What if Burnout is More Like SIRS?

Posted on July 5, 2024 by marylbrandt

Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed. It is characterized by three dimensions:

feelings of energy depletion or exhaustion;
increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and
reduced professional efficacy. (World Health Organization, 2019)

Something has never seemed right about this definition.

It’s as though we said myocardial infarctions “result from stress that isn’t successfully managed” … without discussing coronary artery disease.

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It took a very ill 10 year old child with perforated appendicitis and Systemic Inflammatory Response Syndrome (SIRS) to make me think about this differently.

As I often do, after my initial visit to the Emergency Room and while waiting for the operating room to get ready, I pulled up UpToDate and PubMed to make sure there wasn’t anything new that might help me take care of this child. As I read, a light bulb went off…

“SIRS is considered a clinical syndrome that is a form of dysregulated inflammation. It was previously defined as two or more abnormalities in temperature, heart rate, respiration, or white blood cell count [29]. SIRS may occur in several conditions related, or not, to infection. Noninfectious conditions classically associated with SIRS include autoimmune disorders, pancreatitis, vasculitis, thromboembolism, burns, or surgery.” (UpToDate, Sepsis syndromes in adults: Epidemiology, definitions, clinical presentation, diagnosis, and prognosis, accessed 7/4/2024)

Which led to an important question….

1. What if burnout is more like SIRS?

If burnout were like SIRS, it could be caused by a variety of etiologies…

SIRS is most often caused by a serious infection. But it can also be caused by trauma (gunshot wounds, car accidents, burns), pancreatitis, burns, inhalation injuries, the “trauma” of major surgery of any kind, transfusion reactions…

What if the same were true for burnout?

What if there were multiple possibilities that could start the cascade from stress to distress?

…and should be understood as the end-stage presentation of a progressive process.

In the case of SIRS from untreated infection, patients who present with seemingly mild symptoms like fever and tachycardia can rapidly progress to sepsis to septic shock to organ failure, and even death.

What if thinking about burnout in the same way could help us understand the progression healers experience from distress to suffering to burnout?

2. The treatment would start with resuscitation (and rapid diagnosis).

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Patients with SIRS are hospitalized and aggressively treated with oxygen, fluids, appropriate medications to stabilize blood pressure and antibiotics to treat possible infections. All of this takes place while appropriate exams are being done to find the source of the problem.

What if we approached burnout in a similar fashion? What if, when we first noticed the symptoms ,we provided appropriate “resuscitation” and started looking for specific etiologies?

3. The definitive treatment would be “source control”.

For a patient with SIRS, once we make a diagnosis, we seek to eliminate the source of the SIRS. For appendicitis, we take out the appendix. For pneumonia, we prescribe appropriate antibiotics, and use supplemental oxygen and chest PT as needed.

“Source control” for burnout would be no different. Specific treatments would depend on identifying the specific issue(s) that started the cascade of distress and suffering.

4. Full recovery would require supportive care.

Source control starts the process of healing, but healing is not something we do for or to a patient. In clinical medicine, we facilitate the patient’s ability to heal … and then we support them while they heal.

Burnout should be no different.

I mentioned the need for a good “differential diagnosis” in order to identify the source of SIRS

Which leads to the next important question.

What’s the differential diagnosis for the causes of this syndrome?

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I’m sure there are others, but the major categories of insult and injury that I believe should be included in the differential diagnosis of healer distress and/or burnout include:

Failure to recover from injury (physical, emotional, and spiritual). For example, pronouncing a child dead in the ER and then having to run to clinic because you are now late and patients there are getting angry.
Moral distress, injury, and outrage. Moral injury occurs when we know the right thing to do, but can’t do it. For example, not being able to perform an important elective surgery or prescribe a needed medication because it is denied by the patient’s insurance.
Trivializing the sacred nature of healing. For example, the hours spent typing trivial information (for billing) into the EMR.
Secondary trauma from chronic exposure to suffering or specific traumatic events (like the death of a long-time patient or being sued)
Horizontal hostility. This is a concept I learned from Joan Halifax in her article The Precious Necessity of Compassion. Horizontal hostility, which is bullying by your peers, is often responsible for nurses leaving nursing, and occurs in all other areas of healthcare as well.
The structural violence experienced by being marginalized at work and/or in society (racism, misogyny, homophobia, etc)

You’ll notice lack of self-care and insufficient resilience aren’t on this list.

I believe that insufficient self-care is most often a symptom and never the cause of burnout. That being said, I don’t mean to imply that self-care isn’t important. (You can probably tell I think it’s important just by scanning through the other entries on this blog!)

I’ve come to understand that insufficient self-care should be seen as a “comorbidity” for those in the grip of distress, suffering and burnout…similar to how having diabetes makes it harder to recover from physical illness or injury.

As for resilience… There are no human beings more resilient than those who choose to heal. The idea that insufficient resilience causes burnout is just not true. But it is true that this idea has been weaponized by the institutions who employ us to deflect from the real issue; We work in systems that create moral suffering for those who care for the ill and injured.

What should we call this model?

As I began to think more about using SIRS as a way to think about burnout, I realized I needed a name for this concept. I started with “PDS” for Physician Distress Syndrome, which I loved because PDS is my favorite suture. But a good friend, who works as a nurse practitioner, pointed out to me that this wasn’t just about physicians. Good point. She also said, “But you don’t have to change the acronym! You can call it “Provider Distress Syndrome”.

But I never use the word provider.

Everyone who works in healthcare in the United States (and to a lesser extent in the rest of the world) is affected by these issues. It’s too burdensome to list everyone when we are talking about this – but we need a word that describes all of us.

“Provider” is out.

“Clinician” works, but it is too narrow (and too cold).

The only word I’ve come up with so far that works is “Healer”. So for now, I’m using “Healer Distress Syndrome” to describe this model.

By the way, if you recognize yourself as being somewhere on the continuum from distress to suffering to burnout, you are not alone. Every healer I know is currently or has been there.

You matter.

Your work is sacred work.

We need you.

If you are suffering, please reach out to someone and/or seek professional help.

Things I Wish I’d Known From the Beginning: Preventing Back Pain and Injury

Posted on April 27, 2024 by marylbrandt

When it comes to protecting your lower back as a surgeon it’s all about multifidus.

So says Professor Takuya Shimizu, an orthopedic surgeon and professor of sports science at Chukyo University who I heard speak at the 124th meeting of the Japanese Surgery Society.

I never learned about multifidus in anatomy class, and if you are a physician, I suspect you didn’t either. According to Wikipedia, “The multifidus (multifidus spinae : pl.: multifidi) muscle consists of a number of fleshy and tendinous fasciculi, which fill up the groove on either side of the spinous processes of the vertebrae, from the sacrum to the axis.”

I hope the experts forgive my “translation” of their expertise, but here is what I wish someone had told me about protecting my back (and decreasing back pain).

Anatomy. In the first year of medical school we learn about the large muscles that flex and extend the lower back – rectus abdominis anteriorly and the erector spinae posteriorly. Deep to these muscles are the muscles that stabilize the segments of the lumbar spine, and multifidus, for surgeons, is probably the most important of these muscles.

This is the slide from Dr. Shimizu that explained this in a way I could really understand. The “global” muscle in his slide is the rectus abdominis which we contract when we lean forward to operate or examine patients. If you have weak segmental muscles (i.e. the multifidus), a disproportionate force will be transmitted to the weakest point in the spine. For most people, that’s L5-S1. If you work to strengthen the multifidus (“segmental strategy”) the force generated with flexion will be distributed along all the vertebrae – which helps prevent pain and injury.

How to strengthen the multifidus.

“Walk like a model”… which is a conscious, three step process as explained by Dr. Shimizu. The goal should be to do this as often as you think of it (on rounds perhaps?) … and hopefully for 10,000 steps a day! (any amount helps, though)

There are also specific exercises you can do to strengthen the multifidus. The classic core exercises known as “bird dog” and “superman” are among the most effective. (Dafkou, 2021). Others that help include side planks, quadruped leg lift, and one arm pushup on a counter or bench. There are many more, so if you want a complete list, just google “multifidus exercises”.

Another excellent option is Pilates, which has been shown to be effective in strengthening deep core muscles and reducing low back pain. (Eliks, 2019). Tai Chi, yoga and other similar practices are effective in strengthening core muscles as well.

This amazing art is from the team at Codex Anatomicus… make sure you check out their website!

p.s. If you are a physical therapist, sports medicine expert, or have other expertise in this area, please comment below to add your expertise!

p.p.s If your back really hurts, please go see a good physical therapist.

We Are Neighbors

Posted on August 4, 2021 by marylbrandt

I look around the spaces I work, live, and worship in and I see so many people I love. I believe everyone is my neighbor, but I’m specifically talking about the people I know…the smiling clerk I always choose to check out my groceries, the guy who waves at me every morning when I drive into the garage, my family, the people who share my mission of healing children.

Only ~50% of the country is vaccinated and in some areas it’s only about ~30%. I know this means that some, maybe many, of the people I know and love aren’t vaccinated and, to be honest, it’s breaking my heart.

Because here’s the deal…

The Delta variant is dangerous. Every person who is infected with the Delta variant will infect 6-8 people on average (which is more infectious than Ebola or chicken pox)… Unless you are in a group of people like a break room, a church, a gym…. In which case the number will be much higher because of the closed space. Being vaccinated makes it MUCH less likely, but not impossible to infect people around you other because of “breakthrough infections.” These infections after vaccination are rare but expected – it doesn’t mean that the vaccine “didn’t work”.

Masks protect you (some) and everyone around you (a lot) which is why they are so important now – whether or not you are vaccinated.

But back to my friends and neighbors who aren’t vaccinated. The Delta variant is so infectious and spreading so fast that if you aren’t vaccinated, it’s not about IF you get infected, it’s about WHEN.

That’s why when I think about my beloved friends and neighbors I grieve because…

You will almost surely be infected with the Delta variant if you aren’t vaccinated.

You will go on to infect others around you, including people you love.

You will be sick (and probably really sick)… hopefully at home, but maybe not.

You may end up on a ventilator.

You may die.

And if you don’t die, you may be debilitated.

And it breaks my heart. Because these deaths are preventable. And even one of you dying or being debilitated is one too many.

I beg you…Get vaccinated. Wear a mask. #LoveYourNeighbor

(p.s. We are all neighbors)

Don’t Eat the M&Ms

Posted on July 28, 2020 by marylbrandt

As a former Program Director, I couldn’t help but imagine the conversations that occurred after this event…

After “WHAT WERE YOU THINKING?????” – which would have probably been my first sentence – I would have been upset, but I also would have realized that these residents were meeting in the way that residents and students have met forever. They were having a goodbye party for people who were leaving. Probably not outside, and probably not socially distanced, judging by the outcome, but I totally get it.

But the consequences of a casual party like this are real and it’s worth thinking about this by asking three questions…

1. What are the chances you’ll get infected at a party?

This one is easy. You have 100% chance of getting infected… unless it’s 0%… and there is no way to know which way it will go.

A recent report of 32,480 nursing home residents and staff showed that “Of the individuals who tested positive, 70.8% of residents and 92.4% of staff lacked symptoms at the time of testing.” The authors also showed that the viral load (which helps predict whether or not the individual is infectious) was the SAME in people who had symptoms and those who didn’t; “In a large cohort of individuals screened for SARS-CoV-2 by qRT-PCR, we found strikingly similar distributions of viral load in patients with or without symptoms at the time of testing.”

What this means in practice is that every single person we encounter has to be considered infectious. And that means every event and every encounter has to be carried out in a way that will prevent transmission of the virus.

2. What are the chances you’ll get really sick or even die if you get COVID19?

Based on data from the CDC, for 20-40 year old people with no underlying medical conditions, here’s the answer to my hypothetical M&M question:

700 of the M&Ms will give you fever, cough, and/or shortness of breath. Lots of patients describe it as having “lungs on fire.”
440 of the M&Ms will give you some pretty awful muscle cramps and aches.
120 of the M&Ms will make you lose you sense of smell and taste. It usually comes back, but not always
3 or 4 of them will put you in the hospital (that goes up to around 20 M&Ms if you have an underlying medical condition)
1 of them will put you in the ICU unless you have an underlying medical condition. In that case, 5 of them will put you in the ICU
It’s unlikely you’ll die unless you have an underlying medical condition, in which case 3 of the M&Ms will kill you. If you carry this home to your 70 year old grandparent with an underlying medical condition, they have a 20% chance of dying (the equivalent of 200 M&Ms for you).

3. If you are in health care, what effect will this have on your patients and your colleagues?

Whenever I struggle with a decision as a doctor, I go back to my “rules”, which serve as the reference point for my moral compass.

Rule 1: Do what’s right for the patient.

Rule 2: Look cool doing it.

Rule 3: Don’t hurt anything that has a name.

If, as a healer, you decide that “just this once” won’t be much of a risk and you end up with COVID19, you break all three rules. You will be infectious for a long time before you get symptoms… which means you will expose patients, friends and colleagues (who all have names) to this potentially deadly disease. And – there is nothing less “cool” than creating a avoidable situation that ends up with colleagues having to cover for you while you are in quarantine and/or recover from COVID19.

We all want this to end… and it will.

We have a special calling – and responsibility – as healers (which includes all healthcare workers since healing takes a team). It’s what makes our work so filled with awe, and so rewarding. It’s also a burden sometimes. But we all took an oath, we all made a promise, and when we are past this point in history and looking back, it will mean something that we held true to that promise.

A letter to my car dealership – Your business scared me today (so I have some COVID19 advice for you)

Posted on June 1, 2020 by marylbrandt

As a longtime customer of your dealership, a physician, and a concerned citizen I wanted to reach out to you to talk about the experience I had today when I picked up my car. Please know that this is not an attempt to complain – it’s an attempt to explain – and hopefully make you, your family, your employees and your customers a little safer.

I woke up this morning excited I’d be getting my car back today! Since I realized I didn’t want to expose or be exposed to anyone that wasn’t necessary, I called ahead to pay online (thank you for making that possible!). But, once I got to the dealership… well, it just wasn’t safe.

I stood outside while someone went inside to start the process of checking me out … and here’s what happened – which is what prompted me to write you this letter:

I watched as one of your customers, who was clearly in at least two, if not more, high-risk groups walked up the ramp. She was passed by an employee coming down the ramp, who passed her shoulder-to-shoulder. The employee’s mask was on their face, but below their nose.
I watched as the service folks checked in two people who both had masks on properly (as did your employees). But they walked up to them and held out their hand to take keys, which meant they were within 2-3 feet of each other.
The service employee who checked me out came out with papers and then handed me a pen – which I suspect they had been using all day – and stood right next to me. When I shook my head and asked if there was another way to do this, they said “I can get you hand sanitizer”… and then “We know it’s coming again.”
When my car was returned to me, the employee who drove it up to me had a mask on – around their neck. The windows were up and there was no smell or sign of any disinfectant. They walked up to me (2 feet away) and reached out to hand me my key (which I put into a ziplock bag I had brought for this purpose).
As I was leaving, an employee walked by with their valved mask on… around their neck. Two strikes! These valved masks are being sold because it’s “easier to breathe” but that’s because all the air you breath out escapes… with the virus. So, they have no benefit at all.

Let’s break this down… and I hope this will help you and other businesses to think about this in a way that makes sense. We all want businesses to open – and stay open! So working together to prevent more spread of this deadly virus just makes sense. What’s making this hard for some people is how politicized this has become. But, it’s important to know that this virus doesn’t care how you vote or what you think. This is just medicine, science and common sense.

The official CDC recommendations can be found here, but here’s how I would translate them for your employees i.e. what I would post somewhere if I were in your shoes:

Assume everyone you meet has COVID19

Unlike other viruses, you can be infected for up to 6 days before you feel sick. During that time, you can infect other people. Which means that everyone you meet could be infected… whether or not they are ill. If there is nothing else your employees remember, they should remember this.

If anyone with COVID 19 coughs on their hands, touches something and then you touch it (followed by touching your face), you can become infected.

This is not the primary way this virus spreads but it can spread this way. (This is why it was so upsetting to be handed a pen.) I also wish the person who returned my car had a spray bottle of disinfectant with them. I sure would have felt better if they got out of the car, sprayed down the seat and steering wheel and then wiped it off. Oh, by the way, once COVID19 is on a surface (depending on what the surface is made of) it can last for up to three days. That’s why it’s so important to disinfect surfaces frequently and wash our hands after we touch anything that hasn’t just been disinfected.

If anyone with COVI9 talks, yells, speaks, coughs or sneezes in a closed space, the virus can hang in the air for up to 3 hours. If you walk into that space during that time, you can become infected.

I can’t think of a worse closed space for COVID19 than inside a car! It’s true for any room, including your office space, but this is why I was perplexed when the person who returned my car didn’t have their facemask on. This is also why there is a “6 foot” rule and why we wear masks. (By the way, it’s not either-or, it’s both). We wear masks to protect others, not us… which means if we all do it, we’re are all protecting each other. (That’s also why you shouldn’t let any employee wear a valved mask) We stand at least 6 feet away from each other because the viral load will be much lower if we are talking to someone who is infected. By the way, the aerosol an infected person produces when they sneeze can travel up to 20 feet … and, remember, those viral particles can remain in the air up to three hours.

Most of us will probably be infected eventually, but that’s not relevant.

I understand that in the face of such a terrible disease there is a tendency to just throw up your hands. I’m sure that’s why your employee told me “We know there’s another wave coming”.

But here’s the deal – every day we postpone any one of us getting COVID19 (or preventing it, if all goes well!) is one day closer to a vaccine.

With every day that goes by, we also understand more about COVID19 and how to treat it… so the odds of not needing the hospital, ICU, or morgue goes up.

For every case we prevent, we are actually preventing many, many more cases because of how this spreads.

There’s also the part about just being a good person; You don’t want to be the person who bends the rules, gets sick and then infects family, friends or customers.

You have a wonderful dealership and I will continue to be an enthusiastic customer. Your service is incredible, your employees are kind. Stay safe, stay well, and thanks for giving me an opportunity to share this information with you and for others.

Sincerely,

Mary L. Brandt, MD

Self care in the time of #COVID19

Posted on March 31, 2020 by marylbrandt

It’s so important, and so very hard, to care for yourself when times are tough. When routines are disrupted and fear and anxiety are present, our usual ways of caring for ourselves seem to (appropriately) fly out the window. So, here are some ways to think about caring for yourself in the time of COVID19, whether you are working (at home or in the hospital) or isolated at home.

Connect with nature. Long after this pandemic is over, the earth will still be here and spring will continue to happen every year. Make sure you get a good dose of the smell of grass, the sight of a blue sky, the feeling of a cool breeze on your face at least once a day (but hopefully more).

Move. It’s normal that workout schedules are disrupted right now, but it’s not a good time to completely give up on your physical wellbeing. There is nothing good about being sedentary – not only does it make you feel physically bad, it also contributes to sadness and anxiety. A good, brisk walk outside may be the best “workout” right now since it combines movement and getting a dose of nature… but please make sure you practice social distancing and stay six feet away from everyone.

Eat well and enjoy good chocolate. You may be limited in your choices and your ability to get real food, but do your best. This is not a good time to succumb to the junk food as comfort food diet. Nor is it a good time to be overly restrictive. Splurge on small doses of the foods that make you feel comforted, but make sure it’s the best version of that food possible! Now is not the time for cheap chocolate… just sayin’.

Keep your spaces clean. Our homes need to be a safe sanctuary now more than ever, and that means we need to know they are clean. In addition to creating a ritual to enter your home, come up with a plan to keep your home neat and cleaner than usual. If it helps, what we’ve done is set a mindfulness timer to ring 3 random bells an hour when we are home. Every time it rings, we do one small bit of cleaning (or one set of an exercise) e.g. vacuum one room, clean the countertops, wipe off all door handles or do some pushups. What you lose in efficiency is made up for by breaking up an otherwise boring task and by the “surprise” of the random “request”.

Dose your news. We need to know what’s happening, but we don’t need to know it all the time. The human brain doesn’t like being continually bombarded with potentially dangerous information. It promotes the physiologic stress response and pushes us towards fight, flight or freeze… none of which are helpful in this time. I love Twitter, but I have to be careful right now… it can be an echo chamber of sadness and stress. The news I’ve found that is the most informative, most accurate and least stressful is the PBS News Hour.

Guard your spirit. Find a place and a way to keep your heart full, your #EyesOpen and your compassion alive. This is not a sprint… it’s clear we are in this new world of COVID for a while. #WeNeedYou so please protect yourself in body, mind and soul.

https://www.medpagetoday.com/infectiousdisease/covid19/85438

#WashYourHands

Posted on March 28, 2020 by marylbrandt

And then there is this fabulous video! Stay safe, friends. WASH YOUR HANDS!!!

If you are starting the think you might be depressed, or that your brain is out to kill you, here’s what you do…

Posted on May 5, 2018 by marylbrandt

The following is an “unrolled” Twitter feed from Mark Reid, MD on depression. It’s solid, important advice that I thought should be shared. Dr. Reid is an internist from Denver, who is very active on Twitter as @medicalaxioms. He is also the author of Medical Axioms, a delightful book of medical wisdom

Interview with Dr. Reid about @medicalaxioms

If you are starting the think you might be depressed, or that your brain is out to kill you, here’s what you do:

1. Find or call your primary care IM of family MD. When you call for an appointment and they ask what for, say “depression.” Notice how the scheduler doesn’t flinch. They get this call 4 times a day!

2. When you get to the doctor, and they ask what’s wrong, just say, “I want you to do those screening tools on me to see if I’m depressed.” Let them do their thing. If they say you’ve got it, let them tell you how meds and counseling work. Let them tell you what they know about pills and which one might help you. Decide together if pills are worth a shot. Tablets really work for some people.

3. You also need a counselor. Ask the MD for a referral. That might work. If not,

4. Go to your insurance and find out their preferred providers for counseling. I suggest you pick someone your same gender. Counterintuitive for some but works better for many.

5. If that doesn’t work, go in the internet and type in counselor or therapist and the name of your town or city. Read ratings and reviews. Cross reference them with yelp. Look for someone nearby who writes a bio that sounds okay. Figure you’ll see them once a week and it will cost $100. Give them 4 tries. If you don’t feel like you are getting anywhere, ditch them and try again. I’ve seen 3 people in the last 10 years and in retrospect I can rank them.

6. With tablets and shrinks, the trick is resolve. If they aren’t working or give side effects, don’t just quit. Try again. Different shrink. Go back and try a different tablet with your MD.

You can feel better and you are worth it. You deserve it.

There’s lots of other stuff that helps some people: support groups, sobriety, exercise, sleep hygiene, self help books, spiritual practice, ALANON. If your shrink is any good they will recommend this stuff and know something about it.

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To add a few more comments to Dr. Reid’s advice….

Depression is a disease, not a failing. You wouldn’t judge yourself for a sprained ankle. This is the same…. except for one thing. The disease of depression includes not being able to objectively see what’s going on. That’s why it’s so important to get started on treatment.
If you are a medical student or resident, counseling is available for you and it’s free. The same rules hold, though. If the first person you see isn’t helping after 3 or 4 visits, it’s ok to make an appointment with someone else. This is not personal and you don’t have to worry about “hurting their feelings” any other consequences.
The National Suicide hotline is 1-800-273-8255. You are loved. You matter. This is a disease not a failure. Please seek help.

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Ebola, Personal Risk and Our Trainees

Posted on October 12, 2014 by marylbrandt

Around the world, Ebola and other infectious diseases take the lives of mothers, fathers, sons and daughters … and place at risk those who care for them. This risk is known to all who choose medicine as their career. It is part of caring for the ill, and always has been.

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“A healthcare provider has an ethical and professional duty to address a patient’s needs, as long as the patient’s diagnosis – or when the patient’s initial complaint, on the face of it – falls within the provider’s scope of practice. Refusing to do so is not consistent with the ethical principle of beneficence. “ Twardowski, et. al. RI Med Jl October, 2014

Around the world, physicians, nurses, and all healthcare workers willingly fulfill their duty to care for patients who are or might be ill with Ebola and other dangerous diseases, reflecting the altruism and compassion of those who choose medicine for their career.

Emory Nurse ‘Could Not Be More Proud’ of Those Treating Ebola

Ebola doctors sacrifice all to bring hope.

However, the duty to care for these patients does not automatically extend to those who are learning medicine. Without the experience, context and well developed skills of established providers, trainees are potentially at greater personal risk.

When I operate on patients with HIV, Hepatitis, or any blood-borne pathogen, I take every precaution possible for myself and the staff who are scrubbed. I also take advantage of the “teachable moment” to discuss ethics and universal precautions with my trainees…. but I don’t allow medical students or junior residents to directly participate in the case. Likewise, I am sure that learners will not be allowed to provide direct care for patients known to be infected with Ebola or other dangerous diseases… or to travel to West Africa for clinical experiences while the epidemic is still present.

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All of us in medicine honor those who provide care to the ill despite the risk …and we thank you for the example you are setting for those learning to heal. We hold our colleagues in Dallas, Atlanta, Africa and around the world in our thoughts as they work tirelessly to heal the sick and contain this terrible disease.

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Here’s a list of aid groups working on the Ebola crisis — and how to donate

Top 10 ways to survive (and maybe even enjoy) being on call

Posted on June 10, 2014 by marylbrandt

Like our residents (but not nearly as frequently), my group has started taking “in house” call. For every one who is currently or has been a resident, this is an experience we all know…. and one that’s hard to describe to those that haven’t experienced it. Spending 24 hours on call in the hospital can be emotionally and physically draining, but it has moments that make it a special experience, too.

There are ways to make the experience easier. Here are my top 10 ways to survive (and maybe even enjoy) being on call:

1. Drink water. Put a water bottle in the lounge refrigerator, drink from every water fountain, put your water bottle next to your computer, or come up with other ways to stay hydrated. If you want more flavor, bring a zip-lock with cut up lemons or limes to put in your water or add a splash of fruit juice.

2. Be kind. No matter how stressed or busy you are, knock on every patient’s door and enter their room with the intention to help. Sit down or put a hand on their arm when you are talking to them. Smile.

3. Take breaks. On purpose. No one really expects you to work non-stop for 24 hours and it’s not good for your patients. Deliberately stop to do something else every few hours, even if it’s just for 5 minutes. Go outside for a few minutes for a short walk to catch some natural light and breathe some fresh air. Get a good cup of coffee or tea, listen to some music or just sit. If you want something more active, climb a few flights of stairs, stretch, or even do a light workout.

4. Eat well and eat often. Do not rely on fast food or the hospital cafeteria. By far the best plan is to bring really good food from home. You need to have “comfort” food on call. If you don’t cook, buy really good prepared food that you can look forward to. Make sure you have “plan B” ready if your call day gets completely out of control by having an energy bar (my favorite is Kind bars), peanut butter sandwich or other “quick” food in your white coat pocket.

5. Be part of the team. Notice and encourage the unique camaraderie you share with everyone else who is on call. It’s a small “band of brothers” who find themselves in the hospital at 3am. Be kind to each other, help each other, and use this unique opportunity to get to know someone you might otherwise not get to know.

6. Wear good shoes. If you are in house for 24 hours, bring a second pair that’s completely different (clogs and running shoes for example). Ditto socks. Buy really good socks and change them after 12 hours if you can.

7. Use caffeine wisely. It’s practically essential for many of us at the beginning of the day, but beware trying to “wake up” with caffeine after 2pm. Not to mention that if you “caffeinate” all night, you’ll have that sickly post-call-too-much-caffeine feeling in the morning.

8. Take naps. Any sleep is good sleep on call. If it’s possible, 20 minutes will make you more alert and effective in your work.

9. Make your beeper a “Zen bell”. Use your pager or phone as a tool for mindfulness. When it goes off, take a deep breath, relax the muscles in your face and shoulders and be present. This is a proven practice to decrease stress – try it, it works!

10. Learn. Take advantage of the unique educational opportunity of being on call. The fact that there are fewer people around at night and on the weekends has a real impact on how and what you learn on call. If you are a student or junior resident, you are more likely to be the first person evaluating new consults and admissions. You are also more likely to have one on one time with your senior resident or faculty as you care for patients together. If you are further along in your training, the “down time” on call (if there is any!) is a great time to catch up on reading.