In dealing with those who are undergoing great suffering, if you feel “burnout” setting in, if you feel demoralized and exhausted, it is best, for the sake of everyone, to withdraw and restore yourself. The point is to have a long-term perspective.
The goal of this book has been to provide information, encouragement, and direction to respect the real dangers incurred to one’s psychological and physical health in the process of fulfilling the mission of practicing as a health care professional.
With the onset of Covid-19, and its immediate aftermath, medical and nursing professionals have often felt a combination of guilt, anxiety, fear, and helplessness. Long hours, lack of protective equipment, hospital overcrowding, uncertainty about the coronavirus, and the dangers of exposing self and families have created enormous stress. Through it all and against great odds, they have acted with courage and self-sacrifice closely allied with experiences that others have had during periods of protracted war. However, most physicians, nurses, and physician assistants, even under circumstances of battle fatigue, have never been required to face such acute challenges simultaneously at the bedside and at home.
Also, like the experience of posttraumatic stress disorder, it may seem like the stress never ends. In interviewing critical care nurses, it is not unusual to hear under “normal circumstances” that they later ruminate over activities during their shift. “Did I give the right dose of the medication to that young person? Did I check the wristband for allergies to medications? Was I distracted by the code that happened earlier? Should I have called the family sooner when the patient started to decline?
During prolonged and sometimes mandatory overtime hours, many spent by health care providers during the COVID-19 pandemic’s height, the ruminating became even worse for some—they couldn’t stop thinking about what they had done; in colloquial terms: they couldn’t turn their brain off to what had happened.
Compounding the problem is that because of COVID-19’s contagion, the nurse, physician assistant, physician, or other healthcare professional winds up being the “loved one” physically present, although someone from the family may be “there” electronically as is described in the following May 17, 2020 New York Times first page story by Jan Hoffman:
The coronavirus patient, a 75-year-old man was dying. No family member was allowed in the room with him, only a young nurse.
In full protective hear, she dimmed the lights and put on quiet music. She freshened his pillows, dabbed his lips with moistened swabs, held his hand spoke softly to him. He wasn’t even her patient, but everyone else was slammed.
Finally, she held an iPad close to him, so he could see the face and hear the voice of a grief-stricken relative Skyping from the hospital corridor.
After the man died, the nurse found a secluded hallway, and wept.1p1
Much of this acute stress exacerbates the chronic pressures evident in modern health care today. And so, monitoring one’s own personal well-being is not a nicety for the current caregiver—it is a necessity.
Moreover, in addition to the personal benefits derived from self-care, how the health care professional addresses this area can have a beneficial impact on those being served. It is no surprise that unfortunate—and sometimes even fatal—consequences for innocent patients may be attributable to the inattentiveness and exhaustion of harried, hurried health care personnel who ignore or minimize the value of both self-care and self-knowledge.
Christensen and Suchman summarize the realistic strains of modern health care:
Caring for the health of human beings is a vocation that has summoned forth some of the noblest and most valued work in human societies through the millennia. . . . With increased integration of services, constraints on society’s financing of health care, a swelling of the population moving into advanced age, and the acceleration of information processing technologies—increased demands are falling on the backs of professionals throughout the healthcare spectrum for increased productivity, documentation, vigilance to prevent error, and mastery of expanding areas of knowledge and technology. We often find ourselves racing to keep up with all our tasks without having time to reflect on the deeper meaning of our vocation. The load we are carrying increasingly exceeds our carrying capacity.2p2
Yet even though the stresses and strains can be extreme, the theme and philosophical stance of their message highlights that recapturing the awe of being a physician, nurse, or physician’s assistant is within reach with some knowledge and action. What is almost lost can be rediscovered. What is presently possessed need not be given away. A recently graduated nurse at a leading teaching hospital shared how much joy her work was bringing her. In doing this, she then described some of her cases and challenges, as well as her frustrations. Chief among her complaints was that some of her co-workers in the intensive care unit seemed drained, jaded, and unmotivated. She said in a hoarse voice, “I don’t want to get that way. Nursing is a gift I don’t want to lose or take for granted.” Our point in writing the revision of this book is that this nurse, or any health professional for that matter, does not have to succumb to the stresses of work like her co-workers.
Furthermore, during a pandemic (as in the case of other crises), the possibility for the physician, physician assistant, or nurse to experience posttraumatic growth also becomes more of a reality, although it is by no means, guaranteed—especially if two elements in one’s outlook are not embraced: clarity and openness. On the one hand, during a dark period in one’s life, one must be clear about the trauma or serious stress one is facing. Denying, avoiding, diminishing, or romanticizing what one is encountering is not helpful. On the other hand, not being open to where this unwanted, negative experience might lead is also problematic since it may deny one the discovery of new personal depth or an appreciation of a greater quality of life.
No one wants a crisis or an encounter with personal darkness. Yet, if such a trauma or period of serious stress and life disruption does take place and we have no choice about it, we still have a possibility to grow (and this is important to note) in ways that would not have been possible had the trauma or darkness not occurred in the first place.
This book then has been about retaining and deepening the gift of passion for the care of others while realistically facing the interior and systemic acute and chronic problems that are part of an involved life—especially in such personally and intellectually demanding fields as medicine and nursing. It has also dealt with having a real sensitivity to the acute and chronic dangers to one’s health while not consequently forsaking the honor and privilege of working in health care.
Equally important, this work has been about diagnosing the problems of secondary stress early, taking action—both preventive and ameliorative—as soon as possible, and reviewing the results of such ongoing interventions. To do this, one needs to be aware of what can be learned from the literature on the topic and from clinical work. Above all, it is about coming home to oneself in a way that self-knowledge, strengthening one’s inner life, and self-care are not considered “a given” or “a luxury” but are instead intentionally embraced as part of an essential ongoing process. Such a process, like effective therapy, produces good results and a return to the wonder and awe that entering and remaining in the medical and nursing health fields can and should produce.
There is a need for an ongoing monitoring of oneself and a continual posing of questions such as the following: