A dialogue that recognizes imperfection, and encourages diversity…

It is so important to view our community of peers, colleagues and patients as individuals.  We are all human beings sharing the same world but holding very different experiences. Beyond the updates of everyday life, everyone has a story to tell. We hear from our friends, our peers, and our colleagues everyday, but it takes practice to aside differences, judgements and pre-conceived notions we may have and it’s often difficult to share without the fear of being judged.

After several conversations, I’m sharing of few unique stories, highlighting different reflections. By sharing our stories, we experience first-hand the strength and courage it takes to be vulnerable. Let’s celebrate unique stories and engage in a dialogue that recognizes imperfection, and encourages diversity.

“I spoke to a retired physician; for her “success” was getting up in the morning and baking muffins every day. Everybody has their own definition of success and it’s always changing. I don’t know if I’ve figured mine out yet. I had to redefine what success meant to me in terms of leading a balanced healthy life, and being happy rather than having my definition of success based on my academics. My previous idea of success helped me get to where I am, but I think my new idea of success will get me to where I want to be. “ EM, QMed 2019

“Me going to med school wasn’t all joy for my parents. Don’t get me wrong, my mum screamed like a little girl when she found out I got in. But they wanted me to be home, and this is me being gone. She loves me so much it hurts her. And it fills me with a lot of guilt, because she’s sick; I want to be taking care of her, but instead I’m far away learning how to take care of other people. I mean its all okay, but yeah. I’m very all or nothing, this was an all.” – QMed 2018

“Piano is my first true love. It is a way that I can express myself and bring the music to life in a way that I feel like it should be showcased. When I play Chopin, the music speaks to my soul, and with him, it only gets better with age. Whereas, when I play a prelude by Bach, I know I have to completely focused in order to appreciate the intricacies and perpetual motion of his pieces. I started playing piano when I was five years old and was able to work towards working at a diploma level. Through undergrad, I unfortunately wasn’t able to play as much as I was use to, but I still find solace in being able to sit in a room all by myself, and do something I love and am good at. It is the perfect way to recharge.” LS, QMed 2020

“Over the years, as I made my academic pursuits a priority, my hobbies of camping, painting, and music were put on hold. But now, I haven’t gone camping since high school, my comfort level with a paintbrush has diminished, and I am musically challenged. I think it was necessary for me to feel what it was like to have all of my eggs in one basket. Now, I realize the silliness of it and I feel as though I am trying to make up for lost time.” – SW, QMed 2019

Success. Guilt. Love. Priorities.  Everyone has a story to tell. By focusing on the individuality, the diversity and the various stories of the people in our surroundings, we quickly realize that we are not alone.

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Find yourself a Failure Friend

The article « Failing Up and Failing Better » by Sara Gray published on CanadiEM on Nov 22, 2017 outlined 5 Steps « to fail up ». The premise of the article is that failure is inevitable, so let’s accept failure and learn to fail.  The author outlined 5 principles of failure which included: 1) accepting failure, 2) breaking the silence, 3) excellent self-care, 4) learn and teach about it and 5) taking care of each other.

These principles are incredibly important as we progress further into our medical training. Take a look at this article for more information: https://canadiem.org/failing-failing-better/

It is so important to know how to support one another and debrief.

A few key pointers on learning how to debrief:

  1. Ask for permission: friends and peers may be going through a similar learning process. Debrief is most effective when friends/peers have the time to listen. Friends want to be able to listen and be present but it’s difficult to do so if they’ve had a challenging day themselves.
  2. Just the facts: Outline the story in it’s entirety to provide context to your listener. Provide your listener with context and an understanding of the situation. This allows a   “set-stage” for your emotions, and your thoughts.
  3. Express emotion: There is strength in vulnerability, and finding someone that can be your “failure friend” is key. Take the time to be honest with yourself and to find someone you can truly be 100% honest with.
  4. Learning, not finger pointing: Once you’ve processed all the facts, the emotions, reflecting on your triggers, your stressors and learning from the experience will facilitate the learning.
  5. Be present: We should aim to support, and be present, as we would expect to be supported from our own friends and colleagues; let’s be present and open-minded.

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Burnout isn’t a dirty word

Note: You can see our blog post defining burnout and its symptoms here, and a post on one strategy to cope with it here

In pre-clerkship, I would have told you that I would be able to recognize burnout in myself and my colleagues when it happened. Because, of course, based on the statistics, it would happen to some of us someday! I would have told you that there are many things that can be done to mitigate burnout, and that I, of course, would do them. Get a good night’s sleep, go home when you’re told to go home, make sure you’re eating right, take time for yourself. The thing is, clerkship came, and it just wasn’t that simple. With CaRMS hanging over our heads, we didn’t say no when we didn’t have the energy. We said it’s okay, I don’t mind staying when our preceptors suggested we go home after ten hours at the hospital. We didn’t get eight hours of sleep, we missed meals, we missed workouts, and either missed or were half present during time with friends and family. We filled our “free time” with studying, research projects, and other extracurriculars. We sometimes did, but definitely didn’t always, take the time to unpack complex emotions or debrief after the first time we were part of a code, or a patient died, or we observed a medical error with awful consequences.

We did talk about it. We discussed how difficult it was. We knew, and we tried to take better care of ourselves. We continued to remind each other why we are doing what we are doing. For the record, I don’t think burnout dominated our experience of clerkship. I think most of us would agree that clerkship was an incredibly rich, unique, amazing experience that we feel privileged to have undergone. I do think though that many (most?) of us experienced symptoms of burnout at some point or another during clerkship.

I didn’t notice my own symptoms at first, because they didn’t come out in the clinical setting. Maybe my patients were affected to some degree, but I actively worked to prevent that. I carefully monitored my thoughts and feelings towards patients to ensure that I wasn’t feeling compassion fatigue. What I didn’t realize, however, was that compassion fatigue can manifest in your personal life too. For me, it shone clearly through in the way I treated my family, friends, and partner. After a long day of seeing suicidal or psychotic patients in the emergency department, or listening to and empathizing with oncology patients, or even just seeing coughs and colds on an urgent care shift, I had nothing left. When my partner, parent, sibling, or friend needed someone to just empathize, something that had always been one of my best qualities, I didn’t have the energy to listen. I found myself annoyed with the people I loved for burdening me with more problems, when all I’d done all day was listen to other people’s.

I guess what I’m trying to say is, they’re not kidding when they call burnout insidious. The early symptoms probably happen to all of us, at some point, in some way or another. And it’s TOTALLY OKAY to admit it. Burnout isn’t a dirty word. I’d like to say I’ve figured it all out, and that I can impart some sort of wisdom upon you all to prevent it and/or fix it. But I can’t. I don’t know the answer to this problem our profession wrestles with. My friends and I have all changed, in mostly good ways and a few not-so-good ways, from our first year in the clinical setting. It’s been an incredible experience. Now, I’m actively trying to recognize when I’m feeling symptoms of burnout and create a better balance in my life to help me cope with them. I’ll let you know if I come up with something revolutionary. In the meantime, I’ll direct you to www.thehappymd.com , a site I’ve used to learn about burnout and educate my family and friends on what I’m feeling.

 

OMSA Wellness Retreat 2018: Wellness of Mind, Body, Spirit, Emotion

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Click on the follow link to view the Retreat Brochure:

Wellness Retreat Brochure

There is an exciting lineup of speakers and workshops at this year’s retreat.  See the attached brochure for details, where you’ll find options on everything from Yoga and Urban Poll Walking to Mindfulness-based Stress Reduction and Self-Care.  This retreat is open to medical students across Ontario! Mark the registration date on your calendar (March 5 at 5 pm) – it’s first come first serve with limited spots for each Ontario medical school.

Event Date:                  March 23-25, 2018

Cost:                              $90 per student for the entire weekend (incl. hotel & meals)

For more info and to register, check out the OMSA Wellness Retreat page: https://omsa.ca/en/wellness-retreat

 

A light reminder

winter-63801_960_720It was day five of my first surgical rotation in clerkship. A Friday in November – another day on the wards and in the OR. Waking up at 5am and getting home after 5pm; arriving to and leaving from the hospitalin darkness. I adjusted to my new schedule well. I was going to bed early, meal prepping and coming to the hospital each morning with a positive attitude. I had a gym membership and was going regularly. It seemed as though my self-care was optimal. I thought that I had finally figured it out – the way to prepare myself physically and mentally for the responsibilities of clerkship.

This Friday, however, I had a slight change in my schedule. I was invited by a couple friends to eat my meal-prepped lunch in the hospital cafeteria. As soon as I walked into the cafeteria, my mood improved significantly. At first I wondered, why was this the case?  Things were going well and I felt great. What drastic of a change could have improved my mood to such a degree? Then I realized, it was the first time that I’d seen the sun all week!

It’s that time of year where the days are getting shorter, and sunlight is scarce. Making time to see the sun significantly improved my mood and made me feel energized for my last day of the week.

It is well known that sunlight is important for vitamin D production, ultimately lowering your risk for breast and prostate cancer as well as promoting bone strength. More recently, preliminary research has linked sunlight exposure to improved mood and a reduction in depressive symptoms.

Therefore – I challenge all those reading this post to make sure they make time to take a look outside at least twice a week; either through a window or by exiting the hospital or clinic for a few minutes on a break. It is a small change that can give you the extra boost you need to get through a long day or week!

 

BAKING THERAPY

On coping: There’s no doubt that medical school is stressful – in fact, there’s no doubt that life is stressful. We all have our ways of coping with stress. Mine, for better or worse, is probably the most mundane imaginable: I love to bake. I will admit that my love of baking verges on obsession. Maybe even addiction. Between exploring new recipes and actually making the pastries, I will procrastibake for hours. Hours. When I get the itch to bake something, I will rearrange my entire schedule to do so. I have been known to run home from clinic at lunch hour to mix up banana bread batter. I have been known to show up to friends’ houses with half-baked confections and say “I’m going to need your oven, stat.” I have even been known to skip social engagements with nothing but a “sorry, I’ve got to make a pavlova!” The creativity of choosing what to make and finding the perfect recipe, the methodical process of putting the ingredients together, and the satisfaction of a beautiful outcome are nothing if not therapeutic. (Disclaimer: Not everything I bake turns out, sometimes it’s a mess that I either salvage by turning into something completely different or toss out and start over). And I think we can all agree that coming home to a house that smells like fresh baked cake/muffins/scones/cookies is incredibly comforting.

On the origin: This is not a new thing. As a child, one particular illness kept me out of school for months. My mother recalls that she couldn’t get me out of bed for anything – not to play with my siblings, not to see friends, not to even watch movies. But I would agree to get up to make cakes almost every day. She tells me that after a couple of weeks, she had given cakes to all her friends as well as filled our deep freeze, and had to beg me to stop.

On actual science: And get this – my baking therapy is literally evidence based. Talk about validating!! Turns out tons of people, with and without mental illness, use baking to help cope with day-to-day life.  Many psychologists encourage baking, and some mental health centres even incorporate it as a component of therapy. Unfortunately, while the literature is generally in agreement that daily expressions of creativity, including baking,  can increase positive affect (Conner et al, 2016), there hasn’t been any research directly into the positive effects of baking on mental health.

On art therapy: I honestly hated art class as a kid. Straight up, I was bad at it. I can’t paint to save my life, and good luck getting me to draw anything more than a stick man. I took piano lessons for years and the learning process was akin to pulling teeth. Fortunately, I realized as I got older that the concept of art isn’t limited to fine arts and music. ANY kind of art is therapeutic. What I’m trying to say is, baking is my art therapy equivalent. Maybe your passion is painting, or drawing, or singing, or dancing, or writing, or photography, or knitting, or doing logic puzzles, or any other of an endless list of creative pursuits. I wrote this blog post in part as a reminder that it’s possible to reap the psychological benefits of art without having a talent among the traditional arts.

On what I do with my baking: People always ask me this. As if I could actually eat everything I bake. I give it away, of course! I bring it to work, to school, to birthday parties (or any party really), and to friends and family. Sometimes I freeze it (my roommate and I bought a deep freezer last year, and it is always full). Usually there’s not much left to freeze.

Picture1You didn’t think I’d actually write a post on baking without including a recipe, did you?! This cranana bread is foolproof, moist, banana-y, and actually pretty healthy as far as baked goods go:

3 overripe bananas (seriously, wait till they’re pretty much black all over), mashed

2 eggs

1 ¾ cups flour (whole wheat and all purpose both worked fine)

1 cup brown sugar

½ cup vegetable oil

¼ cup milk

1 tsp baking soda

1 tsp vanilla

+/- 1.5 cups cranberries

Combine oil, eggs, sugar, milk, vanilla, bananas. Add baking soda/flour. Combine well. Fold in cranberries. Pour into greased loaf pan and bake in preheated 325 degree oven for 1 hour. Sprinkle brown sugar over top, cook for 15 more mins or until top/sides golden brown and toothpick comes out (mostly) clean.

You are worth it – Self Worth

While writing blogs about wellness on a superficial level (travel, reading, meditation,
exercise, and nutrition) is not something I’m particularly good at, I do have a knack for
unpacking deep insecurities and life lessons. Life is complicated to navigate, and too often do we try to push away from our problems. Facing them head on is terrifying.
This isn’t to say that travel, reading, meditation, and nutrition are by any means poor uses of our time. They take care of our body and minds. When you are in a good place – liking yourself, liking your path, and planning your time effectively to take breaks from rewarding work – they are no less than absolutely wonderful.

Unfortunately, the world has twists and turns. And, all of us have deep insecurities and
questions that we are afraid to ask ourselves that manifest in challenging ways. My
weekend involved a family emergency instead of going to the wellness retreat. It’s odd, but it was exactly what I needed to be well. For me, going to the retreat would have been
treating a symptom instead of my disease or running away.

My weekend instead opened my eyes to two concepts effective altruism and free will.
Effective altruism is my pretentious way of saying – how do we actually do right in the
world? What does it look like to actually help someone? This is something I ask myself all
the time. I figured out this weekend that it was because I didn’t feel like I had worth unless I was helping. If I couldn’t help other people, I was no good. I don’t think this outlook is uncommon in the physician community. We work so hard to learn so much to help with the hope that makes us worth something.

But, self worth is interesting too. It isn’t something that anyone can give you or take away. People can hurt you with the words they say, but it is only when you let yourself take hurtful words to heart and ignore the compliments that you spiral into the vortex of
worthlessness. A state of mind that is a self-fulfilling prophecy. The narrative goes “I am
worthless, I can’t do anything, I won’t try because I’ll fail, I’m not doing anything, See? I am worthless” etc.

As a self identified helper, sometimes I pull myself out of this with the thought of other
people – they are worthwhile and I can help them. Then, I will be worth something. But,
this isn’t true.

  1. You are and I am worth it. I don’t know what “it” is exactly, but we are worth it. We
    matter and so do our voices, thoughts, and the potential we all have to love.
  2. The only person who can give you self worth is you. It doesn’t matter how badly I want to carry your pain for you. Or how many times I compliment you. You have to believe it. You have to carry and conquer your own pain and insecurities. You can and should ask for help. And other can offer it and ask you the right questions, but *you* have to choose to accept that help and help yourself. This might be terrifying. How can any of us do something we’ve never done, get out of that hole, or deal with the new trauma that we are sure is too much this time? And I think the answer is to be brave, to persevere, and to know that if you can learn to conquer your own adversities that you open yourself to entirely new realms of self worth, confidence, love, and wisdom. And, maybe even a deep, unshakeable happiness that no one can take away – the things that, in my opinion, make life worth living. And when you think how can I be the one to do it? How can I be sure that I’m enough? That trying won’t make it worse? The answer is because you are human. Therefore, you are resilient, strong, and with generations of ancestors before you who learned these lessons in their lives. And, they are all with us – their memories, triumphs, and failures – always. Moreover, these are the lessons that everyone around you wants to learn too. As high school musical made so clear “We’re All in This Together”. It won’t be easy. It’s the hard thing, but that’s why it’s the *right* thing.
    It’s easier to avoid it – turn to some kind of drug, screen, or other person to make it better
    for you. They might dull the pain for a while, but they aren’t your solution. You are.
  3. The only way you can help someone is if they want help. In the same way you can’t force anyone to take their pills, you can’t force anyone to talk about their feelings, conquer an addiction, find their way out of depression, or face their insecurities. You can’t yell the solution at them either because the most meaningful solutions are the ones we find for ourselves. If we all took to heart the lessons from history and the stories we hear, there wouldn’t be anything left to learn. Maybe the world would be perfect by now. But we have our own journeys, our own lessons, our own perspectives, and our own truths. And most importantly we have our own choices – our free will. When you feel stuck, you can always choose to get out, to get off that path and forge a new one. You are not trapped. And you are not alone. And then on the other hand when you’re trying to help someone else, make sure they want your help and that it is to achieve their goal. A wise person told me “I would never take away someone’s struggle”. And it’s true. Conquering our adversities is what makes us strong and good. Taking that away from someone – their free will, autonomy, and responsibility – might be the worst thing you could do, even if it comes from a place of love and kindness. So the hard thing, but the right thing is to let them learn for themselves. Be there. Ask questions. Offer advice when asked. Don’t carry their pain. Don’t solve their problem. Don’t take away their struggle.

Just some thoughts to share on a difficult day. Good luck making the world better. Still
trying to figure out what that looks like.

What is Burnout Anyway?

Motivation-au-travail-410x218.pngWe always used the words “I’m so burnt out.” No one really defined this for me until one of the speakers at the Wellness Retreat spoke about recognizing physician burnout. For those of you who want a quick summary, here are some resources I found online:

First of all, burnout is chronic and is associated with workplace-related stress.

1) This article talked about the signs and symptoms: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072470/

  • Exhaustion – Being both mentally drained (unable to cope) and physically drained (pain, GI symptoms)
  • Alienation from work-related activities – Finding your workplace increasingly taxing, distancing yourself emotionally from it
  • Reduced performance – Affects everyday tasks at work, being pessimistic about being there, hard to concentrate

2) So what order do these happen in?

This one-pager was useful for categorizing it into stages: http://smhp.psych.ucla.edu/qf/burnout_qt/3stages.pdf

  •  Stage 1: Stress Arousal
    • Ex. Persistent anxiety, persistent irritability
  •  Stage 2: Energy Conservation
    • Ex. Overconsumption of coffee, increased procrastination
  •  Stage 3: Exhaustion
    • Ex. Chronic headaches, wanting to move away from family

3) This PowerPoint made by Dr. Yaman at the University of Pittsburgh was also helpful to clarify how it progresses: www.pitt.edu/~super7/4011-5001/4121.ppt

Dr. Yaman cited a paper by Edelwich et al. (1980) on the five stages of disillusionment

  • enthusiasm -> excited for your job
  • stagnation -> working but becoming detached
  • frustration -> question the value of the job
  • apathy -> defend against frustration
  • intervention -> can occur at any stage to prevent/treat

4) So how do you mitigate the situation?

Dr. Yaman also discusses ways that burnt out physicians can intervene for themselves:

  • self-assessment and determination of stressors
  • specification of life priorities
    • valuing yourself and recognizing that not all demands made upon yourself can be met
  • sharing and expressing feelings
  • alleviating stress at work by focusing on positives and small successes
  • setting goals (daily, weekly, etc.)
  • breaks and variety in daily schedule
  • using a team approach to decrease counter-productiveness

Interview: mindfulness in the medical curriculum

Medicine is always thought of as one of the most stressful careers. Therefore, achieving a good balance in life is a milestone we all strive towards – in order to cultivate our fullest potential and be our best self. Mindfulness meditation is one example of a path that can help us pursue our passion for medicine without the associated stress.

To explore this further, Jennifer DCruz, University of Ottawa MD2019 Candidate, interviews their pre-clerkship coordinator, Dr. Heather MacLean, about her thoughts on practicing mindfulness as a Neurologist, and integrating it into the curriculum for all pre-clerkship students.