It's the zero hour

You know what…I’m just going to start writing. I keep letting perfect be the enemy of good (kudos to the 900 people who have quoted that), and because of that, I get nothing done. I don’t end up sharing all these crazy, amazing, disturbing, uplifting experiences I have in the emergency department and with my climate and health work. I worry too much about how I’m going to sound; if I’m “professional” enough or friendly enough or interesting enough or erudite enough. I decided I’m over it. I hit 35 years old this year and my proverbial jar of F's to give has runneth out. With so many people using ChatGPT to write stuff these days, I feel like a little authenticity and a couple of F-bombs here and there might be a breath of fresh air. So get ready for some typos, grammatically incorrect phrases and a shit ton of run-on sentences.

The reality is that I personally feel like I’m at the zero hour for a lot of things, and if I sit one more minute dwelling on it I’m going to have a Starbucks Venti-sized mentyB. So I call this blog "Zero Hour Doctor." We’re at the zero hour for taking climate action. We’re at the zero hour for rebuilding our health care sector into something that works with the planet and serves patients best interests. And I work mostly nights in the emergency department, so I’m usually running on zero hours of sleep. See? It’s all clever and fits.

I live in two separate worlds. In one, I’m a full-time, board certified emergency medicine physician managing patients in the emergency department at three different hospitals plus one urgent care clinic in southern California. In the other world, I’m a climate and health advocate with a special interest in healthcare decarbonization. In World #1 I drag myself out of bed like many many burned out healthcare workers do these days, make myself a scalding cup of hot coffee regardless of the temperature outside and that’s probably going to give me Barrett’s Esophagus one day (if not already), and literally drraaggggg myself to work a shift. During these shifts I see patients with emergent medical conditions and basically try to figure out if they are going to live or die in the next 24 hours or if they need some sort of medical intervention to save their life or limb (spoiler alert: if you came to the emergency department for a refill on your Viagra prescription because you can’t get in touch with your primary care doctor, chances are good you will make it through the next 24 hours. True story. But I’m not here to give medical advice so don’t take my word for it #lawyersscareme). In this world I try hard not to get emotionally involved in the perpetual staffing shortages, radiology fuck-ups, and endless waiting room with pissed-off patient after pissed-off patient waiting to be seen. I’m scheduled (and paid) to work 8 or 10 hour shifts usually, but they routinely end up going 1 to 3 hours overtime (unpaid, I know – don’t even get me started) because…well, patients need care. And believe it or not, I want to deliver good care. Sometimes that takes more than 8-10 hours. At the end of the day in World #1, I come home and immediately jump in yet another scalding hot shower regardless of the temperature outside (again) due to my undiagnosed PTSD from the pandemic, which has instilled in me the indefatigable urge to viscously and immediately scrub off whatever unknown deadly illnesses I may have collected on my body during my shift before doing anything else in my home. That is about as much as I can handle in World #1.

World #2 is very different. In World #2 I care deeply about planetary health. I worry about how this industrialized world is destroying the environment. I worry about future generations, my nieces and best friend’s children, my pediatric patients, and how they are going to fare in these heatwaves, hurricanes, water shortages, and biodiversity loss in the coming years. A pristine, turquoise beach or crisp, airy mountaintop are some of the most gorgeous, healing places I can think of (it’s definitely NOT an emergency department, which is a whole issue in and of itself) and the fact that these natural phenomena are being destroyed by human industry really upsets the S- out of me. And if it's possible to get even more anxious, pissed off and upset about this – we are destroying ourselves and our own health along the way. I see it every day in the emergency department. People coming in with horrible, unexplained asthma attacks (spoiler alert: look at the air quality index next time you can’t breathe when you’re outside or have weird allergy symptoms) – or homeless patients coming in with heat exhaustion that have no where else to go, or older patients having all these poorly explained issues with their underlying illnesses like heart failure because their medications aren’t working right due to the temperatures outside. It’s just totally crazy to me that we are doing this to ourselves.

My two worlds end up colliding in a very specific way. Dr. Jonathan Slutzman, a fellow emergency physician and climate health expert, put this quite eloquently when we wrangled him in to give the umpteenth unpaid talk on climate and the healthcare sector (because that's what academics do). He said we are caught in a “non-virtuous cycle” in the health care sector. The cycle goes like this: Patients are affected by the environment they are living in and getting sick. I want to deliver the best care within my means for sick patients. The act of delivering care, however, contributes to the climate crisis. The carbon footprint of the health care sector is immense. All you have to do is start by thinking of all the possible waste in the hospital (and this is just a portion of a hospitals carbon footprint) and you’ll start having a Starbucks Venti-sized mentyB. Just by trying to deliver good patient care, I am contributing to the problem. I. Hate. This. Feeling. I can’t stand it. But one of the things that brings me so much joy in my medical practice is feeling the hope that there is something we can do about it. My climate and health work is preventing me from burning out completely in the emergency department…it’s sustaining me, if I may. And I truly believe that this can be an outlet for others as well.

With my academic background in climate and health, and by treating patients on the frontline, I feel compelled to do something about all this and finally build my own practice of “climate-conscious health care” I’ll call it, for lack of a better term right now (hey, don't let perfect be the enemy of good). I really want to bring all of this to the bedside with patients and beyond. But I literally don’t know how. I don’t have funding to do amazing, sector-altering research like so many of my idols in this space and literally wouldn’t know where to get it from. I’m not full-time academic faculty somewhere fancy. I’m not a government official so I can’t draft super awesome climate policies and put them into action (although as a citizen I can certainly give educated feedback on them and vote), and I’m not a hospital CEO who can run my dream hospital in a gloriously sustainable way. And frankly, I don’t have the time to really do any of that because I have a full-time job as an emergency physician.

So F- it, I’m going to start with a blog.

In this blog I’m hoping to tackle different…musings I’ll call them…from sustainable health care, emergency medicine, the impacts of climate on health, how messed up the US health care sector is from the inside these days, celebrating other people’s awesome planetary health wins, and other musings of the like with sprinkles of humor and more than a few F-bombs. I’m not holding myself to any of that, we’ll see how this evolves.

But I AM going to make a promise to myself and whoever is reading this to end each post with one easy action item for everyone who cares about planetary health, whether you’re a fellow healthcare worker (my HCDubs) or just anyone who wants to live in a climate-health-conscious way. I’m not going to let the studies get me down that say “omg wait, individual action totally doesn’t matter, we only need global, sweeping, industrialized, political change to make a difference blah blah blah!” Yes, we need those changes too (BADLY). But my instinct is telling me that individual action should not be devalued, ESPECIALLY if it happens on scale. One little bee doing its little bee thing might not be able to pollinate an orchard, but a swarm of them certainly can. For my own mental health, I’m going to believe wholeheartedly that our individual actions matter.

So here is one easy action item that comes to mind as I write this: download the EPA AirNow App and look at it periodically. Slap in a zip code, and see what your local air quality is in real time. Take note of how you feel. Share it with people you love and with people who may be more vulnerable to poor air quality, like people with lung and heart diseases, young children, the elderly, and people living in urban, under-resourced settings. If you’re an HCDub like me, share this with your patients after they leave your care. And no, I’m not getting paid to share this. https://www.airnow.gov/

Thank you for reading guys. Catch you next time for the next zero hour musing ;)

Addendum and real-time pic: My cats decided to capitalize on the fact that I seemingly abandoned my breakfast/lunch, which is a soggy spinach wrap from the hospital staff lounge that I didn’t have time to eat on shift last night. Cats: 1, me: 0.