This article is dedicated to the memory of Prof Bongani Mayosi, a world-renowned South African cardiologist who died by committing suicide from depression this week.
As I sat in front of the couple trying to be stoic and listen to me diagnose their model teenage child with lupus, I regretted being a doctor, the one who had to bear this sad news.
I regretted being the one sentencing the child to a lifetime of anxiety about a complicated illness. I looked at the couple who knew all too well, what the disease entailed as they tried to keep a brave face for their child. I looked at a couple determined to do everything in their power to make it not what it was.
I mourned inside.
I don’t want to make another diagnosis.
Patients take decisions you know some months down the line would not be in their best interest. You try your best to persuade them to choose the path you know has proven results. It’s not a test of faith, but there is a level of assurance there. But, they chose their own path. You know it’s only a matter of time. Months down the line, when the damage is already done, they come back wanting to choose the path which is too late to take now. Regrets.
To see each patient like a loved child, mother, or father to someone, you have to keep questioning yourself. What could I have done to keep this person alive? Maybe I should have tried some other method. You look back, you examine, and reexamine. You may end up blaming yourself even in the face of other evidence.
“Doc I want to see you.”
You look at your schedule and it’s jammed. You try to push the appointment down the line desperately trying to preserve your leave time.
“Doc it’s urgent”
You give in and add her to your already jammed day. You dread how that day is going to be. Your brain is wired up. Too many tabs are opened.
Another week, more ward rounds, five patients in a row and all you have talked about is how they can’t afford their medications. Social welfare has been called, it takes an awfully long time. You want to make treatment decisions, you want to be able to discharge for other patients to come in, or else this will be another week of needless waiting. You pass the hat around again on ward rounds, everyone gives something to enable you to do labs, and buy medications. You buy a crate of eggs so the nurses can give an egg a day to make sure the patient gains weight. On the way home, you turn on the radio and listen to the caller after caller insult and vilify you for being a callous health worker.
Just another day.
You get to work and lives are lost from lack of simple tools. You run around just to find there are none.
Another needless death. Someone’s beloved is gone.
You feel hopeless. You are nursing patients on floors soiled by vomitus and bodily fluids. The oxygen tank is barely going to last the night for that patient. You see certain death, but you can do nothing short of building an oxygen plant on the spot. This is not the first time, you know the drill and are numb from years of heartache. You pretend it’s going to last and walk away.
Caring for others with difficult, often chronic illnesses is a draining emotional experience, but despite the demanding job you have been trained and conditioned that your needs come last as a doctor or health worker. Sometimes, leaving to take a washroom break in the clinic can be met with evil looks by patients who know you have been stuck in the clinic all this time, but they are ill so their needs should be met first.
Burnout is a work-related syndrome first described by doctors in 1974. It is characterized by emotional exhaustion that results in a reduction in work execution. It is characterized by a pessimistic outlook on common-day activities and patients may be viewed in a disconnected way.
Stress and burnout can be caused by a combination of extreme workloads, long work hours, complaints from patients, unsupportive colleagues, inadequate access to administrative support systems, and malignant work environments.
Burnout is more common among doctors than among workers in other specialties. One-third of doctors will suffer from burnout, a common factor being the level of intense interaction with people every day, making daily decisions about life and death. This level of interaction leads to emotional exhaustion.
Emotional exhaustion is possibly the key precursor of stress. Doctors who become emotionally exhausted become stressed. This then leads to them becoming more emotionally exhausted and even more stressed.
High levels of personal accomplishment also lead to increased stress levels.
The lifelong risk of depression among doctors is 10-20 percent. The suicide rate among doctors is double that of the general population.
For many doctors or health workers, there is no support. Nowhere to turn. Patients even comment when they hear you are sick “Oh doctors nso yar3 anaa?” (Oh do doctors also fall sick?)
Doctors find it very difficult to know how to recharge themselves. They simply don’t even know how to get support. With the increasing reports of depression and suicide among doctors, however, this is an issue that needs to be looked at.
As a doctor, I know( but I don’t do and need to do🙃) that non-work activities are key to keeping your emotional bank account full. Schedule these recharging activities in your life. Chose them, insist on them. You can’t fill from an empty tank. Don’t think they are not as important as taking care of other people’s needs.
Do a great job with every patient you see and trust you have done your best
Strongly consider some time off and take your leave when you have to.
Take care of your needs
Switch off work. Put off your phone. The world will go on.
Get some rest.
Get some exercise.
Do something fun you have put off in a while.
Join a social club; be it religious or recreational.
Spend some quality time with your significant other and children.
Dr. Dzifa Dey