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This post is a follow up to last week’s post, “The Flames Of Burnout Have Risen Again. FI Makes It Worse.”
I thought it would be beneficial to share with my readers some of the emotions and personality changes I noticed as I once again fell into the grips of physician burnout at the end of the last year and beginning of this one.
If you are beginning to notice similar feelings and personality changes you may find yourself getting burnt out as well.
Much like a charred piece of wood cannot return to its original form, it is hard to magically transform yourself back to your pre-burnt out self.
Therefore it is vital to try and nip this insidious process in the bud as early as possible before irrevocable damage is done.
Because work begins to feel like a living hell when you are in the midst of burn out, it is quite fitting to take a similar approach when I try and convey my burnout journey.
My circles of burnout hell differ from Dante’s in that there does not have to be a chronological divide between the circles.
You can find yourself in multiple circles at the same time.
It was also a judgement call on which circles I thought were worse than others and some I felt were on equal footing.
Burnout Circle 1: Resistance is Futile.
As referenced in the “The Flames Of Burnout Have Risen Again. FI Makes It Worse” post, the end of the year typically has a marked uptick in imaging studies, particularly mammograms.
In that same post, I also revealed why the end of 2020 was particularly awful because of the influx of extra studies that were previously displaced due to the COVID lockdown.
It was probably in my 2nd week of straight mammography that I started feeling like keeping up with the onslaught of studies was futile.
It truly was a demoralizing realization.
Despite my best efforts, the list never seemed to decrease.
It truly felt like I was fighting the mythical hydra, where I chopped off one head and 2 would take its place.
[Perhaps the tale of Prometheus is more apropos given the natural link between fire and being burnt].
In order to keep up with this I ended up employing a technique that caused me to enter the next circle of burnout:
Burnout Circle 2: Self-harm.
Now I do not want you to jump to conclusions and assume that I was entertaining any suicidal thoughts/actions as a potential course of action.
Nothing could be further from the truth.
Unfortunately, however, there are many physicians that have indeed committed suicide because of burnout.
No, my form of self-harm was far less drastic but nonetheless still damaging.
Because I was constantly reading study after study, I barely had time to step away from my chair.
Although the effects of being sedentary are insidious, there can be long lasting implications.
I had to consciously remind myself to flex my calves every now and then (similar to what is recommended to do on long-haul international flights) to help ward of potential for developing a deep vein thrombus.
Every day I go to work, I bring a 64 oz container of water that is the goal I set to drink during the work day.
Whether it was a conscious decision or not, I found myself drinking less water (I really do think I just did not drink much water because I was constantly dictating studies) which provided the “benefit” of not having to go the bathroom and thus take away valuable time which I could be interpreting and dictating instead.
I know I must have done a number on my kidneys during this time as it was not unusual for me to go a whole work day without taking one bathroom break or if I do take a , usually one maximum, bathroom break, the urine would be a darkened color.
During lunch I would wolf my food down while still looking at studies.
Certainly not an enjoyable way to eat food but it was it was.
Another phenomenon I became aware of during this hectic time was that I was no longer sleeping well through the night, most notably Sunday night.
I found myself tossing and turning in bed and waking up in the early morning hours (often multiple times from 1-4 am).
Sometimes I was able to go back to sleep.
Other times I was not so fortunate.
My mind was often racing in my semi-awoke state.
It did not take a genius to know that the culprit to this was that I was anticipating what laid in store for me in the upcoming work week.
Which leads us into the next circle….
Burnout Circle 3: Feelings of Dread.
This truly was a new feeling for me.
As bad as some periods of work could be in the past, I never dreaded going into work regardless of whatever modality I had to read that day.
But this was different because again it felt like no end was in sight.
I finally realized the beauty of our previous arrangement of alternating modality coverage schedules.
Anything is tolerable for a week.
Much like having a palate cleanser between courses in a fine dining establishment, this former schedule allowed me to wash away any bad taste of the previous week.
Without variety, which is indeed the spice of life, I was stuck in the doldrums of the reading room constantly having mammogram after mammogram populate my screen (I do tend to pick on mammogram reading a lot because it is the study that taxes my visual acuity the most).
My morning commute was filled with dread as I anticipated what laid in store for me that day and I couldn’t wait for the evening commute which I did often mentally exhausted.
Burnout Circle 4: Changes in Personality.
It should come to no one’s surprise but sleep disruption, neglecting basic body needs, and higher levels of stress from working full tilt is bound to have some mental/emotional repercussions.
I became less and less tolerant to minor issues that routinely crop up in an average workday.
I was definitely more irritable throughout the day.
I had to check myself after snapping at a tech if something was not quite right or keeping communications with staff to an extremely terse statement via our work instant messaging system.
I’m afraid to say that sometimes my office manager took some of the heat when she was tasked to notify me of last minute coverage changes that were not in my favor during this month plus of hell.
The worst of this was the two times I had the day I was supposed to be off taken away from me at the last possible moment.
One time I got a text early in the morning on my “day off” saying I had to come in that day as the coverage guy was unable to.
Another time I was notified the afternoon prior to my day off which was particularly problematic as I had planned several phone call meetings etc that ended up getting compromised.
She started off by saying, “Don’t kill the messenger,” but it was really hard not to.
I am quite fortunate that I am relatively isolated in my office with my door closed because often a tirade of cussing would emanate from me as I continued to see the worklist grow despite reading at my limits.
It truly was reminiscent of how my personality changed during my surgery residency before I switched to radiology.
It was an incredibly difficult situation at the time but ended up being the best career move for me.
It would be a lie if I said the thought of quitting and finding a slower paced opportunity or one that may provide a better lifestyle, such as teleradiology, never crossed my mind.
Burnout Circle 5: Spreading wildfire.
Much like a natural wildfire, what started out in one area can spread quickly into adjacent areas.
Unfortunately my bout with burnout did not just relegate itself to the workplace.
How can I enjoy activities at home when I crossed the threshold still mentally taxed from the day’s events?
One of the things I was quick to notice was that my desire to write posts for this blog vanished.
There was a time when I could not wait to put thoughts to paper and share with the world.
I had built up such a huge reserve of posts that at one point I could have stopped writing new material for months and still have 3 new posts a week published.
That buffer quickly evaporated during the end of 2020 and beginning of 2021.
Last week’s Flames of Burnout post and this one were written just days before the posting deadline.
Blogging, unfortunately, no longer moved me.
I soon began rationalizing ending this blog altogether:
- Low pageviews on a published post? Why are you putting yourself through this. Just quit and save yourself the headache..
- Lack of interaction with audience/no comments? Just quit and save yourself the headache.
You get the picture.
It is a constant struggle right now with both the devil on one shoulder and angel on the other chirping in my ear (I will let you decide which of the two is the one encouraging me to continue blogging.)
For the first time I shared these thoughts with someone else (my fiancee) who was saddened by the thought of me ending my blogging journey.
Obviously right now pressing on with blogging is winning, as evidenced by this post.
Just don’t know how long I can stave off the alternative choice.
It is definitely mind games being played courtesy of my burnt out state.
Burnout from work just sucked the joy out of life at work and at home.
If left unchecked it could easily progress to the next circle….
Burnout Circle 6: Friendly Fire.
I consider myself incredibly fortunate that I was able to not let burnout impact my duties as a father and interactions with my daughter.
I know that this is not often the case with others who may unleash their anger on innocent bystanders after having an awful day at work.
I reminded myself to listen to and address problems my daughter had while not dismissing them as trivial compared to the problems/inner demons I was experiencing.
One saving grace was that I found myself rapidly decompressing whenever I interacted with my daughter, be it playing video games with her, cycling, or even watching her learn to drive (she just got her learner’s permit in December).
Burnout Circle 7: You Can’t Unburn Toast.
Like I predicted in my previous post, once the new year was upon us, volumes did trend downward from the record highs of winter.
The strangest thing happened though.
I just so happened to start out the new year wrapping up my 3 week stint with mammography/X-ray/Ultrasound.
Each day I felt no difference from what I was feeling in December.
I was still miserable and mentally taxed with all the personality changes described above in full effect.
At the end of one particular grueling day I just happened to do a tally of the amount of studies I had read.
Lo and behold, it came to a number that would have been considered a slightly slow/normal day in the past.
But here I was still feeling burnt out.
Much like the healing process, recovery from burnout is not as simple as flipping an on off switch for the inciting factor.
This is indeed the residual effects of burnout, almost like mental scar tissue.
As part of “making it up to me” for the previous schedule from hell, it was arranged so that I could be on the CT/MRI schedule (which I enjoy) for 2 weeks straight.
It took until the beginning of the 2nd week before I started feeling a semblance of normalcy return.
COVID-19 has impacted many lives including those of healthcare workers.
It has gotten to the point where some of the psychological effects healthcare workers experience are akin to individuals suffering from PTSD (post traumatic stress disorder).
I won’t go as far to say that is what happened to me, as I am truly not a front line healthcare worker who has seen unspeakable atrocities from COVID firsthand.
But I definitely know what I feel would be classified as burnout in any sense of the word.
If you feel like you are currently in any of the above circles, there is absolutely no dishonor seeking help.
As mentioned in my previous post, I have notified the president of the board who is acutely aware of my situation and trying everything to make it right.
I am keeping my fingers crossed how this hopefully gets resolved in 2021.
At the time this post goes live, I will once again be immersed in a week of mammography, so wish me luck.
Have any other circles of burnout I may have missed? Are you experiencing burnout that was exacerbated by COVID? Please share in the comments below.
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