The emotional strain of healthcare

How do you guys do it. I could never do your job!

How many times have those of us in the healthcare profession heard those questions? Dare I say that, at least once in our careers, most of us will have been asked something similar by a patient to whom we have attended. It may have been as a Student Nurse helping an elderly dear to the commode or the Emergency Department Registrar putting a cannula into the arm of a 21 year old with a blood phobia.

Has anybody ever stopped to think, how DO we do it? This is something that has played on my mind of late. However, I want to probe a little deeper into the question.

The physical actions which we do on a day-to-day basis are sometimes the only thing seen by the lay person outside of the healthcare world, taking blood tests; changing soiled beds; running in circles looking for oxygen cylinders; administering antibiotics; filling in yet more forms – the list is endless. This is all simply on the surface with regards to the workload. I wonder how many people have considered what lies beneath?

Hospitals and other healthcare environments are not always like a ‘Carry-On’ film with bawdy humour and raucous antics. They undoubtedly have a heavy element of exposure to sadness and at times, unhappy endings. I’m sure most people have come home at the end of a long day and reported a sad case in which the heart strings are pulled to the limit, even at times shedding a tear. This is only natural, given that the work we do. It is this empathy and compassion we strive for, using it to help others when they are at their most fragile and exposed. It is this emotional burden, sometimes perhaps forgotten by the public, which just might be the biggest strain of all. Because we see it everyday, does it become second nature eventually, hopefully making it easier to deal with over time as we see more sad cases? To a certain extent, I think this is true – that we can become accustomed to sadness in regards to certain situations. However, is repeated exposure to such melancholy detrimental to the mental health and well-being of staff? Do we bottle it up because everybody else around us does?

To make it personal, I was deeply affected recently by a case whereby a very sick child presented to the department in which I worked. Given the seriousness of the situation with the child, emotions were already running high, however, soon the true horrors of the story began to emerge. Once images were taken and old notes retrieved, it soon became apparent that this child was perhaps the victim of non-accidental injury (NAI). What I was exposed to over the following hours truly shocked and angered me.

I think one of the most shocking features was the potential false emotion displayed by the “guardians”. Although unproven yet, there is strong evidence that one particular parent may have been the guilty party, with the acting prowess of an Oscar-winning actor.

The theatrics of the people involved left me with a sense of hatred, which I can honestly say I had never felt before. I wished that it was they who were left helpless and in unspeakable pain, rather than the little girl lying on the resuscitation bed with the ETT and enough broken bones to rival the career total of a professional rugby player. It was very hard to look at these people and not think that the death penalty would be an adequate punishment for this, what I believe to be, attempted murder of a small child who had not even seen their second birthday yet.

The ethics of this case is not the purpose of this article, but moreover, how do we deal emotionally with repeated cases like this, which test your emotional bottle? My mind has been plagued of thoughts of rage and consternation, which I have been unable to comprehend in the last few days. I know I wasn’t the only one that night going through this, and I realize that there must be others in all the hospitals around the globe experiencing similar feelings in similar scenarios. But what do we do? Do we simply say ‘that’s life” and carry on? I don’t think so. This is not life, this is not even human nature, and to be honest I found it quite hard to accept and put to the back of my mind. I’m quite fortunate to live with some great friends who are also doctors who heard my rant about the case, we discussed it together (and buffered it with discussion of one of the guys’ pending dates) and I began to feel a bit better. It still dwells on me but the opportunity to vent thoughts and feelings towards something otherwise unfathomable helped.

The following days I found myself talking to one of the consultants involved, who as it turned out, had been just as affected as I. After chatting for a while, it made me wonder, that while we are very quick to get social workers and counselors to talk to patients in times of great stress, who do we talk to? What are our coping mechanisms?

Gradually healthcare is being taught to be more open, in the sense that we talk more, reflect on difficult experiences and open up about how we feel about them. It’s very easy to distance yourself from this and bottle it up and it should be acknowledged that this is not a healthy approach, particularly when the literature shows that doctors have a high risk of alcoholism, depression and suicide. A common linkage to these outcomes consistently suggested is stress within the workplace, in which I am sure emotional turbulence is included. I genuinely believe it to be something that is under-appreciated, not only by the general public, but healthcare professionals as a whole.

To recount another case briefly, as a first year resident I was unfortunate to be involved in the resuscitation of a 3 month old baby who asphyxiated. An obviously distressing time for family, but also had a profound effect on the staff, with the mood of the department visibly changed for a week. One thing which will stick in my mind was the action of the Duty Consultant from that shift who took each staff member individually, from nursing to medical staff, through the progress over the following days and discussed the case, not only from the technical side but also the psychological side of it and how we were affected by it. Having gone into our discussion down in the dumps, I came out not satisfied but certainly feeling better. This idea of the ‘de-brief’ and discussion worked to lift some of that tension which was looming over us all.

After nearly 3 years practicing Medicine, one recurring theme is bosses advising me to look after myself, not in a selfish way, but rather, my wellbeing. The ability to communicate and discuss these upsetting clinical scenarios helped to relieve the strain, however, I cannot help but worry about those people in our workplace who don’t open up and discuss it, who let it play on their mind silently in the background and perhaps are becoming affected by it.

To go back to the question – how do we do it? – the answer is, I don’t know. What I do know, however, is that healthcare professionals have an extraordinary amount of compassion, putting patients and their families before their own well-being a lot of the time, particularly when it comes to carrying emotion and stress even when they have left the building. Sometimes this constant exposure can get to people and ultimately lead to deteriorating mental health. We are starting to identify this but maybe its time to take a regular slot for discussion and ‘debrief’ of cases bothering us. Occupational Health Departments need to acknowledge this and perhaps be a bit more proactive with the emotional health of staff. We are quick to deal with depression, and other health issues, but lets look at sorting one of the aspects of why we get depressed and why we get stressed. Sometimes simply a holiday is not sufficient. We need someone to listen to us, listen to our thoughts, because when you’re the one listening all the time, it can get a bit too much at times and we cant help but take it home, because that’s the empathy and caring nature of our professions.

Emergency Medicine Physician, #FOAMed advocate and self confessed rugby tragic | @JohnnyIliff | LinkedIn

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