we are”, we would lose part of what makes us human.
Stress on the inside – what moves us to act toward our goals, to take care of ourselves, deal with disappointment and find meaning – That is good stress.
Stress on the outside – what pushes us to be short sighted, damage our bodies, to become jaded and feel worthless. That is bad stress. When bad stresses burden our lives, we have an increased risk of developing chronic disease, and ulcers.
The way our bodies and minds react to long term stress is very different than our zebra’s standard day. We definitely – as media can attest – react initially with the 4 F’s, but over time, our immune systems malfunction, our hearts and bones clog and become weak, we become inflamed (emotionally and physically), pain receptors start firing inappropriately, we become nervous, anxious & depressed.
Coping itself becomes a challenge and we don’t feel the benefits of recovery as quickly. Some of us even learn a trait of helplessness.
This is not growth. This is unravelling.
Are you unravelling or growing?
Stressing out: The common term for what it feels like to be experiencing stress that’s overwhelming.
I think that as a society, we’ve lumped the growth-oriented, life-enhancing, motivational stressors, with the damaging, exhausting, restrictive stressors.
Certain scary, overwhelming, cortisol spiking events, (ie; a big opportunity, major life change or waiting for results in a competition/exam), can be beneficial to our livelihoods and humanity. They teach us about self-assurance, inspiration, disappointment, decision and consequence. They help us grow.
Do we have a way to describe our reactions to situations like these, other than “I’m stressed out”?
I like to differentiate it. Although we may not be running from lions, these are situations that can mount a response akin to the zebra’s react & recover response.
I call it “Stressing in”: It’s the sensations, emotions and physiology that develop as we stress our system with drive, imagination and hope.
My belief is that when we lump the stressors together, we are likely to react to the growth as if we were unravelling, with the destructive emotions, hyper-reactive physiology and delayed recovery. It’s vital for us to be able to identify & grow from the “good stressors”.
Learning how to react and recover is one of the best things we can do for our stress system.
Maybe the beginning is noticing when we can be zebras.
Maybe being a zebra is not such a bad diagnosis.
You can dance and sing, and smile and scream. You can tsk and tut, jeer and glare. But one thing is for sure: you can’t put people in boxes.
“Who does she think she is?
I asked the Zebra: Are you black with white stripes? Or white with black stripes?
And the zebra asked me: Are you good with bad habits? Or are you bad with good habits?
Are you noisy with quiet times? Or are you quiet with noisy times?
Are you happy with some sad days? Or are you sad with some happy days?
Are you neat with some sloppy ways? Or are you sloppy with some neat ways?
And on and on and on and on And on and on he went. I’ll never ask a zebra about stripes again”
*Please remember this is a slice. not the whole pie.