It’s funny. No matter how much time off I’ve taken prior to my on-call shifts, as soon as I’m on the shop floor again, it feels like I’ve never been away. I wonder if you can relate?
My recent set of weekday nights were nothing short of crazy throughout. They tended to commence with pandemonium as staff frantically handed over and pre-hospital care offloaded several patients to surgery in quick succession, followed by a relay race of clerking interspersed with constant calls from the surgical wards to review patients who hadn’t been sufficiently reviewed by the day team.
But, how to deal with this? I for one find it difficult to consistently keep going throughout these nights without struggling at one point or other. This past week has been particularly tough as a result of the aforementioned pattern. For example, after a string of aggressive referrals, a dash of microaggression from ward staff, and a sprinkling of undermining from some colleagues, it’s easy to feel my resolve begin to fray. It is exactly this which so often drives the cycle of incivility. One uncivil encounter ruins the day of one individual, who then feeds it forwards to the next individual, who feeds in on and so on and so forth.
However, I believe it is possible to break this vicious cycle. One thing I’ve found useful is to befriend other staff members. It may sound slightly banal, but bear with me. Making friends with some of the A&E SHOs has made the receipt of referrals a lot easier and has also injected a social feel to the referrals, with an exchange of some benign chit-chat making the whole thing feel a lot more human. Getting to know their names has also helped soften the otherwise fairly serious and unfriendly referrals. I feel as though it immediately humanises one another – after all, it’s a lot harder to be confrontational towards someone you know than a label, e.g. “Vasudev” vs “the surgical doctor”. I imagine calling me in the first place to refer a patient may also be daunting for some. When I speak with a more junior member of staff, I try to be supportive of their referral and praise them when they have handed over well (making sure not avoid sounding completely patronising). It’s a well known phenomenon that kindness towards others can help you feel better.
Recently I’ve been reading Ross Edgley’s recent book, The Art of Resilience (no endorsement), which has made me contemplate the meaning of resilience and how it relates to me personally in my practice. It’s a fantastic publication full of anecdotes backed up by history and research, something which I largely appreciate. However, the most pertinent aspect of it so far for me has been the following quote:
“We don’t control our external events, only ourselves and our responses.”
This is because all the above components of a difficult shift are these exact external events and my resultant disdain and demotivation is my response to these events. I suppose one could argue it’s a bit of a choice – I often find this challenging to justify to myself when feeling downtrodden. But, if it were possible to tackle this head-on from a mindset perspective then perhaps it’s not so “out of my control”.
So, last week I conceded that I needed to adopt a slightly difference approach. Whilst I had an excellent and refreshing weekend at home with my partner, just focusing on quality time spent together, it quickly dissipated when back at work, as I alluded to before. However, I decided to think back to it with gratitude which enshrined the feeling and allowed it to ostensibly eternalise. I then made a conscious effort to look forward to something simple for the upcoming weekend, like eating a Chinese takeout and watching our favourite TV show with my partner, for example.
Then came the inter-night practice. This normally makes or breaks the nights for me and I maintain its vital importance with an unwavering routine. I didn’t sleep for as long as I’d hoped for almost all 4 nights, waking up to outside noise, thoughts of projects I’m undertaking and impending deadlines. The temptation was to awake and immediately start tackling the admin. I resisted. Instead, I chose to brush my teeth and meditate for 15 minutes. I swiped away my notifications on my phone and opened up the Headspace app (no endorsement), selecting the daily meditation and focusing on settling my mind. Before one of the nights, I followed this up with a workout of whatever I felt like, body weight work etc, it didn’t matter. Just feeling the burn and glow of exertion. All this to the tune of Netsky’s latest hour-long ‘Second-Nature’ album release mix on UKF Live’s YouTube, which is hands down one of the best I’ve heard recently and utterly cathartic (no endorsement). For the remainder of the shifts, I did not possess the energy to do a workout, but I stretched and meditated at the very least which helped.
Next, tempering my expectations of the night really helped forge a mindset that can cope with a busy night. I tend not to expect to sleep nor do my own work and so whenever I did have a quiet moment (sadly this never materialised last week), it’s that much more welcome.
Lastly and most crucially, however, I avoided all caffeine (tea, coffee, energy drinks etc.) like the plague. My rationale was simple: the shifts were stressful enough, why add more stress to them? Caffeine biochemically causes the body to stay stressed for longer as it inhibits the breakdown of catecholamines to varying degrees in different people. I’ve generally found that withholding this substance from a daily routine helps me have more control over my stress levels and reduces the likelihood of a negative, reactive response to external stressor events.
Ultimately, the unfortunate reality is that there is no quick fix. There probably isn’t even a fix at all. Most folks I know describe unhealthy coping mechanisms. On-calls, particularly nights, suck big time and there are no two ways about it. I feel the only real way to deal with them is to treat the symptoms. And for me, in summary, the following holy trinity is how I do it:
Meditation. Expectation. Decaffeination.
Vasudev Zaver 