By Bethany Boulton and Shahina Braganza
Emotional bandwidth – part 1 – the rich and colourful tapestry of working in EM
Jonathan* was 42 years old and the paramedics were performing CPR as they wheeled him through the door on the ambulance trolley. He was a known illicit drug user in a community where it was not unusual to die so young. Sadly, the resuscitation efforts were not successful.
I will admit that to this point the case had not really pulled at my heart strings, but soon came the reality of sharing the news with his mother. Instantly, her emotions erupted, she seized me forcibly in a heart broken embrace and I was shocked to find myself weeping with her as if it had been my very own son.
This is just one example of the emotional roller coaster ridden on a daily basis by those who choose a career in emergency medicine (EM) ride. Emotional experiences come in all forms in our working environment: the confrontational interaction with an admitting registrar; delivering a healthy baby; the gut wrenching feeling of making a mistake; nailing a difficult intubation; failing your first exam; missing your five year old’s first day of school.
Sometimes, the emotions are not only powerful, but conflicting. They are often difficult for others outside the profession to understand.
So how do we deal with the constant barrage of emotional challenges as an individual? As a team? As a profession?
Medicine attracts intelligent people with an innate sense of compassion and empathy for the patients they serve. Those that flourish, in what can be likened to a war zone in some respects, have the ability to turn the compassion and empathy inward. Liz Crowe1 suggests that life is messy and that while resilience looks different for different people at different times, the common factor is self awareness.
“To be resilient is to be aware. To be insightful. To be prepared to feel flawed and human and keep going. To live a mindful life, aware of our engagements and reactions – this is the challenge.”
How then do we build self-awareness?
One way is to practice mindfulness. Originally a sceptic, I have discovered that mindfulness is not necessarily meditation, nor is it the opposite of mind wandering – which is a relief as stopping my mind from wandering is a feat about which I could only ever fantasize! It is being present in the moment, whether with yourself, your patient, or your colleague. It helps you to be more aware of how you are feeling, why you may be feeling that way, then helps to manage your response.
In the case of Jonathan*, I recognised that not only could I identify with a mother’s grief, but also felt pangs of guilt that I had failed to save him for her and even flashes of anger that his life choices had contributed to another’s suffering. These are all normal human emotions – the trick is to manage them so they don’t affect your next encounter, whether with staff, patient or family. Some find it useful to talk; some find solace in a few minutes of silent reflection. For me, most things are brought to perspective by a simple cup of tea.
*not his real name
Emotional bandwidth – part 2 – inward and outward strategies
A suggested strategy for building self-awareness is the practice of mindfulness, but who, I hear you ask, has the time or the head space?
Finding time to practice mindfulness in your busy life is easier than you think. While you are waiting for your computer program to load or in a queue to talk to the radiologist, you could try a few rounds of tactical breathing to acknowledge how you’re feeling, consider your response and reduce that ever present sympathetic drive.
https://runninginsystems.com/tag/tactical-breathing/
The strongest evidence, however, is for finding 10 minutes a day to pause quietly and re-group. Popular apps like Headspace, Calm or Smiling Mind can help guide your early forays into mindfulness practice.
Mindfulness is of course not the only strategy that can be useful to calm the emotional storm. The most valuable resource in a health service is its people. Mayo Clinic research found that drawing on the support of your peers is invaluable in improving job satisfaction and reducing the symptoms of burnout2. It is my experience that while health services provide access to formal psychological support, it is largely under-utilised and sometimes even shunned for various reasons. Peer support systems, formal and informal, can bypass the stigma and skepticism associated with these services, and can provide a safe environment in which to share the emotional impact of adverse events.
Canadian literature showed that talking with colleagues together with ANY strategy used outside of work such as exercise and spending time with family was significantly associated with less emotional exhaustion – what better reason do you need to strive for that work life balance!3
It is becoming increasingly clear that improving the wellness of health care providers is a shared responsibility between the individual and the organisation. The individualist approach has focused on the resilience of doctors – the ability to bounce back after stressful situations. Given the frequency with which we face such scenarios and that most of us are still standing, even if precariously, I’d suggest that doctors, particularly those in Emergency Medicine, are already profoundly resilient.
Nevertheless, there are always cases like Jonathan’s* that impact us deeply and it is essential to have strategies to ensure our ongoing psychological safety and indeed our career longevity. Wellness can be optimised by seeing challenges as opportunities, being optimistic, maintaining strong bonds with people, profession and community and making self protective choices as often as possible4.
So I challenge each of you to move forward mindfully, to find your tribe and both support and use it well and most of all, to look after yourself.
*not his real name
To make your own wellbeing plan – use this to help!
For lots of great additional resources – click – emotional spoke e-learning
References
- https://lizcrowe.org
- Shanafelt, T. and Noseworthy, J. (2017). Executive leadership and Physician Wellbeing. Mayo Clinic Proceedings, 92(1), pp.129-146.
- Lemaire, J.B. and Wallace, J.E. (2010). Not all coping strategies are created equal: a mixed methods study exploring physicians’ self reported coping strategies. BMC Health Services Research, 10(1).
- Sotile, W.M., & Sotile, M.O. (2002). The resilient physician: Effective emotional management for doctors and their medical organisations. Chicago: American Medical Association.
WRaP EM 