A chef and a paramedic walk into a bar …

I’m a huge fan of the late Anthony Bourdain – chef, documentarian and general bon vivant. I’ve read all his books, seen him live and watched all of his series.

In his book, “Kitchen Confidential,” he talks about the business of cooking food a lot like colleagues I know talk about EMS. In one of the better parts of this book, he shares a typical day in his life, from waking up to end. It’s pretty grueling; and as I read it, I distinctly felt as though, although I enjoy cooking, this was not a life for me. If you don’t believe me; feel free to read the chapter entitled “A day in the life.”

Bourdain’s depiction put you in the shoes of a member of the food and beverage industry. There is pressure, pain, stress, struggle, unforeseen circumstances and setbacks, and the almost endless grind of knowing that whatever happens by the end of the night; you’ll be back again tomorrow to do it all again. You worry about being “in the weeds” or worse; “Dans la merde.” You subconsciously worry about your reputation in the kitchen, whether dishwasher, porter or chef. You collect scars, both mental and physical. And in the end, the only thing you really can depend on are your fellow cooks and service people; because they are in it next to you.

It doesn’t sound fun, per se; but it is a calling for some people. Kind of like EMS.

So why do they, and we, do it? What makes us embrace a career and lifestyle that we know is hard and works against us? We know instinctively that the years of running calls, driving incessantly, long hours posted and inherent risks of being a paramedic or EMT will get us back in the end.

What keeps us from leaving, running to another job that pays just as much and never looking back? Why do we do what we do? And why do we keep doing it, even when we know it’s probably not good for us?

In the kitchen, Bourdain talks about the ballet, the feeling that comes from a brigade that is in the zone, functioning as one, pushing out plates almost as fast as the orders come in. It’s an artistry of movement, teamwork and communication that seems to come out of nowhere and yet is everywhere.

It’s not masochism. It’s something called the flow state, and I think it’s the reason we keep doing what we do; whether you work a sauté station in New York City or an ambulance in Arkansas.

The flow state?

It’s a term, coined by Professor Mihaly Csikszentmihályi, that comes from a field called positive psychology; and it refers to being in a state where you have intense concentration at the moment, action and awareness become combined and, interestingly, you lose self-consciousness as you focus on the tasks at hand [1].

In the flow state, you feel like you have control over what’s going on, and you may notice that your sense of time may be altered; something that takes a set amount of minutes may seem faster or slower. But you are always on top of it. More importantly, the situation is one you find rewarding to you [1,2].

As I read through the structure of what constitutes a flow state; I started to understand just why people like chefs and paramedics keep coming back to their inherently difficult jobs:

Because it feels good.

Reflecting on my career and practice; and as I struggle with my place on the burnout continuum, I tried to remember the times when I liked being a paramedic the most. Invariably, I go back to those calls where things went so smooth, communication was effortless and we were all in the moment, or “the zone.”

Tasks were performed quickly and effectively with seemingly minimal stress. Everyone contributed and played their role well. Even the problems seemed minor and easily handled.

When you’re in a flow, everything is a well-oiled machine. Think about the perfect sports play – the smooth transition of a basketball fast break or a perfectly executed double play; a gymnastics or figure skating routine with a perfect score.

Now think about the smooth motions of an experienced clinician as they sail through a patient assessment, expertly weaving therapeutic communication, informed consent and medicine into a thing of beauty, or the intricate dance of a well-drilled resuscitation team as they all move as one to keep the patient alive and able to live another day.

That’s the flow state. But is there a downside? How does the flow state work against us? Could it be that the flow state we secretly crave hurts us in those moments where it doesn’t all come together?

It’s possible, but I’d guess it hasn’t been studied yet. More likely, there are other factors at play here. But understanding the concept of flow and the flow state may give us more understanding of just why we keep signing on for that next shift.

References

1. Nakamura J, Csikszentmihályi M (20 December 2001). “Flow Theory and Research”. In Snyder CR, Lopez SJ (eds.). Handbook of Positive Psychology. Oxford University Press. pp. 195–206. ISBN 978-0-19-803094-2.
2. Cherry K (8 September 2014). “What is Flow?”.