Getting Stuck in Crisis Mode
So , it ’ s a direly stressful situation that , for physicians more than most , just goes on and on and on . How do people not get burnt out in this situation ?
The truth is , maybe it can ’ t be entirely avoided . That ’ s the conclusion that Dr . Novack came to earlier this year after experiencing burnout herself . Her story begins shortly after taking on the position of medical director of Infection Prevention . Often a part-time , behindthe-scenes job , the role became center-stage and demanding during the pandemic . “ My contract started in December of 2019 ,” she said , “ and by the end of January 2020 , six weeks before our first COVID case in Arkansas , I was sitting in meeting after meeting in preparation . There was a lot of speculation about how bad it would be .”
By March 2020 , cases were starting to be seen here in Arkansas , which brought growing amounts of pressure for Dr . Novack and her colleagues . “ At that time , every outbreak , every positive employee , every new patient that turned positive was a new disaster that required crisis management ,” she recalled . Still , she was getting by all right , even as the days wore on . “ At one point , I think I went 63 days without a day off . On Memorial
out sick , so many patients , higher ER and ICU volumes ,” she said , “ and by then , I was also treating COVID patients in our infusion clinic while managing the Infection Prevention program for the whole hospital system .”
It wasn ’ t until April of this year that the pace finally slowed for Dr . Novack . Only problem was , she couldn ’ t follow suit . “ I couldn ’ t calm down . I found myself , physically , in a constant state of being wound up , anxious . I was being short with coworkers and getting riled up over issues that were important , but were not ‘ emergencies .’ I began questioning whether I should be doing this job .”
WASHINGTON REGIONAL MEDICAL CENTER IN FAYETTEVILLE .
She was suffering from true burnout , she learned from her therapist . “ I told her , ‘ The crisis is over , but I ’ m still so down , so sad . Nothing sounds good , and I feel like I can ’ t catch my breath ,’” said Dr . Novack , who compared her feelings to what soldiers might experience . “ I don ’ t mean to take away from the unique situation that soldiers face or to compare what I do to war , but it felt like a similar process , like trying to go from a [ war-type ] disaster to normal civilian life . That was a hard shift for me to make .”
Day weekend 2020 , I turned off my
A Fresh Perspective phone . That was the first time I had Dr . Novack took time off in gone 12 hours without a phone call . June to recuperate . “ It was about
Over that summer – with the mask Amanda Novack , MD four weeks ,” she said , “ and it took a mandate in place – things kind of couple of those weeks before I could calmed down ; still , I knew that fall , flu season , sleep through the night , before I could feel like I and respiratory virus season would be hard was ‘ off ’ and let my guard down . And then , I spent again , so I stayed in preparation mode . a couple more weeks focused on immediate and Winter came , and her fears were realized . extended family and reconnecting with friends
“ It was exhausting … with so many employees that I had basically lost touch with for a year .”
By the end of her respite , Dr . Novack felt capable of enjoying her work again – provided she made some changes . “ I realized I would have to get back into a maintenance mode of not just putting out fires , but also long-term planning ,” she explained . “ When it was time for me to come back , we saw cases going up again . Through those first weeks of July , I felt so grateful to have had that time . I didn ’ t take time off to prepare for another crisis – I took it to get out of crisis mode – but it ended up giving me a chance to reprioritize and reorganize my brain … to let my body know that this isn ’ t an emergency anymore . So as things started to build again , I had better photo courtesy of Washington Regional Medical Center
coping mechanisms and , frankly , more selfcompassion .”
Taking time off initially led to feelings of embarrassment and even guilt for the high-level physician , who had to get past the culture of “ toughing it out ” that is common for physicians . “ We tend to link being over-stretched to heroics ,” she said , “ like we ’ re superhuman for working 80 hours or not needing a vacation . And as a team member , there is a real sense that this is hard for everybody – why should I be able to take a break ?
“ In retrospect , what convinced me to do it – and what I used to comfort myself when I was doubting it — was recognizing that someone has got to fill up their tank . If we ’ re all tired , none of us can be that good listener or that extra support for someone else .”
Now , Dr . Novack tries to keep a fresh perspective in relation to time management and self-awareness . “ I regularly acknowledge now that this is a crazy-hard job and I ’ m doing pretty good at it ,” she said . “ I ’ m not going to be a super star every day . I ’ m letting go of that expectation . Instead of time management , I started thinking about energy management . I ’ m intentional about building the capacity for more energy – physical exercise is part of that as is putting healthy things in my body and having time to foster relationships in my life . I ’ m not always a winner at these things , but the time off has given me a chance to realize that burnout is , to some extent , inevitable with this sort of crisis , and it ’ s not a failing . All humans need restoration . No one has limitless energy and resources .”
Dr . Bolding , too , has learned lessons as he ’ s gone through this pandemic . For example ,
( Continued on page 106 )
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