Healing the physician

Dr Zirak Marker May 31 | Updated on May 31, 2021

Dr Zirak Marker, Senior Psychiatrist & Adviser - Mpower The Centre

If a medical practitioner or health care worker is experiencing symptoms of stress or trauma, it is important to reach out, writes Dr Zirak Marker

“Every time I close my eyes I see his face, mouth slightly open gasping for air and taking his last few breaths. The sound of the medical machines around us seem heightened in my head. My heart seems to pound and feels like it is about to explode in my chest and I too feel like I cannot breathe. I wake up in a cold sweat with my T-shirt drenched on many a night like these. I feel overwhelmed with the smallest of things that seem to be happening in my life. I cannot seem to focus or concentrate much on my work. Recently I found my hands to be trembling whilst conducting a small procedure for another patient. I feel I have emotionally shut down and cannot talk to anyone and don’t want to meet my friends over the weekend. I have started drinking heavily to take away these feelings and numb the pain. But that doesn’t help. I try and do a hundred things in a day but I can’t seem to block out these repetitive thoughts and images.

The worst feeling however is the guilt. It eats me from within. I feel responsible for his death. I feel that I could have done much more or done something differently perhaps to save him. I cannot forget the expression on his wife and son’s face when I had to share with them that there was nothing else that we could do in the emergency room. This is the eighth time I have felt like this. This is the eighth patient that has died under my care in the last six months.” (Dr Rahul, Pulmonologist and Emergency care practitioner at a hospital in Mumbai)

Like Rahul, there are thousands of frontline medical practitioners and health workers who experience symptoms such as these. However, there is sometimes no time to process why one feels these aspects and others feel it’s a phase that will pass. There is a huge burden of responsibility that most health care practitioners garner. Canadian research on PTSD among nurses estimated a prevalence of as high as 40 per cent in this current pandemic.

Whether one’s a nurse, surgeon, paramedical, physician or psychiatrist - the responsibility, duty and liabilities always remain the same. Thus, the risk of experiencing trauma and stress is very high for such professionals.

Long working hours, fatigue, lack of rest and sleep, dealing with complications, the uncertainties, difficult caregivers or relatives and unrealistic expectations can also contribute to burnouts and drained emotions. Many a time doctors or emergency care workers have also been beaten, threatened, abused or mobbed by family members or relatives who’ve lost their loved ones under that professional’s care. This also leads to apprehension and anxieties amongst professionals who deal with critical cases.

Sometimes there is a lack of basic sanitisation, equipment, instruments, protective gears, masks, gloves or shields that expose health professionals to various viruses, infections and this worsens in times such as these. Some professionals who work with the paediatric population, terminal cases like HIV /AIDS, cancer or other chronic health conditions, find the emotional trauma very difficult to deal with, as in most cases death is prolonged, yet inevitable.

Many mental health professionals and psychiatrists too who have lost people to suicide have silently suffered the loss and experience symptoms of grief and bereavement. Many have felt responsible and wondered if they could have done more to prevent suicide.

What we need to realise is that we are human beings first with feelings, emotions and hearts just like any other person in other professions. We are not super-humans or Gods that can be in control of every given situation or predict how things may turn out. We try our best despite putting ourselves in at risk. We tirelessly work despite sometimes having difficulties or problems of our own, at home or at work. We come to work despite sometimes not feeling up to it or if we’re feeling sleep deprived or fatigued. We show up the next day despite having performed surgery or procedure or dealt with an emergency case until the early hours of the morning.

We do all of this because we’re dedicated, committed and passionate about what we do. We do this because we care and have a duty to uphold. We do this because we’ve taken an oath to treat, heal and care for anyone that comes to us for treatment.

However, this cannot be possible at the cost of our own health or peace of mind. We cannot take care of others if we are not okay physically or mentally. We cannot work optimally and to the best of our abilities if we have not looked after our own well-being. We will not be able to maximise our own potential if exhausted, stressed, burnt out or unhappy.

If a medical practitioner or health care worker is experiencing symptoms of stress or trauma, as listed below, it is important to reach out and speak to a support group, counsellor or mental health professional. They include vivid memories or flashbacks, feeling like the incident has happened now , intrusive repetitive thoughts or images, disturbed sleep or nightmares, intense distress at real or symbolic reminders of the trauma- sounds, voices, certain images, people or even smells, physical sensations such as pain, sweating, nausea or trembling, using alcohol or drugs to avoid memories, and blaming yourself for what happened with tremendous guilt, shame and low self-confidence and esteem , to list just a few symptoms.

You can manage and heal yourself by finding healthy ways and coping mechanisms during these distressful times. Staying away from alcohol, drugs and negative people or situations is imperative. You need to ‘talk and share’ feelings with someone you can trust. Consulting a health professional may be the best option. We need to create boundaries and put into place a work-family-self- life balance. And taking breaks, holidays and being with nature really helps unwind and disconnect from work . Take time for yourself, pursue hobbies and among other things, have realistic expectations.

Doctors need to find ways of ‘letting go’ and ways practice mindfulness, gratitude or meditation. Deep breathing exercises, progressive muscle relaxation, self-monitoring, expressive writing and journaling can be very useful. Remember to prioritise and love yourself unconditionally first always - then only can one be most efficient as a Father, Mother, Son, Daughter, Husband, Wife, Sibling, Doctor, Nurse, Surgeon or Mental health professional.

(The writer is a Senior Psychiatrist & Adviser - Mpower The Centre. Views are personal.)

Published on May 31, 2021

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