Caring for Ourselves While Caring for Others

It was 1984, and I was rotating through the PICU as a sub-intern during my fourth year of medical school. Her name was Aisha, my first PICU patient, a two-year-old with a presumed diagnosis of a new mysterious disease that was only seen in IV drug users and gay men – AIDS.

Aisha was the first child in our hospital who had acquired the infection through maternal-child transmission. Every day, I gowned, gloved, goggled, masked and went into her glass-enclosed isolation room to perform all the procedures she needed. Aisha’s nurse was the only other person allowed in the room routinely.

Over the next two weeks, I got to know Aisha’s family well, a family living in relative poverty in rural Virginia. I did my best to explain her condition to them as we all watched her health gradually decline. Finally, we could do no more, and she succumbed to pneumonia.

After the code was called, I slipped out of the PICU and into the hospital chapel where I cried for an hour, wondering how this could happen to an innocent child, how I could have prevented it, how I could still be a pediatrician and watch children die.

No one was there for me at that time: no chaplain to process the grief; no attending to console me; no resident support group to surround me in love. I just gathered myself up and returned to work in the PICU. Everything back to normal.

As physicians, we are constantly asked to stay detached and put “patients first.” We are all experts in repressing our feelings, putting our heads (and hearts) down, and getting to work. But too often this just leads to resentment and burnout.

Now, with COVID-19, all of us in the medical profession are being called to double down with a warrior mentality. We are asked to do whatever is needed, prepared and equipped or not, with protocols changing daily. All the while, we’re worrying about exposing family and friends to this virus.

What if all health providers had someone we could turn to for support? What if we were all looking out for each other, allowing each other to be openly afraid and angry? What if we could let our guards down and admit to each other that we don’t want to be heroes, but just want to help, while still caring for ourselves and our families? What if our healthcare leaders could create a space where we all felt truly invested in belonging to each other? I believe all of this is possible if the will is there.

Physicians were already suffering from burnout at alarming rates before COVID-19 hit. Our call to action and self-sacrifice can only make the situation worse UNLESS we all contribute to a culture of compassion for ourselves and each other. Here are some small concrete suggestions for how we can do this. Try one or two each day.

• Spend 5-10 minutes each morning in meditation, body movement, prayer, or some centering practice before encountering the news of the day.
• Check your own internal weather forecast each day to understand what you bring to your encounters with others (e.g. “Cloudy with periods of rain and sunbreaks in the afternoon”)
• Stop and ask one clinical colleague each day how they are doing, and truly listen to their answer.
• Reach out each day to one support staff member with empathy and say a kind word of gratitude or affirmation. Be specific and in the moment. This can also be done in a note form later if you choose. (e.g. Tell am M.A., “I noticed how kind and patient you were with that family. You inspired me to be more patient today. Thank you!”)
• Look for one opportunity to inject humor into your workplace each day. (e.g. Share a funny story, meme, or appropriate joke with your colleagues.)
• Look for one opportunity to ask for or accept help when offered to you. Remember how good it feels to have someone else accept your offer to help.

I believe we can come out of this crisis with a new culture of a caring community. But this is only possible if we invest in self-compassion, bringing abundance to our patients instead of an empty tank. Let’s get through this together, in shared humanity, vulnerability, and hope.

This article was originally published in the April 2020 Newsletter of the WA Chapter of the American Academy of Pediatrics.

Joe Sherman, MD is a pediatrician, professional development coach, and consultant to individuals and healthcare organizations in the areas of cross-cultural medicine, leadership, and provider well-being. His mission is to help health professionals rediscover the joy of practicing medicine. Reach him at joe@joeshermanmd.com