Burnout Sometimes Looks Like This

Okay kids, storytime.

This is a story of me realising how burntout I actually am in my job.

I didn’t think I was burning out. I was still fine to wake up every morning and go to work. And when I had weekends or days off after working weekends, I was usually unproductive and felt like I would be better off at work and being productive. I haven’t had any leave since last Christmas. I had a couple of weeks of leave planned and requested, but due to the wonderful COVID19 era, and lack of anywhere to go, and my working in the frontline during the pandemic, I cancelled all my leave requests.

I kept telling myself I’d be fine. My roster isn’t that bad. I get most weekends off and days off post weekends and sleep days post nights. And there wasn’t really anywhere else I wanted to be or could be. So it’s all fine. I’ll just keep chugging on.

Spoiler alert: Not a good move.

So on this fateful day, I was working in the medical ED (AMU) as usual when I received a call from the hospital’s discharge lounge. (It’s this area with a bunch of LayZboy chairs where patient’s who are waiting for discharge papers or rides home sit patiently). Basically people who are completely stable and need no further treatment/management go here.

So a nurse calls me up and says “Good morning, I have a patient from your team here for a blood transfusion. She needs to be admitted and blood charted please!”

My first response was a big HUH? I work in AMU. Yes I have an acute medicine “team” in AMU that admits patients with simple conditions like a viral illness, but they get discharged the next day. And we certainly don’t take elective admissions and we DEFINITELY don’t take patients in discharge lounge. Needless to say, I was super confused.

The nurse on the phone didn’t really clear things up for me. She said the patient was under my team. And she’s here and she needs admission. Over and over. Strike 1. In the end I said okay I’ll ask my registrar and come sort that out, and hung up.

I approached one of my registrars and asked him what was going on. He said that he and the other registrars had received an email from a medical consultant stating that a GP had called her saying a patient who was 8 weeks post partum was still experiencing PV bleeding and had a low haemoglobin and she needed to come in for a blood transfusion. The email also had the line “In retrospect I probably should have asked the GP to discuss with OBGYN, but given she only needs this, I’m sure we can handle it under general medicine” And of course, the house officers (like me), who actually DO the admissions, were conveniently left out of this email. So we had no idea about this patient. The other house officers were otherwise occupied so I guess it was up to me. My registrar also said it was up to me to sort out.

I didn’t know blood transfusions happened in the discharge lounge but the medical consultant had specifically asked for the patient to be admitted to the discharge lounge. It struck me as odd because that wasn’t a place unwell patients should be at all. They didn’t have a lot of equipment for medical managment there.

But I went anyway. I went to see the patient and made sure she was consented to receive blood products and was about to take some blood tests (nurses at my hospital are not certified to do blood tests and IV lines themselves. Even though nurses at the other 2 Auckland hospitals are) when I realised they didn’t have the right blood tubes for the blood bank. I asked the nurses and they had no idea what I was talking about. I huffed and had to walk all the way back to AMU to get the right tubes and returned to carry out the blood tests. The patient’s nurse and the head nurse stood in the room and hovered over me, watching. They seemed just as uncomfortable with this patient being in discharge lounge as I did. Only they didn’t really want to help me. I passed them the blood tubes I had collected and they just placed them on the table next to me instead of sending them off. Strike 2. I was sending the bloods off myself when the head nurse pushed a piece of paper under my nose and said “please chart the blood”. We were still standing in the patient’s room.

I looked at her. I was getting more confused. We have e-prescribing at our hospital. All patients admitted to Middlemore had to have an electronic prescription for their medications. I asked why I couldn’t chart it online. She said “She’s not in the system. It’s fine we can use a paper chart”. I felt super uneasy about this. And so I said “That’s a bit unsafe isn’t it? If she’s being admitted for this, she needs to have an electronic chart for the records.”

The head nurse just looked at me and said “Well she’s not in the system. You can just chart it on the paper”

Strike 3

In that moment, I got super annoyed. At the entire situation. But most of all, at the consultant that orchestrated this difficult scenario. So I said that out loud as well. “You know I’m really going to talk to Dr. A about this. Patients like this really shouldn’t be admitted to discharge lounge”.

The head nurse turned around and said “You can talk about this in the nurse’s station. Not in front of the patient okay?” And then she walked away. There was a steely note in her voice that made me raise my eyebrows. I immediately shut up. I begrudgingly wrote the prescription on the paper like she asked and took it back to the nurse’s station.

I was about to leave when the nurse, Ronita, asked to speak to me for a minute. She took me into the drug room and started talking fast, with a strain in her voice. Like she was trying hard not to cry. She told me that I was completely out of line and I cannot talk to her that way in front of the patient. She doesn’t usually have patients like this in her discharge lounge and she was doing it as a favour to Dr. A and the house officers aren’t doing Her a favour by charting medications so I shouldn’t be so entitled and she was going to file a complaint against me.

In that moment, I probably should have been appalled. I probably should have argued. I’m not sure. But I didn’t. Because I wasn’t sure what exactly was happening. I said the thing that was most obvious to me. That I didn’t mean what I said to put her down. I didn’t really understand how she made that connection but she had assumed I was hinting she was incompetent and discharge lounge was a crappy place for patients. I hadn’t meant that. I was frustrated that Dr. A had decided to place a patient there and stress out me and the nurses. I tried to explain that as best as I could to Ronita. I apologised for what I said and reassured her that she was doing a good job and this wasn’t a reflection on her. She seemed somewhat appeased and let me leave.

The situation with the patient continued, however. Ronita called me again in the next 10 minutes after I had returned to AMU to say that the patient had online prescription available and I could go ahead and do that. So I did as I was told. She then called back and said blood back refused to provide units of blood. I didn’t know what to do about that. The blood bank called me and said it was irresponsible of us as a medical team to just treat the patient with a blood transfusion when she had ongoing PV bleeding that was not addressed. She said she had called Dr. A and told her this, but Dr. A had told her to call the person who prescribed the units of blood. That would be me. The blood bank head nurse told me to assess the patient properly and call OBGYN. Again, I did as I was told. I took a gynae history from the patient, something I hadn’t done in years, and referred the patient to OBGYN. As I went back to tell the patient, Ronita reported she’s going to file a complaint against Dr. A for sending this patient to discharge lounge without calling OBGYN first. She seemed warmer towards me since I referred the patient over to the right service and out of her discharge lounge.

What a debacle.

Time for reflection. I guess this kinda shows my burnout because of the things going on in my head at the time. From the moment I received the first call from the nurse, I was annoyed. Annoyed that I was asked to do something that wasn’t my job, annoyed that I was left out of an email that would have helped a lot initially, and annoyed that it was in a place that I knew had very little resources for medical intervention. My entire walk over there I was thinking how dumb this was and why it had become my job.

When I got there and realised the proper equipment wasn’t there I got increasingly annoyed because the number of jobs just doubled. I was annoyed that the nurses weren’t helping me more and annoyed that none of this was planned out properly so that I could just do my thing and leave.

Loosely, all of the above translates to me being annoyed by kind of minor inconveniences. I should have known that the nurses there aren’t there to do stuff like this and they were just as annoyed with the situation as me. I should have expected this to be long and difficult. But I chose to be annoyed by it. And I said something to a nurse that was taken the wrong way.

Bottom line, I shouldn’t have said it. Even if it was Dr. A’s fault, it wasn’t my job to say that. It would only make a hard situation worse. It wasn’t going to help anyone. And the consequence was a nurse threatening to complain about my professionalism. Something I value a lot about in the image of myself as a doctor.

While trying to reassure Ronita, I realised how numb I was. I talked like an automaton doing confrontation de-escalation 101. Without really processing what I was saying. The word complaint definitely sent a wave of fear through me and I wanted to fix the situation before that happened, but in general I just said a bunch of things that I didn’t really feel strongly about.

And then I did something worse. I went back to AMU and started doing jobs. I admitted a patient and carried out a treadmill test and said nothing to anyone. I didn’t take a few minutes to reflect. The word “complaint” still bouncing around in my head as I was doing everything. After I finished sorting that patient out, I felt gross. I didn’t want to show my face in discharge lounge again. I saw some friends in the cafe at lunchtime and made a dramatic show of retelling the story of what happened that morning. I said it as though I was the victim in this situation. Being good friends, my audience joined in with my outrage and agreed that Dr. A and Ronita shouldn’t have put me through that.

But later on, when I was alone in my car driving home, I wept silently. I didn’t like the way I talked to Ronita. Both what I said initially, and when I was trying to fix it. I didn’t like the thoughts in my head about Dr. A. I didn’t like the way I told the story to my friends.

I realised my entire outlook was toxic from the get go. Every day I show up to work and do work, but I take things out on others in subtle ways like this. It isn’t always clear who I’m annoyed at but it’s likely to affect someone compeltely unrelated. And that’s because of my headspace. I think so much. Twice, three times when I see patients these days. I second guess every plan and every examination. I dismiss things as “useless” and “dumb”. I have no faith in what others tell me.

And it all starts with me.

Me not having a break from work, me not taking the time to appreciate the good things others do, and the way the system works. Me just not being wholly in the moment and appreciating it for what it is.

It’s a form of burnout. I didn’t even realise it was until I had brunch with a friend and she told me her usual personality of being loud and animated had dimmed in the last few months and nothing seemed to faze her. Good or bad. She said she felt apathetic about everything.

It takes something like this to realise that you need help and you need to make a change. I vowed to change. I made a simple effort. Very simple. Every time my work phone rang, I would take 10 seconds before answering it. I would literally breathe, clear my mind of everything, be aware of those 10 seconds, before I answered the phone. No matter what was happening. I would listen completely without interrupting whoever it was on the phone and I would keep my mind as open as possible while they talked.

I would then approach my RMO admin and ask for a few days off work. Just a few days. Not heaps of time. But enough to really feel like a break.

The leave hasn’t been approved yet, but the phone thing is working well so far!

I feel lighter. I feel more in control. The situations haven’t changed. There’s still a lot of questionable things I get called about, but I feel less intensely about them. I feel like I can manage them a bit better.

And in making this change, I’m slowing down my burnout process.

I felt a lot of anxiety when I got the roster for my next rotation starting in September. I aim to have some leave approved during that time.

It’s really important to realise the subtle features of burnout. It can be so variable for every person depending on their personality. You’ve just gotta keep reflecting and realise that it can always happen to you.

On that note, if you’ve read this far, thanks for doing so. Here’s a reward:

Silent treee

A calming photo of a sunset. Hope you’re all well!

The Feeling Of I Am Enough

So this post will be a recount of some of the things I have experienced over the last couple of years.

I don’t know how to explain it and it’s taken me a while to write this post. But basically I want to talk about something I think is quite important. 
Now I understand that this may not apply to everyone and I don’t want this to be a preachy, over-emotional post. Because I’ve complained several times about posts like that and I wouldn’t want to do that to you guys. But this is more for me. It’s so I can have a reminder of the things I learnt from some experiences I’ve had so that next time I face something similar, I’ll be able to follow my train of thought on here and hopefully cope with it. And in that way, I hope it benefits a few people out there.

I want to talk about a few themes. But they’re connected in a way. So I apologise if I’m jumping topics here and there.

Basically, I want to talk about people, and vulnerability. 

I’ve had a completely horrific last couple of years. And I think I’ve alluded to some of these things in previous posts. Basically, I’ve had some hard things happen to me emotionally. And this was because of events and people that are significant to me. But it’s not even about that. It’s about what happened afterwards.

See, when I was going through this, I found it hard to cope with multiple things happening at once. And one thing I kept hearing over and over from all sources was this: talk to someone about it. Or, seek help. 

This wasn’t from people I had approached. Basically, my closest friends and family can pick up on when I’m upset, etc. So when they try to strike up a conversation about it, I’d say I’m just having a hard time, and this would always be followed by that golden party line. 

As time went on though, these became more than suggestions. I was being pressured into talking to someone. Talk to friends, talk to family, talk to a counsellor. Just do it! You need help!! 

This was anything but helpful to be honest. For me personally, I have wonderful people around me. But I always feel like I can’t explain things to them in a way that makes them understand exactly what I’m feeling. To put it bluntly, I don’t believe anyone really understands me. I know that sounds melodramatic, but I’ve never lost sleep over it. It’s something I’m aware of and accept. Surely you can’t expect people to understand you completely. So you can imagine why I was having trouble with this talking thing. It was more than that though, I felt that I had the strength and insight to deal with my own problems.

But of course, things were getting worse for me. So over time I started to believe what everyone else was saying. That I needed help. I got to this place where I felt I wasn’t strong enough to deal with these issues and other people knew something that I didn’t. So I was talked into talking to others.

It was hard. It was really difficult. Went to counsellors, who to me, were saying pretty standard things about how I shouldn’t worry about what others think and I should let go and focus on good things, etc. Stuff I already know. Which made me more frustrated.

Then I was talked into talking to friends- people I didn’t really trust, actually. Not that there was anything particularly wrong with them, it was more that I wasn’t comfortable talking to them about certain issues. But I forced myself to, anyway. Because I believed I needed help. And it really did Not help.

The thing is, people can have the best intentions. But often when you show people you are vulnerable, they want to fix you. This somehow makes them feel they have the authority to make decisions for you. And they interfere. Which is the last thing you need, sometimes. And it’s what happened to me. Things got much worse. Only now, I was reduced to feeling like others don’t understand, but also, that I was wasting their time with problems that they could care less about.

Awful feeling, that. The need to want someone else to listen, for them to understand, comfort you, but also put up with feeling like you’re taking up their life with your petty issues. 

They’re probably not petty, but you’ll definitely feel like they are, sometimes. 

At one point though, something had to give. I was talking to one of my friends when he straight up said something to the effect of “I can’t help you. You’re not accepting of any thing right now and I have some other serious problems to deal with”. 

It was a huge shift for me. Someone had just confirmed that they couldn’t help and that they had more important things to do in their life. It wasn’t a half-assed attempt to make me feel better but not really understanding anything. It was the truth. 

That gave me resolve. I completely rejected the hypothesis that you need to talk to others to feel better or work through your problems. Because everyone is a separate person with their own battles. To expect someone to understand, let alone fix your problems is a bit unfair in my opinion. 

It’s also unfair to you. I feel like I underestimated myself quite a bit. 

I am enough.

The leading evidence-based treatment for depression is actually “self-help”. As in, you are enough to sort your own issues out. You have all the things you need. 

No you don’t need a counsellor. No you don’t need pills and therapy. What you need is to trust yourself. I know that sounds so fluffy and cliche. But hear me out.

I made a resolve. Never to talk about my problems to my friends again. I still talked to all of them everyday. But I made it a point to only talk about positive things. I projected myself as a happy, content person. And this made me deliberately look for positive things in my life. I spent a lot of time on my own. Not ruminating, but going to new places and doing different things until I absolutely enjoyed my own company. I focused on helping other people with their issues (Not by interfering, but by being there). I went out of my way to help others. I guess I felt better by putting myself in a position where I am able to assist someone else.  It was like a defense mechanism. It helped me focus less on my issues and allowed me to put more energy into others. It really helped.

I also continued blogging. I can’t explain the positive effect blogging has had on my life. But even on here, I try to keep my posts about the positive, interesting things that happen and the most I can learn from them and the people I interact with.

If it’s one thing that I want to conclude from my experiences and this post, it’s that whatever ridiculous things happen to you, you have all the strength and tools you need to deal with them on your own.

Now this isn’t to say that you shouldn’t seek help or talk to people or become a loner. Because if you have people that do understand you and help you feel Better, then for God’s sake talk to them. Because that’s rare. And it can make all the difference. Even counsellors are helpful. Maybe not in my case, but they do help lots of people out there. 

But if you’re like me, and  you don’t want to talk about your problems, don’t feel like an oddball. You’re capable of dealing with it on your own. Believe that.

But most importantly, don’t make any bad decisions. I had made several that I regret. And I’m not one of those people who thank their horrible experiences for the person they are today. I’d rather acknowledge that they were bad experiences and I had made bad decisions, but the person that got past all those things has always been inside me. It just took a while to be released. 

I know this is a rather bleak topic and may be irrelevant to many people out there. But if this applies to even a single person out there, I’m grateful. 

I learnt a lot about myself.  That was important over the last two years. And I hope that should I face similar things again, I will apply the same principles you get through them. 

The Time A Chef Cared

Life is sometimes hard when you’re a vegetarian. Like I’ve mentioned before, I’m iron-compromised a lot. But also, I get discriminated against a lot. 

Especially when you’re the only vegetarian among your friends. 

It’s not fun when you want to catch up with some friends for lunch/dinner or a birthday, and when the question arises about where we should go eat, they give each other the side-eye and say “we have to go somewhere with vegetarian options”… blech. Or they invite you somewhere, saying there are vegetarian options, and you arrive only to find that the “options” are 3 different types of salads. Or something with tofu. 

Like excuse me I am Not a rabbit. And I hate tofu. 

Now I’m not ferociously vegetarian. I don’t tell people they’re going to burn in hell for eating meat or they’re murderers for eating a cheese burger. Everyone has their beliefs, and I have mine. I actually enjoy watching cooking shows and like appreciating how well the chef prepares a filet mignon. And sometimes, I just wish I were non-vegetarian. Just so I wouldn’t have to put up with the discrimination from the carnivores. 

I call the people who are ferociously non-vegetarian ‘carnivores’ because they are the people that cannot contemplate my lifestyle. And make a point of telling me so. The people that go “omggg you have NEVER tried chicken?? Omg you poor thing” “ahh you’ll never live life properly” “you wouldn’t understand about this… It’s so good though. You’re missing out on life” …Like for real? Get over yourselves. It’s just food. No need to be so dramatic. But oh well. I’m used to it. I’m just glad I’m not an overbearing vegetarian.

But anyway, today I had a different experience. Some friends wanted to meet up in a Café for brunch and I went along. This cafe had hardly any vegetarian options to choose from. 

So I had to do my regular walk of shame to the counter and ask if one of the dishes could be made without the meat. It was this ‘Mexican omelette’ thing that had bacon and chorizo etc. So without those things it was essentially a spinach and mushroom omelette. Which was fine. Better than nothing. And definitely better than salad or tofu.

But when the dish came, the chef came up to me and placed a very colourful omelette in front of me. I looked up at him and he smiled and said “I added some extra vegetables just so it’s a little more interesting. Hope you like It.” 

I could have burst into tears in the middle of that place just then. It was such a thoughtful thing to do and it tasted amazing. I thanked the chef repeatedly. 

He didn’t need to do that. He could’ve just put in less effort and made the bland spinach thing. After all, I was paying the same amount as a full Mexican omelette. And I’m someone who will probably visit this cafe very rarely. I’m not a regular. He didn’t have to care. But he did. He realised I was vegetarian and made the effort to make sure I didn’t feel like the annoying customer I usually do. 

That gesture completely made my day. It’s not that hard to be considerate. He showed me that. I am extremely grateful to him.  

Sighh…..

You know what sometimes sucks more than being depressed yourself? Hearing that someone close to you is depressed/anxious/upset.

It’s the feeling of helplessness.

Like you know there’s realistically nothing you can do to help them except try to convince them that often, the things they’re upset about are not true or not worth being so upset about.

But it’s never that easy. You can’t ever ‘talk’ someone out of their blues.

You can support. And they’ll probably appreciate that.

But man. It sucks to watch them go through that.

Eugh. Must it be so difficult?

Moving on.

Yesterday:

(Midday)

Nurse: Mr. M’s GCS is improving. He’s moving around and responded to his name. He even waved at me!

Neurologist 1: He’s responsive and alert. His condition post-stroke is improving. His cancer and other comorbidities are still present and he really is struggling. We can’t scan his head because of this. Let’s work out a long-term plan.

Neurologist 2: Right. So the plan is……

Neurologist 1: Great. I think we will see some improvement long term.

Today:

House officer to med student: Yesterday afternoon while you were at tutorial, Mr. M dropped his GCS and oxygen sats. He passed away…….. How was your tutorial?

Med student: O.O   ………..Uh it was okay

Neurologist 1: Write up the papers. Family is coming in.

Nurse: Yes will have all that done today. It was an awkward time he chose yesterday. Couldn’t do it then. *laughter*

Neurologist 1 & 2: *laughter*

Neurologist 1: So what’s happening?

Registrar: We’ve got 2 ward reviews and one referral on ward 33.

Neurologist 1: Right… moving on. Let’s go see the referral first.

Med student: O.O

The day continued on as usual. Mr. M was not discussed further.

Med student thoughts: “I can sum up in 3 words everything I’ve learnt about life. ‘It goes on’ ” – Robert Frost

It’s been a while.

First of all, I apologise for my absence. The past 4 weeks flew by so fast, I haven’t really had time to do anything at all. Not that I think my absence has actually affected anyone. I guess I’m really apologising to myself because I promised I’d be good and stick to regular blogging. So far that hasn’t happened very well, but hey! I’m trying!

Anyway, the past few weeks have been my first in hospital. Hospital. Allow me to sum it up in one word: Huheughhooherrrhuuh?! Yeah that’s not a word but it does sum it up appropriately. So much changed in such a short time. When I was about to start in hospital, people warned me about the practical problems I would have like not being able to find my team, or not being able to move as part of the team, feeling left out, not knowing what to do, where to stand, etc etc. This left me a bit worried because it sounded a lot like first day of school which is usually not a lot of fun until you make friends and find your classes etc. Fortunately, this was not a problem for me. I was able to find my team and they immediately took me in and gave me things to do like scribing patient notes on ward rounds. Felt like an important part of the team!

However, something I really wished wouldn’t be a problem at hospital, surprisingly was. Mind-blanks. In the weeks before starting hospital I attempted to study a lot of things at once because I didn’t want to be that person that stares blankly when asked a question by their consultant. Plot twist – The only thing worse than not knowing something, is knowing something but not being able to say it. Picture this: Endocrinologist consultant asks you an endocrinology question about diabetes that you’ve read twice, written tests on, discussed with friends but you just can’t remember what the heck it was. You know you know it. So you start off with “Oh it’s….” Big mistake. Because you’ve implied you know what it is and so are expected to complete this sentence in the next 5 seconds. You then try to buy time with “uhhh…”  hoping you can recall it in time, but all you’re thinking is “omg I’m blanking, omg they’re waiting, omg this is the longest anyone has not said something!! Not good not good not good!!” And of course that makes you blank more, so in the end, you give up and say “I don’t know, sorry”. Which is then followed by them giving you the “well it’s okay” look with the answer you knew and you mentally killing yourself multiple times in your head. SIGH. I cannot quantify the number of times this happened in the first two weeks of my run. Not. Fun.
But the good news is, it was probably just nervousness, and it has gotten a bit easier to answer questions and there have been fewer mind blanks for me. Hopefully it gets easier.

And every day seems to be overloaded with information that I’m not really sure what to do with. They tell me I should study. But what? Everything?? Apparently, yes. I sort of try to come home and read up on things patients I’ve seen have but it never seems to go in one direction. I end up reading about a million things at once and none of it really sticks. I’m hoping this is just because I’m on my general medicine run and every patient has 50 different issues with them at once that make no sense and half of which the doctors decide to ignore because “mehh it doesn’t fit the diagnosis, let’s just leave it out.” I don’t know about you but this line freaks me out a bit. In my head I’m thinking but it’s a problem!! And we don’t know why it’s there!! Eugh. Maybe I just need to get used to it. Or at least I hope I can.

But the best part about hospital are the patients. What I enjoy most is interacting with patients and helping out with their treatment. Even if it’s the smallest things like asking them how they are or talking to them about their stay in hospital, etc. It’s surprising how much even I seem to affect their lives. I’ve been introduced as the med student and while the doctors and nurses etc. think I’m not that important, the patients seem to want to ask me how things are going and compliment me on the hard work I’m doing and that I’ll help so many people who will be eternally grateful. This seems to give me lots of joy. While I’ve not achieved the things they’ve said, it’s nice to know where it is I’m headed and what sort of things I’ll hear from people. Sounds overly corny right? Helping patients gives me joy!! But I realised it’s actually a bit selfish and self-centred. Makes me feel good that I’m needed. Or will be needed. And I guess I’m okay with that. Don’t judge me too much.

I guess I learnt that every day even though I feel lost and useless and like I don’t know anything, that stuff doesn’t really matter much. Maybe it’s not about being in control and being great at everything, maybe it’s about the little things that get you through the day. Like a compliment from a patient, or helping out a team member, or getting a patient’s veins on the first go for bloods, seeing a cool procedure, or even just having lunch with a friend. This stuff keeps me going. So I’m just gonna try go with le flow.

Many more things have happened and are happening but I won’t spew them all out at once in one blog because it’ll go on for 4 weeks and I have no intention of taking that time out of your lives. So this is all that shall be said for now and hopefully I’m a bit more regular in recounting future events and thoughts…. Hopefully.

I hope the last 4 weeks for all of you have been fabulous!