Economy of motion

I love that phrase: economy of motion. I first heard in my Jeet Kun Do class (so enamored was I of the phrase that I thought I'd ponder that for the next 6 months instead of return to the class). Jeet Kun Do is the martial arts system developed by Bruce Lee. Economy of motion is defined as (as always, thank you Wikipedia):

1. Efficiency: an attack which reaches its target in the least amount of time with maximum force.
2. Directness: doing what comes naturally in a disciplined way.
3. Simplicity: thinking in an uncomplicated manner

The second two are what fascinates me the most: doing what comes naturally and thinking in an uncomplicated manner. When I first started my anesthesia residency, I was sure I made a horrible mistake. I watched every number and squiggly line and listened to every beep and buzz with such intensity (lives were on the line!...sort of) that it was if I was pausing the screensaver in brain so as to burn the picture forever in my memory. And, although I was competent, my procedures were riddled with a second to second critique of the prior steps and intense analysis of the future steps. I was an alien in the OR. Nothing was natural; nothing was uncomplicated.  Everything was extraordinarily stressful.

Now I don't think at all. I can discuss the case or chart or whatever without thinking about the beeps and whistles. But if the heart rate changes by 3 beats per minute, everything else gets shut out and I return to the same intensity I had as a resident. When I perform procedures now, it's like dialing a number: don't ask me what the number is because I don't consciously know it; I can just dial it. I can just place the line or intubate.


I learned the complexities and theories behind anesthesia in residency. But what I really learned was to breathe it. To be it. Performing anesthesia is natural; it is uncomplicated. I do it without thinking.

Economy of motion is action without self-consciousness.

Loss of economy of writing: I thought I'd start linking to blog entries that have helped me better understand the medium. This is blog that I find quite entertaining. The reason I'm linking to this entry is that, based on his first couple paragraphs, Suldog developed a level of self-consciousness not there before getting the blog nod...  Suldog: Hello, New Followers! Here's Where You Begin To Realize I'm A Lazy Slug!

Jesus saves snowboarding from cancer

If you've ever snowboarded, you've probably experienced the skill bolus you seem to get the second and third days.  I went from a red ass and frozen legs from falling on the bunny hill the first day to a red ass and frozen legs from taking jumps on the intermediate runs the third day. Granted my athletic abilities are near perfect (I like to put lies in my entries to throw your scent off and maintain my anonymity), but I suspect it is a similar occurrence for most everyone. I don't think my technical skills improved that much over a course of two days, however. What I think happened is I gained confidence. Instead of a tendency to lean back so I could force a fall if I started going too fast, I started leaning in and accepting the speed. I was less afraid because I was more familiar with what to expect. I was less self-conscious.  I wasn't thinking about what I needed to do to protect myself and was, therefore, not analyzing my every move.

I don't believe that a cross, a buddha, an ohm, or a naked lady tattoo confer actual physical protection.  I do, however, believe that they provide an alternative to self-consciousness provided that the user places significance on the object.  It will protect me so I don't need to protect myself.  I can concentrate on the task at hand and not on myself.  I would argue that, even though I am placing my security in the hands of something that truly only exists in my head, this puts me at less risk.  Often the true danger is in one's head.

Such a symbol can help the ill as well.  I've already hinted at this with my Surrender entry: the physician becomes the symbol.  Disease is a scientific description; illness is what the patient experiences.  Finding one's "new" identity lies in between.  (Imagine the identity crisis one undergoes when s/he feels fine but is diagnosed with a disease with a treatment that causes the patient to feel horrible.  To justify the acquisition of illness by the treatment, one has to redefine oneself, often as "sick".)  I can think of no other time in a person's life that they are more self-conscious than when one loses his/her identity.  As physicians, we need to consider this as part of our patient's illness: an acute sense of self-consciousness.  Symbols may be the treatment for this.  Of course, 9/10 symbols actually get in the way of what I feel is the proper course of treatment.  But a blog for another time...