Dr. Graham Walker (@mdcalc) is a physician that truly advocates for balance and wellness. He is currently an emergency physician practicing in San Francisco. Despite multiple work commitments and an active involvement with several successful start-ups, he still finds time to engage in his interests, keep fit, and stay well. From taking it to the next level at Bootcamp, to ensuring the day is infused with laughter, Dr. Walker is always taking the time to build on his personal wellness. He’s definitely got some great pearls you’ll want to know about. Here’s how he stays healthy in EM!

  • Graham WalkerName: Graham Walker
  • Location: San Francisco, CA
  • Current job(s): Attending Emergency Physician, Kaiser Permanente San Francisco Medical Center. Co-Creator, Developer, and President of MDCalc.com (Coming to the Apple App Store very, very soon!). Co-Creator and Developer of theNNT.com. Writer, Emergentology monthly column (em-news.com).
  • One word that describes how you stay healthy: Flossing. (Okay, fine… humor.)
  • Primary behavior/activity for destressing: Baking, and watching TV with my boyfriend

What are the top 3 ways you keep healthy?

  1. Laughter. I watch a lot of comedies, try to crack a lot of jokes, and laugh as much as possible. Current favorites include Nathan for You, Ash vs. The Evil Dead, and especially for the medical folks out there, you must watch Getting On, on HBO. It’s based on a British show of the same name, and is the driest, most spot-on medical show that humorously portrays the mundane and the everyday that never gets told about medicine, along with some humanity along the way. I guarantee you, you’ve met a nurse and physician like the ones on the show.
  1. Writing. I used to blog at Over My Med Body! back from 2003-2008 (ages ago!) and it was a wonderful outlet. I don’t write nearly as much as I used to, but I really do love getting to put my thoughts out into words and sentences and paragraphs and prose. Emergency Medicine News gives me 1000 words to say whatever I want about my job and our specialty every month, which is really a great outlet for my frustrations — and my ideas!
  1. Exercise. I’d like plead the fifth, or hell, lie — and say that I exercise as often as I should, but recently I’ve been in a bit of a slump. Fortunately, I’m good at motivating myself by fear and forced commitment — my boyfriend and I will be riding in the 2016 AIDS LifeCycle from SF to LA in June, so I know once the weather warms up I’ll be hitting the road pretty hard. I also can’t say enough good things about bootcamp classes like Barry’s Bootcamp. I really, really hate it while I’m doing it, because it’s the hardest workout you can possibly imagine, but it feels great after it’s over and you know you really pushed your body during the class. (Another example of forced commitment: I purposefully chose to live in an area not too close, but not too far from the hospital; I bike to work every day, barring rain.)

What’s your ideal workout?

Ideally? I’d love a 3D, virtual-reality video game (Oculus Rift-style) where I’m actually running around and playing the game interactively. Barring that, however, I’ll happily settle for a good long session of Just Dance on Playstation, a Barry’s Bootcamp workout, or the Muir Woods bike ride here in Marin County. Absolutely gorgeous.

Do you track your fitness? How?

I’ve got a Fitbit Surge and use Strava, which I activate on my bike. But I’ll admit they don’t really motivate me like I’d hoped they would. I’m too stubborn. I had done a decent job of tracking my calories with MyFitnessPal, but alas, I stopped that too. I really wanted to be the guy that disproves the “Most people use apps for a few months and then stop” research that’s come out, but I’m unfortunately just a Regular Human.

How do you prepare for a night shift? How do you recover from one?

Preparation:

  1. Wake up early (so that you’ll be tired later).
  2. No caffeine past maybe 10 am.
  3. Have a big lunch.
  4. Go to bed around 2 pm while watching a rerun comedy show on my laptop, hoping for a good 3-4 hours of sleep. (I’m an expert napper, those “LCD screens are bad for your sleep” people, be damned!) I will also endorse the 4-7-8 breathing technique to help slow your body down, whether it’s for sleep or otherwise.
  5. Wake up around 6:30 pm for my usually 8 pm shift, caffeinate, eat half of my Thai food take out dinner (the other half is my 3-4 am meal), and bike into work.

Recovery:

  1. Sleep until 12 pm-1 pm, then GET. UP.
  2. Get up, Graham. GET UP.
  3. After the inner monologues, I typically get going with some lunch and caffeine, and then try my best to stay active and moving throughout the day. I find if I can fall asleep between 11:30 p-12 a, I will sleep through the night. Otherwise, I’ll wake up around 2 am wide-eyed, bushy-tailed, and the least tired I ever am in my entire life.

I do not use benzos nor Ambien. Have heard too many stories, and my techniques usually work okay for me.

How do you avoid getting “hangry” (angry due to hunger) on shift?

Oh. I, uh, eat. I get hangry very easily in life, not just on shift — so I’ll typically have a snack. I have terrible GERD and gastritis/dyspepsia and so I struggle to just not eat because it’s often the only thing that quiets the stomach issues.

How do you ensure you are mentally in check?

What’s this mean?

What are the biggest challenges you face in maintaining a longstanding career in EM? How do you address these challenges?

Definitely burnout. I’d say for myself (and I’d bet other emergency physicians) — when I say burnout, I really think of a few categories:

  • Boredom. I never thought in a field as “sexy” and “dramatic” as emergency medicine I could have shifts where I was just… bored. I think we all have those shifts where the only patients we see are low risk chest pains, or worried wells, or weak and dizzies. It can certainly make me feel like I’m not really “doing anything,” or helping anyone, or contributing — and I think that’s probably a key ingredient of what makes us emergency physicians tick.
  • Compassion fatigue. We have a selection bias typically of people who aren’t doing well or aren’t feeling well. A lot of patients take out their frustration on us or our colleagues (techs, nurses, staff), or they go into regression mode when they don’t feel well. Don’t get me wrong, I’m a cranky jerk when I don’t feel well. But day after day, seeing patient after patient, who only tells you about what’s wrong and how bad things are and not getting to really see them get better or feel better over time, can be really draining over a career.

There’s a few things I try to do to combat this:

  1. Humanize the patients. I’m certainly not going to find that deep, close personal connection with every single patient every single time, but I always try to ask a few completely non-relevant questions to a patient. This is usually in the context of trying to distract them or pass the time (like when I’m suturing or squeezing out pus, or introducing myself to family) — but it makes it much easier to see them as a person, and often comforts them and improves their mood, too.
  2. At Kaiser we email our patients for follow up, which, 99% of the time, only gets us warmth and praise that we otherwise never get as emergency physicians. My inbox is typically filled with responses from patients that they’re better, thanking me and the rest of the team for the care we provided, and how we both treated them quickly and effectively, but also relieved their anxiety about coming to the ED. (And in the rare times that they’re not feeling better, I’m actually happy that they tell me this too, so I can either come up with a plan for them, book them a follow up appointment with our urgent care or a sub-specialist, or recommend they come back to the ED.)
  3. I actually go up to the ICU and see my sickest patients a day or two after their admission. This lets me see how they’re doing, follow up to see if there’s anything I missed or could/should have done differently, and say hello again to the family if they’re around. More humanizing I guess, as well as educational for myself.

Best advice you have received for maintaining health?

Stay active. Every day. I think interval training is probably overall better than prolonged exercise.

I’d also like to take this time to jump on my soapbox and re-define “healthy” a bit as well. Emergency medicine is physically, mentally, emotionally, and spiritually exhausting work. I think there are very few fields of medicine — or any job for that matter — that really tax an individual on so many levels, all at once. I think physical exercise helps with all of these other aspects of health, but I think it’s important that people take the time and energy to address any of these areas when they feel they are being particularly taxed. I could not comprehend until I’d been an attending for a year or two that my medical career is a marathon, not a sprint. We spend so much energy while in training trying to jump over the next hoop to get to a point where we’re finally, FINALLY done with training! — only to realize that now we have about 30 years of doing the same thing ahead of us. I personally struggle with anxiety issues from time to time (kept in check by all of the above) — and it’s vital to check-in with yourself* to make sure that you’re making wise decisions for yourself and your health.

*I really hate that phrase, but it summarizes things pretty well.

Who would you love for us to track down to answer these questions?

Dan Egan
Bory Kea

Zafrina Poonja, MD

Zafrina Poonja, MD

Editor, How I Stay Healthy in EM series
Emergency Medicine Resident
University of Alberta
Zafrina Poonja, MD

@zafrinapoonja

Emergency Medicine Resident. Assistant Editor @ALiEMteam. Lover of travel, soccer, and boat shoes.