The Buffer Zone

It's July, the time of year when new interns and residents begin their training programs. It's our busiest time at my academic hospital, where all of the anesthesiology attendings pitch in and teach the newcomers. When I'm teaching in the OR, I always ask a simple question: Why do we care about the patient's blood pressure? They usually get it right - adequate blood pressure ensures good blood flow to the brain and other vital organs. Then I sketch this diagram:

Remember the Circle of Willis from medical school? Along with redundant vasculature, our brains possess an elaborate sensor system that autoregulates cerebral blood flow in a sort of "buffer zone". (This curve may also look familiar to you as the representation of how a buffer acts to regulate the pH of an acidic or basic solution.)

Autoregulation is an evolutionary survival mechanism that is meant to ensure adequate perfusion of the brain at a wide range of blood pressures. But at the extreme ends of measurement, autoregulation breaks down. I love how analagous this is to living life. We proceed through our busy days, oftentimes like a pinball falling through a pinball machine, while stressors are flung at us like flags and obstacles in the vertical maze. Too much or too little input leaves us in dangerously unhealthy territory. The next thing we know, we're fighting a virus... or worse.

How can we stay in our own buffer zones? I try to reprioritize self-care. I take some extra vitamin C, drink warm fluids, sit in an epsom salt bath, write in my journal... Make sure I'm nourishing my body with nutrient-dense foods. Say no to extra responsibilities when I can. Sleep as much as possible!

What are the steps you take when you feel you're falling off your autoregulation curve?