The Top 5 Ways Working As A Barista Influenced And Continues To Shape My Medical Practice

I recently finished Supernova In The East, which is a podcast by Dan Carlin, in his Hardcore History show. It is over 25 hours long. Yes, 25 hours. The first 4 or 5 hours are dedicated to the backstory of Japan and how they ended up in WWII. The need for context -- a foundation to properly understand any given event or happening, is key to gaining that understanding.

How far back does one go, however? History, as told by us humans, is often packaged up into discrete chunks that are independent of the millennia that came before, sometimes even the year that came before. And the same struggle is mine when it comes to writing about any particular subject. I like to say that while we are not necessarily defined by our past, we are shaped by it.

Where does my story start?

Is it with my grandfather who left the comfort of his Ohio farm to come west to the frontier town of Portland? Okay, maybe it wasn't a frontier town in the earlier part of the 20th century, but perhaps it was his adventurous streak and need to explore that lives in me. But the generation before him took the leap of faith and left the safety of Europe to come to the new world -- to America, so their mass could be huddled, and their breath could be free. Maybe that is where it started.

I will tell those stories but I think the tale for today starts when I moved to Denver, Colorado in the summer of 2003. This was not the first time I have moved away from home. Two years prior I had moved to Tampa, Florida with a girlfriend, who, with the benefit of hindsight, probably didn't want me to move with her in the first place. The deterioration of this relationship, even after moving back to Portland was one of the motivations to leave Portland. Also, a lifelong friend (our grandmothers were good friends, as are our parents) extended an invitation and through his generosity and connections, I started working at a coffee shop which was a roaster as well, with a wholesale business. It was very popular and decades later, Kaladi Bros Coffee (now just Kaladi Coffee Roasters, but referred to as KBC for our purposes today), in south Denver continues to be successful and produce the best coffee. I may be biased, but put it this way -- we live near Seattle, and we still pay to have coffee shipped from Colorado simply because it is the best coffee available. Our house is still brewing KBC every morning.

I've written about this before, but it is interesting to note that I moved to Colorado with a job offer to work at Copper Mountain resort -- which is in Summit County and one of the many ski hills that can be driven to from Denver for just a day trip. The brother of a warehouse manager I worked with was high up in the organization and had extended an invitation. I was planning on moving there before the season started. I was then planning on working for a whitewater rafting company when summer came. I basically had my life planned out at the age of 23 and was excited for this new chapter. Mountain man was my destiny, so I thought.

When I started at KBC, I didn't have a clue what kind of impact it was to have on my life. Afterall, it was just a coffee shop job, right? Before I moved to Denver I was running a relatively successful contractor business. I was a floor installer. The calluses on my knees have since healed. I thought of it as a downgrade, in a way, from being a business owner.

I remember my first day on the job. Lisa and Ray were my coworkers that morning. They started to teach me all about the coffee -- from buying the green coffee beans, to roasting it, blending it, storing it, selling it and of course -- most importantly, how to brew it. We were and I assume KBC still is, an espresso focused shop. I remember Mark, one of the two owners of the shop telling us that the only reason he even owned a coffee shop was so he could make the espresso that he wanted to drink. All the rest of the business and hassles were simply to provide him unfettered access to the espresso he deemed worthy of drinking. A principled man.

That first day I had so much espresso I threw up in the bathroom. I am still an espresso afficionado and it is my first love. I miss the souped-up La Marzocco 4 group head turned into 3 group head machine that was the workhorse of the shop -- what I would give for a campana right now from that machine. We'll talk about the M3 Machine at a different time.

The type of roaster (Sivetz Fluid Bed Air Roaster) used produced(s) coffee that is best stored in a freezer in an airtight package. The prevailing thought amongst most roasters and coffee-heads is to avoid freezing coffee, as freezer-burn degrades that coffee. Before I left that job I wrote a paper exploring the reasons why the air-roasted coffee did well in the freezer -- the short of it, or at least my theory, was that there is significantly less water content in the air roasted bean and the elimination of the chaff during the roasting process kept it stable, compared to other styles of coffee roasting. So, I did learn a lot about the coffee business -- from sustainable coffee purchasing practices, to the science behind roasting and preparing coffee.

I learned another lesson, however, that has proven to be surprisingly invaluable in my life. the art of small talk and how to talk to anybody. The service industry, including the coffee shop game, is driven by tips -- and how does one earn more tips?

Ray, who was a early-30-something family man worked this angle by wearing a thong style pair of underwear that would show a "whale tail" when he bent over to get a jug of milk. While I appreciate the Universal law stating that "sex sells," I pursued and gravitated towards building relationships with the customers. Knowing their drink and their name goes a long way. People want a place where the barista knows their name. People like it when the baristas are always glad they came.

I worked there for over 9 years. Not all of those years were full time, and I worked my way through undergrad, earning a B.S. in biology and chemistry with a minor in creative writing. I also worked in an emergency department to get some experience as to what this healthcare thing was all about. But I always came home to KBC.

My barista days are over, at least in a professional manner, and now are looked back upon as some of the best years of my life. Here are the top 5 ways my background as a barista has shaped my medical practice.

• Number 5

As many primary care doctors do, I order fasting labwork on a regular basis. Generally, especially if it is just for a lipid panel, I try to make sure that the patient knows that they can have black coffee along with water.

Lord knows I'm a danger to myself and society if I don't have my coffee in the morning.

The 5th most impactful way that working as a barista and subsequently developing a physiological dependency on caffeine, is that it has motivated me to go out of my way to make sure that a fellow coffee drinker knows they can still have a cuppa before getting their fasted blood draw in the morning.

• Number 4

Heart palpitations are very common. The most common type are Premature Ventricular Contractions (PVC) and usually, this is not a harbinger of a larger medical issue -- it can be, and should be discussed with your doctor if they are happening. PVCs are causes by a variety of issues -- one big one is caffeine.

When I was in residency I had palpitations once in a while. Stress, exhaustion, poor sleep, and large amounts of coffee was a state of being for months on end in those years. Since then, I've noted that a large bolus of coffee can trigger this. I've also noticed that some anxiety can come up -- perhaps for me, a feeling of "unease" is a more appropriate term, but undoubtedly this is a real thing and some people are very sensitive to this.

The 4th most impactful way that working as a barista (and again, the requisite caffeine dependency) has impacted my practice is providing me a firsthand experience with some of the side effects that caffeine can have. I think that anytime a doctor has first hand experience with any given medical issue, the care for that issue is improved. Above and beyond the palpitations, is the dependency issue. I get nervous if I can't get coffee in the morning. If I'm travelling this becomes priority one. And while this addiction, which it is -- it is a physiological dependency on the scale which demands to be labelled as an addiction -- is not going to cause me to lose my house, divorce my wife and end up on the street shooting caffeine into my veins with a dirty needle from a rusty spoon, it is still an addiction and this, too, allows me empathy with my patients.

• Number 3

My mother was a night owl. I am naturally a night owl even now. I've never been a person who had major problems with oversleeping, or sleeping through an alarm but the morning opening shift at the coffee shop will having one struggle to maintain any semblance of night owl activity.

The 3rd most impactful way that working as a barista has helped my medical practice, and the process through medical school and residency is by forcing me to function on little sleep and to get up and get to work no matter the hour. A simple thing, but a good portion of any job is simply showing up.

• Number 2

In a recent post I discussed how medical school is actually memory school.

The Kaladi shop was usually very busy. Often there would be a line at the counter for many hours of the morning with hardly a moment to restock the mild fridge or clean a dish. Drinks would be ordered at the register and communicated to the person pulling the espresso shots and that person would communicate with the person who would steam the milk.

A point of pride for the workers, before I even showed up, was not writing down, either on the cup itself or on a separate piece of paper, what each drink was. There were times a dozen cups were lined up and not one had a marking or a word pointing to what the drink should be.

The 2nd most impactful way that working as a barista has had on my medical journey is building the short term memory muscle for years before memory school came along. There were days I was frustrated that this was our process but even now, when I go to a coffee shop and see them plaster a printout on the cup, or mark it with a pen, I have a flash of fiery pride that if it were me (and all this goes for all the coffee studs and studdettes who are KBC alum) I wouldn't need that crutch to know what the next drink was. I would simply know because I had built my memory muscle to do so.

• Number 1

The list up to this point has been mostly how it has benefited me during the training years. Being able to communicate with people is always helpful, no matter the vocation or endeavor.

I look back on the years spent in the construction world. I worked for my uncle as a roofer for about a year. Not long after I started working with a floor installation crew. Eventually I started my own floor installation company. For many of these years I worked in restaurants as well. In fact, I started working at Burger King the day after I turned 15 years old (been working since, almost none stop) and then, at Red Robin. I wanted to be a bus-boy as there were some cute hostesses there but I was talked into working in the kitchen. Difficult to flirt with the hostesses when stuck toasting buns and grilling breasts. None of these were public facing jobs and developing the skills to deal with the general public did not develop until that first day at the KBC shop, way back

I was not always at my best when working and interacting with the public but I learned a lot and even now, I consider many of the customers friends of mine. I learned by doing but also from my colleagues who already had the art of coffee shop communication down to an artform.

The most impactful way that working as a barista has impacted and benefited my career as a primary care physician is allowing me to quickly build rapport even under duress or with difficult situations. I am proud of this aspect and while this is not a skill I learned in medical school, or even residency, in the world of primary care, where specialized and technical procedures are not the norm, and where exceedingly dangerous medications and treatment options are also not the norm, it comes down to being able to communicate and build rapport, which leads to trust and that leads to being able to practice medicine in a manner most effective.

• Number 1b

In 2005 I had been at the coffee shop for a couple of years. I was snowboarding as much as possible -- I never took the job at Copper Mountain and I never worked as a white water rafting guide -- I simply spent all my money and time pursuing those things as a customer. But as my mid-20's loomed and questions began to arise as to what I was going to do with the rest of my life, something began to swirl in my subconscious, right below the surface. I had a lot of fun in those years, but even the party animal version of my younger self felt the pull; the subtle, instinctive drive to achieve, to explore to do something impacting the world and myself, for the better. Is this what my ancestor who decided to get on a boat crossing the Atlantic Ocean 200 years ago felt? Is this what my grandfather felt when leaving Ohio?

In 2005 I was becoming friends with some law students. The KBC shop was near DU (University of Denver) and the law school, at that time, was noteworthy for being the alma mater for Condeleeza Rice. I would lift and carry around sacks of green coffee that weighed 160lbs on a regular basis. At some point this light went off above my head and I realized that these friends of mine were on their way to making a living for themselves simply by using their brain. They weren't going to be lifting heavy things, or even washing dishes to pay their bills. I didn't want to be a lawyer, but I had a feeling that being a doctor would be what the ladies were looking for.

While this may be a little hyperbolic, framing this in a fashion that somehow I never realized this before, but I think I had just never though that I, a person with a well functioning brain, albeit a little beat up from concrete and ice smashes and some other fun activities, could actually pursue in earnest.

The bonus aspect of being a barista specifically at this coffee shop in this period of time is that it allowed me to see myself as a person who could be a doctor, if I so motivated. Here I am; a fully licensed and board certified physician. Still, at times, when I ponder the past that shapes me (but does not define me) it doesn't seem real. This is not some cool depersonalization tip, but is just an honest reflection of this incredible, unlikely journey I have been on.

• Number 1c

I cannot publish this without a mention of that cold November night in 2005, when a young lady, with legs that went all the way up and a nice smile walked into the coffee shop with her friend, to get an americano, on the way to Evergreen, Colorado.

This woman slept in my bed last night.

By far the biggest impact on my medical practice, in that I would not have one, is that I met my wife at this coffee shop. She came in for an americano and less than 9 months later we were married.