Reflections from the Eye of the Storm

Prologue: 

I wrote this reflection not even two days after my second panic attack that effectively stopped me from going into my work as a doctor. Looking back now I had so little idea of what was still to come yet obviously still a fair bit of insight into my own thoughts and feelings at that time.

I was really taken by surprise by the fact that I had that series of panic attacks that in hind sight spelled the beginning of this journey for me. I had never had them before and I was so used to being able to mitigate whatever hurdles- both physical and psychological- I had encountered that I was just completely unaccustomed with not being able to push through. 

Since that time I have certainly learnt a lot about myself and built upon parts of myself that working in clinical medicine was slowing wearing down, like the way I experience empathy. For a long time I was always told to "care less" to avoid burning out. Never able to do that, I felt wholly unsupported and ill-equipped to learn how to care differently. Which is something that I now strive to teach other healthcare professionals who sit at a similar point on the empathy spectrum as I do. And learning how to authentically practice self compassion. Another so called soft skill that despite my many years of academic training and going into a field that abounded with compassion for others, I had never managed to master.

So these were my reflections when I really was still in the eye of the storm.

Friday: 28th June, 2019.

I love helping people. It makes my heart smile to know that I've made a difference in the lives of my patients. But that flip side of the same coin is that I also feel the setbacks, the bad outcomes, the unexpected, in a way that I can't quite steel myself against. I walk beside them for the highs and the lows. And I think this is what a lot of my patients love about me as a doctor. 

This week, I've found myself as a patient, also now feeling these lows. With an amazing, empathetic GP walking beside me. And I look to her, seeing this intense feeling of totally understanding what I'm going through in her eyes. I know she sees me, but I also know that she feels it too.

We in the caring professions do tend to be a certain type of person. Someone who wants to impact on others lives in a positive way. Someone who feels deeply and gives openly. Added to that the innate complexities of intellect and constant searching for knowledge that medical school has nurtured and fostered within us. We are a high achieving bunch with generally high expectations of ourselves. So how does this become burnout?

 Well, for me, it's a combination of things:

1. I've long felt the weight of taking responsibility for my patients. Logically I can tell myself that they are individuals who will make their own decisions and assume responsibility for themselves. But the responsibility I'm talking about is more of an emotional one. I've never been able to compartmentalise that feeling.
2. Professional isolation. This is a big one for me as it happened so slowly, insidiously almost. Some time off during medical school then having a couple of kids during fellowship training has meant that I've found myself with no real contemporaries. I tried to join a Balint group some months ago but was told that unfortunately there were no places within that group at that point in time. It feels like it is all of a sudden that I've felt this way- but clearly it has been building up over many years.
3. Following on from number 2- General Practice as a training program sees registrars seeing patients alone behind a closed door from very early on. I have always felt that responsibility very heavily.
4. The sheer breadth of knowledge needed to safely practice medicine. General Practice in particular demands of us an incredible breadth of knowledge that is not only broad, but also dynamic. It's this ever shifting landscape of new treatments, protocols, medications and knowledge that can be quite exhausting to keep abreast of.
5. The emotional toll of taking those small weights of distress from your patients. Lightening their load but very slowly, incrementally making yours heavier.

So slow was this process that I didn't notice it for what it was. I thought I was feeling anxious or stressed so I did more meditating, practiced more mindfulness. But it wasn't working. Why wasn't it working?

Because work itself had become a subtle trigger for me in ways that I didn't notice at the time and it took this huge physical collapse to help me to see the distinction.

Epilogue:

I've come a long way since this point. In the course of my recovery I have finally given myself permission to be at a point in my life that practicing clinical medicine isn't the best thing for my health. I often reflect on this and question myself as to whether this is simply me just running away from it? And while I'm not sure that I have fully closed the door on my work in clinical medicine, the conclusion I have come to is that there are actually some amazing, fulfilling and truely enjoyable things in my life right now that are not pushing my exhausted and recovering body and mind back into burn out. Things like teaching, speaking and even running retreats for doctors- and I simply wouldn't have the cognitive space for these things if I was also trying to just keep my head above water in General Practice. I would also be running the very real chance of pushing myself back into burning out again.

The self awareness I have gained in the last 2 years has meant that I have finally been able to make these tough decisions actively rather than reactively- that I feel is the biggest difference. So often we make decisions in life not actually from a place of agency but rather out of necessity. We leave making hard decisions until the last minute so that time has effectively knocked some options out for us. We say yes to every opportunity that comes knocking to flatter our Ego, not because we actually want to do something but more because we're so enamoured by the idea that someone thinks we're good at something. I certainly did that. Turning down opportunities that you know  aren't good for your life right now is a hard thing to do, and yes the FOMO is strong when you realise what you're potentially missing out on. But it also takes strength to make those tough decisions when you know that ultimately, they are the best for you, your family and your life.