by Melanie Rule
Wellness has become a key topic for discussion amongst the healthcare professions in recent years. It is heartening to see that after many years of silence, wellness of healthcare staff is being discussed on social media, conference programs, and every day in the workplace. It seems to have become a buzzword for our generation of clinicians.
Yet it still seems to be elusive to so many people, especially in medicine.
I am certainly not the poster child for wellness. Like many, my personal journey to wellness started with an episode of burnout. I was an enthusiastic third year Registrar who had recently passed the primary exam for Emergency Medicine training. I loved my job and I was committed to a career in Emergency Medicine. I loved the chaos, the challenge of dealing with the variety of patients that walked through the door, the thrill of a successful resuscitation and the camaraderie of working in a team. I worked nights and weekends with enthusiasm and a healthy hint of apprehension. You never knew what would happen when you walked through the front doors of the hospital. The constant state of adrenaline about what might happen on that shift was exhilarating.
Then, after a few years, it wasn’t.
My normal roster consisted of up to 8 shifts in a row, working every 2nd weekend, every 3rd week on nights, with a supplementary roster that filled in some of the few existing gaps on the initial roster. Every rotation I did over a 2 year period was so short staffed that we were told there was no provision for recreation leave. (We had stopped calling it annual leave because there clearly wasn’t anything annual about it…). I was given increasing responsibility with every rotation, sometimes being the one making the decision about which patient best deserved the last remaining ICU bed in the hospital.
After a while it stopped being fun.
My fellow Registrars started to leave. Some left the hospital to pursue a career in General Practice or Occupational Medicine. Some left for the better coffee and more regular hours in Anaesthesia. Many rushed to get their exams finished so they could become a Consultant and work fewer hours for more money.
Meanwhile I found myself becoming exhausted, then resentful, then eventually hating my job. This reflected in my work as I started to get into conflict with inpatient colleagues and made some errors in my clinical judgment. I stopped caring about patients and saw them as just another obstruction to taking my lunch break or going home on time at the end of my shift.
One day in early 2006, I resigned from my job and quit Emergency Medicine. I decided that this career was no longer worth the impact it was having on my life. My friends and family had eventually just stopped calling as I was always working or “on nights” when they phoned. My usual response of “Why are you calling me? Don’t you know I’m trying to sleep?!” had the effect of scaring away even those closest to me.
I reacted by doing what every young Aussie does & decided to pack up my life and go to Europe for a gap year. I was burnt out even though I didn’t know it. Burnout was not yet a recognized part of the vocabulary of the medical profession. I told myself and my colleagues that it was a wonderful opportunity to do some travel but it was really just a way to escape the job that I no longer enjoyed and could no longer see myself doing.
I spent the next seven months wandering my way around Europe, seeking excitement and fulfillment in new places, new experiences and spending my idle hours writing about my adventures. I had lost a huge part of my identity by leaving my job as a doctor. I was too ashamed to apply for jobs that I was way overqualified for: How could I go from resuscitating people in cardiac arrest to pulling beers in a pub? I missed my old life during which medicine and learning had been fun.
Eventually my path crossed with a trusted mentor at a pub in London. She asked me if I was enjoying my holiday and when I would be ready to go back to work. I told her I didn’t think that I could go back given that the job had broken me and I had walked away and left my department short staffed. She reassured me that it would be fine; that she could help me make some enquiries about coming back to work if that was what I wanted. We then talked about what I had loved about medicine and discussed how I could return to work in a more sustainable way. I felt my enthusiasm for my job slowly rising and some of my identity starting to return.
I returned to work three months after that conversation and completed my training. I now work as a specialist Emergency Physician in a busy suburban hospital. I love my work especially the parts that allow me to be a teacher and a mentor as well as a doctor.
I have learnt a lot about myself in the subsequent 12 years of my career but I have yet to find that elusive state called “wellness”. Most of the time I feel like I am surviving in my career, and only sometimes do I feel like I am thriving. The juggle of family life and work is never in perfect balance. It always seems as though even a minor disturbance could tip us over the edge at any time.
However, despite this, I have managed to rediscover the joy in my work.
I love looking after patients, especially when I have the time to slow down, have a chat and make a real human connection. I like making scared kids laugh at my terrible jokes, and holding the hands of the elderly as they tell me their life stories. I enjoy working in a team and being able to teach the next generation of emergency doctors. I love the variety and challenge of my work. Every shift is different and the breadth of knowledge and skills required in this job means that I get to continue to learn new things every time I go to work.
The single most important thing I have learnt, however, is how to take care of myself.
I prioritise my rest and recovery in order to deal with the challenges of lifelong shiftwork. I schedule time in my week for the things that I enjoy, such as a basketball game, a mountain bike ride or a few hours of peace and quiet with a good book. I take regular breaks from work to travel to new places and spend time in nature. I have built up my support network both inside and outside of work. These are the people that boost me up when I need it. I know I can lean on them when I have a tough shift or a challenging case and I save enough energy in reserve to able to return the favour at their time of need.
These lessons have become the steps in my personal wellness plan. I keep copies of this list on my phone and in my office so I have a constant reminder of the things I need to do to keep myself well. I have shared it publicly on Twitter so now I have that additional level of accountability to my broader professional network. I don’t always get the balance right but having made the commitment to follow this personal recipe for my own wellbeing, it means that when I am feeling run down I can easily work out what I need to prioritise to get myself back on track.
The time has come for the medical profession to change the discussion from burnout to wellness. I hope that by sharing my story I can help others recognise the signs of burnout and act to prevent themselves from reaching the bottom of the spiral as I did.
The time has come for us to start taking care of ourselves the way we have been trained to take care of our patients, with kindness and compassion. Investing in our own wellbeing makes us better, more compassionate doctors in the long term and allow us to thrive, both in the workplace and in life.
My personal wellness plan (see below) was created over a year of trying many of the ideas presented on the WRaP EM website. With time I was able to discover what was personally beneficial and what I need to do to thrive in my life and career.