Burnout. It’s real. And I know, because I’ve been there.
I knew that I’d been feeling bad mentally, that I’d had random aches and pains, that I was very anxious, that I couldn’t sleep – I was just…off. “Oh, I’m just tired,” I thought. “Maybe I’m coming down with something,” I reasoned. As far as I was concerned, I was fine. But when my chair, our program director, and the executive director sat across a table from me and told me how they saw what was happening, I realized that everything wasn’t OK. I’d completely decompensated. They told me that the nurses didn’t want to be around me and had were switching out of my shifts. They said the residents were terrified of me. They thought that I had bit off more than I could chew and was overwhelmed. I was so overcome with embarrassment and disappointment that I broke down crying right there in the middle of the meeting. It was horrible. But it was also a wake up call. I was completely burned out – and not tip-of-a-matchstick burned out, but more like the Great Chicago Fire of 1871 burned out. I needed some major H2O to put out this blaze.
Rather than bury my head in the sand and give up, I was going to overcome burnout, but how? The first step was a deep dive into self-assessment. What have I been doing the last few months? Where have I dedicated my time? The list was as follows: changing resident didactics, revamping SIM, redoing curriculum, representing GME on the IRB, getting our sepsis mortality below benchmark, writing an M&M blog for work, getting on the national speaking circuit, creating a women’s physician forum at work, working on publications, establishing faculty development modules, developing curriculum for a med-ed elective rotation, spending time with my kids, spending time with my husband, cooking for my family and taking care of household things dominated that list. Interestingly, not one thing on my list had anything to do with my personal wellbeing.
What is this self-sacrificial life I had set up for myself? Well, perhaps it has to do with the culture of being an EM physician. We are notorious for sacrificing ourselves for the sake of others. We come into work vomiting and sick, seeing patients with an IV pole in tow because we don’t want to bother the jeopardy physician to come in for us. We don’t sit down and eat a meal because we need to get to our patients’ needs immediately. We don’t go to the bathroom because we are too busy. We literally ignore our own life sustaining needs for the 8-12 hours we are work. That work culture gradually translocates into our daily lives. It becomes our constant culture and is far from healthy.
I needed to make some major changes if I was going to recover from burnout. And these needed to be lifestyle changes. So what is going to have a long lasting effect? Changing my attitude, my eating and sleeping habits and my stress management were the key.
The very first thing I did was gather my support system. I told my husband about my horrendous meeting and that change was in order. He is a remarkable man and told me that we were in this together. My mother is also a key player so I told her as well and she of course was 100% supportive. The fact is that I can lay out a well thought out plan but I need the help of other to implement the plan because I CAN’T do it all on my own.
The next item on the list was to change my attitude. I was actually getting annoyed that I needed to work clinically. It was interfering with the time I needed for other work related things. Seriously? Taking care of patients is a privilege and I completely lost sight of that. It’s the reason I went to medical school. No matter how tired or miserable I was, I repeated to myself that going to work today is a blessing. Many people do not have the ability to do what I do. Many are unemployed. God gave me a talent that I am going to put to good use today. I will not allow the “I don’t feel like doing this today” attitude take over. It takes work. Some days, it takes (A LOT) more work than others. The key is to come up with a positive phrase/saying you actually believe. Mine is, “It is an honor to make a positive difference in someone’s life today. I am blessed to have this job so I am going to enjoy it.” If you believe it, you will find success with this method. I now really enjoy working clinically again. It provides a great feeling and sense of satisfaction I was missing for months.
Changing my attitude also changed my perspective about a lot my patients. Rather than approach someone as a “drug seeker” with frustration, I approach it as this individual needs help and I am going to try to help him. Rather than think of someone as just another crazy coming to the ED for nonsense, I approach it as this person is mentally unwell and is absolutely terrified about his presenting complaint. I am going to take the time to help them feel better about this problem. It doesn’t work all the time and I still find some interactions frustrating. However, the frequency is much less and the way I handle the frustration is much better.
Before every shift, I rally my troops and have a pre-shift huddle. This huddle includes every single person that will be working in my pod in any capacity for the shift. Initially, I used the huddle to share that I was struggling with my work-life balance and am on edge. I am aware that I may have upset some of them but am working to get better. I asked them to please call me out publicly or privately on anything I may inadvertently say or do that they find upsetting. Well, my team LOVED it. It made me human and built some really strong bonds of trust. Now, our huddles are more like mini-pep rallies that get positive energy flowing and my team still LOVES it. I worked very hard to gain forgiveness and regain the trust of those I upset and recruited the troops to help me get through the fire. I strongly believe this step transitioned me from someone with a title into an actual leader.
Next was to take care of my physical wellbeing. I am a strong believer in endorphins yet made zero time to exercise. Let me be very clear. This is not 2 hours a day in the gym with hopes of recovering my pre-pregnancy bikini body. That ship sadly sailed an extremely long time ago. Instead, I look at my weekly schedule and mark off 2 hours where I go to my local YMCA and take a couple classes. 3 classes a week is a bonus. I also make sure that I get enough sleep. Some people can function very well with 4 hours of sleep. I am not one of them and require 7 to 8 hours. Without sleep, my ability to cope with stressors is greatly compromised. Additionally, I never go to work hungry anymore. To my family, friends and colleagues, I am notoriously hangry, so I make sure I have a solid healthy meal before all of my shifts and that I have a steady supply of healthy foods to maintain my glucose levels while at work. With adequate sleep, food, and some low levels of endorphins circulating, I am setting up my body for success. In this state, stressors feel less severe and my coping skills are better.
Saying NO is still something I am learning but it is a necessary skill. There is also more to it than simply being able to say no. Each time a project passes my way, I am forced to analyze my current list of items and determine if what I am doing requires my personal attention or can be passed off to someone else. If the project is something I would really enjoy and meets my priorities and goals then I go for it and assign another item to someone else. If the project does not meet any of my current priorities or goals, I say no regardless of how interesting it is. When I do say no and explain that I am pretty tied up at present, people are very understanding and usually leave the door open if anything changes. It helps to remember that saying “yes” means saying “no” to something else, and that can be your wellbeing or your family,
The last thing and the most challenging was to open myself up to an entirely new world and reach way outside of my comfort zone. Have you ever seen a yoga master lose his/her mind? I have not and decided perhaps these individuals are onto something. I’ve participated in yoga several times but have never fully committed my mind to the practice. Rather than take a few more classes, I gave my children to my in-laws and escaped with my husband to the Berkshires for a 48-hour yoga and meditation submersion. This experience was life changing. I learned a great deal about being mindful, finding happiness, staying centered, prioritizing my own needs without feeling guilty and how to incorporate these items into my daily living. We will now be going back at least twice a year in order to maintain, refresh and learn more. The physical practice of yoga meets exercise requirements but the mental practice is what greatly improves stress management and coping skills.
My journey is not complete. There will be ups and downs. But as with all things worth doing, preventing (and recovering from) burnout is a challenge and requires a relentless commitment. That’s something I can – and will – do.