Tag Archives: self-care

Physician heal thyself…

And nurses, counselors, therapists, caregivers, social workers, case managers, community health workers, teachers, first responders, peer outreach… in short any person who spends their time (work or volunteer) opening themselves to the experiences of others’ suffering. In a recent continuing education exercise, I was asked to examine myself for resilience and potential risk of compassion fatigue. The simple act of participating in the exercise and completing the assignments for the course reminded me of the very great risk that people in caring roles face of suffering from the “cost of caring.” Amy Cunningham speaks of this beautifully and concisely in a Ted Talk, describing what this cost can be and toll it takes (link in the credits below, totally worth the viewing).

Many of us who work and volunteer in roles of service have adopted the philosophy that self-denial in pursuit of career, advancement, and the care of others is to be admired. Self-sacrifice is applauded and rewarded. Going above and beyond is the expectation. Adding insult to the expected self-injury is that we are frequently also required to be above the consequences or be able to physic our own resulting ailments. To a certain extent, I can agree with admiring dedication and industry. A good work ethic is absolutely to be admired. However, there is a fine line between a good work ethic and good self-care. I occasionally use that line as a jump rope (more about that later). For those of you in the caring professions, and a few of you who are not,  you have likely heard the term “compassion fatigue.” You may also have heard this described as secondary traumatization or vicarious trauma. What many people think of when folks talk about stress related to caring for others is burnout. I want to tell you now, that these are different concepts, related but decidedly not the same.

As caring professionals, we frequently are exposed to the traumatic experiences and information that can be shocking, depressing, or even devastating just being exposed to it, hearing it, visualizing it, and empathizing with the victims in our care. Empathy is one of the most important tools of the caring professions, but there is a cost involved in being empathic day after day. Repeated exposure or even just one event that triggers some recognition or identification becomes a lived sensory experience that transports the care giver into the realm of the victim. Some professionals begin experiencing symptoms of traumatic stress, much like those of the people who have been involved in critical incidents or crises. Different than counter-transference where the experience mirrors or parallels experiences from their own lives or triggers emotional reactivity in the part of the caregiver because of personal history, they respond with stress related symptoms purely out of empathy for the situation of those they assist. The frequency or intensity of just experiencing the trauma through the eyes of the individual they are helping is sufficient to trigger signs and symptoms. This is compassion fatigue. It is not my intent in this post to give all the specific signs and symptoms of traumatic stress, but in broad strokes, it has physical, cognitive, behavioral, emotional, and spiritual impact. It can impact relationships. It can impact efficacy as a professional.

Ok… I hear you saying, “but that sounds a lot like burnout.” Here is the most significant difference: Victims of burnout have gotten to the point that they just want to give up. They have nothing left to give, no space to absorb. They have exhausted their energy, empathy, and passion, like a bulb that was used until failure or a battery run past minimum charge. The way most experts in this topic differentiate between compassion fatigue and burnout is that people who have gotten to the point of burnout frequently no longer want to practice their profession or calling. While compassion fatigue results in risks for the professional and their clients due to potential boundary concerns and difficulty managing the stress they experience, burnout can lead to the loss of empathy and resentment towards those for whom they once cared. Professionals and volunteers with burnout can become callous and appear uncaring or harsh. It can result in errors of omission in services rendered and potential harm to patients or clients.

The important piece of this puzzle is that neither of these conditions are unavoidable. Taking the appropriate actions in self-care, consultation, and support can provide preventative measures to avoid the pitfalls of vicarious trauma and even help bring caring professionals back from the brink of burnout.

Insight into your own needs and responses can be the best preventative measure. Watch for your own signs of drowning: Irritability, sleeplessness, dread going on shift, numbness to any and all emotional content (personal or professional), rumination and inability to let go at the end of the day, fatigue, isolation, using (or abusing) alcohol or drugs… You know your own signs best. Self-awareness is the best primary defense, but when we fail to see our own symptoms, it is good to have the buddy system. Friends, family, colleagues are often great at noticing when you are “not yourself.”

Over the years, I have gotten to be much better at spotting my own particular signs of distress (and knowing how to combat these signs). When my natural defense system is on emotional overload, I fall back on my introversion and a combination of task and avoidance oriented coping (You thought task and avoidance would be mutually exclusive, didn’t you?). When I start running a tad low, I tend to become more task-oriented, workaholic, and isolating. I avoid situations and people that require my emotional presence. I tend to shut people out if it isn’t work related, and I let things go that are my best forms of self-care: Running, gym time, sleep, meditation, and play… yes play. Adult or not, we all need recreation. It helps us rejuvenate our cognitive processes. But when I’m overdrawing my emotional and empathic accounts due to work or personal stressors, these self-care processes always seem to be the first to go. I know myself well enough (after, the unspecified number of years I will admit to being on the planet) that I recognize when things in my life have gotten out of hand and I have reached that aggregate limit. When this happens, I try to fill my time and avoid any activities that might let my mind drift to the very topics or memories that hurt… and yet theses topics and memories are likely the very ones that probably need most to be taken out, examined, and processed. With that self-awareness, I also know that timing is key. If I push myself too soon, it doesn’t serve the best purpose, but if I leave it too long, my self imposed exile becomes way to comfortable and I won’t want to rejoin the world. This is where that support network comes in handy. Friends and colleagues who know me best are also the best at dragging me back out of any caves I might crawl into and encouraging the self-care I’ve probably been neglecting.

For you, my readers, I encourage an honest self examination and evaluation. Be ruthless. Be thorough, and try to recall how you handle critical events and times of intense stress. Evaluate time and outcome. How did it work? List the coping strategies that you have in your toolbox, and objectively determine whether they are truly helpful or maybe not so much.

Prevention is a keystone to good health and good mental health. Restorative and preventative exercises can divert compassion fatigue from become burnout. It is important to get rest, exercise, nutrition, and time away from constant exposure to shared trauma and the histories that recount horrific occurrences. Most jobs and deployments have leave or paid time away. It is there for a reason. Take a break. Use that time. Most importantly, it is crucial to have appropriate training, refresher courses, supervision, and/or consultation. Carrying the burden can get extra heavy, and consultation (or supervision) provides ethical opportunities to identify and address challenging aspects of situations that may trigger stress. It is important to employ your ethical decision making model and engage with colleagues who can be objective and provide good clinical counterpoint. Professional colleagues can often provide support to each other and offer insight when we get overwhelmed in our own empathic response.

Lastly, I would encourage those of you out there caring for others to remember your own natural supports: Family and friends. We often have to be concerned with confidentiality, and we also wish to protect the ones we love from some of the things we see, hear, and experience. However, don’t shut them out. You need not share details of information gained under the cloak of privacy and confidentiality (or when the story is just too terrible), but you can share your own feelings and fears. You can explain your own reactions without having to give details of the stimuli. Stay connected to humanity, especially your own. That can give you a life jacket to prevent drowning in empathy, and regardless of the proverbial command in the title, it is completely unnecessary to heal yourself.

Amy Cunningham presents on Ted Talks, Drowning in Empathy. http://edu.ava360.com/drowning-in-empathy-the-cost-of-vicarious-trauma-amy-cunningham-tedxsanantonio_d7a4359c8.html

 

In the event of explosive decompression…

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So, as it happens, I was having a discussion with a friend… Ok, the discussion was an overestimation of the amount of contact I get to have socially. It was email. I admit it freely, but there was back and forth and all of that… and what was I saying? Oh, yes… so, I was having interactive commentary electronically with my friend about self-care. Hmmmm… well, now, that is just a little sad. So much of my interactive contact lately appears to be via technology… <sigh> It is better than nothing at all, I suppose. I think that somehow we have become incredibly polarized in our modern western society about what constitutes appropriate levels of caring for oneself vs. levels of that self-care becoming selfishness and self-centered disregard for others. The problem seems to be that we have become as hyperbolic in this continuum as we have in opinions and the expression thereof. Happy balance seems to be something that people struggle with universally.

I’ve touched on some of the issues previously (See previous post on Living Life Without Giving a F@$%), and a friend of mine has often talked about the art of being considerate and having some manners… or the sad fact that consideration and manners seem to be remarkably absent from too many of our daily interactions. There are so many ways we’ve lost the art of just interacting with the other humans and individuals that share space with us in a non-damaging way. The excuse I hear too often is that we live in a fast-paced world where antiquated social conformities have no place… or “they were rude to me first”… or “I don’t know them and probably won’t ever see them again.” These are horrible excuses. Who cares if it is a perfect stranger? Does that give anyone the right to be a complete jerk? I don’t think so, but I digress. I think I’ve also touched on the paying it forward philosophy at some point as well. You may never really know how your effort to be polite, kind, or just smile at a stranger might actually impact them in a way like the “trickle-down” effect made multiple individuals have a better day than the one that started for them. It could happen. And… not really where I was going when I started this… so…

I guess what prompted all of the musings and ponderings and interacting via email was that somehow for a good many people in my social and professional sphere, the pendulum has swung very far the other direction. For a good many people I know, the prospect of doing even the smallest thing for their own pleasure is riddled with guilt. They have fallen into an abyss of abnegation where they are unable to perceive their own martyrdom. Yep, that’s what I said… martyrdom.

Honestly, it isn’t that martyrs in history were so very bad. Hell, many of them were granted sainthood… until they were decannonized or whatever it is they do to remove them from our calendars. Great sacrifices in the cause of their faith, the well-being of others, or various acts of rectitude earned them the honor… usually posthumously, which seems a bit of a shame to me. Seriously, if these folks are such pillars to be idealized to advocate for the rest of us poor sinners… wouldn’t it have been nice to have their example around for a bit longer? Just a thought… Anyhow, I didn’t mean to take this into an ecclesiastical place that will likely get me in trouble with the various organized religions of the planet. That wasn’t really my intent. I guess what I am saying is that saints and martyrs for the most part are rare. It’s true. I suspect that there are a good many aspects of those lives may not have borne well under the scrutiny of modern media or social media where privacy is non-existent… BUT those lives were exceptional, which is all to the good. It doesn’t mean that all of us should live those same austere lives of sacrifice. In some ways, it is not only unhealthy… it’s pretentious.

We are all human… well, I’m making an assumption, y’all feel free to examine that point for yourselves, but I strongly suspect that if you are reading this… you are human. Most human beings are not actually set up for sainthood. Not saying that it couldn’t happen given the right circumstances, but we are programmed for survival and to that end, we are programmed with needs and wants and all that jazz.

I’m going to let you in on a secret… There is absolutely nothing wrong with that… provided of course that it doesn’t actually harm or interfere with someone else’s needs, wants, and all that jazz. The whole idea of self-sacrifice to the detriment of one’s own well-being ultimately results in one outcome: YOU WON’T BE THERE TO HELP THE NEXT TIME.

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Yep. That is what I said. I’ll let you in on another secret: There are a lot of other people, employers, and entities in the world that are perfectly willing to let you sacrifice everything. To put no finer point upon it, they will use you up and find another one just like you. It sounds harsh when I put it that way, and I by no means am trying to say charity is wrong or a waste. I’m just saying that giving and caring starts at home… frequently with oneself. There are those in the world who adhere to this particular maxim a bit too stringently. Those people are the ones who are living their lives without giving… well, you know. However, it isn’t so much that they live their lives without inhibitions due to external judgment, but some of them live their lives without consideration for others or the feelings/rights/expectations/etc. thereof. They do what they want, when they want, say what they want, and they don’t care who it impacts, hurts, or even destroys so long as they receive what they wanted. That is the far end of that spectrum opposite the saintly souls who never pay attention to their own wants or needs and frequently sacrifice either or both to accommodate those of others.

NEITHER OF THESE EXTREMES IS HEALTHY OR SOMETHING TO WHICH WE SHOULD ASPIRE. There. I said it. It took me over 1000 words, but the idea is a balance. That happy medium thing I typed earlier. People need to think about and have some consideration for the other humans around them, but that includes themselves. Everyone should engage in regular self-care. This goes beyond the general eating, drinking, breathing, and sleeping. It also means that there should be opportunity to engage in enjoyment. Aside from nourishing the body, each individual should also nourish the soul… or psyche if you prefer. That means that there should be activities in life that enrich and… just make you feel good (obviously respecting the same rights of others and the various laws of the land… the fact that I have to put that in there is annoying but some people would take it too far). It also means that when a person takes the time to engage in those activities, there should not be the overwhelming guilt of “Oh no, I shouldn’t be [laughing, reading, coloring…insert other life affirming and enjoyable activities] because… reasons.”  The reasons are immaterial. Everyone needs to have some pleasure in their lives. Our brains and bodies need the chemicals that are produced when we experience pleasurable sensations. When we deprive ourselves of that chronically, it can be as detrimental as depriving the body of nutrients or sleep. We function better as human beings when we feed our bodies and our psyches with the things that enrich us.

There are a lot of people in the world that are totally out of practice with this concept. They have been put in positions where self-sacrifice has become the norm. Self-sacrifice occasionally is not an unhealthy concept. In fact, when we love others, we frequently put their needs above our own. However, when it becomes an all-the-time situation, it is no longer healthy. It can even become detrimental to the care of those individuals we love. Occasionally it is not even in their best interests due to fostering dependency or setting them up for false senses of entitlement. Sometimes the idea of setting boundaries and engaging in the occasional self-indulgence is so foreign that when it happens, the guilt become unbearable. If this is the case for you, dear reader, it’s possible that you have lost the ability to have fun and enjoy your @#$%. I prescribe a consistent program of regular fun and daily self-care until it becomes less foreign. Doctor’s orders. If you are struggling for ideas, reach out to a friend… I’m betting they have some ideas or at the very least can brainstorm over chocolate ice cream (or chardonnay or… you get the idea). You have the absolute right to be the star of your own show and have some fun without the guilt leeches trying to suck all life from your soul.

Remember what the safety lecture says at the start of every flight on an airplane, in the event of cabin depressurization, breathing masks will fall from the ceiling. They always, ALWAYS, remind you to position your own mask before helping anyone else. That is to make sure that you don’t pass out or expire before you can actually assist the others. You can’t help someone else if you are incapacitated due to your altruism. So, charity and kindness and the care of others are entirely admirable, but remember to start with yourself. If you don’t take care to stay healthy and strong (physically or emotionally), you won’t be at your best for anyone else either. So, remember to affix your own mask over your nose and mouth first… and breathe normally.

The New Cheese: Sick at Work

 

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That’s right. I said sick at work, not sick of work. Believe me, if I was just talking about being overtired, burned out, and downright annoyed with the concept of putting in a 40 hour week for people who do not appreciate it… that would be a different post and probably a whole lot longer.

I have a pretty decent work ethic. Some of my friends think my work ethic borders on the obsessive and possibly masochistic, but I feel that it is my responsibility to stay out of bankruptcy court, pay my bills on time, and do the best job I can for the employers that provide me that opportunity whether they appreciate it or not.

What that boils down to is that I can be a bit of a workaholic. I can actually hear a few of you out there who know me screaming at the screen “A BIT?!?” Yes, a bit. I have actually seen and experienced worse. I’ve actually seen and been worse. However, Iknow that being the Type A individual that I am, I’m a happier person busy than indolent or bored.

I try to be more conscious of life and take it a little bit more easy. I recognize my own limitations and that I am not getting any younger. Yes, that was difficult to type. In other words, I’ve only got the one life, and there are… in fact… more things in this world than money, possessions, and job. That was almost painful. However, I recognize, too, that I am lucky enough to have family and a few friends that probably never appreciated playing second chair to the career virtuosity. They might even appreciate spending more time with me.

Strangely, that is not where I was going with this post, though. I only said all that to illustrate my own approach to work, and showing up for work, and not letting anything stand in the way of work… and you get the idea. I can literally count the number of times I have called into work on one hand and remove a few of those fingers while I am at it… in the whole of my life. I have worked through varying degrees of illness and infirmity… frequently when I should not have. Yes, that is what I said… SHOULD NOT HAVE.

The thing is, I appreciate a solid work ethic. I appreciate people that won’t be beaten. I appreciate people who don’t let a little cold or allergies keep them down. I tend to be a little concerned with the person who calls in too frequently or always has some ailment that prevents them from being reliable. I value being able to count on a person to show up when they are supposed to and do the job that they are supposed to do. That is pretty typical of most employers. In fact, there are not a lot of employers that are going to say “Now, you are just working yourself too hard, and you need to take better care. Take it easy and stop putting in all that extra time…” Yeah, never going to hear that in the corporate world. Some companies do try to be more understanding and try to make their organization a decent place to work where people want to be. They understand that content or happy employees are loyal and productive. However, most places (especially larger ones with less highly skilled or highly educated workforce) operate on the philosophy that if you use one up, you can get another for cheaper anyway.

Harsh, I know, but sadly true. Again, I’ve wondered from the point… but not really, because it is all a foundation for what I’m saying.

Because the modern employer and modern company generally do not acknowledge that humans become ill and perhaps shouldn’t be worked until they drop, many employees also choose to ignore the physical limitations of the human body. Also, a part of that modern system is that many places do not have separate sick time and vacation time. Most role it all into something called “Paid Time Off” or PTO. PTO can be planned or unplanned, and some companies have rules about how many “unplanned” absences you can have as well. The point is that people do not want to take off when they
are ill unless they really just cannot function. They would rather save that rather valuable commodity of PTO for things that are more enjoyable like a vacation or time off around the holidays.

The result? People come to work in all manner of conditions. I’ve been guilty of this myself. People suffering from colds, mild flu, varying degrees of contagion… they all push themselves to show up for work because they do not want to miss work for something as simple as a stuffy nose or coughing fit. They don’t want to use the PTO, or they may not have the PTO to use if they have used it all for more enjoyable reasons. This is the problem with not having designated sick time. People come to work when they are sick.

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Sounds very self-sacrificing and diligent, doesn’t it. Sometimes people legitimately will say that they have too many projects, deadlines, etc. that cannot afford a delay of them staying home. That is all well and good… so, maybe not so well, and perhaps not so good. People who come to work with their illness and germs share that with their workspace… and colleagues… and that is how entire office buildings end up sick. What people do not think about when they come to work with their head cold or slight flu is that everyone with whom they come in contact is at risk to catch their illness… and take it home with them. It’s a fine line, and I know it. What constitutes a legitimate threat of contagion to the point that you should ditch work for the public health? Some companies will actually send announcements out during particularly virulent outbreaks. Some organizations sponsor flu and pneumonia vaccines for all their staff. Still, there is usually a few times per year that some disease gets passed around an office.

Telecommuting has provided an opportunity for some employees to stay away from the office petri dish but still work their ducky little hearts out from home. Sadly, this doesn’t necessarily improve productivity. What I’m saying here is not new. There are several articles in the past few years cautioning people about going to work sick and the actual costs to the business that range in the 9-figure range (Bratskeir, 2015; Rasmussen, 2013)… that’s right over a hundred billion dollars lost due to people being so diligent that they come into work when they are not well. It is called presenteeism. Yeah, I didn’t realize there was a name for it either until I started thinking about this post.

Technology has made it possible for us to work straight through almost every situation including hospitalization. That doesn’t make it wise or the best choice. Just because one can work while convalescing does not mean one should work while convalescing. The whole point to being off while you are ill is to get better. Most prescriptions for your average cold or flu involve rest and fluids. The body heals best when resting. So, working while one is ill can actually prolong the suffering and sometimes the contagious period.

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I know… I really do. Taking time to get well puts you behind or leaves someone in a jam or any number of other reasons not to stay in bed and drink fluids from a bendy straw (Gaskell, 2015). I am one of the absolute worst and will probably work until lunch on the day of my funeral. However, I do try to avoid spreading my plagues, and if you aren’t going to stay in bed and take care of yourself when you are sick, at least try to stay away from the rest of us. Thanks.

Bratskeir, K. (2015). Global study shows why sick people go to work – http://www.huffingtonpost.com/entry/why-employees-go-to-work-sick_us_5640dab9e4b0307f2cae408c

Gaskell, A. (2015). Why coming into work sick makes you a villain not a hero – http://www.careeraddict.com/why-coming-into-work-when-sick-makes-you-a-villain-not-a-hero

Rasmussen, D. (2013). The real cost of going to work sick – http://www.careerealism.com/real-costs-work-sick/