“WTF??!!” — This was how my pandemic burnout was manifesting. It seemed like every new email, organization-wide protocol change, “red zone” area, COVID-19 related symptom, or essentially anything outside of my control, had me in a perpetual “WTF” state of mind. I had reached a point of where the reinvigoration of, and “call to duty” towards, this worldwide medical emergency started to give way to mental and physical exhaustion in trying to keep up with it all. I was BURNED OUT by it all, but I did not recognize it until one precise moment.
The precise moment when the gravity of my BURNOUT state hit me: During an off-hours, socially-distanced gathering with the other clinicians in my office, my medical director asked me: “How are YOU feeling with all of this?” It was at that moment, with that basic inquiry, when I felt like someone was finally and genuinely checking in with my state of mind, that my anger completely melted away and it took all that I had not to just cry. That one question cut so deeply and quickly through the layers of armor that I was carrying around that I was shocked by my own reaction.
“Me?” I said. “I’m fine.” Nothing could have been further from the truth, but I almost felt guilty in stating otherwise, given what was going on in “hot spots” across the U.S. and the rest of the world. I had been telling myself that I should be feeling lucky to be where I was, where COVID-19 cases have yet to manifest in large numbers. There was no surge here, despite our extensive preparations, and in watching what some of our medical peers around the country were going through, how could I be feeling burnt out? Was there any validity to me feeling that way? In hindsight, the answer is 100% YES.
Although it was looking different up here in Vermont, as compared to other places across the country and the world, the near future was looking gloomy, and it felt like the we were bracing for an impending viral-tsunami. It was decided, after both of the doctors valiantly volunteered to take inpatient shifts for the possible “surge”, that I, along with a nurse practitioner from another practice, would take over all responsibilities in our clinic. I was suddenly thrust into a de-facto Medical Director role, with thousands of patients, many of them unfamiliar to us, under our care. There was not time for a transition period, as things were evolving so rapidly, and as with all medical facilities, we were reacting to the daily, and often hourly, changes.
As part of the de-facto Medical Director role, I was now responsible for holding the three-times-a-week staff meetings, keeping the staff safe (in the face of sickening PPE shortages), coordinating with organizational leadership and keeping abreast of news from the CDC, Vermont Department of Health, New York Times and other sources. I somehow was sleeping less and had more energy, but in hindsight, this was probably a constant source of draining my batteries. Despite my time-tested resiliency strategies, I don’t think I was winning the battle, or more appropriately the war, but I can confidently say that I was doing all that I could to project that I was.
Still within my provider role, I was triaging, doing visits with (although we were almost exclusively telemedicine in the early phases, along with some parking-lot medicine visits), and treating some folks sight-unseen. Practicing rapid-decision-medicine wasn’t new to me, as I’ve worked in multiple busy Express Care settings, but I, more than some, appreciate the unsustainable nature of such practice. Doing all of this for three patient panels, in addition to the new medical director duties, was admittedly A LOT.
So how could I, without being surrounded by a hospital full of COVID-19 positive patients, patients on ventilators struggling to be kept alive, or having to even make any life-or-death decisions, be feeling burnt out? Was I just not as resilient as I thought? These thoughts led to some serious guilt and shame.
It all started off well, as I embraced how I was needed most: running our clinic. My PA friend said that he felt invigorated by it all, and I agreed that I felt the same way. The feeling of a “call to duty” sure beat routine hypertension and hyperlipidemia follow-up appointments, and there was a feeling of responsibility to do whatever we could to keep our community informed and safe. It was in these early days of the pandemic that I saw some of the best of humanity on display, and I like to think we, at our clinic, were a part of that.
As we now know and continue to feel the effects from it, this pandemic has shaped up to be more of a marathon than a sprint, although it feels like we started fast and furious out of the gate and continue to try to keep a brisk pace. The bottom line is that much of the medical community continues to run on fumes after such an effort to meet the demands of a pandemic, because those efforts were just not sustainable.
As someone who once made the 5k rookie-mistake of sprinting out of the gate, and subsequently paying the price for the other 80% of the race, I should’ve known better than to not pace myself appropriately. I dove in head-first, embraced my new role, exercised more to “keep up” with mental demands, became a checklist maestro, and thought I had hit my stride and finally felt a “calling” with my medical career. Little did I know that, as we were starting to figure out that the “surge” wasn’t coming to Vermont, and as we began to reintegrate ourselves back to some semblance of normalcy, another tidal wave of stress was heading our way: budget shortfalls and possible furloughs/layoffs. My mental mantra went from “I got this” right back to “WTF?”
How did we, in what seemed like an overnight shift, go from “Healthcare Heroes” to possibly losing our jobs? Wasn’t this STILL a medical emergency that was STILL happening? The threats to our jobs were real and they were imminent…it was do whatever it takes to make up for these budget shortfalls associated with the pandemic, or there would be cuts. Our benefits and salaries were the first to feel the cuts, and it was uncertain if we would retain our jobs. This felt a little too polarized from where we just had been, and I felt like I was on a rollercoaster with a blindfold on.
I, admittedly, did not see this one coming, and I think that the surprise nature of this new stressor contributed to my inability to deal with it well. I was somehow fine with potentially getting COVID-19 and possibly not having a good outcome (I even spoke with my wife about how she felt about me heading to NYC to try to help), but the thought of losing my “essential” job shook me to my core. And, on top of being shell-shocked by this latest development, pressures were now being put on us to increase our outputs, all still within the dangers and confines of practicing “pandemic medicine”.
This second tidal wave of massive changes came at a time when my batteries were already running a little low, and it was soul-crushing (or consistent with the title of this post, my soul was now officially Pandemic-fried). From invigorated and feeling pulled towards the fight to feeling like a powerless pawn, worse than ever, and all within the span of a few weeks. I didn’t need a pat on the back at this point, but what I really needed was time to process what we had just worked through. It felt like we went from one enormous stressor to another, like jumping from the fire into the frying pan. There was no time in between to rest, recharge and rejuvenate. Without this time to do so, I felt beat down and was now totally burnt out. Returning back to more of the pre-pandemic same, but this time with higher demands and consequences, felt like a huge slap in the face. “WTF?“
It was around this time that we had our off-site provider meeting, the one where I almost broke down and cried in front of my colleagues, when I realized exactly how low and “crispy” I had gotten. If I was employing all of my resilience strategies, and was still “losing the war”, then I needed help. My first step was to apologize to my colleagues for being as “crispy” as I had been for the few weeks before my burnout recognition, then I immediately contacted my Employee Assistance Program (EAP*) to get some help via counseling.
As I waited to connect with a counselor, I doubled down on mindfulness activities and discussing my feelings more openly. As a patient of mine recently said: “There’s a [emotional] debt that you’re going to have to pay at some point, so you might as well pay it as soon as possible.” Well, as it turns out, I never did connect with a counselor, but by giving some much-needed attention to how I was feeling, I was able to “pay my debt” and start the road to burnout recovery.
Within two weeks of my near “breakdown”, I felt like I was back on solid ground and my batteries were recharged, all while continuing to work full-time within this new pandemic landscape. I credit myself with having many strategies from pre-pandemic days to call upon, so recharging my batteries happened faster than I anticipated, thankfully. It was on the other side of my (latest) burnout that I started to think and worry about my fellow medical professionals, some of whom had an even more stressful experience with the pandemic, and also many of whom don’t have good resiliency tools in their toolboxes to call upon, that may still be suffering. I understood, better than ever, that their experiences were valid.
Back to a big part of my existential crisis: Was my burnout legitimate and valid, such as compared to the medical professionals in New York City or Northern Italy? YES, YES and YES. Here’s why:
1) We should not judge how we are feeling. Shaming ourselves for our feelings is not productive and will only lead to feeling worse. It is better to just observe and own how you are feeling, without judgment. The energy spent on shaming ourselves should be put towards trying to figure out the reasons why you feel that way, or better yet, on finding solutions on how to feel better.
2) It comes down to a simple concept: If the stressors that are draining your batteries are more than what you are (and can be) doing to recharge them, then you are in a net-negative energy state. This is not sustainable. You need to decrease the energy drain, increase the recharging, or better yet: BOTH! Although my experiences differed from the medical professionals experiencing a “surge”, my energy was being depleted faster than it could be replenished, which is a path that always leads to burnout.
My heart goes out to all of those people, maybe even you reading this, who are in a perpetual burnout state. I hope that in reading my story, you not only can relate, but can also be inspired to try to get yourself out of this unsustainable and joyless state of being. As it appears at the time of this writing, the pandemic stressors aren’t going anywhere for quite a while, so now is as good of a time as any to acknowledge your burnout, without judgment, and ask for help. If you think that I can help you in any way, reach out and let’s start the process of turning it around. I hope that together we can become “pandemic-proof” from here on out.
*Many larger organization have an EAP in place, and usually employees can get counseling free-of-charge, at least up to a certain amount of sessions. Contact your Human Resources (HR) department to see if you are unsure if your employer offers such a valuable resource.
DISCLAIMERS: 1) The views expressed here are my own and do not necessarily represent the views of my employer. 2) There are no conflicts of interest to report. 3) I don’t know what I don’t know, so feel free to message me if you don’t agree with something that you read.
KEYWORDS: #burnout #doctor #APP #nurse #pandemic #medicine