Who's Caring for the Carer?

"How can we help bring healing back to healthcare, beginning with our doctors who are so overwhelmed?"

These moving words were like a small pebble dropping onto the clear lake of my mind, creating ripples of growing intention in my heart these past few years to address the silent suffering of the medical profession. A meagre effort, no doubt, of one individual's desire to tackle a massive systemic malady. But the call kept growing stronger until I began to meet other companions on this path—glad to realise that I am not alone in this hopeful vision of healing the heart of healthcare.

While the word "burnout" was hardly uttered in my medical school days some 40 years ago, academic papers and publications have since bourgeoned to highlight the rising trends of stress and burnout in healthcare professionals in the past few decades. How did this come to be?

Perhaps modern healthcare with its seeming advances has burdened the finite human mind with an overload of relentless thinking and driven-doing, robbing healthcare professionals of the delicate balance between 'being' and 'doing' in the art of medicine. More is not always better, as what is truly healing in the doctor-patient encounter is the skillful combination of head and heart—wise essential knowledge and deep relational presence.

Burnout has been termed 'the erosion of the human soul—an erosion in values, dignity, spirit and will' (Maslach and Leiter, 1997, quoted by Cole and Carlin, 2009)—whereby one's deep value system to be a compassionate caregiver is not well-supported, leading to a state of exhaustion as one tries to deliver quality care against the odds. The insidious loss of personal values and decline in the altruistic vision of healthcare professionals are potential contributing factors to stress and burnout.

Remen (1996) cautioned us as early as 1996, 'The expectation that [physicians] can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to be able to walk through water and not get wet. Protecting ourselves from loss rather than grieving and healing our losses is one of the major causes of burnout.' The healthcare fraternity is surely bathed in this sea of suffering, fear, loss and grief with the 2020 Covid-19 Pandemic.

As a shaft of grace, in the past 40 years, contemplative practices in mindfulness and compassion addressing the chronic health struggles of patients have now extended to include the care of healthcare professionals. We are beginning to recognise the benefits of mindful self-care and self-compassion for caring professionals who are, after all, 'also human' (Elton, 2018) and subject to similar internal and external stressors as the people they care for. Doctors may hold the mistaken notion that illness is what happens to others called 'patients' and may mistakenly be harsher on themselves for being unwell.

In my personal life, I encountered the acute need for self-care and self- compassion when, after some 15 years in Family Medicine and 10 years of offering psychological counselling, I became a patient overnight suffering from 20% second-degree burns.

Despite my extreme debility and long-drawn rehabilitative journey of several years ahead, the physician in me still assumed the need to tend to others who were troubled. But the unmistakable physical weariness, post-traumatic anxiety and growing depression of losing a sense of who I am were signs that my other-centred stance would no longer serve my recovery.

15 months into my accident, my self-worth shattered and physical mental health in the doldrums, I came across "The Trauma of Everyday Life" written by practising psychiatrist and mindfulness teacher Mark Epstein (2013). It came as a ray of understanding into my cave of uncertainty, isolation and darkness—offering a new way for me to view my suffering as a physician-turn-chronically-unwell-patient with greater self-compassion and self-acceptance.

In the ensuing 7 years, my mind began to wake up to the reality that I had been in a state of empathy-fatigue and burnout. My badge-of-honour as the dedicated doctor and community leader—constantly putting others before self at the cost of my wellbeing—needed to change. Suffering in silence was not wise. I needed to take off my caretaker hat, articulate my true needs and receive tangible help to recover a life still worth living.

What is one to do when staring at the ceiling from the hospital bed: body swathed in bandages and reeling from intractable pain despite the maximum dose of painkillers; my mind catastrophising potential worst case medical scenarios (will I get air embolism? MRSA infection? drug anaphylactic reaction? anaesthetic accident?); and spirit devoid of hope—sinking deeper into anxiety and depression?

The yoga breath and movement practices that I had neglected for years (from too much service to others!) slipped in quietly to keep me steady, breath by breath, day by day. I found myself saying, 'I don't have to make it through the rest of the day, just the next hour is good enough.' In addition, staying with gratitude from moment to moment and being opened to receiving compassion from others brought me through the worst 18 to 24 months.

Hence, I was not surprised to learn years later, when training to teach mindfulness, that the grounding practices of breath, body awareness, mindful movement, gratitude and kindness were essential elements to a mindful and compassionate existence, regardless of one's spiritual roots.

Recovering from this personal challenge has led me to the present desire of bringing mindful compassion to healthcare communities, with a specific interest to assist student-physicians in cultivating self-care and self-compassion early in their training—to enhance their personal and professional well-being in order to better care for themselves and their patients (Novack et al, 1999).

[We will be exploring facets of mindful self-care and self-compassion for healthcare in the next few articles. Do stay tuned!]

References:

Cole, T.R. and Carlin. N. (2009) The Art of Medicine: The Suffering of Physicians. The Lancet.

Elton, C. (2018) Also Human: The Inner Lives of Doctors. London: Windmill Books.

Epstein, M. (2013) The Trauma of Everyday Life. USA: Penguin Books.

Novack, D.H., Epstein, R.M. and Paulsen, R.H. (1990) Toward Creating Physician Healers: Fostering Medical Students' Self-awareness, Personal Growth and Well-being. Academic Medicine.

Remen, R.N. (1996) Kitchen Table Wisdom: Stories That Heal. New York: Riverhead Books.