I started my hospitalist shift like any other day. I arrived at 5:30 a.m. for shift hand-off at 7 a.m. A full hospitalist load and endless administrative tasks to complete, the duality of both roles punctured me like a venomous snake bite. I had two full-time jobs to complete in 12 hours. Impossible! Or was it? I added one and one-half hours to my shift at the beginning–time hidden behind closed doors to tackle administrative tasks. “If they don’t know I’m here, they won’t ask me for anything,” or so I thought.
Still, the time was more productive than it would be between 7 a.m. to 7 p.m. My shift started at 7 a.m., and this marked the loss of governance; my time was not my own. From one fire to the next, the 12-hour shift flew by in a blur of family meetings, emergencies, administrative meetings, admissions, patient care encounters, etc. At the close of my shift, I still had notes to write, reports to create, timecards to certify, and so much more. I stayed two additional hours past shift change. This was my life pre-COVID and resemblant of so many other health care workers in the pre-COVID era.
COVID was yet another villainous crook out to command more of my time–not the shift time, but the family time traded as extra time for the cause. Faced with tremendous adversity, many of us continued to work despite our dwindling mental health. Politicians and leaders touted how resilient the health care community was. Indeed, we have been. The Brene Brown referenced “dig-deep button” was alive and well, and daily we pushed ourselves to do a bit more for a bit longer, expecting an end was in sight. Two and one-half years later, the end is not in sight. Have we truly possessed resilience throughout this pandemic? I would argue no. By appearances, we recovered quickly from the excessive stress. Realistically, we just dug deep and pushed ourselves to deliver more because the world was in crisis. Recovery has not occurred for many. We talk about the systemic issues: staffing shortages, unsafe care, long hours, and toxic work environments. We haven’t shared the deepest darkest suffering in our hearts.
Institutions inherently recognize the extreme stress/duress many health care professionals face. However, rather than work to mitigate these factors, the proposed answer seems to be about changing the health care professional to withstand more of it or withstand it better. Resilience training has long been cited as an answer to burnout or at least a substantial factor for burnout reduction. The COVID-19 pandemic only intensified the recognition and emphasis on “resilience.”
While fostering stress recovery is an outstanding component of wellness, as a solo intervention, it is insufficient. The fundamental culture and systemic issues that only further heighten and propagate the stress remain unaddressed. What’s more, the emphasis on resilience implies that these health care professionals are “weak” or lack the ability to cope and invalidate the trauma and suffering that does take place.
Quite simply, resilience training completely ignores the causes of this suffering and the wounds that are present so long as the health care professional can heal faster. Alone, resilience training is akin to “Experiment X” in the X-Men Marvel movies. I imagine we all show up for training mere health care professionals. Just like Wolverine, we are subjected to an experiment that gives us claws bonded with adamantium. We are painfully drowning under water before we emerge with a guttural yell armed with claws and officially deemed “unbreakable.”
Herein lies my grievance. I don’t want to be unbreakable. Breakable is part of my humanity. I don’t want my skin to heal faster; I want to stop being cut all day, every day; the scars, while healed, are too thick. The current dysfunctional health system was built on the backs of so many “resilient” health care professionals.
So how do we move forward? I cannot speak for the system, but speaking for myself, I am in pursuit of true healing. I am on the path to the life I create in service of my own wellness. I have cultivated the belief that it is possible and that I can create it. Seeing isn’t believing; believing is seeing. I now wake up embracing the idea that I am worthy of prioritizing my well-being. I am enough! If this different life makes me a pariah to medicine, then “thank you, next!” I am more than my career! While I dreamt of being a physician from a young age, my predominant dream now is to create this new life with or without medicine.
In Life, the Truth, and Being Free, Steve Maraboli says, “life doesn’t get easier or more forgiving; we get stronger and more resilient.” I’d argue that we get stronger when we allow ourselves to break. For in recognizing our brokenness, we can truly heal. My “dig deep button” is officially out of service.
Cathi Whaley is a hospice and palliative care physician.
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