Showing posts with label burnout. Show all posts
Showing posts with label burnout. Show all posts

Monday, June 20, 2016

Witnessing sorrow and grief; taking trauma home.

About a week ago, I awoke to the news of the Orlando mass shooting-that 49 people had been murdered in the Pulse nightclub--for no other reason than that they were gay, and most were Latinx. The mass shooting du jour in America. You know the rest of the story, because unfortunately we've all heard these stories repeatedly. But it made me wonder about something else, tangentially related--but related to us in our work.

I came across a Facebook post by Dr. Joshua Korsa, an Orlando resident who described his experience caring for the surviving victims. Check out his story here (original post) or here (short news story)--. The "tangible reminder" he refers to below? His blood soaked Keens. He writes (about the survivors of the shooting):

"They've become a part of me. It's in me. I feel like I have to carry that reminder with me as long as [those patients] are still under my care. So this is a tangible reminder that the work's not done. That there's still a long way to go" 

Later I read the NY Times' "Orlando Medical Examiner: ‘Take a Typical Homicide Scene, Multiply It by 50" which was just amazing (for lack of a better word)--in less than 48 hours they were able to identify all 49 victims and in less than 72 hours autopsies were done on every single one of them. That's a logistical accomplishment and an emotional....quagmire. I cannot imagine being a part of that. I cannot imagine how hard that must have been. What exceptional work-- bringing confirmation to each of the 49 families and countless loved ones involved.

But wow, logistics aside--consider for a moment about the pathologists and technicians who did this work, who painstakingly photographed each victim, prepared them for transport to the morgue, the pathologist/assistants who later performed the autopsies, cleaned the bodies--these are the unrecognized people behind the scenes in such catastrophic events. How are they doing this week? How are the police officers? The crime scene technicians? Are they ok? How do people that witness such awful mass casualties cope? 

So that got me thinking (this is how my ADHD brain works, one topic to another, bouncing along)...WE deal with some really difficult stuff.  Not mass casualties (I don't think most of us do, anyway) but day to day casualties of life. Car accidents. People losing limbs. Diabetes, heart attacks, cancer, strokes. Kids dying. Homicides, suicides, accidents. Alcoholism. Lung cancer. New diagnoses of leukemia (surprise! you didn't just "have the flu"!). Homelessness. Stillbirths. Domestic violence. And so on. It's a lot to deal with.

How do you deal with the anger, death, violence, despair, stress, grief in your job? Sometimes it isn't even the death that's so hard, it's the sorrow, the daily witnessing of human distress. Death is a separate entity, and varies in it's impact on me--some deaths leave me with a sense of calm, some break my heart and I swear I never want to go back to work again (but I keep showing up.). Some don't seem to affect me emotionally much at all, and that's ok too. Every one is different.

As I walked around the oncology ICU recently, several rooms were empty-- and I realized as I walked around that I associate almost every room with a patient I have cared for in that room--and who has since died. I often think of them as I pass by (Oh, that's J's room...oh, that was D's room...etc).

As I walked down the long hallway to grab lunch, I thought:
  • M's room-she was my age--she died in that room over there, overlooking the water. She and her husband were avid skiers and mountaineers and he shared incredible pictures of their adventures together. I swallowed back tears during rounds that day; that was the second time I'd cried that day. M died of relapsed leukemia and candidemia. 
  • D's room-she coded suddenly, and died before her daughter could make it in. The chaplain put her daughter on speaker phone so she could say goodbye to her mom as her mom underwent CPR ("Tell her she was a good mom....tell her I love her....tell her she was a good grandma"). D died of advanced lung cancer.
  • M's room-an older woman with AML, the same age as my mom. Wonderful family, with a toddler grandchild who liked to sit on the bed and who was fascinated by the sat probe on grandma's finger. That boy lit up the room. M died of a disseminated fungal infection. 
And so on. I remember many. 

We carry our patients in our hearts and in our minds--they are with us/in us, year after year. And sometimes memories of them/their deaths are comforting while at times they are heart breaking and hard to revisit--even years later. Some patients/deaths I look back on and I feel peace, and I smile at the memories that surface. Some patients/deaths I think back on and tears still come to my eyes-and the deaths were years ago. Some I look back on and my heart rate increases--because their deaths were so awful that I still have an emotional/visceral response. 

So I wonder. I wonder how the nurses, doctors, EMTs, police, pathologists-how everyone that helped victims of the Orlando massacres is doing. And I hope they're ok. And I'm grateful they were there to face such horror, to run into a scene that hopefully none of us will ever have to face. And I hope now that they've taken care of so many others, that others are taking care of them.

And last but most certainly not least, may we never forget these 49 people, almost entirely queer people of color, murdered en masse for being...themselves. 



In Memory.
June 12, 2016.

Stanley Almodovar III, 23 years old
Amanda Alvear, 25 years old
Oscar A Aracena-Montero, 26 years old
Rodolfo Ayala-Ayala, 33 years old
Antonio Davon Brown, 29 years old
Darryl Roman Burt II, 29 years old
Angel L. Candelario-Padro, 28 years old
Juan Chevez-Martinez, 25 years old
Luis Daniel Conde, 39 years old
Cory James Connell, 21 years old
Tevin Eugene Crosby, 25 years old
Deonka Deidra Drayton, 32 years old
Simon Adrian Carrillo Fernandez, 31 years old
Leroy Valentin Fernandez, 25 years old
Mercedez Marisol Flores, 26 years old
Peter O. Gonzalez-Cruz, 22 years old
Juan Ramon Guerrero, 22 years old
Paul Terrell Henry, 41 years old
Frank Hernandez, 27 years old
Miguel Angel Honorato, 30 years old
Javier Jorge-Reyes, 40 years old
Jason Benjamin Josaphat, 19 years old
Eddie Jamoldroy Justice, 30 years old
Anthony Luis Laureanodisla, 25 years old
Christopher Andrew Leinonen, 32 years old
Alejandro Barrios Martinez, 21 years old
Brenda Lee Marquez McCool, 49 years old
Gilberto Ramon Silva Menendez, 25 years old
Kimberly Morris, 37 years old
Akyra Monet Murray, 18 years old
Luis Omar Ocasio-Capo, 20 years old
Geraldo A. Ortiz-Jimenez, 25 years old
Eric Ivan Ortiz-Rivera, 36 years old
Joel Rayon Paniagua, 32 years old
Jean Carlos Mendez Perez, 35 years old
Enrique L. Rios, Jr., 25 years old
Jean C. Nives Rodriguez, 27 years old
Xavier Emmanuel Serrano Rosado, 35 years old
Christopher Joseph Sanfeliz, 24 years old
Yilmary Rodriguez Solivan, 24 years old
Edward Sotomayor Jr., 34 years old
Shane Evan Tomlinson, 33 years old
Martin Benitez Torres, 33 years old
Jonathan Antonio Camuy Vega, 24 years old
Juan P. Rivera Velazquez, 37 years old
Luis S. Vielma, 22 years old
Franky Jimmy Dejesus Velazquez, 50 years old
Luis Daniel Wilson-Leon, 37 years old
Jerald Arthur Wright, 31 years old

Thursday, December 10, 2015

Home Alone

This summer, my three kids spent several weeks with my parents in their home in Connecticut.  For the kids, this is an amazing time when they bond with their grandparents and get away from the city.  For my husband and me, this is an amazing time to spend a few weeks focusing on work, spending kid-free time together, and getting a break from the day to day bustle of life with kids.

This summer I realized another bonus: that I could be HOME ALONE!  Yes, you heard what I said. At home with no kids, no husband, no nanny -- no one but me!

For people without kids, the simple pleasure of being in your own home with no one else around may not seem that exciting but for a mom who never (and I really mean never) gets to be home alone,  this simple pleasure is on par with fancy dinners, spa days, and juicy beach reads.  Being home alone is one of the most delightful experiences of my life as a mom.

When it first dawned on me that I could be home alone for hours at a time, I felt like the little kid from the movie Home Alone when he first realized that his family had disappeared during holiday break.  I wanted to sit in my pajamas, eat potato chips, and watch movies all day.

Of course, I had other things to do and couldn’t spend hours on movie marathons but during the two weeks when I had a few hours at home with no one else, I started to think about how rare and important alone time is.  

There’s something peaceful and rejuvenating about being in your own home when no one else is there. And it’s different to be home alone rather than other places alone.  I am alone in my office a lot but that’s different. I try to get along time by going to the spa or going to a bookstore but that too is different – it doesn’t last for long and I’m not in my own private space.

As working moms, I wish we could have more times home alone.  Not just quiet time after the kids are in bed but real time – hours when we are not exhausted, can have the freedom and comfort of home, and just enjoy the special place that we have built.  I think many of us are looking for the chance to let our hair down and if not literally but figuratively sit on the couch and watch a movie marathon.

In the months since summer, I have counted the hours when I have been home alone. I don’t think I’ve hit 5 hours yet.  I don’t know if I’ll add any more hours until next summer but there’s no question that I’m already anticipating my two week break and the bliss of my time home alone.

Monday, May 12, 2014

Hot (Scheduling) Mess

There has been a lot written lately about work-life balance. In a session with my Therapist last week, she laughed and said “you’re a Resident, for this last year of residency, I really just want you to survive!” We spent the remainder of our session coming up with ways that I can pay people to do things I don’t have the time to do. And she made me promise to work harder to eat better, sleep more, and exercise more; my turn to laugh. Next week, our family will be trying out a week of made-from-scratch meals from a local organic market while I finish a busy week of nights. And we are looking for a second cleaning person after the first one proved to be a bad fit with our family.

Scheduling time away from work for things like research, board exams, and doctors appointments is an exceedingly stressful aspect of my life. Because we get our schedules pretty late, I try my best to email the our Scheduling Attending and Chiefs at least several months before I think I’ll need time off. Nevertheless, I sometimes get my schedule and there are conflicts and then I have to forward back my original email requesting time off and the hot-scheduling-mess begins.

Last year, when I took my Step 3, I emailed the Scheduling Attending and waited so long for a response that the dates kept filling up. I had to extend my eligibility period and finally had to use research time to take the test. I have heard countless stories from other Residents recounting their shared experiences (many have to use vacation time) and how stressful it is to try to do things you have to do.

This year, my son will be spending my last Intensive Care Unit month with his grandparents while my husband is away doing research. He will spend the first 3 weeks with my parents, but once their vacation time is used up, he’ll spend an additional week with my in-laws. At the suggestion of my husband, I emailed the scheduling Attending and requested off a single day and offered to make it up during my vacation.

I feel guilty that we need our parents to watch him. I feel guilty that I asked for a schedule change. However, it would have been a very stressful and traumatizing experience for all of us if I tried to travel, get Zo acclimated, and get myself ready for life without my family for a whole month in 2 days. And then to make me feel even worse, I get an email saying that the Scheduling Attending talked to my Residency Director and my Clinic Attending and she would like to know if I really need that extra day off. They understand my unique situation but they want to double-check before they reschedule me.

As I began to stifle my tears, my husband came over to rub my back. I explained my distress and he reiterated that even though it’s hard, I have to ask for what I need. He reminded me to not feel bad and that “it’s the culture” of medicine that makes it difficult for folks to realize that what we are asking for is not unheard of.

After taking a break, I responded that yes I do need the day, that I would personally call the 2 patients I have scheduled, and that I again would be more than willing to make it up using a vacation day.

Thus ends this installment of my hot-scheduling-mess until the response email. Dunnn dunnn dunnnnnnnnnnn.

Tuesday, January 21, 2014

MiM Mail: Burnout (already)?

I am a hospitalist with a 3 year old child and a child on the way and I am burnt out after only four years out of residency.   The prospect of working sickens me and I want to scream when I receive yet another page from the ER about a patient who needs to be admitted with intractable pain/vomiting/weakness with no diagnosis that they could attain.   I am so tired of hearing people's complaints.   I feel like I have not made an ounce of difference in anyone's life.   I am a scut monkey for most physicians and a substitute doctor for their primary care providers.   I no longer get a rush from seeing someone critically ill and helping them become well.  To make matters worse, we are short staffed as many other hospitalist programs are with no candidates thus far.   I am in the process of looking for a job but cannot find one that will pay me not to work.   I wonder on an almost daily basis why I incurred more than $150K of debt to do something that makes me miserable.   I have contemplated switching to a clinic job but cringe at the thought of even longer least in my current position, I am free to come in and leave when I want as long as I finish my work.   The prospect of another hospitalist job is less than appealing and doing chart reviews seems like a surrender.   I have even wondered what things would be like if I had trained in a different specialty.  Would things be different?  Would I be more satisfied with my job?   My husband is a graduate student and thus the option not to work is not realistic at this point.   What can I do?  How do I overcome this overwhelming sense of disappointment and dread for my life's work?  All my life, I wanted to be a doctor and now I'm here and just want to stay home and play with my child.  

Saturday, June 2, 2012

My Postpartum Overhaul: First Physical, and Now Mental

OK, It's a rainy Saturday. I am not on call. My husband is watching our 2 kids (under 2 years old) so I can work out. I just jumped on our Spinning bike and banged out 15 minutes of hard up-down cycling, while watching Cupcake Wars (It makes the time go really fast, and I vicariously enjoy the cupcakes, while actually burning calories!).

I thought up this post in the midst of the workout, and I jumped off the bike. Now I'm sitting here, sweaty, trying to bang out the writing. Meantime I can hear my toddler boy yelling. He's got a cold and is just  cranky, and he wants me. The baby is whimpering, and Hubby will have to make her a bottle one-handed, while our toddler howls and hurls things around the living room.

So let me be brief.

Quick backstory: I'm a part-time internist in group practice, and I had my second baby 5 months ago. My last few posts here on Mothers in Medicine have focused on my journey back to fitness after baby #2. I was 4 weeks postpartum, and realized that at 5' 2" and 163 pounds, I was officially obese. In spite of the fact that I was breastfeeding exclusively, I was gaining weight (and yes, that is common). It was my eating habits. Carbs, carbs, carbs. Bowl of Cheerios here, toast with butter and jam there.

I was shocked, but motivated. I got on the South Beach Diet and I lost a ton of weight. Listen, folks, the low-carb diets work. (I get no endorsement monies from them, BTW) (Though I would take some in a second, if they offered :)

I also started exercising again. For the first 3 months, I just ran outside when I could (though to call it running would be exaggerating. More like jog-walking) and did some Pilates on the floor before bedtime. This month I added back the gym.

And in 4 months, I have lost 30 pounds, down to 133 pounds, only 10 pounds away from my goal. I am well out of obese BMI range, and I feel great. Physically.

However, mentally, I am sagging. Now, Babygirl is still not sleeping through the night. My husband travels for work, alot. Though we have great family support, it is just a hectic schedule. My reserve is low.

But, some days, I find myself just suffering through clinic. The day will start out OK and manageable, and then, as happens not infrequently, I will encounter a difficult patient, and I will just get so down. I mean, so down that I come home and start surfing the net for non-clinical doctor jobs.

Now, the vast majority of my patients are absolutely lovely. Honestly. I have been so boosted, even blown away, by the interest people take in me and my family; by the unsolicited support for my working part-time; by thoughtful cards or baby gifts; by positive feedback on my clinical work

But just one angry/ blaming/ abusive/ demanding patient, and I am just crushed. Even when I am in the right (like in diagnosing an alcohol problem, or not prescribing narcotics). Even when I know the patient has psychological issues, and is only acting out at me because I happen to be sitting there. The negativity will get to me, even if there is no overt confrontation, or raised voices, or complaints. If a patient is unhappy, I feel like a failure. I get shaken, even to the point of physically shaking. I feel like I will have a panic attack in the office.

Colleagues are supportive. We all see many patients a week, and we all have similar experiences, day in and day out. There is plenty of camaraderie, and I can always find someone with whom to vent, and feel validated.

But, at the end of the day, I hate these negative encounters. They make me want to quit my job.

I'm trying to look into this, to see what steps I can take to build resilience so that I don't feel like I need to please everyone; so that I don't feel a failure when a patient is unhappy. I used to be much better at this.

I'm currently looking at the concept of Compassion Fatigue. This is new territory for me. What do other MiM know about this? Is this something that applies? Or am I just an exhausted new mom with little reserve in a demanding profession having a normal experience?