S2.9 Walk, Don’t Run


There are good reasons to run. Exercise and fun are probably the best and most common. Rarely if you are in immediate danger such as are going to be hit by a car, trapped in a burning building, or escaping from a flash flood. Running could also be necessary to help someone else, perhaps a child or senior citizen, escape from the above as well. To be fair, I have never had to run for any reason besides exercise. 

Not only is running not necessary, but could even be problematic in critical situations. The one time in the hospital when running is often expected is during a code, that is when someone has lost their pulse and is not breathing. In most hospitals this is a Code Blue and everyone is expected to respond as fast as possible. I am against running even in this life or death situation for several reasons.

First, nearly everyone in the hospital is Basic Life Support certified, that is, they are able to do chest compressions and begin the critical steps in resuscitation efforts. In fact, the most important prognostic factor for a patient in the hospital who has a code is the quick initiation of good, high quality CPR. Nearly anyone, including the person or people who called the code will start this critical intervention. (As a side note, CPR is incredibly physically demanding. In my view, these are the only people who should be out of breath at a code.) 

Second,  running to a code can be dangerous to the team running as well as other patients or visitors. The mentality is that “we have to run to save a life” which is an entirely false notion. Narrowly avoiding collisions with other healthcare workers and other people in the hospital is not uncommon in these situations. 

Third, the responding medical professionals show up with their heart racing and adrenaline pumping. Similar to the reason that high speed chases can lead to judgment errors by law enforcement, so running to a code does not lead to clear headed thinking. As the famous quote in the House of God by Samuel Shem goes, “ At a cardiac arrest, the first procedure is to take your own pulse.” Instead of promoting good, clear headed, evidence based medicine at this critical time, sprinting to a code pushes you back to fast, reflexive thinking based on heuristics, without taking the time to fully assess the scenario. Ronald Epstein writes more about the importance of mindfulness and being able to step back while practicing medicine in his book Attending: Medicine, Mindfulness, and Humanity. Codes on the general hospital ward where people have to run and where teams are often less familiar with one another and the equipment available on a given floor contrast with resuscitation efforts in the Intensive Care Units and the Emergency Department where everyone is familiar with one another and the equipment, and no one has to run. In good Emergency Departments seasoned attending  physicians will often take a back seat, occasionally asking a questions or giving orders for a medication or test. There is an element of relaxation, almost of boredom that allows clarity of thinking and a 30,000 foot approach to make sure all aspects of medical care are being managed. The same principles go for many of the things in daily life that we want to run to and stress about. We often want to release some of our nervous energy through some sort of activity which counterproductively serves to accomplish little and clouds our mind. 

In general, save running for exercise and escapes. Instead walk with the purpose of maintaining a clear mind.

Published by JR Stanley

I am an MD, PhD student, training to be a physician scientist, with a deep interest in science, faith, and living life as an adventure. Join me as I entertain ideas from new findings in science, evolving interpretations of faith, and experience life one day and one adventure at a time.

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