I can safely speak for most people when I say that we went into Medicine to help people heal, to help prevent people from dying. This is especially so in Critical Care Medicine. And so, when our patients do die, it is very hard to not take a patient’s death as a failure, not to take it personally.

This was especially true during the pandemic. Over, and over, and over again, we tried our hardest – spent blood, sweat, and tears – to care for Covid patients, and they kept dying despite everything we do. It was very hard not feel like a failure when our patients died.

Dr. Chen’s words brought me such comfort. Death is not a failure, it is a transition. And, like it or not, some of our patients – despite doing everything right and trying our hardest – are going to die. They are going to make the transition.

We need to stop taking it personally. We need to stop feeling like our patients’ death are failures – so long, of course, as we did everything in our power to try and help our patients. And, when it is clear that our patients will die, that they are making that transition, as Dr. Chen puts it, then we need to do all we can to make sure our patients die with dignity and comfort on their own terms. It is much easier said that done, no doubt, and it is essential that we remember it as much as possible.

Helping our patients conquer critical illness is the honor and privilege of a lifetime, a fulfillment of a lifetime dream for me personally. And if we can also help our patients die with dignity and comfort, on their own terms, it is also as Dr. Chen says,

“a huge privilege to be with patients in that setting….to walk alongside them and their families as they are approaching a transition.”

Dr. Elaine Chen, Rush University Medical Center

Very well said indeed.

Listen to the entire conversation with Dr. Chen.

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Almost every day, I am witness to one of my critically ill patients “losing the battle” with their critical illness. This was especially true in the Spring and Summer of 2020, where we witnessed patient after patient “losing the battle” with COVID-19. It is part and parcel of my job, and when I recognize that my patient will more than likely “lose the battle” with their illness, it then becomes my job to try and minimize their suffering as much as possible, along with helping the family minimize their grief as much as possible.

While it may be uncomfortable to reflect upon, it is nevertheless inevitable that all of us – every single one of us – will, one day, “lose the battle” with some sort of illness, condition, or accident. One day, someone will say that we will have “lost the battle” with this or that. That should not be our main concern. The main question be this: will we have won the war?

The human condition is full of battles: battles against its hypocrisies, battles against its vicissitudes, battles against its difficulties, battles against its contradictions. There are also battles against personal moral struggles and physical illnesses. All of those battles constitute the overall war, and it is one that is waged each and every day by each and every person.

If we can conquer the hypocrisies, vicissitudes, difficulties, and contradictions of the human condition; if we can conquer our personal moral struggles, then we will have won the war, even if we lose a battle against a physical illness, condition, or accident. And, to me at least, winning the war is much more important in the overall scheme of things. The reward of winning the war, to me at least, is eternal, and that is my ultimate goal in life.

Now, some of the battles against illness can be quite brutal. I do not dismiss them in the least. My daughter suffered tremendously in the six months she received chemotherapy before she died. Almost every day, I witness the brutality of critical illness and what it can do to the human body and human psyche. Sometimes, many times, “winning the battle” against critical illness can actually be worse than death itself. This was especially true with COVID-19. I pray none of us suffers the casualties of a particularly difficult battle with illness.

At the same time, if we lose the war of the human condition, the consequences can be devastating and eternal in nature. That must be avoided – in my belief, at least – at all costs.

As the years have passed since my daughter’s death, my goal has been singular: put my head down and live a life of righteousness to the best of my ability. That way, when I lift my head up, I will see the Face of the Lord and once again see the smiling face of my daughter. I am trying, to the best of my ability, to win the war of the human condition, with the help of the Precious Beloved.

I pray that I am ultimately successful. I pray that, one day, people will say about me that I “lost the battle” but ultimately won the war.

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One of the phrases I tell myself came directly from a Maternal Fetal Medicine (MFM) attending, and anyone who trained at MSU has heard this.  “It’s better to have a living patient without a uterus than to bury them with it.”  I remember my intern year and the first time I heard this phrase.  It seemed so obvious to me.  Of course, I would do a hysterectomy to save someone’s life.  

I was chief rotating on the MFM service during my third year of residency.  We arrived early to conduct medical rounds, check patient vitals, ensure fetal status was stable, and plan for the day ahead.  We had been watching a patient for premature rupture of membranes (PPROM).  She had a very desired pregnancy and was seven weeks away from the fetus being able to survive outside of the uterus.  I was rounding with an amazing attending, and she was precise, detail-oriented, and focused on doing the right thing.  She spoke about all the pregnancy options with the family daily.  

She was keenly aware of the risks of continuing a pregnancy with PPROM.  One of the risks of this pregnancy is infection.  If the bag of water, the amniotic sac, is broken, then there is an open area where bacteria can take hold.  Unfortunately, this infection can become significant and risk the mother’s life.  

One day, this very thing happened to our patient.  Once an infection starts, patients often have more pain, uterine tenderness, and vaginal discharge.  Sometimes people will begin bleeding and can hemorrhage.  The uterus is a muscle; if infected, you can imagine, it will respond with contractions.  

At the same time, the infection could spread through the patient’s body.  This is something called sepsis.  A patient’s heart rate goes up, blood pressure can go down, and chills, dizziness, and a loss of consciousness can occur.  People can develop shortness of breath, nausea and vomiting, diarrhea, and other dangerous symptoms.  As sepsis progresses, organs can start shutting down.  When septic shock appears, mortality is between 30-50 percent.  

Physicians need to be trained to notice when someone is becoming sick and developing an infection.  The concern is the progression of the infection to shock and death.  In some states, the legislation is so vague that physicians wait for patient instability to act.  In Missouri, an ectopic pregnancy was being observed, and physicians felt like they couldn’t legally act until someone showed changes in their vital signs and hgb dropping, which means bleeding internally.

Now, imagine the physician unable to act to save a life – confused – confused by the ambiguity of state law – not medical best practice.  Imagine years of training and oversight; the patient must be shunted aside for procedures and policies. Will the residents of the future be trained to turn an eye to a primary medical credo written millennia ago and guiding skill and mission? “Do no harm.” 

These pregnancies aren’t viable, meaning the fetus will not survive outside the patient’s body.  If the patient dies, the fetus dies.  We are handicapping physicians from practicing evidence-based medicine.  We are putting people at risk, even in our hospital systems.  Who is going to be held accountable for this? Who will take responsibility for the impossible position healthcare workers are in?  

We should be acting in the best interest of our patients, always. 

Physicians specializing in women’s health should be part of critical policy conversations.  We are endangering the lives of the American people.  Laws created in 1849, like in Wisconsin, have no business regulating what a physician can and can’t do in modern-day healthcare.  Let healthcare be provided by the people who trained their whole lives to provide it.  Hospitals, administrators, nursing staff, and physicians need to meet and develop ongoing policies to handle things in a timely fashion instead of waiting for life-threatening events to happen.  

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This is how it has felt caring for critically ill COVID patients throughout this pandemic. Patient after patient comes to the ICU, and with each one, we have some semblance of hope that this one will be different. Maybe this one will be the one who beats the odds and survives with a good outcome. Then, more often than not, we watch them die after suffering terrible affliction. Just this past week, we lost count of the number of patients who died of COVID. And there are even more who will likely not survive.

This has happened again, and again, and again. It is absolutely exhausting. And it makes me feel like I’m Sisyphus, endlessly pushing that large and heavy boulder up the hill, only to have the boulder fall back down. In fact, a “Sisyphean task” is one that seems fruitless and absolutely impossible to complete.

It is so hard to keep going, and it is taking an enormous amount of effort to resist the urge to give up and “just swim down.” But here’s the thing: we have to keep going, because our patients need us. They are relying on us to be there for them at their most vulnerable moments.

Yet, as I think about it, the reality of the situation is different, and in this, we should take heart. When we are in the thick of things – caring for our patients – it may seem that we are alone, endlessly pushing that boulder up the hill. But we are not alone. We do not have to shoulder the burden alone.

For we physicians, we have our partners and colleagues that will help us push the boulder up the hill. The same is true with our nursing, respiratory therapy, and care technician colleagues: they are also not alone, and their colleagues and teammates will also help push that boulder up the hill. And, we all have each other, and we all will help each other push that boulder up the hill.

Yes, it is still difficult. Yes, the boulder is very heavy, and the hill is very steep. But we are not alone, and we need to lean on each other and use our collective strength to see through the pandemic together.

I truly hope and sincerely pray that we are finally at the beginning of the end of the pandemic and crisis phase of SARS CoV-2. I truly hope and sincerely pray that we will finally be over the scourge and madness and death. I truly hope and sincerely pray that the tragedy of this pandemic will finally come to an end. It cannot come soon enough.

Yet, we need to always remember that we are not Sisyphus. Sisyphus was truly alone, and he was forever punished by having to bear an impossible burden alone. We are not Sisyphus. We are not alone. We have each other, and together we will win, and we will behold the beauty at the top of the hill, gleefully watching that boulder crash down the hill into the sea of oblivion.

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In the very beginning, I must admit, there was a small bit of a thrill inside me: “I’m joining the war against SARS CoV-2…I’m part of the fight in this global pandemic.” People all across the world stood up to thank us, whether banging pots and pans from their windows, or sending us cards, posters, and treats. While we are not in it for the praise, the praise was nice nonetheless.

Almost two years into this pandemic, I must say that thrill is gone.

In my entire career, I have never experienced the scale of death and destruction by one condition. I was in practice during the 2009 H1N1 pandemic; I have worked many bad influenza seasons. All of those pale in comparison to the SARS CoV-2 pandemic. It has been horrific.

There are scenes in my head that can never be unseen. Patient after patient after patient has died – many times alone in the ICU with their families screaming in anguish on an iPad. We are exhausted, physically, mentally, and emotionally.

We had thought that, with the advent of vaccines, it would be the beginning of the end. Indeed, tens of millions of us have gotten vaccinated, and in the beginning of the summer of 2021, it seemed like it was over.

But there were also tens of millions of us who didn’t want to get vaccinated, even though the vaccines are incredibly safe, incredibly effective, widely available, and free of charge to boot. And when Delta hit our shores, the anguish started all over again.

Hospitals and ICUs were, once again, overwhelmed with COVID-19 patients. Once again, tents were erected outside of Emergency Rooms. Once again, resources were running thin. In one of my hospitals, we came dangerously close to running out of ventilators. In some parts of our country, fellow colleagues had to choose which patient would live or die. I never though it would be like this – again – in the summer of 2021. But, it was, and we are exhausted.

And now, way more than before, the patients coming in with COVID-19 – the overwhelming majority of whom are not vaccinated – are younger. And, they are dying.

What’s more, many of them are angry and belligerent towards us. What did we do? Why are you taking our your frustrations out on us? We are angry, too, but we would never take it out on our patients, who come to us seeking our help to relieve their suffering. It’s been a terrible road, and we are exhausted.

And, like I said, the virus is not yet done with us. I genuinely fear this winter, where we may very well have “Revenge of the Flu” along with a steady stream of new COVID-19 patients. It may very well get worse before it gets better. But, we don’t have much left to give. We are done with this virus, and we are exhausted.

And so, as we soldier on, all I can say is, “Thank You.”

From the very bottom of my heart and soul, I say “Thank You.” Thank you, my sisters and brothers on the front lines, for all you have done. Thank you, my sisters and brothers, for your fatigue. Thank you, my sisters and brothers, for your exhaustion. Thank you, my sisters and brothers, for your exasperation.

This pandemic has tested us to our very cores, and I pray that we will come out of it much better caregivers and much better people, our emotional scars notwithstanding.

If I said “Thank You,” my sisters and brothers, for eternity it would not be enough. But still, let me say, one more time, “Thank You.” You are all so special to me, and you will always be in my heart and my prayers.

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I almost always say this when I speak to families about the condition of their critically ill loved one. Usually, when I say these words, my patient is very sick, and they are at high risk of dying. I have lost count how many times I have said the above words to families of patients suffering from COVID-19.

Most recently, I said these exact words to a family who was grieving after their mother, suffering from COVID, just got placed on a ventilator. She had been sick for a long time, and now that she required mechanical ventilation, her prognosis was likely very poor.

I did not pull any punches with the family. I gave them “brutal honesty” about how their loved one was doing. I told them that, while I do not want to crush all hope, I also did not want to give them false hope, which was much worse. I could tell they did not like what I had to say, and – to be honest – I didn’t feel right after our interaction. For some reason, I was may more blunt than usual.

The following day, I got feedback that the family really didn’t appreciate they way I spoke to them. They felt that, as a physician, I should have had more compassion for them and their situation. The nurse, in fact, told me I probably should not go in the room with the family present. I felt I had to rectify the situation, repair the damage to our relationship. And so, I went in the room and spoke to them again.

I said that it is essential that we – myself and my patient’s family – have a good relationship because, we are a team, and if we don’t work well together, then my patient – their loved one – will ultimately suffer.

They told me that they didn’t appreciate how I spoke to them, that it made them feel that I had “given up” on their loved one, that I had no hope left or didn’t want to fight for her. This was the worst day of their life, and my interaction left them wondering what kind of physician I was to whom they left their loved one in his care.

I listened to this “brutal honesty” about how I acted, and I apologized. I didn’t mean to come off this callous and uncaring. I totally understood how they were made to feel, and that was never my intention.

I told them that, if I didn’t care, I would not be there the bedside. I thought about leaving medicine, I told them, but I never did because, I really do care. They were very appreciative of what I said, and I felt we were able to establish rapport once again.

I still believe in being honest, sometimes brutally honest, with my patients’ families. I truly believe that giving false hope is the absolute worst thing I can do as an ICU physician. At the same time, there is a balance between honesty and compassion, and my recent interaction taught me that.

Although I have seen the movie of how critically ill patients with COVID fare time and time again, my patients’ families have not seen it before. For them, seeing their loved one get worse and need a ventilator is the worst moment of their lives. I need to be more cognizant of this fact and do my best to deal with families in a gentle manner.

That doesn’t mean I sugar coat how my patient is doing. I will never do that. At the same time, I need to make absolutely sure I do not come off as if I could care less about their loved one. I need to make sure that I am not conducting myself as if to say, “Why even bother?” It can be a tough tightwire to tread, but tread over it I must as a critical care physician.

We are all exhausted. We are exhausted from the relentless death, destruction, and despair wrought by this pandemic. We are frustrated at the senseless death, especially now with widely available vaccines. People need to understand that. At the same time, it is as important – if not more important – that we understand that our patients’ families are devastated when they see their loved ones crash with COVID. We need to be careful not to be brutally callous in the attempt to be brutally honest.

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This same “lather, rinse, repeat” cycle has played itself out again, and again, and again, and again, and again for the past 18 months. It is exhausting. It is exasperating. And it makes me want to say, when yet another patient follows the same path outlined above, “Why even bother? They’re going to die anyway.”

I am sure many of those on the frontlines – doctors, nurses, respiratory therapists, techs, medical assistants, and others – have asked themselves the exact same question. And perhaps the answer to the question, “Why even bother?”, has led to the dramatic shortage of healthcare professionals across the country.

Yet, when I think about this question, “Why even bother?”, it makes me wonder: would I say that about life itself? I mean, in all reality, the human condition is ultimately fatal: all of us, down to the very last one, is going to die one day. And so, given this fact, would it be right for me to just give up on life and say, “Why even bother? I am going to die one day anyway.”

Absolutely not. It would be criminal of me to do so.

Yes, I am going to die one day. I don’t know when. I don’t know where. I don’t know how. But, one day, I am going to die. But that doesn’t mean that I should just throw up my hands in defeat and not live my life to the fullest, saying “Why even bother?”

On the contrary, I should do my very best to live the very best life possible. I must do my very best to be the best husband I can be, the best father I can be, the best son I can be, the best brother I can be, the best neighbor I can be, the best citizen I can be, and the best believer I can be.

And, yes, I must do my very best to be the best physician I can be: to do all that I can to help alleviate my patients’ suffering as much as possible, even if I know that they will die one day. No where in this equation does the statement, “Why even bother?”, ever even come up.

That would be, in the words of Hamilton, “The moments when you’re in so deep/It feels easier to just swim down.” We must resist – with every cell in our body – the urge to “just swim down.”

Now, for some, the urge to “just swim down” – to give into the hopelessness that is inherent in the question, “Why even bother?” – leads them down a dark path to self-harm and suicide. Dear reader, please, if this is you, please, please, please seek help. Please, please, please talk to someone. Please, please, please don’t follow that dark path.

We must stop focusing on the outcome and start focusing on the path to that outcome. Even if I know this latest patient with COVID-19 will ultimately die, I need to make sure that I do all I can to care for them in the very best manner possible. I need to make sure I do all I can to minimize their suffering as much as possible, and then – if their death is inevitable – I need to make sure that death is a “good death,” one free of suffering, pain, and anguish.

And if I do that, then I should stand tall and feel proud: I did all I could to the very best of my ability.

On so many days, it absolutely “feels easier to just swim down.” It is tiring having to swim upstream all the time. And it is absolutely essential that I do just that. My patients need me to do that; my family needs me to do that; my country needs me to do that; my world needs me to do that. There really can be no other way.

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Feeling burned out and overwhelmed? Here are some strategies that might help you during these very difficult times.

Check-in with yourself

Are you feeling anxious? Depressed? Angry? Scared? Worried? Try to identify all of the emotions you are experiencing. If it helps, write it down in a journal. Exploring your recent thoughts and feelings enables you to make sense of what is happening in your inner world and how the health pandemic is impacting you.

Access mental health supports

If you need professional help, reach out to your doctor if you are noticing difficulties with your sleeping and eating patterns, mood, energy, and if you are having distressing thoughts. You can use the Employee and Family Assistance Program (EFAP) mental health services available to you through your workplace for free, short term counseling for you and your family members.

The Ontario COVID-19 Mental Health Network offers temporary, free, short term, individual counseling to healthcare workers, where interested workers are matched with a therapist through their network website .
The Canadian Psychological Association is also offering free, short-term therapy by registered psychologists and has more information on their website.

Another resource is The Centre for Addiction and Mental Health (CAMH), which offers short term psychotherapy and psychiatry services via their website.

If you feel you need more intensive or ongoing psychosocial support, reach out to a therapist through Psychology Today to find a counsellor who has a therapeutic approach or style that fits with your needs.
If you need urgent support, call a crisis line in your local area, which you can find through websites such as this one. In mental health emergencies where you feel you are at risk of harming yourself, call 911 or go to your nearest hospital emergency room.

Challenge negative thoughts

In health care, where you are surrounded by upsetting news daily, it is common to have a whirlwind of thoughts going around in your head that might further increase your stress and anxiety.

Some examples may be: “I’m going to get COVID-19”, “I’m going to give COVID-19 to my patients”, “My family will get COVID-19 because of me”, and so on.

While there is sadly no guarantee in life that these things won’t happen, we can still try to challenge these thoughts with more positive ones that may feel real to us, such as: “I’m following all of the safety protocols to protect myself, my patients and my family”, “I’m doing everything I can to be safe”, “I’m washing and sanitizing my hands regularly and that is the best strategy to stay healthy”, or “By staying at home when I’m not working, I’m doing what I can to slow the spread of the pandemic”.

Insert any other positive thoughts here that may help you manage your anxiety, stress, and overwhelm.

Remind yourself of your professional values and interests

In this pandemic, it is hard to think about anything but the risks associated with working in health care and it may be hard to see beyond that. If you find yourself questioning everything and feel unsure of yourself in your role or position, it may be useful to keep in mind why you went into your field of practice in the first place.

Was it because you always knew you wanted to help people? Or because you wanted to make a difference in the world and contribute to society? Or perhaps you have a unique interest in a certain client population or area of expertise and this is your specialty now? What other reasons led you to do the meaningful work you do?
These reminders might ground you and help you feel refreshed in an unsettling and confusing time.

Know that you are doing the best you can

When you feel that you aren’t doing enough to make a difference, take a moment, stop, and look around you.

See the clients or patients in your line of sight that you have helped. Notice their smiles of thanks, the gratitude you hear in their voice, and the efforts they make as they try to follow your recommendations and guidelines.

These types of mindful moments will help you shift your focus away from your stress toward focusing on why you chose to do this valuable work in the first place — to provide excellent care to your clients and patients.

Talk to coworkers you confide in and trust

The people you work with are the people you often spend the most time with as so much of our days are spent working. In your group of colleagues, hopefully, there is at least one person you really connect with and who you feel you can talk to. Reach out to them if you need a moment to vent, to share a funny story, or discuss how you are feeling. This helps foster a sense of trust, community, and shared experiences.

Connect with loved ones

Calling and video calling your close family and friends and spending time with your spouse or partner or children during this time of uncertainty can help manage feelings of stress and burnout.

Talking with important others about things that are not related to the pandemic can help get your mind off of it. This allows you to focus on other topics that interest you and make you happy while also investing in key relationships in your life.

Limit media

Watching the news or reading articles on your phone or computer constantly can add to your anxiety, stress, worry, and overwhelm. You may already be supporting patients who are COVID-positive daily, you may be concerned about eventually working with COVID patients, or perhaps you are worried about passing it on to or getting it from others. Constant consumption of media further feeds into this stress and exacerbates it. This cycle of thoughts can continue to spiral if they are not kept in check.

A mental break from all things COVID at points throughout your day can be just what is needed to help you refocus. Permit yourself to turn off your phone and computer when you need to.

Focus on the basics

Eat. Drink water. Sleep. Exercise. No need to follow a perfect and ideal routine here, but try to do what you can, when you can. Do activities that help refuel and relax you, such as deep breathing, yoga, meditation, mindfulness-based activities, or anything that rejuvenates you, such as losing yourself in a hobby that you are passionate about. Building in positive habits and routines, especially when you feel stressed and overwhelmed, can go a long way toward helping you feel better.

Focusing on these basics can motivate you, re-energize you, and keep you going through those long and tiring workdays.

This is a very challenging time for everyone. Your health is number one and needs to be stable before you can fully help others. Take care of yourself and be well so that you can continue to do the important work you do to support patients and clients every day.

The post Working in Healthcare During COVID-19? Tips for Reducing Burnout and Overwhelm appeared first on Medika Life.