What repeated trauma without healing can do to a health care worker—and how to establish a new and healthier “normal”.

Therapist and client talking through trauma during therapy session

When someone asks you, “How are you doing?” your instinctive response is probably to say, “Oh, I’m okay.”

But let’s be honest. Many of us are not okay. The pandemic has taken a toll on all of us in the palliative care field. We were asked to care for people who were seriously ill with COVID-19 and provide support to their families, all while grappling with our fear of a deadly virus that could harm not just us, but also our families. And after an initial burst of support from the public, the appreciation dwindled. But we had to keep working.

It’s understandable that many of us are showing more wear and tear than usual. We may not be able to “get back to normal,” but we can take steps to help ourselves establish a “new normal” that’s healthier than where we are now.

Acknowledge the reality of the stress effect of trauma

The stress that so many of us are experiencing is different from the burnout that was previously fairly common among people in the health care field. For some individuals, the stress of COVID could have even pushed them into the DSM-V diagnosis of Posttraumatic Stress Disorder (PTSD). Being aware of the symptoms of nightmares, flashbacks, irritability, and hypervigilance should alert yourself or a colleague to get an evaluation by a professional.

Recent research tells us that there’s a compounding effect in trauma, raising the risk of PTSD and the severity of the diagnosis. If you experience one episode, then another one, you increase your chances of PTSD. As we worked through multiple surges of COVID, our risk stratification rose with every surge.

"It doesn’t help that we can’t avoid the hospital or other stress triggers. We’re expected to return to the scene of our trauma over and over again."

It doesn’t help that we can’t avoid the hospital or other stress triggers. We’re expected to return to the scene of our trauma over and over again. We have to enter the rooms where our patients died of COVID to see even more patients with this virus, again and again. We have to care for them, suppressing the feelings we are experiencing. We have to brace ourselves and summon all of our training, all of our compassion, while people all around us have decided that the pandemic is over. We have to face our triggers every day.

Go back to the basics

Trauma and the healing process for that trauma are very complex. But going back to the basics can help us navigate the rocky waters of recovery. As a palliative care clinician and a psychiatrist, I’d like to offer a few ideas for colleagues to focus on as they heal from this unavoidable trauma:

1. Your diet

Are you eating, and if so, are you eating three meals a day? Is your diet comprised of nutritious foods?

2. Your sleep habits

Are you getting enough sleep? Too many physicians try to make it on five hours of sleep per night, but that may just not be enough. Make sure you’re well-rested. That might mean starting an evening meditation to help you wind down before bedtime, or making an honest re-evaluation of sleep hygiene and getting rid of bad habits (like doom-scrolling through your phone at night).

3. Your priorities

Are you finding meaning in life? Are you engaging with those who are important to you, and activities that bring you joy or give you a sense of satisfaction? Many of us stopped doing those things during the pandemic, but it’s time to rediscover and prioritize them. Finding meaning in life will help you stay grounded.

Simple endeavors like journaling or exercise might help you, too.

Find a buddy

In the military, soldiers have battle buddies who check in on them, making sure they have their helmets and other vital equipment. We could take a cue from them because the work we do as palliative care clinicians is very emotionally heavy—having a buddy could go a long way. They can check in with you and identify signs that you’re exhausted and running on fumes. They can help you identify when it’s time for a break. And you can do the same for them.

Do you have a friend or team member whom you trust to check in on you—and to be honest with you in their assessment of your mental state? If not, it may be time for your team to talk about how to monitor each other for signs of distress.

Seek care for yourself

In my psychiatry training, we were encouraged to seek out psychotherapy for ourselves, so we would be less likely to let our own issues color the care that we provided to our patients.

There’s a significant emotional component to palliative care, and that can weigh heavy on you as the clinician. So you, too, may need to find a mental health care professional who can help you cope with the strain and recover from the stress of the pandemic. When you can do that, you can rediscover the satisfaction in the work that you do.

Not sure where to start? You could try your employer’s Employee Assistance Program (also known as an EAP), which likely offers free and confidential, short-term counseling sessions and makes referrals for ongoing care and follow-up services.

Take a break

In palliative care, we need to take care of ourselves so that we can keep providing this critically important care to patients who need it. If we are run down, exhausted, and burned out, we can’t do that.

Professors take sabbaticals to give themselves some time and space away from the classroom so they can focus on their development. If your stress or trauma is disruptive to your life, it may be worth even considering taking a sabbatical from your work as a palliative care physician.

I realize that this could be a shocking suggestion to some of you. But let me explain. I would much rather that you take a break for six months or a year and then return than that you leave the field of medicine—and palliative care—altogether. Our field is small, and we can’t afford to lose anyone.

Give yourself grace

Ultimately, you have to give yourself some grace. The last two years have been incredibly difficult for health care providers in general—and palliative care in particular. You may not be the same person you were before the pandemic began. You may look the same, but you’re not the same—not really. You may need to pay extra attention to your emotional and spiritual health going forward. And that’s okay.

"Trauma and the healing process for that trauma are very complex. But going back to the basics can help us navigate the rocky waters of recovery."

Three Sheets of Newspaper
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