“….But who takes care of you?” Part 2
“…But who takes care of you?
Part 2: “Now I take care of me, too.”
In part one of this article, I detailed my experience with professional burnout. In this second part, I describe the importance of self-care and the physiological mechanisms that underlie what was happening, with the goal of teaching anyone who is experiencing something similar to take it seriously. Stress creates very real, and dangerous, physical changes.
The physical symptoms that I described in part one of this article were a warning sign that my body was not functioning in a healthy way, and the stress of my job was creating a severe hormonal imbalance. Consequently, I could not handle even the smallest uptick in my stress levels. I was already “functioning” beyond my capabilities, so when a small stressor, e.g. going out with my friends, came along, I was physically and mentally unable to do it. The thought of getting dressed up, interacting with others for an extended period of time, and going to bed later than I had planned, was unbearable. Unfortunately, for someone suffering from anxiety and depression, social interaction is not only helpful, it is a necessity for recovery.
Some is good, but more is not better.
“Cortisol” is a buzzword we encounter frequently on health blogs and talk shows. Vital to our internal functioning, cortisol is somewhat misrepresented as a “stress hormone.” Yes, it is released when our bodies have to kick into a higher gear to cope with our surroundings, but that is not always detrimental. When your child runs towards a busy street, you find a way to get to him before he sprints into oncoming traffic. That is your brain recognizing the stressful situation and allowing your body to respond to it appropriately. Exercise is a much less dramatic example; you impose a burden on your body to which it must adapt, e.g. lifting something heavy, or running in a race, and it allows you to do this. Without the spike in cortisol, your muscles would not have the energy they need to deadlift a new personal record or to beat your last marathon time. The effects of cortisol should be relatively short lived, allowing the body to return to its pre-stress state. To accomplish this, cortisol has self-regulating functions. [See Fig. 1 – graphic of cortisol pathway]
So in my case, where did this go wrong?
The constant nature of stress in my life disrupted the balance of cortisol in my body. Rather than the threats being large and acute, they were small and chronic, which overrode cortisol’s self-regulating mechanisms. Patients and paperwork bombarded me at the same time that I was in a long distance relationship. I was an orthopedic resident, which meant lots of studying with culmination in a high-pressure specialist exam. I am an exercise addict, which though it is a healthy habit, is still a stressor on the body. On top of my job, exercise, and relationship, I had to find time for self-care: eating healthfully, sleeping regularly, and maintaining a social life. All of these things came at me daily, and my personality does not allow me to let the quality of my work slip, or quit any activity, thus I was unable to take my foot off of the gas in any of these arenas.
Going warp speed!
Each of these things increased the release of cortisol in my body, and because the “threats” were constant, I never returned to a normal, baseline level. I was constantly in a heightened mode, and the deregulation of cortisol release meant that my brain reacted inappropriately to threats that should have been perceived as minor. If a patient was five minutes late, or showed up at the wrong time, it was enough to send me into a tailspin, both physically and mentally. Hence, after a particularly busy morning, I would be exhausted, unable to speak and then would just start crying. If my supervisor placed a new burden on me, such as asking me to work on my day off, I would need a three-day weekend to adequately recover. Internally, I responded to these things in the same way a panicked parent would when her child runs into traffic.
With my knowledge about what causes the stress response, how could I have better attenuated it? Truthfully, I could not have once it reached the crisis point detailed in my first article. Even now, I am still managing my overly sensitive stress response with weekly counseling, reduced hours at work, and making self-care a priority. I take sick days when I am sick, I make sure to get enough sleep, and I take breaks throughout the day to make sure I am eating and drinking enough. By reducing stressors over which I have control, I have equipped myself to handle stressors I am unable to control, such as when a patient arrives late, if there is traffic during my commute, or if I am reprimanded by my boss. I am learning to set boundaries by picking and choosing which extra projects I take on as part of my job, and I allow myself to say no when I feel it is appropriate.
Most importantly, I allow myself to vent to my husband and friends, rather than attempting to tough everything out. I lean on my social network and have learned to see it as a sign of strength and maturity rather than as a weakness. I have made a point of being in touch with how I am feeling, and being more sensitive to when I am getting overwhelmed or tired.
So what was happening internally that was causing me to be the stressed out mess I was on the outside? The stress response was running out of control in my body [Fig. 1 for the science], causing my brain to react to everything as though it was a threat, through the action the hormone, cortisol.
The lesson in all of this
Management tools can be used as preventative measures for healthcare workers who find themselves to be overwhelmed and succumbing to the stresses imposed by patient care, documentation, and answering to supervisors and administrators. Allow yourselves to be vulnerable with the people you love; lean on them. They will welcome this, as I have learned. It is our job to be both strong and flexible for our patients, but we do not have to take that part of the job home. Learn to self-care, as well as letting others help us with it. Most importantly, learn to be in tune with what your body is telling you before it reaches a crisis point. It is much easier to prevent a problem than treat it when it is out of control, as all of us know.