It has been an interesting week in Tatamagouche. The week started cold and wet like a Nova Scotia spring and ended hot and dry like summer. The province had a 10th straight day of no new COVID cases. Our little hospital had plans to re-open our COVID shuttered ER as an urgent care center. A long standing colleague had a health event leading to an unexpected and sudden retirement after 30 years. A new doc arrived from Britain, completed her quarantine, and started work. It was eventful, exciting, sad, worrying, hopeful, and new. I felt tired, frustrated, and flat … the same way I have felt for much of the last 1/2 year or so.
Something clearly is not right with me. I read an article this week regarding physician burn out and read that the hallmarks were a feeling of inevitability (nothing will ever change and I don’t know how much longer I can do this), futility (does anything I do really matter in the big picture) and rudderlessness (I think my leaders lack the will and understanding to make effective change). Sometimes it feels that a writer is spying on your life. At least I now had a name for this flat numb frustration. It was called burn out
My daughter came back from riding her horse earlier this week. I asked her how it had gone. She said ‘So so, he (Ford, her horse) is getting ring sour.’ This was a new term to me. Apparently it means that a performance horse is getting tired of doing the same movements, same actions, same routines, in the same work place over and over. They get cranky, irritable, and uncompliant. I now had a new name for how I was feeling. I was ring sour.
It’s one thing to name an issue, but then what? What am I to do with this awareness of burn out or ring sour in my life? I am not alone. I know others, probably many others, who feel as I do, both in medicine and in other vocations. I also realized that I may need to change my perspective on what this means in my life.
Being burnt out is viewed as a bad thing in a doc or nurse, but in many other aspects of life, being burnt out is a positive. When a forest fire burns itself out it means that safety has been reached and restoration can begin. When a disease, like rheumatoid arthritis or schizophrenia, has burned out it means the disease is no longer active and working with the scarring from the disease can be aimed toward a ‘new normal.’
This made me think of the way we talk about being ‘on fire’ in those around us. We see this as a high ideal. Someone is burning brightly with passion and power. Back to the equestrian world, a talented performer of a horse often needs to be ‘hot’, unmanageable except by the very skilled of riders (and dangerous in the hands of the unskilled) To achieve performances of riveting power and beauty
We have ‘hot’ performers in medicine too, they burn brightly, they can achieve really remarkable results, but they can be barely manageable, throwing OR furniture, berating co-workers, dangerous to a health care community unless controlled with great skill.
The ‘hot’ horse is striking and inspiring, but is not consistent. It would not faithfully pull a plow or safely pull a wagon. You could not run a farm with one. The farm would do better with predictable, uneventful, cool. Likewise, our health care system is dependent day after day on the burned out to plod through the day, through the lists, through the same issues in the same people at the same workplace and to do so predictably, uneventfully, coolly. In short, our health care system requires the burnt out doctors and nurses to run much more than it needs the fiery performers who may be special in terms of talent but their fire isn’t safe to be around too long.
This means that instead of seeing our burned out colleagues and our burned out selves as being people who need to be replaced, avoided, or fixed, we need to recognize that these are the traits that hold our medical system together. We need to mange our dismay and flatness rather than cure it. We need more burned out, Ring sour docs and nurses, we just need to find out how to be healthy while In that place.
