„I give back the unhelpful feedback, it reflects on you, not me“- When your supervisors fail you

As always, in memory of Chloe Abbott and thinking of her wonderful family.

With thanks to Power Living Yoga and credit to Laura Ellen for the cover photo.
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In yoga today, the teacher Cherry had us visualise ourselves on a wooden raft, cherishing every breath of salt air, reveling in the sun and the sea. As the meditation ended, we directed our sails and let the wind take us toward our destination. We accepted the uncertainty of our futures, that some things may take longer than we expect and committed to being present and valuing each other here and now.

I haven‘t been writing much on Doctor‘s are Human. Neither has Brooke. We have each been swallowed into work holes of our own. My year has not been difficult with workload, nor unrealistic hours or expectations. Rather it has been difficult due to interpersonal clashes and the impact on my mental health.

I own my part in these clashes. I do not show much emotion on my face, unless I am comfortable with the people I am with. I am intensely socially anxious and shy, which means being comfortable takes time. I also think the blank face is part of my engrained invisibility act – when I am not comfortable, I use a tiny voice, I turn myself blank and make myself small and hope noone will see me. Without question, authoritarian alpha- doctor environments are places where I am uncomfortable and I have no clue how to fit in.

I have a habit of becoming distracted by my phone in meetings. When I am sitting at the back of a clinic room, sedentary and relatively unengaged I struggle. I fiddle. I squirm. I worry that I am missing something- from the dv group, on medevac, from work colleagues. So I check my phone.

No patients were harmed. I doubt any patients cared. But doctors did, they thought it was disrespectful and I was disinterested. I own this and commit to changing. The simple act of ensuring I am fully present in the space I am in, a deep breath, intensely observing the people around me for a few moments, has already almost cured me! Those actions were symptoms of a restless, unsettled mind.

Yet I have been the victim of a duplicitous disingenuous supervisor, who used these faults, not to provide constructive feedback but to try and ruin my career by actions behind the scenes, while smiling sweetly to my face. In her opinion, I am so socially inept and insightless that I shouldn’t be around patients, especially those with difficult and complex conditions.

The impact of working with this supervisor was phenomenal, especially given that up to a week ago she was only sickly sweet to my face. Sitting in her presence, watching her be kind and caring to patients, left me questioning myself – what do I do that is so awful? I let myself down an anxiety spiral culminating recently in panic attacks and intense suicidal ideation. As the panic increased, my „disinterested“ behaviours probably worsened, but I was no longer self aware or in control.

Other supervisors and „supportive“ doctors have amplified the abuse, by relaying her assessments without question. By adding criticism. By making minor sins insurmountably large and unforgivable. By letting their friendship with one another reign paramount, drawing me into a web of power from which I could not find an out- no action, or apology that could set things right.

Yet I am 32. I have done years of psychotherapy to reach here, flawed and vulnerable as I still am. Yoga has been vital for me too. It has taught me to forgive myself and accept my humanity. It has taught me that none of my actions will ever define who I am. Yoga has helped me to see people around me with kindness and compassion- anyone who isn‘t self aware is suffering in their stories. It reminds me to focus on what I can control, and I cannot control what other people think or what evils they commit.

So those supervisors can think what they think. Here and now, I forgive myself. I look at the frightened child within me. I hug her and tell her, „you are safe and I love you.“ I lovingly tuck her in bed. She won’t be coming out so much anymore. I create space to move forward and turn away from the web that entangles, condemns and does not forgive.

I take useful lessons from this experience. I take the constructive parts from the advice I have been given. The rest I hand back to these leaders, as projections of their own flaws and limitations.

You are disorganised is a lapel pin.

You are too slow is a belt.

Your behaviour is inappropriate over and over without reprieve is a cream that lathers all over their skin.

You are socially inept and should not be around patients sits in their hearts as a heavy rock. It is not me. It is not mine.

Part of me looks upon these flawed doctors kindly, saying they are human and imperfect too. I should forgive. Another part of me says, how dare you? 3 of my colleagues killed themselves in 2017, as many have before and since. How dare you perpetuate an authoritarian patriarchal system, in which I am an cog not a human, and which allows the abuse of power to the detriment of workers and patients. How dare you blindly judge misfits in this system and call this judgement feedback. You need more misfits at the top of medicine: feminists, lgbtqi and other races. These people will innovate and improve. Old white men and the women that emulate them keep medicine frozen in the early 20th century. Make no mistake- systems take a long time to change, but this is only true because powerful people hold change back.

Here I am, on my raft, embracing my uncertain future and committed to love and forgiveness for myself. One day this experience will be a blip in the distance, a challenge I surmounted. Instead of hatred for myself, I turn to my friends in gratitude. I re-focus, with them, on protecting women and children from domestic abuse and a complicit system. I re-focus on efforts to help the refugees treated so cruelly by our government and on supporting Indigenous Australians, the disabled, the mentally ill, the impoverished and otherwise disenfranchised in any small way I can. I re-focus on genuine action on climate change.

I don‘t know what heavy seas await me, but here I am, as I am – brave, kind, flawed but learning.

Everything. Will. Be. OK. ✌️🥰🍀🌞

Me and my favorite people in the whole world…

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The relentlessness of life and the insanity that results from poor self care – what do you do? #exhaustion #burnout

Doesn‘t life seem relentless? I‘m the last person who should be saying this, I have no children, no mortgage, nothing other than work (and my work isn‘t even busy) and things I engage in of my own choice. Yet, I still feel like I am running a never ending marathon. I complete a task, whilst adding 3 more to my list. I never sit back in satisfaction at a job well done. Self care, if it occurs, has to be meticulously scheduled and even so, other tasks eat into the scheduled time. 

Often I find myself thinking: Is this how life is supposed to be? 

Rushing about harried, till one day I am old and crippled and cannot work any longer. 

Brooke and I have neglected this page this year. In reality, I relied excessively on her enthusiasm for blogging, whilst I dipped in occasionally. So, when she chased her urological dreams and started a job that had no room for the basic requirements of life, the regular posts lapsed. Also my desire to keep up the weekly wonderpost, where we shared our reflections every week and tried to maintain some wonder and gratitude, dissolved after the nsw state and federal elections. Everything that filled me with wonder, was also tinged with horror – look at this photo of a giant gas bubble in the Siberian permafrost, when it bursts it will contribute to global warming and our extinction. Hooray! 

Then in the wake of the election, whilst I knew from hard lessons that self care was essential for emotional wellbeing and intellectual function, I found myself prioritising so many things above self care. Everything seemed so important: things threatening the wellbeing of loved ones close by, actions important to ward off human extinction, work, projects and meetings important to progress my training so I can do more, be more flexible, wield more influence. 

One of my senior colleagues, a kindred spirit, went on holiday, switched off and took that family time even though she knew it was „selfish“. Me, I said, „no holidays, I must sacrifice myself to achieve every…single …thing.“ Where has this left me? With much more difficulty sleeping, feeling on edge with heart palpitations and frequently so overwhelmed that I don‘t want to get out of bed to face the day. I can‘t think logically because my amygdala takes over and all I can do is panic and feel like a failure. 

So, it turns out self care is important. I need to exercise, return to yoga, take time for myself to drink a coffee whilst smelling the salty air by the seaside. I am privileged, as if I was disciplined I could probably find fifteen mins every day or a few hours on a weekend. However to do so,  all my activities must be efficient. For instance, I might consume the news by podcast whilst washing my clothes and replying to an email, but for others efficiency won‘t stop the children demanding attention or the phone call from the hospital at 3am. So I wonder how they do it?

Since social media is always on, always flashing with new stories, ads and outrage, I need to take care to be mindful- turn off my phone and notice that I am drinking coffee by the seaside. Actually listen to my family when they talk to me. Don’t mistake me, I love social media, but it certainly isn‘t good for my mental health. 

In this second half of 2019, I must recentre myself and reprioritise to keep myself sane. I can only do my best as one small human, as pressing as all the problems facing humanity are. If I take a small break, I will come back and everything will still be there and I will be in a better head space to cope. I am one small human. I am one small human. I am one small human, and that is OKAY. 

I know I will improve transiently then fall back into the same bad habits again, need these same life lessons again.

So many of you juggle so much more than me. How do you cope? How do you maintain your sanity with ridiculous abusive work expectations, a crazy hoard of kids to look after and other demands on your time? 

We doctors are human, working within a system that could destroy you. Lessons in self care from a PGY7

Hi all. We are now well into the clinical year and I thought I would share some of my “wizened 32year old” “7years into medical training” wisdom around self care, self respect and setting boundaries, especially since the news cycle has turned away from Miko’s story, with minimal immediate change, and in the wake of several horrific deaths which are sure to affect many of us. Some of you will be wiser than me and won’t need this advice, but when I pitch these blogs I remember by 21year old self starting medical school and my 25year old self as an intern. I also find so much value in the reflections of my colleagues, such as Imaan Joshi and Nikilinit Avtar, and I hope that I, in turn, may be similarly useful for someone else.

Now, I’ve had a tough few weeks. Why? I started a new job (it is an extremely chill job, but a change in routine none the less), I discovered, yet again, that public transport by bus is pretty sucky AND as usual, I zealously over committed myself outside work, a common problem for me since my Mum let me fly from the coop. They were important things and I wouldn’t take any of them back. Yet my body sadly demands 8-9h of sleep per night, whilst I often try to get by on 5-6. Last week, for the first time, I either ate out or had microwave meals all week. By the end of the week, I had constant tension headaches and my brain was not working (no point trying to engage in anything remotely intellectual). Plus, when I am tired I am so, so miserable and cranky. I am often like, “The world is ending. I will never recover. Everything is always terrible. Then 24hrs later, oh wait guys… false alarm. I totally just needed a good sleep.” Clearly, I’d taken it too far, yet again, and my body was crying out for some rest.

I am not complaining. I was mostly doing fun stuff, as opposed to all of the Mikos out there working a run of nights then days with minimal turn around time or on call and sleeping on site followed by the usual day shifts, with much of the labour unpaid. Moreover, I shouldn’t complain if I know I will repeat the process next week quite deliberately. Rather, over time this continuous cycle has made me more aware of my limitations and physical and spiritual needs. Previously I resisted the crash with mental self flagellations: you are not good enough! You must do everything! Stop whinging when Muslims have just been murdered in Christchurch! You did not get up to swim at 5:30am, you are a failure and will get fat! If you hide to recharge your introvert batteries you will be alone forever! Etc etc. Now I have more respect for my body. I listen to it, instead of battling against it. For instance, last week, to my infinite disappointment, I was so tired that I chose to sleep in instead of going to swimming at 5:30am. I felt better for it. I ensure I have a balanced diet, with plenty of vegetables and protein and let myself have the occasional treat, whilst keeping the inner body dysmorphic voice from making me too guilty. If I want to binge, I know it is usually a sign that I am tired. (I often binge anyway). I prioritise activities that allow me to recover, such as sleep, yoga and pleasurable hobbies, rather than seeing them as dispensable.

My work and energy for advocacy are more sustainable, because I stopped fighting my body. I have the blessing and curse of being highly emotional. I take the tragedies of others and the injustices of the world to heart, so that I spend a lot of time alternately angry and heart broken (especially with our current government and the current world).  Yet at the same time, I know that I am one person, with limited power, and that institutions change at an agonisingly slow pace. Working with Doctors for Refugees, I found the passing of the Medivac bill, then the despicable efforts of the current government to render that bill ineffective, excruciating. Yet, I know I am unhelpful to refugees if I collapse in a heap. Rather, as Stephen Young, Illawarra Greens convenor, taught me: I should try to focus on the things I can control and change. At the same time, I need to celebrate the small victories: the fact the bill passed at all and that the tide of opinion is changing on boat arrivals. At the same time, my heartbreak was valid and shared with many and I should accept and acknowledge that, rather than actively suppressing it. I should take time for self care, so that I can recover from genuine distress, even if it means setting boundaries regarding watching distressing news coverage and logging into social media for a few hours.

These thought processes and behaviours aren’t easy or automatic. I am still working on myself and it is so easy to slip back into old habits of disregard for my own needs; my most recent example, accepting poor treatment from men, which is deleterious to my self esteem and happiness. Moreover, all of this is easier for me than for other doctors. I have essentially chosen a “research fellow” position, which is bludgy, compared to a clinical job, and involves no after hours shifts or on call. It is essentially a “paid” year off. This was a deliberate choice so I could prioritise myself and my happiness, instead of being subjugated to the tyranny of medical training. Frankly, I made this choice because I was on the verge of quitting altogether.

However, longevity is important for all of us, regardless of career and life goals. Moreover, there seems to be a culture of glorifying over committing and self sacrifice in medicine, as though we are not human. The older I become, the less I am sold to “delayed gratification”. As current and future surgical, O &G and anaesthetic trainees know, the path to accredited training positions is long, the training potentially longer and if delayed gratification continues till consultanthood, one risks losing too much of the rest of life (kids, families, hobbies, precious friends). Brooke lost a precious friend last year. One of our colleagues just lost a precious sister in frankly horrific circumstances. At nearly 32, I have seen far too many suicides and deaths to cancer in young friends and colleagues.

At the AMA doctors in training committee, we work to improve the system, whilst more cynical older advocates remind us that the health minister is happy to say nice things for the media, whilst avoiding substantive change (because effort and time) and the colleges and HETI need to be dragged along as dead weights for the smallest benefits. In these contexts, we working within this system need to look after ourselves and each other. We need to value ourselves, our loved ones and to resist being engulfed. This isn’t telling you to quit when the going gets tough. Rather, I see it as essential for longevity in a system that causes us ongoing “moral injury”. If you are in a position similar to Miko’s, following my advice is pretty much impossible and all you can do is hold on for dear life. In fact, I admire your courage and commitment to medicine, because I never had that in me. However, please look after yourself physically and spiritually in any way you can. Set boundaries. Listen to and respect your body. Don’t forget your loved ones. You work in a system that would replace you in a heart beat, but you are also more than your job. You and your wellbeing are important.