Self-care in Residency

I lingered for few minutes as I stood transfixed totally awe-struck by the beauty of the magnificient sunset. Then I realized that I had been too busy to even have time to watch one of the free wonders of nature, the sunset.
It is so easy to get carried away by the sense of urgency that pervades our busy lives that we miss out on the simplest pleasures of life if care is not taken.
For doctors in residency, especially interns, it is so easy for all the excitement of getting into residency to gradually become a blur or fade into oblivion. That need not be your story. Hence, the purpose of this article.
There is a lot of discussions on avoiding burnout. I remember that was a whole lecture during our residency orientation.

 I have a long-term affair with libraries. Hence one of the places I located when I started residency was the library. I had gone in to the hospital to study when on my way out, I discovered the library actually has books that are non-medical. It is a real library! I exclaimed to myself. So I paused and lingered a bit on that aisle that took me by surprise. There were a lot of self help and motivational books. However, my eyes caught this particular book titled " Burnout : The Cost of Caring " by Christina Maslach. She said and I quote that "In many of my research interviews, people said that  the first bout with burnout was likely to happen in the first few years of one's career". I found this interesting because it only means that interns are particularly at risk. Since the intern year is usually the first job for most doctors.

Physician burnout is like an invisible force that 'drain' well meaning people who set out in their lives to do no harm, having sworn to the hippocratic oath. We all know this is an oath of ethics doctors have historically taken for years on end. However, when care is not taken, the very people who set out with good intentions for their patients stand the risk of causing them harm one way or another either as a 'near miss' or as an error. Nobody wants that. Hence, the grave importance of paying attention to the practice of taking action to preserve or improve one's own health. It is crucial to take active role in protecting one's own well-being and happiness, in particular during periods of stress, which pervades residency.
Allow me digress a little as I was particularly fascinated by the content of the modified version of the hippocratic oath as at 2019 that I came across while putting this blog post together. It states that:

"I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will protect the environment which sustains us, in the knowledge that the continuing health of ourselves and our societies is dependent on a healthy planet.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help".

The last time I read or spoke aloud this oath was several years ago during my induction as a doctor, and as I read it again, I basically got goose bumps because, the contents are not for a timid soul. Being a doctor comes with great responsibility such that to be that quintessential doctor that every patient would love, there is a need to pay attention to being sure that we are in the right frame of mind in all ramifications of life. Being the good doctor who is "hippocratic-oath-compliant" would require a person who is more than willing to take personal responsibility to first look after himself or herself. The truth remains, that you cannot give what you don't have. It is not possible to  pour from an empty cup.

Whether we like it or not, at some point in our professional journeys,  we would be faced with stress. Hence the need to talk about practical ways to deal with these stresses life would confront us with so it does not take a negative toll on the entirety of our lives as a whole.

Good self-care is key to improved mood and reduced anxiety. It's also key to a good relationship with oneself and others. It is perhaps the panacea for the exhaustion that is commonly associated with working in a high-pressure work environment like the hospital. Tell me who doesn't want that?
Here are some of the things you can pragmatically do to avoid  burnout and actually self-care. They help maintain a balance between stress and calm:

Deliberately take walks.  You will come back from work very tired. My advice is to wash your hands( especially if you work in the hospital you have to be obsessed with doing this already), wash your face. Put on your walking shoes and just move it. Your body would resist it initially, your legs will protest, your brain would make you believe it is irrational because you are physically tired, but eventually, as you take those first few steps, as you take those couple of breathes of fresh air into your lungs, gradually your legs would follow the rhythm of your gait, your brain would apologize that "well this isn't a bad idea after all, I almost robbed you of this bliss". Then you might be able to monster a smile at the end of the process. All I know is that it is not the same individual who walked out that door that returns. Then you could go shower, eat dinner, bond with family, read if you can and sleep. Self-care done! You are so rocking this and your program director would be so proud of this resplendently energized resident that has emerged.

Have a simple workout routine as basic minimum. It could be just 25 squats a day. I would take that over nothing. Half bread is better than none. It could be just 50 jumping jacks. It could be a short while with the skipping rope which by the way is just a dollar at the dollar store. I know there might be the temptation to give excuses that you do not have time to go to the gym. Create your own "gym" right where you are.

Eat healthy. Do meal prep. My residency program during our orientation did a great job of making us have a team building session that was a meal prep activity. It was really nice. Apart from the fact that I had enough tasty meals prepped ready for several weeks, it was a wake up call on the importance of meal prepping during residency in order to have optimum nutrition while outside the walls of the hospital because the hospital provides food at work.

Sleep well when you are not working. For someone who has worked crazy busy shifts back in England. I remember a particular season I was working at the acute care unit, taking calls while about seven months pregnant with my first child and working really hard because nobody really cares you have a bump, they just want you to do your job and deliver you must! One thing that perhaps saved my life was sleep. I never joked with my sleep. Don't either. Don't binge watch Netflix till the wee hours of the morning when you should be sleeping, you will pay dearly for it. Do not cheat nature . Do not underestimate the power of your beauty sleep. I resist the temptation to talk about the sleep cycle and the pathophysiology of sleep.

Connect with family and friends. You definitely need your social support. You need your village at this crucial moment in your life. This is not a time to start acting all grown up and maintaining a distance from your family while using work as an excuse. Arrange to meet up with a friend or group of friends. The love and support of family members helps an individual to cope with the emotional demands of work.

Do not abandon your hobby. Do what you love doing? For me, obviously, I am still blogging! I know many people who medical school took a lot of talents and hobbies away from them. Don't allow residency do the same to you. They say to stumble over the same stone twice is a proverbial disgrace.
Never give informed consent for this to be your portion.

Listen to relaxing music.
Music therapy is proven effective in stress management. On my interview trail, during the residency application process, I came across a Program director who mentioned to me some kind of music deemed "the most relaxing song on earth".
The song is "Weightless" by English ambient music band, Marconi Union. ... Dr. David Lewis-Hodgson of Mindlab International explains to Inc. that "Weightless" "produced a greater state of relaxation than any other music tested to date," dropping participants' anxiety rate by 65 percent.
“Without music, life would be a mistake” ― Friedrich Nietzsche.

Have a massage. This a great way to compensate yourself for all the hard-work you put in. You definitely deserve it. Just call for your own synchronized body massage today and revamp your life. Unpaid free advert alert...

Invest in some essential oils and body lotion.  They have really calming and soothing effects. In fact I walked into a body shop once and came across a bottle of natural essential oils body lotion that practically had "Stress Relief" written on it. A very useful aromatherapy resource you should consider investing in. To be honest, it works wonders plus it has an amazing smell. Mind you, this is again an unpaid ad. Just sharing useful tips that I found helpful with others. I am not a selfish person. Take a trip to the nearest body shop to your domicile today.

Put on some yankee candles. One of my friends gave me a very lovely yankee candle as a parting gift just before I moved for residency and I am loving it. It is always so nice when I lit up a number of candles. Yes, I am now officially a yankee candle collector! Yankee candles do not have to necessarily connote romantic things, this is simply romance with yourself in form of self-care.
You can try to light some candles too. Apart from the fact that it is relaxing and you get a great ambience and you also get to reduce your electricity bill. It is a win-win situation.

Read a book. You either buy highly recommended books or re-read your favorite ones. Or better still get a library registration. Sometimes the most important thing to do in a day is it to try to take a rest between two breaths, and a good book would help you do that really well.

Show genuine concern for your colleagues. Be willing to help by stepping in with comfort and support in whatever way you can. Maybe just checking in to say hello or simply helping to answer questions they might have. You are the early warning system for burnout for your mates. If any of your colleagues suffer a burnout, it is on you. Just kidding. However be your brother's keeper or should I say be your 'sister's keeper'.

Avoid Binge-watching Netflix. I mentioned this earlier and now just reiterating it. I have nothing against Netflix. In fact I have a list of movie- backlogs that I need to clear, but one of my personal rules for residency is to try not to binge-watch season movies because one way or the other, you will pay dearly for it. In that, you are decreasing from your regular daily sleep quota. I tried it in the past, it felt good in the moment but afterwards, I did regret my actions. You can watch a couple of episodes, then place a personal embargo on any more.

Lay your own bed. This is a rare or outrightly weird form of self-care. How can making my bed ever be a form of self-care? Let me explain.
If you make your bed every morning you will have accomplished the first task of the day. Making your own bed will also reinforce the fact that little things in life matter. Those little things that the stress of work so easily snatch away from us. Making your bed might be a small accomplishment, but it's very important because it sets the tone for the entire day. This is a great form of self-care. Make your bed today!

Ensure you hydrate throughout the day. Always grab a bottle of water before  you head out of the door. Drink lots of water. Cut down on or avoid caffeine if you can. Don't allow residency turn you into a caffeinated person. Coffee is okay but don't become a coffee addict. Drink water.

Never skip breakfast. Breakfast is the most important meal of the day. I do not think it is an economic strategy by the cereal manufacturers to make more money. Think twice next time before you skip breakfast.

I have talked about a number of things which I continue to find really helpful. I hope you make of paramount importance your own self-management and personal care. Never forget to take time out to listen to the tweeting of the birds, the chirping crickets or perceive the smell of the beautiful flowers, to feel the breeze blow across your face.

Residency is not a 'sentence', it is a pathway to greater things to come.
The way most residencies are designed, it seems like a sinusoidal curve to me. In which there is this season of crazy, mad, busy patch of the rota and then a 'cooling' down season. You need to take advantage of this. That season when it seems like work is chilled, take advantage of it. Visit fun places, bond with family, take time to cook your favorite cuisine since you know that might not happen again till the next 'cooling season' which could be another month. However, I would rather take something than nothing. That is the smart thing to do.

In other to avoid burning out from the stress of our daily lives in the fast lane, there is a great need to make of paramount importance self care. Deliberately reseting our whole being. The key to prevention is early action. Putting the right measures to reduce your risk of burning out. An ounce of  prevention is worth a pound of cure. I know it is easier said than done, but at least Try! 
Fuel your tank and never run on empty.
Who will help the helper? Just look in the mirror - Yourself!

“Almost everything will work again if you unplug it for a few minutes…Including you.” –Anne Lamott


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