While stuck in an angry snarl of traffic during another grey morning commute, I had time to contemplate the view from the car’s rear-view mirror. If this was the “family car” then the back seat would be decorated with children’s toys and crayons. It might be messy, but would reflect adventure and discovery and excitement. Instead, my commuter vehicle had two neglected child seats. In contrast, on the front passenger seat there was a horror show of adult mess and misgivings. I couldn’t help but think the universe was trying to tell me something. Welcome to lessons from the car seat of life.

I had ricocheted through a busy run of clinical shifts. The faces of the many patients I had cared for still occupying my mind. Over the past week I felt I had done my bit for humanity. However, while you can largely leave the patients at the hospital, it is the “curse of extra tasks” that follows you home. We want to help the greater mission and therefore we volunteer left and right. However, every “sorry to bother you but…” and “can you just help out for a sec” adds up and takes away. So I covered a locum shift here, attended a meeting there, tried to co-write a paper, delivered extra teaching, and squeezed in a conference call or two, or three. The resulting early arrivals and late departures could be tallied in the lines under my eyes. We might recognize the toll of overwork in our morning mirror, but this time it was writ large in the passenger seat to my right.

Instead of a lovely conversant human sitting next to me on my drive, let me describe the detritus of my week and the self-recrimination that followed:

–      Fast food wrappers: one for every meal and beverage shoved or guzzled. Was I reduced to such low-grade fuel just to keep my engine going?  

–      A mobile phone charger and cable: my lifeline to the world which I scrambled to recharge after my phone died. How long had I lived with the spectre of being called back at all hours and never really getting away.

–      A mouldy apple core: a vain attempt to reach my five-a-month let alone five-a-day. What does it say when you don’t eat right and don’t clean up compost?

–      A chocolate bar wrapper: a “pick me up” because of missed meals and lousy sleep. Can you really make up for lost sleep and time?

Some of your car seats may look like this all the time—and perhaps that is fine. I am not here to moralize only to reflect. The point is that mine is normally empty and clean and as uncluttered as my mind. This state of affairs was not normal. It could just as easily have been a blinking light on the dash. I really shouldn’t ignore this, but who has the time? Perhaps it is more accurate to admit that I had temporarily forgotten my priorities.

There may be other areas of your own life screaming out a warning. My polite suggestion is that you dedicate time and space to listen. For example, does your refrigerator routinely contain food well past its sell by date? Are you wardrobe hangers empty because your clothes are conducting a protest on the bedroom floor? Do you climb over unopened mail by your front door? Do you routinely forward yourself emails because you can’t bring yourself to deal with them now. This is not piety, and I am not suggesting that cleanliness is next to godliness. Instead the issue is that modern life may leave you feeling that you no longer have time for general maintenance or self-care. When you get so distracted that you fail to do what is now known as “adulting”. These routine chores used to be the cornerstone of everyday life. Clean your shoes, brush your hair, and tidy your room. Get the little things right and the rest will follow.

The following week, I tidied up my car seat of shame. I also tried to hit reroute. I cancelled a meeting, I turned down a locum shift, I excused myself from a conference call, and I got a half decent sleep. Small steps but at least I felt a little more in control. My car seat was clean and my life was a little manageable. I then borrowed the family car and threw the kids in the back seats. We headed out for a quick adventure that coincided with the route that I cover on my morning commute. The kids made a shocking mess of the back of the car. In contrast to feeling distress, it felt like a clean start and a fresh perspective. I have a way to go but am getting better at enjoying the journey.   

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Research and Development lead in Critical Care at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan. Matt’s first book, Critical—science and stories from the brink of life is available to order now www.drmattmorgan.com.

Peter Brindley, Professor of Critical Care Medicine, Medical Ethics, Anesthesiology at University of Alberta, Canada. He is on twitter @docpgb

Disclosures/conflicts: none. This work is original