How to measure happiness

And other puzzles.

my friends. sorry to have left you. if you’re wondering where i’ve been, it’s been here, same as always, puzzling. here are four I find myself most in the middle of today:

1. ER doctors are the most burned out of any medical specialty. I don’t think it’s just the work, though it remains of the hardest there is. I think the ER is the most intimate reflection of society, a bellwether, and we all are holding more pain and anxiety than ever.

how burned out? that’s what i’m puzzling. the tools we use ask leading questions, ie, how much do you hate your job? no really, you hate it right? if you ask a person enough ways about what they don’t like about something, it’s what you’ll find.

Q: “how did you like the bathroom?”
A: “I don’t know…happy face? I was kinda focused on getting out of here.”
Q: “the spots on the mirror didn’t bother you?”
A: “uh. again, didn’t notice, but…”
Q: “there wasn’t a single moment when you were, like, meh?”
A: “I’m feeling kinda meh that we’re still talking about it..”
etc.

you get me. so how would a person best measure the emotional wellbeing of emergency doctors (or anybody) as related to their work and in general and find a true measure. surveys are their own cruelty and you don’t want too many, same as you don’t want to time it for when people are likely to be cantankerous, like Monday, or for emergency doctors, the past three years.

but you must measure. it is integral to science/improvement, how much, how fast, traveling in what direction at what speed, you know. ultimately, two survey instruments for wellbeing would be best. a more involved one that can detail particular aspects of a person’s life that are difficult¹, delivered once every year (quarterly at most). the other would be like a “vital sign”, like taking the temperature, ie, how are you doing right now, all things considered? happy face or sad face, the type of thing you might get (or do) randomly couple times per week, administered enough that an average would emerge, such that the efficacy of changes/insults might be tested.

the two contenders for measurement tool are the Copenhagen burnout Inventory (CBI) (there’s an online version here), which was the advantage to being open-access, ie, less douchey, but a bit of a downer, like someone worked on it mostly in the danish winter with seven hours of sunlight. the language tilts toward misery (if you weren’t burned out before taking it, you probably are after), but it has been validated in physicians, and used to survey emergency medicine trainees² too. the other contender is the WHO well-being index which is both open-access AND translated dozens of times, and uses much more positive language. a bit shy on particular aspects of a person’s life. here is an online version if you want to take it yourself, maybe write down the results, get a baseline. even if it isn’t accurate, it might be “reliable”, ie, measure change if not position.

https://qxmd.com/calculate/calculator_535/who-five-well-being-index-who-5

a third possibility is to combine the two, but then you would need to prove validity against more measured tools (like Maslach Burnout Inventory, the most tested measure) and the world would have another survey which is not what anyone wants. still, I would choose something more affirmative and powerful, remind a person why they choose their work.

a few years back, before COVID/ihadmyneckcutopeninthenameofcancer, that era, a few of us visited Addis Ababa, interviewed Ethiopian visual artists, asked if and how art was medicine, whether we could use it to treat some of what ails our heavy hearts, perhaps paint the inside of emergency departments to better reflect their humanity. the answer I remember best is from Elias Sime, who understood the idea right away.

”You don’t want what greets a person in a hospital to evoke only sorrow, a statue of a doleful angel holding a child, for instance. There is something much for powerful inside too, what would eat all the sickness if it could, is eating it even now...”

puzzle #2. why is suffering the crucible through which peace must pass, our loving hearts blown to smithereens, again and again. it is so bitter, this bile of war, choking down the illusion of scarcity again and again in order to sell newspapers or the public on military spending. only Ukrainian men and russian men sitting in the cold blowing on their fingers. one mother in Gaza another in Israel refresh-refresh-refreshing their phone, off and on, maybe a message about their daughter lost in the air. I’ve only one prayer: may the children of this world never forget that though they have inherited violence, it need not be their legacy.

3. okay, I have more than one prayer. nothing like cancer to make you a praying man. these days, I mostly just give thanks. for another breath, the people in my life, all the puzzles. it is more an act of meditation, where I focus myself fully on that forever part of my body where gratitude and humility and reverence live, and what wants the best for all people. I keep on doing it until I can hold my awareness there through all the distractions caterwauling in my head, let it calm my heart. (then I try to read³ for a bit but almost always fall asleep).

I bring that up because it is number one on the list of what I found among my mother’s things after she died about how to make it through her time in the hospital (“1. go the chapel and meditate/pray”). I trust no one more than her, and she faced her life (and death) with such grace. you’ll be seeing more of the list as I unpack it.

i’m not sure you need to go to the chapel. I suppose if there’s one near, it’s an easier place to find reverence than, say, the 7-11. I imagine the edge of the bed did just fine for her most days. it’s where the last prayers often come, might as well get familiar with it.

4. re: writing, and rewriting…it’s going well. definitely falling in “like” with the book i’m writing (my third, upcoming). love often only comes when you get the chance to miss it, so i’ll take ‘like’ for now. a book is its own puzzle, reveals itself sentence by sentence, an arrow into the middle of us. i’ll post some excerpts here soon. it’s fun to play with time and words, make things like months of grief gray, and when it fades, life more vivid for it.

my challenge as a writer is always the same: show, don’t tell, and just enough that people’s imagination carries them the rest of the way. in this book it is also to remember to let humour travel along with the pain (something burnout tools forget), because life has room for them both, and since this journey is but one way, you wouldn’t want to miss a thing.

here’s hoping we get to glimpse the full range this week, top to bottom, at least once, at least for a second. and that the force at work inside emergency departments, the one that wants to meet the needs of as many people as possible, no matter who they are when they need it what time of day while remaining well ourselves, grows in efficacy and intelligence like the immune system has in our body, birthed as it is from the same stem cell that sits deep in our bones, the blank egg of our one mother.

i’m in the mountains. it snowed softly today, all day, muffled the sounds. even the train whistle was covered in cotton.

we walked through the woods and at times the branches would let go of their weight at once, flakes spilling, spinning in the wind, drifting like a sigh.

1. if focused on occupation, it should also include mention of the life outside of work, how each is in interplay with us no matter where we are, and ideally not fall prey to negativity bias that is part of the human psyche. one way to do that would be to ask more “present-centred” questions, ie, do you feel exhausted now, because you know how it is, you have a perfect day, you get your errands done early, are jamming along to a song in the car, singing your heart out, green light after green light, and someone cuts you off then gives you the finger: poof. your reverie disappears, and anger becomes what you remember for days.

2. though the paper seems to test internal consistency, ie itself to itself, so claims of “validity” are rather strong (you would need to test the same residents with a different survey to catch that more cleanly).

3. rn, reading: https://us.macmillan.com/books/9781250844217/collisionofpower

you’ll like it if you’re a publishing nerd or wonder what is travailing the world’s newspapers. it’s written by the former editor of the Washington post who famously answered trump’s assertation that the post was “at war” with him, with “We are not at war; we are at work.”

keep going.