On the verge of burnout…and how shingles saved me

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From Luke’s Journal Jan 2023  |  Vol.28 No.1  |  Evolving Professionals

2019 – THE YEAR THAT I ALMOST BECAME BURNT OUT….

Given the statistics related to the mental health of Australian doctors and medical students,¹ I suspect that I am not the only one with a “near burnout” experience.

Maybe you or someone you know have also come close to feeling burnout?

I’m not entirely sure how I ended up feeling emotionally exhausted and utterly spent. Perhaps, it was my desire to take on ‘just one more thing’, combined with a deep-seated belief that I must keep my word no matter the cost. Perhaps, it was a need to maintain my previous medical school lifestyle without properly compensating for the changes that returning to study involved. All I know is that, for months, I performed my roles almost mechanically without any joy or delight. I was grumpier and sadder. I was less patient with those close to me. I knew I had to slow down but I felt like I could not give up anything. I prayed for rest, but when I looked at my calendar, there didn’t seem to be a break for months. On the outside, I was still functional and optimistic, but my performance hid the hollowness that I felt inside. Many Sundays, I would find myself bursting into tears. If I was lucky, I made it to the car or my room. I felt utterly exhausted physically and emotionally drained. I was only able to move from one task to the next.

One thing saved me from imploding – a mild case of shingles

It was the rest I needed and had prayed for, but not what I’d imagined or how I’d wanted it to be. Having an infectious disease was irritating. However, it also forced me to take time off. I had a reason to pause my commitments and slow down. Having shingles reminded me that I am not indispensable and that I am finite.      

My realizations were ironic because if you had asked me at any time throughout the year, I would have told you that as a Christian I knew and believed these facts. Yet, my actions had become incongruent with the values that I hold deeply to be true.

There is a story in the Bible of a rich young man who comes up to Jesus and says, ‘Good teacher, what must I do to inherit eternal life?² This was a young man who had kept all the rules since he was very young, and one who appeared to have been living a good life, if his wealth was anything to go by. I often wonder why the young man had gone to ask Jesus this question. Perhaps, the man had thought that what he had done was good enough and wanted a final seal of approval? Perhaps, the man was looking for yet one more thing that he could do to tick that final box? Nevertheless, Jesus’ response was unexpected. He asked that rich man to sell all his possessions and to follow him. A task that seemed impossible for that rich man. Jesus responded, ‘It is easier for a camel to go through the eye of a needle than for a rich person to enter the kingdom of God.’ An impossible task, and not just for rich people.  If I were to leave it there, the gospel would not be good news at all. But I am thankful that Jesus didn’t stop there. Rather, Jesus went on and declared, ‘What is impossible with men is possible with God’.

The message of the gospel, or ‘the good news’, presents a radical alternative of grace in a performance-driven world. We may be tempted to think that the gospel suggests that if we just keep trying, we’ll eventually succeed, or that what we have done is good enough. However, that is not THE good news. Rather, the gospel says that, to God, our worth is not found in what we have done or will do, but in what Jesus has done for us already. This message frees us to enjoy the work that we do now, in a way that goes beyond the reward of a performance outcome. It is a message that gives us rest and free us from the need to perform if we allow it to.

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2022 – Back on track and what I learned from my experiences

Since then, I have experienced some rest and revitalisation, despite life’s busyness and uncertainties, which for me included COVID-19 lockdowns, 6 moves between different homes and  4 church moves. I was strengthened by the many prayers and encouragement from brothers and sisters-in-Christ who remind me that we have an unchanging God who is in control and whom we can depend on.

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Like many of my colleagues, I am juggling the beautiful myriad of personal relationships and responsibilities God has given me at home, church, work, and everywhere else. As I continue to do life in this season, I am thankful that I have not experienced burnout, like I did two years previously.

Here are 5 things that God has reminded me of through the people who He has placed in my life. These have helped me and sustained me.

Remember H.A.L.T.S.

The hospital has been bed-blocked for two weeks now. I’ve had to ask one of my patients if she would be willing to be transferred to a peripheral hospital two hours away. My patient and her daughter exploded in anger and accused me of not caring about her well-being or safety. Every alternative solution I’ve raised has been shut down with angry comments and this conversation has taken over two hours. I’m starting to feel resentful because I am not the one who can make these decisions and I do actually care about my patients and their safety. AND, I haven’t had lunch, plus I still have other patients to see, but really, I just want to go home.

When I was a medical student, my anatomy teacher joked that everyone is somewhere on the spectrum of HALTS – hungry, angry, late, tired and/or stressed. Patients. Colleagues. Yourself. It was a throw-away comment at the time. However, remembering it, especially when I am on the high end of the HALTS spectrum, has helped me immensely.

God has made us people who depend on food and sleep to survive. Taking 15 minutes out to eat and breathe makes me a more gracious, patient and kind person.

There was a meme that was going around a few years ago about Elijah after that great mountain top showdown on Mount Carmel between Baal and the God of the Bible (1 Kings 18-19). It went something like this:

The author of this meme wasn’t wrong but if I could add one more thing, it would be this: not only did God provide Elijah with food and a safe place to sleep, but He also provided Elijah with a glimpse of Himself before sending Elijah back out to do His work. As Christians, we are also people who depend on God in the little and the big things. To take time out to be reminded of who God is and to pray, to cry out with frustration and ask for His help, puts things back in focus in the context of eternity. When we earnestly seek and cry for God’s help, He comes.

There are no ordinary people

I’ve known Mr TB for the last 3 months as the man in Room 2 with a right below-knee amputation. Today I found out that he is an accomplished country music singer and this year will be the first country music festival he will miss in 40 years.

Often, we are so busy throughout the day that caring for people can end up feeling like a checklist of things to do and things that have been done. There is a pragmatism to this attitude. It enables many of us to continue to work well and care for many people without becoming too emotionally drained. But I am thankful for the reminders that my patients are not just “part of my to-do list” but that they are individuals. Individuals like you and me. Individuals with families and friends, with niche hobbies and pet hates. Individuals who are in need of not just physical care but also eternal care.

Although I often forget this truth, what a difference it makes to be reminded that our Father orchestrates every single encounter throughout the day, both the seemingly insignificant moments and the life and death situations, and to remember that each person we meet is ‘no ordinary person.’

Resting well

Like many hospitals, we are currently understaffed. Medical administration has asked for volunteers to work more after-hours shifts. I haven’t seen the sun for the last two weeks and I am exhausted. I want to say no… but I also want to say yes, because if I don’t take some of the work, it will be one of my colleagues, who is also overworked and tired, who bears the burden.

One of my weaknesses is to say ‘yes’. I want to say ‘yes’ to helping out with things. I over-commit and keep pushing myself to try and help others. At the heart of it is pride, the root of many sins. Pride in being able to do and be seen to do things. Pride in not taking sick leave. Pride in thinking I need to be the one to solve the problems or fill the gaps. Pride in thinking I do not need to rest. And yet, ironically, I am completely replaceable.

Our God is a God who rests. When He finished creating the world, He rested. And though there were many immediate needs for our Lord to address (healing the sick, feeding the hungry), Jesus often took Himself away to pray. Although we are still waiting to experience that final rest when everything will be finished, we can rest in Him now. Knowing that work will always be there, but also being mindful that He has it in His hand.

I came off an evening shift, was feeling exhausted and my nose was running. I had the next day off and then a run of eight days, so I thought I had better get tested for COVID-19 and asked my boss for a PCR form. To paraphrase his response: “I’m giving you a medical certificate for 5 days off. If you need the time off, take it. The hospital and the work will always be here, and they won’t always look after you. So, take time off if you need to and don’t feel guilty about it.”

Being reminded to take the time off to rest well, and seeing my seniors model the same to me, has been a great help and encouragement for me – a very prideful girl, who often doesn’t want to rest!

We have the privilege of being in a community

God gives us a community of people. These are people who keep our wheels rolling when we can’t: friends who dropped off meals when I was sick, the hospital chaplain and other Christians who pray for us and our colleagues, colleagues who call to check in after a bad shift, colleagues who you can call if you’re stuck and need a hand, people who stop for a few minutes between jobs on a shift to ask, ‘How are you?’ and colleagues who remember you’re more than your job and ask how your holiday or your family or your netball team is going.

Are we people who accept the care of those around us?

Are we people who might be able to care for others?

Come, Lord Jesus, come

The locum doctor (PGY3) has just burst into tears after trying to transport a patient to a major tertiary hospital for 24 hours under the advice of the neurosurgical team there. We (the locum doctor and I in my first eight weeks out working) have no consultant in our department for the next two days. The locum doctor has been madly calling the other teams on call to find someone to take over care, in case our patient deteriorates overnight because neither of us has any clue of what to do if things were to go wrong. She has been shouted at by two other consultants over the phone who have said “No”… my senior has been crying for the last two hours since.

There is nothing more terrifying than knowing a patient is deteriorating and not having the skills, or people who have the skills, to help.

I love the work God has given me in this season, but I know that I work in a system that is flawed and will fail me and many others. Sometimes, despite our best efforts, we cannot provide the best care that should be possible. In more recent years, the use of the term ‘burnout’ within the medical world is slowly being replaced by the term ‘moral injury’.“Moral injury occurs when we perpetrate, bear witness to, or fail to prevent an act that transgresses our deeply held moral beliefs.”³ And when we experience this pattern of moral injury repeatedly over and over again, it affects our practice and can deeply impact physician wellbeing. It leads us to become cynical, exhausted and less productive.⁴

There are three (of many) responses which I have found helpful, as I begin to traverse this system:

First, to be reminded that our God is in control and provides for our every need. My non-Christian colleague was recently given a verse by a patient’s family member, “Therefore I tell you, do not worry about your life, what you will eat or drink; or about your body, what you will wear. Is not life more than food, and the body more than clothes? Look at the birds of the air; they do not sow or reap or store away in barns, and yet your heavenly Father feeds them. Are you not much more valuable than they?” (Matthew 6:25-26).

We have a God who is in control, a God who knows what it is like to suffer and who weeps with His people (John 11:35), and a God who we can trust to work all things for His glory and our good – though we may not always see that immediately. Whilst we cannot always change the system we are in, we can entrust the care of our patients to our Father who controls all things, and we can keep plodding on whether in the system or away from it.

Second, give thanks for the blessings we have at work, at church, at home. With the bad days come also the good days. Seeing a baby’s first breath. Being able to discharge a patient home to be with their family to die a good death. Treating an infected foot and seeing the resolution. Seeing a patient get a new prosthetic leg and learning to walk. Having lunch with your colleagues and laughing lots. There is much to be thankful for, even on the days when I just want to grumble.

Third, the reality of our broken world sometimes leads me to cry out “Come, Lord Jesus. Come”. At the end of the day, this world will fade away. Not sheltering our junior colleagues from the reality of the system we work in (or the world we live in) may actually help them. Continuing to work to try to change the system and/or to keep faithfully plodding on is an encouragement to others. Pointing others toward the eternal reality is far better.

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Footnotes

1. https://www.beyondblue.org.au/media/media-releases/media-releases/urgent-action-needed-to-improve-the-mental-health-and-save-the-lives-of-australian-doctors-and-medical-students
   
2. The story can be found three times in the Bible, Luke 18:18-30, Mark 10:17-31 and Matthew 19:16-30.
   
3. Whilst I don’t think the main point of the story is about how we use material possessions, I do think that the Christian faith (like many others) has some radical thoughts about how we should use our wealth and possessions, as opposed to merely accumulating these things.
   
4. “It is a serious thing to live in a society of possible gods and goddesses, to remember that the dullest most uninteresting person you can talk to may one day be a creature which, if you saw it now, you would be strongly tempted to worship, or else a horror and a corruption such as you now meet, if at all, only in a nightmare. All day long we are, in some degree helping each other to one or the other of these destinations. It is in the light of these overwhelming possibilities, it is with the awe and the circumspection proper to them, that we should conduct all of our dealings with one another, all friendships, all loves, all play, all politics. There are no ordinary people. You have never talked to a mere mortal. Nations, cultures, arts, civilizations – these are mortal, and their life is to ours as the life of a gnat. But it is immortals whom we joke with, work with, marry, snub, and exploit – immortal horrors or everlasting splendors.” – C. S. Lewis, The Weight of Glory