“What do you do for a living?”
I ask this of nearly all patients, as inflammation doesn’t just come in processed food wrappers, plastic bottles of carbonated beverages or cartons of tobacco products. Artery irritating, arrhythmia triggering inflammation can also emanate from one’s occupation.
Keep your eyes, ears and mind open, and it is striking what you see. Even a seemingly staid twenty-four hour business trip can serve up medical lessons. Not all lessons are learned in the classroom or at the main event, much wisdom can be accumulated on the bus ride to and from–from the journey itself.
Take for instance, my first hand discovery of a new occupational cardiac risk factor: that of the frequent business traveler.
Talk about an inflammatory stew. Fortunately for me, business travel is an infrequent necessity, but here is the most recent race report.
In your hometown, you drill it to the airport after a full day. Don’t miss a day at work. You leave in the early evening when the afternoon rush hour makes it easy to get to the airport. At the airport, the double doors open, you are in, the intercom is blaring and you move forward to the lines, with the rest of the like-minded middle-aged upwardly mobile.
(“Sugar,” the contact lens solution bottle is too large; it must be checked for flammable vapors.)
Invariably, planes headed to and from hub airports are jammed. Once aboard the sardine-can like plane, the automated messages drone on at ear-bud piercing volume with the same message about water landings, and most ironically, even though the recorded message states, “let us know if we can make your flight experience better,” the surly expression of the flight attendant says, “I dare you to ask.”
After arriving in the late evening in a far-away city, often in a different time zone, the same scrum starts all over again. You search for dinner, find the hotel and hope for sleep. Morning comes too soon, and the early breakfast with strangers requires conversation at an hour of the day in which human interaction is ninth on a list of eight wishes.
After twelve hours of activity is squeezed into only eight hours of meetings it is time to venture out into the evening rush hour of an unknown city to repeat the same late-day ritual of navigating through overcrowded airports, awash in noise, air and food pollution.
You wait in the airport, place the earbuds, and try to read something. For the novice traveler, and blogger-on-the-alert, not looking up is impossible.
What does one see when the looking at the airport crowd during the dinner-time rush?
Worry for one, worry about whether the measly 0.2% growth is for the quarter or the year (I actually heard this). Or, worry that the approaching thundercloud will impede making it home before your family is asleep. Loneliness for another, travelers are amongst each other in space but in reality, each is alone. I felt alone. What else did I see? Everyone in this hub airport looked fatigued–not a little tired, more like there were invisible backpacks on people’s shoulders.
Then there is the diet of the business traveler. In a single rotation of the earth, this bike racer turned business traveler crashed hard off the nutritional wagon, shocking the GI tract with a myriad of toxins including, red meat, ice cream, cookies, bacon, apple cobbler, french-fries, and even pizza. Oops, I forgot the fermented glass of grape juice, which in the singular may have been the only non-nflammatory part of this trip. Granted, cyclists usually plan the forced time off the bike of a business excursion with a previous few days of heavy training, but when you add a little hunger knock to the constant barrage of airport and restaurant junk-food it is hard to turn away the evolutionary food response of humans–eat when you can, always.
Exercise on a business trip? Yeah right. You arrive late to the hotel, have an early breakfast, meet all day, and travel the rest of the night. It is hard enough for people to control their routine lives, but while on the road, the notion of carving time out for health is confusing to others. After hours in the lead-walled confines of the arrhythmia institute, I ask, “Where is the main lobby, I need some air, a brief walk outside, perhaps?” Pause, confusion, “ah…here I will take you.” No one has ever asked to escape this place in the middle of the day, is the look on the face of the handler of business travelers.
Take home messages…
Over the years I have learned to ask patients what they do for a living. Not to add an additional bullet point on an EMR-office note, but rather because knowing one’s occupation sheds light on an individual’s life-influenced dosage of inflammation.
Many years ago, a famous cardiologist at IU taught this young, recently graduated doctor from Connecticut about the enhanced heart disease risk of the professional truck driver. In my first week of Cardiology fellowship, the senior professor says with a serious look, “Dr Mandrola, back in New Jersey (he knew I was from CT, but Indiana natives do not distinguish eastern states), you probably did not see many truck drivers, but you need to know that heart-wise, there are no more riskier professions.”
I think I found one. Business travel’s repetitive punches to the body, like toxic food, inactivity, and noxious noises combined with its hits to the soul, like worry, emotional stress and loneliness are surely a recipe for fragile arteries and active arrhythmia triggers.
To the medical student, I say, ask about a patient’s occupation; it is surely more valuable than how many cups of coffee they drink.
To young people that have yet to choose a career, I say pay attention on career day. In checking the right box on that fateful day, consider intangibles, like the frequency of business travel, or perhaps, your future access to a private jet.
Home sweet home.
JMM