Thanks for your support of this newly-launched blog. I’ve already had great feedback through Facebook, and I’ve made several unexpected connections with others who wanted to share their feelings of stress or lack of balance. PB will be back in the new year with more personal stories and content. Have a wonderful holiday!
In his book Is It Worth Dying For?, Robert Eliot describes his experiences with stress, culminating in his own heart attack on the job. He identifies five stages on the downward spiral to burnout: Job Contentment, Fuel Shortage, Chronic Symptoms, Crisis, and Hitting the Wall. Here, I continue with my journey from a fuel shortage state to the recognition of some serious health problems.
Before I continue with my own personal navigation toward balance, I want to define some terms and alert you to the potential problems that unmanaged stress may cause.
“Stress is the spice of life; complete freedom from stress only comes in death.” – Hans Selye, MD
This quote from the originator of the concept, cultivated back in the 1950s, says it all. Of course, stress and our responses to it have been around since the origin of living species. The oft-termed “fight or flight” response of our sympathetic nervous system served a very important purpose in our primitive days, as humans fought for our food, shelter, and the like. How does such a system built into our DNA in order to protect us cause so much harm in today’s modern, professional lifestyles?
Stress becomes an issue when demands on us outpace our ability to respond. Our internal homeostasis becomes unbalanced, resulting in perturbations of the autonomic nervous system, hypophyseal-pituitary-adrenal axis, and the immune system. A key factor in this imbalance is the chronicity of stress. Our internal response systems were designed for acute stressors, not the scenario in which most of us live today: overworked, underslept, undernourished/malnourished, overexercised… take your pick of characteristics that describe your life.
Luckily, stress is both entirely perceptual AND individual. Ever heard the phrase, “One man’s stress is another man’s walk in the park”? The literature on stress reports some common personality traits that predispose individuals to stress, and unfortunately most of them are commonly seen in medical students, law students, graduate students… basically any budding professional:
- High achieving
- Tendency towards negative self-talk
- External locus of control (where daily activities may not be the individual’s choice)
We fulfill many roles as we grow into our professions – student, teacher, worker, spouse, parent, caregiver, provider… During our undeniably grueling training for our respective professions, the prevailing culture becomes ingrained: we are taught to be self-denying, expect delayed gratification, and sacrifice our own health/well-being for our patients or clients. Most of us perpetuate these ideas when we become the teachers of the next students… that is, unless your own personal experience leads to a shift or the paradigm for you (like it did me)!
Burnout is a specific syndrome at the negative end of the stress spectrum, characterized by emotional exhaustion, depersonalization, and a reduced sense of personal accomplishment. It is both chronic and irreversible when the individual is removed from the offending conditions. Here is just a sample of headlines from recent publications related to stress/burnout and physicians:
Just a very cursory glance of the literature as it applies to lawyers reveals that these statistics are not unique to physicians. In the March 2010 issue of the Michigan Bar Journal, Burkett likens chronic stress to a form of battery. The heavy emphasis on competition and conflict as an integral part of the profession leads many to seek alternative methods of coping in an environment where “showing fallibility is a weakness”. Subsequently, an estimated 40-70% of the disciplinary actions brought against attorneys are related to substance abuse or mental illness.
I’m not sharing these statistics to be apocalyptic; my goal is to raise awareness of these often under-recognized problems in professional settings. These issues are under-addressed in most graduate schooling, and effective, system-wide proactive stress management programs are scarce. We are often left to our own devices when it comes to figuring out how to manage our stress.
Thank you for visiting PracticeBalance.com! As the site gets underway, look for stress management and health news, discussion, quick tips and inspiration to use in your own quest for balance. First, I want to share with you the experiences that lead to my interest in this highly under-addressed area of our lives as professionals. In this first installment, I will describe the initial decline in my own state of wellness, which began in my residency training.
Three of four years had gone by already. I was a senior anesthesia resident, working toward a career in one of the more sought-after paths in medicine, let alone in a field that is repeatedly rated as one of the most satisfying lines of work. I fancied myself as a hard-working resident and a good physician who cares about her patients. But my stress management skills were so poor that I was literally making myself sick.
While seeking to preserve life for others, something inside of me was dying. I could taste the bitterness building in my blood, and the cold hospital air further crystallized the acids. As fellowship applications came due and other residents mulled over their future possibilities with excitement, I couldn’t even fathom the concept of practicing medicine after graduation. I knew it was time to DO SOMETHING. My health, my relationships, my psychological state were all suffering… and for what? Was it all worth it?
Prior to residency, I had a career and well-rounded interests. While there were some difficult rotations and experiences, medical school was for the most part positive and exhilarating. Internship began with the excitement of new responsibility. On this steep learning curve, micro-adjustments to my daily technique resulted in what seemed like substantial gains in my performance, work efficiency, and satisfaction. The amount of medical knowledge to assimilate during this period was great, but there was no way to move except forward.
Like the swipe of an eraser on a white board, all the positivity and excitement quietly vanished once my Anesthesia training was underway. The sheer volume of material to learn was overwhelming, not to mention the technical parts of the job – placing IV’s, preparing drug doses, mastering the anesthesia monitors and ventilators, patient positioning, and the delicate dance of the consent process that is unique to anesthesia. Every day was a great battle to keep wits and stay calm while learning the academic and procedural aspects of the specialty.
As the fall months spread into winter and the days became shorter, a gloom washed over me. Rushing to work in the dark and returning home in the dark… was this what I had signed up for? Were other residents feeling the same way? How did I compare? These questions never really get answered since we don’t work together in the same OR. Come wintertime, performance evaluations from faculty started to trickle in. Many comments were positive, but the negative ones cut deeply into my motivation and self-esteem. A month in the ICU during the coldest part of winter did little to help. I began to seek solace in the break room, where free baked goods were always available. Eating fatty sweets became a way of life to stay awake on call and to soothe the emotions. I required large amounts of coffee to wake up each morning and medications to sleep each night. I was burning the candle at both ends and surviving on the fumes.
Stay tuned for the next chapter of my story, where I describe the interplay between my physical and mental health and what I did to avoid major burnout during residency!