After working a 10-hour Monday, I came home and wanted to collapse on the couch. It was a typical day of dealing with more needs and demands than what was humanly possible to meet. Specifically, I was chewing on what happened at the end of the day regarding a patient’s unrealistic demands juxtaposed up against a medical system that cannot meet the physical and psychological demands of the latest wave of COVID-19 patients.
I felt conflicted within myself about so much need, my limitations, and feeling overwhelmed in the face of that need. My conflict manifested as an argument inside myself about whether I would eat a cookie before eating my dinner or whether I would eat dinner at all. The cookie won out once again as I collapsed onto the couch for the evening.
I had sent an email to some key people in my organization about managing patients’ expectations and how that needed to be addressed differently on an organizational level. The truth of the matter is that I am powerless to change the way the system handles a lot of things. The more personally relevant issue is managing my expectations, both how I relate to the needs/expectations of those in front of me and my own personal needs and expectations of myself in delivering that care. Since we truly only have control over ourselves, the key question becomes how do I manage my own expectations better as a way of managing my own inner resources, namely, time, energy, and mental/emotional output?
So here are some guidelines regarding managing expectations personally while working in the middle of the pandemic:
1. Expect to be overwhelmed. Know that there will always be more needs than resources to go around. Right now, it feels like we are delivering health care on the border of some war-torn country or in some refugee camp. I realize that visualizing the image of providing care in a refugee camp helps to lower my expectations and thus reduce my stress.
2. Expect that people/patients will be dissatisfied. The helper in me and in all of us want to know that we are helping someone. This means we want to know that they feel better when we have given so much time, energy, and effort to care for others. We crave the feedback that we are meeting others’ needs well. The “helper” inside needs validated by us rather than craving that soothing balm of feedback from anyone else.
3. Validate your helper inside. Notice how you were doing everything in your power to deliver top-of-the-line quality care. Express gratitude to yourself that you’ve gone the extra mile as if you were sitting across from yourself in a chair. What is so demoralizing and feels so lousy is that it doesn’t seem to be enough no matter what we deliver. Express compassion to yourself for the limitations you’re facing. The concept of doing the best we can with extreme limitations has only really hit home in a big way since the pandemic. We are not responsible for the entire system, but we are responsible for doing the best job possible. But we need to remember to give ourselves a pat on the back for the level of difficulty we are all experiencing.
4. Provide nurturance or nourishment for the nurturer. No amount of oatmeal cookies (or any other kind) is going to satisfy the void and disconnect between trying to meet all the demands placed in front of you and feeling like you’ve fallen short of those demands. No amount of taking the work home or charting better is going to change that either! The key question is what really feels nurturing or nourishing? What really fills you up? What am I (you) passionate about outside of medicine? Go do some of that in your spare time.
5. Practice good self-care techniques. If our goal is to provide optimal care effectively, we need to prioritize ourselves. Engage in regular meditation or mindfulness practices. Regular exercise, 8 hours of sleep & eating quality food all help the engine of our brain & body function at optimal capacity. Know how to do breathing exercises at the moment to down-regulate your nervous system in stressful situations. Singing or humming (even if off-key!) helps relax the diaphragm & increases vagal tone and the parasympathetic system. We are all resilient people, or we would never have made it this far! We need to find ways to maintain a sense of community and connection in the face of an extremely challenging 2+ years. There is strength in acknowledging that we are human too.
Anne M. Miller is a psychiatrist.
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