Just Take A Breath
When I was younger, my life’s fuel was more stress than joy, but I was too busy to notice. I started college as a nursing major, switched to a joint major in biology and chemistry after two years, and graduated three years later with honors and an extraneous fifty to sixty credits. While earning top grades, I was cajoled (read: forced) into working as a lab assistant, a supplemental instructor for biology and chemistry courses, a research associate for professors in the departments of chemistry and microbiology, and a tutor and a grader—jobs that paid under minimum wage and took a considerable amount of time, but were done in pursuit of the much-coveted glowing letters of recommendation required for medical school. As you might guess, I slept about four hours a night. During my third year of college, my mom was diagnosed with what was supposed to be a terminal cancer. Her oncology team at Stanford Hospital described her recovery as “miraculous,” but for an only child with a single parent, the weight of almost losing the sole person who had ever supported and loved me unconditionally weighed heavily on my heart.
By the time medical school began, I was running hard on perfectionism and adrenaline. I was thrilled and intimidated by the opportunities ahead, sinking under the weight of anatomy and pathology textbooks, trying to squeeze in intramural basketball games and dates, and occasionally vacuuming my seriously crappy apartment.
Despite my exhaustion, I could never sleep well and never once woke feeling rested. I was constantly hungry. I lived on coffee and diet soda. I had a breast lump scare, mononucleosis, and severe joint and muscle pain, developed an autoimmune thyroid disorder, and endured five or six sinus infections every winter. I started “taking call,” which meant once or twice a week I had a thirty-six-hour shift in addition to my regular clinical duties. It was not unusual to work nearly a hundred hours a week in the hospital and clinic, without counting the hours of study required to pass rigorous examinations. My specialty and subspecialty training took another five years. I continued to work between eighty and a hundred hours weekly, and the stakes became much higher: a mistake could harm or even kill someone, and the appropriate hypervigilance combined with my underlying perfectionist tendencies only exacerbated my stress.
I was elected president of the department’s resident organization, which meant I led weekly meetings of resident gripe sessions and was tasked with putting out the fires of personality clashes while serving as an intermediary between disgruntled residents and mostly disinterested faculty. I was asked to serve as one of the chief residents during my fourth year, which meant I had to write lectures and teach in addition to my other duties. I worked overnight shifts in the emergency department, served on a citywide suicide prevention task force, spoke at conferences, helped a colleague open a clinic for pregnant drug users, and when the state legislation held back our funding, participated in a letter-writing campaign to get the funds released. I had so little time off, the idea of wearing pajamas became a luxury, as was being at home, and I morphed into a person who’s only hobbies involved things that can be done at home in one’s pajamas (mostly baking and watching Top Chef or Ice Road Truckers, if you’re wondering).
One day, I folded my arms and felt rolls where my ribs were supposed to be. I knew I had been gradually gaining weight over the years; hospital food is hardly healthy, and at two in the morning the only place in the hospital to get food is the coffee cart, and the only food at the coffee cart is brownies, so I kind of knew it was in the cards. I refused to step on the scale, but I knew my clothes weren’t fitting, I was always tired, and this former athlete could barely get through a thirty-minute workout.
What happened to me—to my body—during all of those stressful circumstances spanning about fifteen years? My brain’s crisis system went completely bonkers. I slept poorly, craved sugar, and suffered with irritability, fatigue, and burnout. Does this sound familiar? I bet you’ve struggled with similar symptoms. You’re stressed, stretched, internally preoccupied, and have lost your grasp, your edge, and your mojo. You might be in such an enormous crisis you think you’d rather trade your life crisis saga for mine! So now that we’re all bonded in misery, let me explain why this happens to us, so we can move on and do something about it already.
There are two types of people in the world: those who love science and those who don’t feel the need to discuss whether the USS Enterprise could actually travel to another galaxy through a black hole in order to enjoy a film series. While the latter somewhat perplex me, my college science professors discovered I was gifted with the ability to communicate with this majority group, the disinterested-in-science students, and I was coaxed into being a sort of translator, breaking down science into easy-tounderstand concepts for my classmates.
As we examine the science of stress, I’m going to use two languages: first, a simplified version of the basic science, and then, a translation of sorts using analogies. It doesn’t matter which you follow: there’s no exam here. Just bear with me, and within a few pages you’ll have a basic understanding of the physical origin of your life crisis symptoms.
As humans, we are hardwired to manage stress via an intricate feedback loop between the brain and the adrenal glands. Three anatomical structures are the key players composing what is referred to as the HPA axis: the hypothalamus (in the brain), the pituitary gland (also in the brain), and the adrenal glands (we have two, one on top of each kidney). Together, these areas maintain homeostasis, which is just a fancy scientific term for metabolic balance within the body. In other words, the job of the HPA axis is to create and maintain a relatively stable internal environment, even when we experience physiologic changes. The hypothalamus senses the environment, then send a chemical message to the pituitary gland, which then sends its own chemical message to the adrenal glands, which respond by releasing several chemicals, with cortisol as the final step in the feedback loop. Once the hypothalamus senses the cortisol, it stops sending its message and the system can stop and rest until the next stress comes along.
Think of it this way: The brain is Command Central, like 9− 1−1. When distress is sensed, the hypothalamus assesses the level of danger and calls 9−1−1 right away; the 9−1−1 operator (the pituitary gland) dispatches a message to alert the first responders. The adrenal glands contain the first responders. Once the first responders address the crisis, dispatch is notified, stops coordinating the response to the call, and goes back to waiting for the next call.
The adrenal glands pack a pretty big punch considering their diminutive size. It’s wild to realize something the size of an olive has so much power over how we feel. You might think it should be at least the size of a Cadbury Creme Egg to serve any purpose, but I don’t recommend saying so in medical circles, not that I speak from experience. Each adrenal gland is divided into zones (like a Cadbury Creme Egg, hello . . .), which have different functions. The center (called the medulla) releases epinephrine (a.k.a. adrenaline), which is the main chemical responsible for the fight-or-flight response. So if you’re walking along and suddenly encounter a bear, within a second your hypothalamus has sensed the danger and ordered the release of adrenaline, which prepares you to fight or run by redirecting blood away from certain areas (like your bowels) to essential survival areas (like your muscles and brain); it dilates the airways in your lungs to maximize oxygenation, and increases your heart rate and the strength of the heart’s contractions. All of this combined gives you the best chance for survival in that moment as you face the bear. The Science of Stress, by Dr. Jennifer Love From WHEN CRISIS STRIKES.
