No Wonder I’m Burned Out!

Once again, I ask my friends:  How are you? 

I am not great!!  Neck, back and head pain, insomnia, low mood, and the worst case of stress eating in a couple years—GRRRRRRRR!  *deep breath*  …So, like a good primary care doctor (she says with tongue in cheek), I evaluate and treat myself.

I ask patients to rate the stress and meaning of their work and then compare:  Is work overall more stressful than meaningful, or the other way around?  It helps me assess the sustainability of their work life, and gives me insight into their values and priorities.  In recent years when I’ve asked myself, the answer is consistent: moderate stress, HIGH meaning.  Today it’s high stress, less high meaning.  For the first time in a long while, work is not necessarily more meaningful than stressful.  Yikes.

Stress:  It’s COVID. 

Meaning:  I ask patients how they derive personal fulfillment and meaning from work.   I recently asked myself again.  It’s twofold:   Relationships and Efficacy.

Relationships: I am your primary care doctor. Sometimes I’m your therapist, your cheerleader, your drill sergeant, and your accountability buddy. I have always loved this, even on the hardest days. But this year, I am also a resolute public health advocate. Sometimes that rubs you the wrong way, because I tell you things you don’t like. I recommend against flying. Don’t eat at restaurants. Don’t gather with your family for the holidays. Don’t go to church. Stay home for 14 days after an exposure. I interrogate your COVID precaution practices. Then I dissect and judge them (not you), thank you on behalf of humanity, and admonish you to persist, longer and longer, for all our sakes. It kinda puts a damper on our relationship.

Efficacy:  I. Help. People.  It’s my calling!  Hemorrhoids?  No problem.  Back pain?  I’ got this (yer back, that is).  Viral gastro?  Migraine? Core instability, palpitations, paresthesia, GERD, thyroid nodule—even  depression and anxiety—I can make a good plan for all of these things.  I can walk you through it, reassure you, and help you feel better, even when I can’t fix the problem. 

Not so with COVID.  How did you get it, when you were so careful?  If the test is negative there’s still a 20-30% chance you’re infected if the scenario is high risk, but I can’t say for sure.  If you’re sick, how long will it last?  Will it get worse before it gets better?  How much worse?  Will you have lasting symptoms or long term health problems?  How long does immunity from illness or vaccine last?  I cannot lie:  I. Don’t. Know.  I will stay with you through it, but I can’t even satisfy your most basic questions, while you sit alone at home coughing, short of breath, unable to see or touch your loved ones, sipping ginger ale because you throw up anything else.  I can’t help.  And it kills me.

On top of that, I’m not doing any good as a public health champion, either!  Have I changed any of your behaviors?  Have I made even an iota of difference in my community to stop the spread?  All signs say NO.  I’m failing left and right.  No wonder I’m eating so much.

Burnout

Burnout is widely understood to have three key components: 1. Emotional Exhaustion, 2. Cynicism/Depersonalization, and 3. Reduced Personal Efficacy. Studies of physicians generally show that while we often score high on the first two, we do better with the third. I think not anymore. Burnout affected about half of all physicians in all specialties a few years ago, but had improved due to widespread research, awareness, and advocacy for systemic change led by professional societies such as the American College of Physicians and the American Academy of Family Practice. But think about 2020: Whatever emotional exhaustion my emergency medicine and critical care colleagues felt before, caring for the sickest of the sick, likely pales in comparison to the horrors of this pandemic. When their health systems ignored their pleas for PPE and then laid them off, making remaining docs work that much harder, and when they saw people partying and spreading virus all over the place, could you blame them for getting cynical? And though we’ve learned so much and fatality rates are lower now than in March, imagine going to work every day to watch patient after patient suffer and die alone, despite your and your team’s best efforts. We can no longer count on efficacy to save our morale.

Re-ignition

So how do we hold it together? Well DUH, it’s about connection! I had not felt this bad in a long time, but I’m better now, thanks to my peeps. They’re everywhere, and we hold each other up. Texting a meme here, venting (a lot) over there, and generally being present for one another, sharing, even embracing, the deep suck of the morass. Because this too shall pass… Like a kidney stone, as they say.

The only way out is through.  The best way through is together. 

I haven’t thought, said, or written that in a while.  It’s not that I forgot.  I got overwhelmed.  Happens to the best of us. 

What a Privilege

NaBloPoMo 2020 – Today’s Lesson

I’ve said it before and I’ll keep saying it:  People are suffering.  Not everybody, but many, and many pretty badly.  A prolonged global pandemic, unprecedented political polarization, escalating agitation for social justice—any one of these would be enough to push us over the edges of our sanity, and yet here we are, surviving all three and more.

I know it’s a challenging day when I’ve handled three phone calls before getting out of the car at work in the morning, and in the afternoon I think Hallelujah and give joyful thanks for one patient’s globally negative Review of Systems and another’s 95% oxygen saturation.  But this is also the most fulfilling day.  I did good work today.

Like most primary care doctors, my message volume has increased by about 30-50% in recent months. Complex questions and issues require time and patience to think and talk through. Many cannot be readily answered or solved, and the uncertainty calls out all of our anxieties and defenses, insecurities and grievances. Every patient experiences this historic moment in a unique and acute way. As the storm rolls over the neighborhood, I see it land on each doorstep, knowing what’s already in the house—how the furniture is arranged, what’s in the closets, maybe even the state of the foundation. I am allowed inside, invited to inspect and advise.

What an amazing privilege to be a physician in this moment, to witness, and to help.  This is absolutely what I signed up for, what I’m called to, and what I trained for.  I promise to do my best, and we will get through it together.

Exponential Risk

NaBloPoMo 2020 – Today’s Lesson

Things are looking really bad again, folks.  Illinois saw more than 10,000 new COVID cases for the fourth day in a row.  Between the first and third weeks of October, COVID inpatient census rose 500% in one metropolitan hospital system, and it’s still climbing.  At this rate, we may run out of ICU beds by Thanksgiving.

I had more calls today about COVID (symptoms and/or exposures) than any day since the pandemic started.  Every call takes time to explain the profound importance of distancing, masking, and minimizing contacts, then the logistics of quarantine, testing, and contact tracing.  It’s totally straight forward in some ways, and completely convoluted in others. 

With rapidly escalating disease prevalence, every unmasked contact with a non-household (or ‘pod’) member carries exponential risk.  You breathe on me, I breathe on you.  We have now exposed each other to everybody we have each contacted in the past 14 days—we have merged our bubbles irrevocably in this one encounter, endangering everyone in each bubble and all of their extended contacts.  It cannot be undone.  This is the nature of a pandemic. 

I understand how hard it all is—how inconvenient, fatiguing, disruptive, and maddening.  Our masking and distancing, missing friends and activities, restricting our kids’ social lives, is all immediately and concretely costly to us, and only distantly and abstractly beneficial to others (and us).  Still, it is what we can do to slow the spread of a deadly virus that has infected more than 10 million Americans, and will have killed more than 240,000 of us by tomorrow.

Avoid these 9 pitfalls to stay safe.

If you want to pod, follow this guide closely. 

We can stop all paths of the virus through us.  But it takes all of us.