We don’t talk about Bruno: How Encanto reflects our pandemic pressures

If you spent any time around kids recently then you know: we don’t talk about Bruno. The tagline from Disney’s enchanting Encanto arrived as we enter into new lockdowns and kids staying home waiting to hear about return to school and COVID vaccine boosters. A family-friendly movie packed with catchy tunes? Exactly what the doctor ordered. But while the cha-cha-style We Don’t Talk About Bruno may be the movie’s earworm we’re all humming, it’s Surface Pressure that resonates with what we as doctors are experiencing. Sung by the character Luisa Madrigal, a 19-year gifted with superhuman strength, it speaks to the weight of unrealistic expectations that are placed on those in privileged helping positions. It doesn’t take much to see how her words reflect our experience. Read: Steps we can take to improve access to family medicine I’m the strong one, I’m not nervous I’m as tough as the crust of the earth is I move mountains, I move churches And I glow ’cause I know what my worth is We’re put on a pedestal from the moment we receive our acceptance letter to medical school and become accustomed to the admiration and trust given to us by our patients. I don’t ask how hard the work is Got a rough indestructible surface Diamonds and platinum, I find ’em, I flatten ’em I take what I’m handed, I break what’s demanding Taking extra call to help a colleague? Checking labs before the sun comes up or long after it’s gone down? Calling patients on the weekend because they’re anxiously awaiting important results? All part of the job, right? But Under the surface I feel berserk as a tightrope walker in a three-ring circus Under the surface Was Hercules ever like “Yo, I don’t wanna fight Cerberus?” Under the surface I’m pretty sure I’m worthless if I can’t be of service After so many years of training, so much delay of gratification, so much investment of time and money, being a doctor is central to our self-identity—and often our self-worth. We’re at risk for moral injury when we can’t properly care for our patients because of systemic issues like unreasonable administration, limited resources, and inequity. A flaw or a crack The straw in the stack That breaks the camel’s back What breaks the camel’s back it’s Pressure like a drip, drip, drip that'll never stop, whoa Pressure that'll tip, tip, tip ’till you just go pop, whoa The very personality traits that helped us get into medical school and survive the rigourous training also make it difficult to cope with normal human error. Imposter Syndrome is prevalent and, while humility grounds our work in humanity, the art of medicine is complex and perfection is impossible. We feel caught within the dynamic balance of objective detachment and empathic care. Give it to your sister, your sister’s older Give her all the heavy things we can’t shoulder “I’m not sure what’s going on. See your doctor,” they tell our patients. We are often the last line of defense. Who am I if I can’t run with the ball? The thought of failure is terrifying, both for our patients’ outcomes and our own esteem. If I fall to Pressure like a grip, grip, grip and it won’t let go, whoa Pressure like a tick, tick, tick ’til it’s ready to blow, whoa Give it to your sister, your sister's stronger See if she can hang on a little longer Who am I if I can’t carry it all? If I falter Under the surface I hide my nerves, and it worsens, I worry something is gonna hurt us Under the surface The ship doesn't swerve as it heard how big the iceberg is Under the surface I think about my purpose, can I somehow preserve this? Line up the dominoes A light wind blows You try to stop it tumbling But on and on it goes There are always patients to be seen, inequities to fight, and information to share. The current of challenges feels relentless. But wait If I could shake the crushing weight of expectations Would that free some room up for joy Or relaxation, or simple pleasure? How many of us feel guilty booking time away from work? How often do we tell our patients to balance or integrate professional and personal lives, only to find ourselves struggling to do the same? Instead we measure this growing pressure Keeps growing, keep going ’Cause all we know is We are indoctrinated that pressure is part of our work and that those who came before us dealt with it and so should we; those who try to change the system or set boundaries risk being labeled entitled, lazy, or soft. Pressure like a drip, drip, drip that'll never stop, whoa Pressure that’ll tip, tip, tip ’til you just go pop, whoa-oh-oh Give it to your sister, it doesn’t hurt And see if she can handle every family burden Watch as she buckles and bends but never breaks No mistakes just Perfectionism, again. Pressure like a grip, grip, grip and it won’t let go, whoa Pressure like a tick, tick, tick ’til it’s ready to blow, whoa Give it to your sister and never wonder If the same pressure would’ve pulled you under Who am I if I don’t have what it takes? No cracks, no breaks No mistakes, no pressure Life before the pandemic was difficult; COVID-19 has exponentially increased the pressure on us and in turn leads to depression, burnout, anxiety and suicide. We’re human, but not often treated like it. So while it may seem counter to the predominant culture of our profession, we must be aware of our feelings and our needs. Because unlike Bruno, those are things we should definitely be talking about. Dr. Eric Cadesky is a full-service primary care physician in Vancouver.

We don’t talk about Bruno: How Encanto reflects our pandemic pressures

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