I'm becoming everything I hate

Recently I had advised a friend to visit a nearby Taluk Hospital. Apparently, the doctor there was not only not helpful but also gave a mouthful of colourful words to boot. This behavior is not uncommon in our profession and over the past few months, I feel that I can hardly consider myself to be an exception to this problem.

I had decided early in my practice that I did not want to be one of those doctors who needlessly scolds patients. But simply having good intentions is not enough to prevent compassion fatigue from creeping in. It’s a cultural problem.

Only a couple of days back I had someone ask me half-jokingly why I needed a day off when I don’t have any family at home (thanks for that). While this comment was tongue-in-cheek, it is more or less along the lines of how most people think. I never realized before how good it is to have an excuse to take a day off (the most acceptable being usually family or religious reasons). Things like trying to recharge your mind is viewed as a sign of weakness.

Pandemic Fatigue

Yeah N95s aren't easy on your face. At least the good ones anyway. 

The pandemic has made work that much harder in the government sector (at least for those engaged in Covid duties). Working hours are longer including time spent in PPE. You are working even when you are “off duty” by uploading Covid data and attending calls from home isolation patients. Interaction with local politicians is at an all-time high, which is enough reason by itself to start banging your head on the wall.

This has led to two important consequences. Firstly, when you work when you’re really tired, mistakes are somewhat inevitable. One night when I was approving data after a really tiring day at work, I mistakenly approved a patient’s result as positive when it was actually negative. The patient worked at the local village office and this obviously turned into quite an incident. But I’m not as bummed out by this as I am about all the mistakes I must have made in the casualty that I’ve just not received any feedback on.

Secondly, you find yourself in a perpetually pissed off state.  I often find myself one annoying incident away from exploding. It is inevitable in our profession that this will happen from time to time but I find this happening to me most days of the week now, which is not healthy. This is much more of a problem at the end of a long shift than at the start meaning it is likely an attrition issue. I find myself much more compassionate talking to patients over the phone once I get home and relax a little. It’s difficult to show compassion when you go on autopilot because of the stress. Sometimes I know my behavior is crap but find myself too tired to do anything about it.


Me drenched in sweat, dehydrated and tachycardic after a particularly hot day in PPE. 


Trying to improve my behavior

Yes, it does take quite an effort to be on your best possible behavior in a busy hospital. You have to will yourself into doing so. People tend to do stupid things – like drive a scooter drunk without a helmet on dangerous roads in the middle of the night. It’s much more natural to berate them than remain neutral and do your job. This is especially true in the latter hours of a 24 hour shift.

Another huge problem in the Covid era is infection protocol. You’re much more likely to be able to follow it on a 8-12 hour shift than when you have put in double or triple that. The fact that I haven’t got Covid yet (I think) is much more down to pure blind luck than any skill on my part.

There are other possible reasons that contribute to my bad attitude. My chronic back pain has gotten worse over the past few months. Sleeping on crappy beds while on duty probably exacerbates it. Postponing all the other things I need to do in my life is also frustrating. I have no one else that can help me out at home. I barely spend any time on myself anymore.

Prophylaxis

So how does one combat this compassion fatigue? I’ve never been shy to do work I’ve been assigned and always want to be seen as a team player but everyone has their limits. Covid means other people are far less likely to be bothered if you run yourself into the ground. One cannot combat this effectively as an individual. We need to look out for one another, identify the signs that something might be wrong and help out at the right time. It’s important for our patients to have us in our best possible frame of mind when we provide them care and we should each strive to make sure that happens in our hospitals.

Comments

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