Breakdown to Breakthrough moments in 2021
2020 was an unquestionably rough year. Yet, most of us in healthcare figured that if we just hunkered down and waited for the vaccine, everything would be okay. Well, 2021 heard that and said, "Hold my beer." Amy Cuddy and JillEllyn Riley coined the term "pandemic flux syndrome," in an article they co-authored in August of 2021, just as Delta began to surge. This term described the angst that so many of us were feeling as things returned briefly to somewhat normal, then the rug was pulled out so hard during the Delta wave. While pandemic flux syndrome varies in presentation, it is generally a mix of anxiety, worry, grief, frustration, and confusion about the present and the future.
As a physician, I hit a wall in March of 2021. I was the most burned-out I had ever been in my career. I nearly left emergency medicine, but after going part-time and doing intensive reading, journaling, meditating, coaching and therapy, I came out the other side of 2021 changed. As Omicron rises, I stand ready to work in the emergency department. Not with the false bravado of the healthcare hero trope, but now grounded and in tune with my emotional and physical needs.
As I scroll through Twitter and my DMs from my friends and colleagues in healthcare, it is full of despair and anguish about Omicron. While the response of the United States has been a complete dumpster fire, complete with severe gaslighting of healthcare workers (HCWs), simply screaming into the void is no longer a workable strategy for me to live or be a doctor. At the ripe age of 36 during the pandemic, I had what I think can best be described as what Brené Brown calls The Midlife Unraveling. She describes a series of mid-life nudges that precipitate necessary changes in one’s life. I'd describe 2020-21 as not so much nudges, but rather hammering blows. Below are the top 10 things that helped me go from breaking down or unraveling to being whole and thriving:
1. BOUNDARIES. It is my 2021 word and the single most important thing every physician can create in their life right now. Here are a few ways to get started. I know some of these seem basic, but based on my experience, that’s where we need to start.
· With kindness and compassion, remind patients & visitors of the masking and other hospital policies, i.e. no verbal or physical abuse. When they don't listen or worse, escalate, I explain that I will not be able to be involved in their care. This has been extremely effective. I also reach out to security if I feel physically unsafe.
· Sometimes you must remind colleagues that they can’t yell, demean, or condescend. I try to do it with compassion, as usually, their poor behavior is related to fatigue and burnout, but it is not okay for them to unload their crap on you.
· Stop charting at home. Any time you're working on charts at home, you're working for free. Consider cutting down on the number of patients, requesting a scribe, or more admin time. Something must give, and it shouldn’t be your personal time.
2. Take time off. Really. Right now, even now during another wave. Wave 1, 2, 3, or whatever we're on now, we powered through. That is no longer sustainable. You are not responsible for holding up the house of medicine. This may not be the last wave, and we need you to stay in medicine. You won't be able to stay if you physically or mentally deplete yourself into exhaustion, burnout, or worse suicide. Yes, wait times may increase due to more HCWs needing to take time off. To me, taking time off due to mental or physical exhaustion is like a soldier being wounded in combat. Take time to heal to come back to the fight, if and when you can. Preferably, please take time off well in advance of being exhausted. We'll get to that next, as it requires being in tune with your physical and mental needs.
3. Feel your feelings. Yes, there is some level of compartmentalization that occurs at work, but afterward, the stuff must come out! For me, that’s been a mix of journaling, talking with friends and colleagues, and therapy. I can assure you the stifling and numbing of emotions will only last so long. For many, the feelings eventually manifest as burnout, depression, anxiety, or substance abuse/dependence. The rates of all of are higher in physicians, and that was true before the pandemic. Many of us cannot name feelings beyond happy, sad, angry, or mad. Many of us don't even notice when we're beginning to feel anxious, frightened, or concerned. There are many great books to help you get started on increasing your emotional literacy and regulation. My top recs are The Thriving Doctor, Atlas of the Heart, and Emotional Agility.
4. Get sleep. Our training required (largely unnecessarily) extreme sleep deprivation and this created sleep debt and bad habits around sleep. Sleep is the cornerstone of all health. With more sleep, I found my mental clarity, creativity, and energy return. I learned a lot about sleep speaking to Dr. Vinny Arora on episode 51 of The Emergency Mind. I also wear a WHOOP device that helps me track my sleep. I learned that it takes two full days for me to recover from one night shift. It's not that I can't do anything on those recovery days, but I must be more kind to myself after night shifts.
5. Eat better. Phase one of 2020 for me included thinking that I might die, really, there’s a Washington Post story that featured me. I figured that eating my feelings was at the very least justified. 15 lbs and a new scrub size later, I figured it was time to be more of an adult about this issue. Besides not wanting to buy a new wardrobe, I just didn’t feel good. I felt lethargic and literally weighed down by my poor diet.
6. Rest. Rest is different than sleep. Many physicians go from work to sleep with barely any rest built into their day. Rest includes restorative activities that may include hobbies, quality time with friends and family, self-care like taking a bath or getting a massage. The Nagoski sisters’ book, Burnout: The Secret to Unlocking the Stress Cycle explains the importance of rest and strategies to increase rest in your life.
7. Meditate. There's a reason great minds like the Dalai Lama meditate. If you're results-focused and need some feedback, consider getting a Muse device that provides biofeedback on your meditation practice. I’m not a master meditator, I do it for 5 minutes a day. Everyone has time for that.
8. Journal. I've been consistently journaling throughout 2021; first, it started off as a combo journal/planner from Leaders in Heels that has built-in prompts that encourage planning and reflection. Then, I transitioned to journaling every night. The journal has promoted catharsis, introspection, and creativity. I honestly don't know how I lived before the journal.
9. Adaptogen supplement. An adaptogen is a natural substance that helps the body adapt to stress. Many are thought to support the adrenal glands in the body. Examples include Ashwagandha, Rhodiola, and Ginseng. I added an Ashwagandha supplement to my daily routine.
10. Stop making excuses. Healthcare is a hot, steamy, mess right now. Nearly everyone agrees that large, systematic changes are needed for physician safety, mental health, and career longevity. For all of 2020 and most of 2021, I waited to do the necessary work on myself, out of anger and disappointment that the system wasn't treating us better. While there needs to be A LOT, I mean, A LOT of changes to make this a sustainable profession, that is not an argument to postpone your own work. In fact, it's an argument to get busy taking care of yourself right now. No one is going to do it for you. If COVID-19 taught us anything, nothing is promised. Don't postpone your own recovery and healing.
Giving up your maladaptive coping strategies like worry, anxiety, numbing behaviors like overeating, and binge-watching bad TV is not easy. I highly recommend getting a therapist and/or a coach, in addition to sharing your successes and struggles with a wonderful group of friends. For the coaching side, follow @RevitalizeWomen and reach out to us to schedule an individual consultation. You deserve to thrive in 2022.
If you’re a healthcare worker that needs help today, please reach out to these resources:
For ACEP Members, https://www.acep.org/life-as-a-physician/ACEP-Wellness-and-Assistance-Program/
From the National Alliance on Mental Illness, HCW specific resources: https://www.nami.org/Your-Journey/Frontline-Professionals/Health-Care-Professionals