Are you trying to do it all and risking your health in the process? In an extract from her blog doctor, blogger and TSE’s brand new health contributor, Doireann O’Leary shares her own experience of burning out.
Returning to Work
Consultant 1: “You need a more believable story. It doesn’t sound like you were that sick.”
Nurse: “I wish I had the luxury of sick leave - you’re like a lady who lunches.”
Consultant 2: “Some of your friends told me you weren’t that sick. Be careful who you’re friends with.”
Consultant 1 (again): “Doireann’s here! The doctor who’s never there when you need her! She’ll be a great GP!”
Junior doctor: “I wish I was out on ‘burnout’ for a while.”
Some of the comments that I was kindly greeted with on return to the hospital from an episode of sick leave/burnout. I wish I could go back now and tell those people that their level of nastiness is still incomprehensible to me. All in the caring profession. How caring of them all. Looking back now I know that venom is a symptom of something wrong with them, not with me.
I remember the morning I realised I was heading towards burnt out. Peter was on call in Dublin. I was lying in bed after a 24 hour shift. My family had been out to dinner the night before. They offered to drop a present to the hospital as I was pretty much working right through the ‘holiday’ period. I was scheduled to do another 24 hour shift on St. Stephens day. My knee was aching; a recent MRI had shown a tear and my physio recommended rest. Fat chance of that. I took anti-inflammatories even though I knew I had already taken a dangerous amount. And then, like everyone who has ever lost someone, I began to think of my sister and how she should have been there with me on Christmas Day. Feeling so sad on what is billed as the happiest day of the year - it’s hard to describe that pain.
I had *asked for help* in the previous weeks and for some time off to work on my knee but was told ‘you don’t need your knee to take a history and examine patients’.
I knew that morning that I was not going to last much longer in the working environment I was in. But I didn’t think of how I could change things or get myself better. I was just trying to rest in anticipation of another 24 hour shift. I did it, clocking up about 22km, and doing further damage to my knee. I was obviously limping and taking pain killers walking through the wards in between patients. No one thought to ask if I was ok. How naive of me to think anyone would eh?
At 3:30am, I went to a patient that I had admitted at 8:30am the previous day. She assumed I’d been home. Nope. I hadn’t been home at all and hadn’t eaten. It was the third 24 hour shift that week. She said ‘they don’t let pilots or lorry drivers do those hours!’ I just smiled and asked if she was feeling better.
New Year, same thing
Five days later I was down for another 24 hour call. I texted the registrar in charge of the rota to say I couldn’t keep going and *asked for help*. She opted to reply in a public whatsapp group for all 30-40 junior doctors in the department to read. I left the whatsapp group immediately. I wasn’t going to subject myself to the modern day equivalent of a public stoning.
I went back to work on the Monday. Two e-mails came through saying I had two presentations due to give that week. I *asked for help* and asked for some extra time. I was told to just get them done. I finished one and submitted it. I got a reply saying the topic had been changed so a new one was needed. My call rota came through shortly after. On again on Wednesday. I knew I couldn’t keep all of the balls in the air anymore. Officially burnt out.
Asking for help…again
I didn’t want to keep stumbling (literally and figuratively) and lurching from crisis to crisis. I asked again if I could take some time off the 24 hour call rota. I explained that running to and from A+E for 24 hours at least once a week was becoming increasingly difficult with the pain I was in. I was told: “24 hour call is a part of this job. You either do it or you not. There’s no in between. You’re either in or out.” I picked up my bag and said I was out. Asking for help continued to fall on deaf ears. Turns out that meeting probably didn’t need to happen anyway as I was admitted to hospital via resus less than 12 hours after that. My 5th admission in six years.
Some cold Saturday morning in January
I was lying in bed when I got a sudden jolt of pain in my stomach. I reverted to my usual painkillers and doubled up the dose of both. The pain was getting worse. I vomited. My mom drove me to SouthDoc – I wasn’t fit to drive. I vomited again in the waiting area. I had to go to A+E. Back to CUH- no escaping the place.
Yet more analgesia was given. Morphine. Difene. Tramadol. Buscopan. More morphine. More tramadol. I was moved to the resus room for ketamine- pretty much the strongest pain killer there is without actually going under general anaesthesia. I needed a CT scan but I started to hallucinate – I think possibly due to the ketamine. Through a haze, I looked across at my mom. She was crying saying she can’t lose another daughter. My brother and Peter had arrived at that stage. That was the last thing I remember of that night.
I woke up in a high obs room on the surgical ward connected to an IV. Apparently I had kidney stones – most likely due to chronic dehydration. I wasn’t surprised. Working 90 hour weeks, 24 hour shifts, without breaks, without eating or drinking had taken its toll.
“A Gesture of Goodwill”
Asking for help hadn’t worked so I was more assertive this time; I sent a one liner e-mail from my hospital bed saying I’d get back when I was better. I was asked to go back a day later as a ‘gesture of goodwill’. I had no more goodwill left to give. I worked tirelessly during my twenties, doing hours I wasn’t paid for and working beyond my job description daily, obliterating my own health all in the name of ‘training’. I had been acutely admitted to hospital on a number of occasions. It was now time to prioritise myself. I told my mom that I felt like no one cared about how much I was struggling. Her response: “Well if nobody cares then it’s up to you, girl. Protect yourself. Don’t leave it to other people to save you”.
The next few weeks were spent attending follow up hospital appointments, going for CT and MRI scans and physio appointments. I saw my GP weekly to keep an eye on my bloods and to come up with a plan to return to work. An agreed date was set. It was good to have a goal to work towards and focus on. He gave me time but also kept a clear plan on the agenda.
My GP was wonderful in motivating me and encouraging me to get back to a job I love. No matter how awful things got, seeing patients has always been what I love doing. I love helping people but I can’t help people if I’m unwell myself.
When I did eventually feel ready to go back (with some gentle nudging from my GP), I had a new perspective. I had a wall built up around me this time. I was ready to protect myself this time. I was there to do a job and for my patients. Not for small talk with colleagues or to make friends or to prove anything to anyone. I wasn’t expecting the abrasive comments that were thrown at me but they just rebounded off my new, more detached self. As always, getting back to seeing patients again made me feel myself again.
Insanity is doing the same thing over and over and expecting different results – Einstein
A lot of people have asked me how I dealt with this episode. I very much consider it an episode of burn out- I’d hit a wall and couldn’t keep going. What works for one person won’t work for others. But what worked for me:
- Go to your GP. Your GP is trained to help you. A lot of people say ‘oh my GP is old and doesn’t listen to me’. Whilst your GP may ask you the same questions a few times and forget your husband’s name (or if you’re married at all! Lol), I promise you he/she is listening and will help you. My GP is an old gentleman in an old, single GP practice. But he got me through it. I would have been lost without my GP.
- If you ask for help and you don’t get help, stop asking. Do what you know you need to do to get better. I begged for help. A few times. I knew things were heading to crisis. I was told ‘toughen up’. Asking for help didn’t work for me. So I stopped asking and started doing.
- Surround yourself with people who care about you and who recognise what you’re going through. Stay away from people who say ‘ah you’re grand, you’ll be fine’. My mom and my husband were my rocks of support.
- Take all the time you need to recover. Don’t go back a day too early. Forget ‘goodwill’.
- Ask yourself what your top priorities are and make sure those are the areas in life you are nurturing. For me, at that time, my top priority was getting physically well again. It seems so basic but I had to take time out to work on it.
Everyone’s experience of burnout will be different. I see patients with burnout for a myriad of reasons. Taking practical steps to combat it will be different for everyone- and I think that’s really what it’s about. Practical, real, tangible changes need to happen because obviously the way things were has resulted in burnout. Something has to change. Visit your GP. Talk to those who care about you (and I mean REALLY care) about practical measures – maybe it’s taking time off work, stepping back from non-essential commitments, saying no to anything that isn’t your top priority at that time. Once you feel steadier, you can reintroduce things again. But only when you’re ready.
I know there’ll be a lot of hospital doctors who read this who will roll their eyes and think I’m being melodramatic about my experience. Roll your eyes away, guys. I truly don’t care. I will never accept 24 hour shifts/90 hour weeks as normal or acceptable. I don’t care if that makes me come across as weak to hospital doctors. I’m now surrounded by happy, supportive people. Other people’s opinion of me isn’t my concern. The only person’s whose approval I need is my own. X