Ankarana National Park (northern Madagascar)
It was the beginning of a long and stressful night. I was a first year resident and still nervous each call shift. I glanced at the roster of doctors on call with me at the hospital that night and my heart sank. He was on call. I worked with many amazing doctors. Fantastic mentors who were smart, compassionate and who had wonderful bedside manners. He was not one of them. Last time I was on call, he cursed me out for disturbing him in the middle of the night because someone was really sick and I didn’t know enough to help them. Then he came in and proceeded to yell at the nurse and then the patient and her family, all because the patient had the nerve to get sick in the middle of the night. I shared this experience the next day with my family practice preceptor. I was shocked when she told me that this doctor had once been fantastic and loved by all – the residents, the staff, the other doctors and the patients. In fact, people would seek him out to work with him and to be treated by him. But then slowly, over years of 1 in 3-call nights, being in the constant pressure cooker of treating life and death medical problems, he began to change. He grew grumpier and snappier. At first it was tolerable and he only took out his exhaustion on the staff. During this time his marriage fell apart and he lost his family. Eventually his poor mental health spilled over into his patient care. He was unable to find locum coverage nearly as often as he needed. He was trapped, burnt out and now a terrible doctor and human being. My family practice preceptor shared this with me as a warning of what not to let happen to me. I couldn’t imagine turning out like that. I loved what I did. I loved how challenging yet rewarding it was to care for people; to be there for some of their greatest and hardest moments in life. I loved how medicine stimulated my brain and required me to constantly learn and grow. I so enjoyed working as part of a team with medical staff and nurses supporting me, challenging me and helping me to be a better doctor. I couldn’t imagine ever getting to a place where I would curse someone out just for doing his or her job or worse yet, reprimand a patient for being sick at an inconvenient time.
My first few years in practice were definitely a honeymoon period in my career. After 10 years of schooling I was finally doing what I loved. And for the first time ever I was getting a real pay cheque. I was on a high. I was young enough that the 36 hour shifts with no sleep were tolerable and I seemed to bounce right back the next day. But slowly, undetected to me at first, I began to show the first signs of burn out. It started at home. I could hold things together in public but once I went behind closed doors all I wanted to do was be alone. The TV became my escape- mindless nothingness. I could turn my brain off. It never needed anything from me. I became more withdrawn from my family. I had a much shorter fuse and would snap at the kids for minor offences.
limestone tsingy in Ankarana
Then it happened. My phone went off in the middle of the night and a flash of anger surged through me. How dare they be calling me, don’t they know how tired I am and how busy my day is going to be tomorrow. It took me the 15-minute drive to the hospital to talk myself down, to remind myself over and over that it isn’t the nurse’s fault or the mama’s fault that she is in labour now. I knew it was completely irrational that I would be angry but I was very surprised how hard it was to calm down. Then the next week I was running out the door to get the kids from the babysitter and my receptionist said a fax just came in from the nursing home. I barked at her and marched back to my desk, muttering the whole time about the nursing home nurses and how dare they fax me at this time of day. Now I was late and in a terrible mood. The traffic seemed to be against me. By the time I got the kids, zoomed home, thrown some food on the table I was foul. When Mark came home from work I picked a fight with him about something completely insignificant then stormed up to our room.
It was starting to happen. I was becoming that horrible doctor, wife and mother I vowed never to become.
I was burnt out.
inside the tsingy
I am now much better at seeing the signs that I am heading down the road to burn out. And I try to prevent them from appearing. By the time I am getting angry with nurses or receptionists for doing their job I have let things go far to long. I discovered that 4 months was the key to mental health- I needed to get away every 4 months. That might seem luxurious but when we would push it to 6 months or longer the sleep deprivation compounded by the mental and emotional strain of life and death situations (or the fear of missing them) would get to me. The weight of the 24-7 responsibility for human life would become such a mental strain I could no longer do my job properly. If I waited until I was burnt out to take a break, it would take way longer for me to recover. By escaping out of cell range every 4 months I could go away for much shorter periods of time, get some good sleep, recharge my batteries and then be ready and capable for what challenges faced me both at work and home. The vacations didn’t need to be fancy. Camping worked great. I just needed to be somewhere where no one but my family needed me for anything.
700-800 year old baobab tree
I have discovered some striking similarities between medicine and those doing humanitarian work abroad. In fact, I think that the risk of burn out is far greater here. Living in a country where absolutely everyone you know and love is desperately poor is extremely exhausting. The needs are overwhelming and constant. There are no breaks. There is always someone at the gate asking for something- money for burial costs for their mother, medications they can’t afford to buy, money for food for their kids, help with an unjust imprisonment. There is a huge high from helping others but that comes crashing down around you as you feel helpless, overwhelmed and incapable of making a lasting difference against the monster that is poverty. Plus you have the massive mental stress of a new culture, language, limited creature comforts like good food, power, running water, and internet. Living life in an impoverished country is hard-core.
Island of Ankify
But, unlike physicians who get paid well and can afford frequent vacations, missionaries make nothing. Sure they raise support but even if they are fully supported there is very little/ almost zero wiggle room in the budget for vacations. There is a perception among some supporters that they are sending money for the missionary to work and not take amazing and luxurious vacations on their dime. Very few missionaries get any kind of encouragement to take a vacation or a break from their crazy lives. A common myth is that furlough, time back in North America, is a vacation. That is absolutely not true. Time at home is extreme chaos, seeing dozens and dozens of supporters all while having to deal with culture shock in reverse. I guarantee you that missionaries return from furlough more exhausted than when they left the country that they are serving in.
female black lemur, lookobe reserve
Why am I sharing this with you? Well, I really want to encourage you that next time you find out your doctor is out of town, be happy for him or her. Know that your physician is actually looking out for your best interest by making sure that he or she is mentally fit and not burnt out. If you know people serving abroad, whether it is with a non-profit or a church organization, please encourage them to take a vacation. Perhaps even direct a donation for that specifically. I guarantee you that it will make them much more effective at ministering to people if they are able to get a mental break and recharge their batteries.
adult brookesia chameleon, Lookobe Reserve
We just returned from our first vacation here in Madagascar. We definitely had a honeymoon period when we first came, much like when I was first practicing medicine. Life here was exciting, new, challenging but so rewarding. It wasn’t until just last month that I could sense the first signs of burn out. We had planned our vacation towards the end of the time here in Madagascar as we figured we would be better able to navigate the country with more time under our belt to learn the language. That was true but I think that the Lord knew I would need a break just about now. We have 2 months to go and I feel like my battery is now on full and I can tackle the months ahead with renewed energy and purpose. And we had a wonderful time seeing a new part of this amazingly beautiful and diverse country.
leaf tailed gecko, Lookobe Reserve