Have you ever been faced with an upcoming shift at work and felt an impending sense of doom? This type of anticipation can be a real killjoy. However, taking calls, working nights, weekends, and holidays is all part of the job, right?
Worst. Call. Ever.
I was just drifting off, entering the first phase of sleep when the whole body is relaxed, and you’ve entered that sweet twilight zone. Suddenly the shrill and frantic beeping of the code pager alarmed. My entire body jolted, and the now-familiar adrenaline release shot me out of bed and sent me running.
On arrival, it was clear this baby was not doing well; her skin was pale and grey; she was lying limply while the respiratory therapist was providing positive pressure ventilation. (Details were changed in order to protect patient information.)
I was relieved, as a fellow, to get the baby quickly intubated. It didn’t take long to discover that there was a massive pulmonary hemorrhage. We started chest compressions and drew up epi. We were able to get a heart rate back. I vividly recall manually pushing repeated syringes of blood products myself because the IV pumps couldn’t push it fast enough through the tiny bore IV tubing. My hand muscles were sore for days after.
But, there were not enough hands around this tiny body to keep up. I had to tell this baby’s mom that her twin would grow up without its sibling.
She wanted to know if it would happen to her other baby. I didn’t think so. But as we all know, there are no guarantees in life.
It comes as no surprise that we, as doctors — real, human people — have a certain degree of anticipation, even anxiety, when it comes to taking our shifts. The truth is, not every call is as bad as I imagine it could be. Yet my body learned to brace itself, a defense mechanism for “just in case.”
These unwanted feelings are something that I grew to affectionately refer to as “call dread.”
But have you ever wondered how much time we spend worrying about call, versus the amount of time that we actually spend being on call? What about the Monday after a long weekend, returning from vacation, or an overnight shift? Is it as bad as we think it’s going to be, even a fraction of the time? Is it worth all of that anticipation?
My path to on-call acceptance
1. Awareness. It took me a while to identify why I was incredibly grumpy before and during my call shifts. I was confused by it– what was the matter with me? It turns out it was anxiety masquerading as irritability.
While there is clear evidence that mindfulness practices are associated with improvement in burnout, I can’t say I was entirely relying on the science here. I just knew what felt right to me. I began a mindfulness practice. Meditation and journaling allowed me to tap into specific thoughts and feelings that were driving my irritable behaviors. It also allowed me to do the critical first step: identify the problem.
The answer I discovered was disheartening at best. I absolutely dreaded being on call. How bad would it be this time? Here’s the trip: “terrible” events only happened on a small portion of my call nights. So why was I letting this ruin 100% of my pre-call days?
2. Find common humanity and be open to help. Fortunately, at this time, I was digging further into mindfulness and personal growth. I attended a physician wellness retreat, and there I learned the value of building relationships with other physicians. Connecting with others who have shared experiences provided validation about many of the unwanted feelings that can accompany our jobs– including the stressors associated with being on-call.
The retreat also introduced me to physician coaching. I was skeptical, despite evidence to support coaching as an effective way to improve physician well-being and decrease burnout. But I was also intrigued. I told myself that if this coach can help with my call dread, they must be able to help with anything!
Thirty minutes, some vulnerability, intense questioning, and a few tears later, it was like the skies parted. I was able to take a deep breath and face my next call with some new tools in my belt. A few questions helped me discover the answers that were already within me: Do other people feel this way? Are bad things sometimes going to happen? Do we really have control and certainty in any part of our lives?
While this line of questioning may seem simplistic, it provides incredible validation and allows you to get out of your brain and into reality. The value in asking these questions is when you truly explore them for yourself. I eventually learned is that all I can do is show up as my best self and do what I was trained well to do. Letting go of control and certainty has a shockingly stabilizing effect on one’s ability to cope.
3. Reflection. Ask yourself why, and decide if it’s true. As I reflected, I realized that preceding each call night, I worried that there could be an adverse outcome. And the reality is, the more I perseverate about the call being “bad,” the more time I waste, the less sleep I get, and the more time it usurps from my family. Ironic, eh? Reconciling the futility of specific thoughts can be a powerful tool, and helped me feel neutral about being on call.
4. Help others. With this new mindset and framework, I now look forward to a long and healthy career in a field I genuinely love and worked so hard to become a part of. The next step for me is to help others find the same peace with those struggles that may prevent them from having the career they desire. While I know that taking call is just a tiny piece of the puzzle, I feel hopeful for myself as well as others who have faced the same challenges. If I can get this one, daunting piece figured out for myself, what other impacts can mindfulness, growth, and coaching open up for the health care profession?
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