I’ve been concerned

words: Dr Bill Webster

Could we have a little talk, just between us? I’ve been concerned about you, and I was just wondering about a couple of things.

Can I ask you about how you’ve been feeling?

• Do you find lately that you have very little energy and more frequently feel fatigued?
• Have you been more irritable, impatient and angry lately with everyone at home and at work?
• Do you find yourself distancing yourself from people and being cynical and suspicious about their motives?
• Do you seem to have been suffering more long-lasting colds, headaches, stomach upsets or physical complaints?
• Have you experienced uncharacteristic mood swings and seem to yourself and others to be more depressed and anxious?
• Do you seem busier than ever yet feel like you are accomplishing less than ever?
• Are you finding it more difficult to concentrate or to remember?
• Do you have trouble with delegating and just end up doing most things yourself?
• Do you feel less of a sense of satisfaction with yourself and your work and feel like whatever you do is never enough?
• Do you ever feel like you just have nothing left to give?

If you answered yes to more than five of these questions, then you may be suffering from what is known as ‘bereavement overload’, ‘compassion fatigue’ or ‘burnout’ (all these terms basically mean the same thing). And the higher your positive responses, the closer you are to the edge.

There are 12 early warning signals, including:

• Chronic fatigue, exhaustion, a sense of being physically run down
• Anger at those making demands on you – at home and at work
• Self-criticism for putting up with or giving in to demands
• Cynicism, negativity and irritability
• A sense of being besieged and overwhelmed
• Exploding over seemingly inconsequential things
• Frequent headaches and gastrointestinal disturbances
• Weight loss or gain
• Sleeplessness and depression
• Suspicion over everything and everybody
• Feelings of helplessness
• Increased degree of risk taking

So let me come clean and tell you why I am concerned.

It is because someone was concerned about me a few months ago and asked me the same questions. I won’t tell you how many positives I had, but it was double digits! I realised that I was so overloaded that I was feeling tired and drained even before the day began, and feeling as if I simply had nothing more to give; I felt disconnected from other people, and resentful about intrusions on my time and energy; I began to wonder if anyone really appreciated what I have accomplished over the years, and even questioned whether the results I have achieved were meaningful.

Perhaps the biggest problem in dealing with self-care is confronting our old friend denial.

Some of you will say: “Gee, sorry to hear that Dr Bill was struggling with bereavement overload, but that couldn’t happen to me. I can handle it.”

That is exactly what I would have said a year ago.

After all, we as professionals are supposed to handle things. That is what we are trained for, and so we feel we have to be seen to be in control and on top of things. To admit that we are not handling it seems like a confession of weakness or incompetence.

So even if we do experience such symptoms, we are usually reluctant to admit it to those around us who might think we are “losing it”. The ultimate denial is ignoring and minimising the symptoms, even when they are staring us in the face.

Believe me, I know what I am talking about here, and that is why, having had to address these things in my own life recently, I am concerned about yours. Because as professionals, you and I are probably similar in many of the old attitudes about ‘competency and coping’, even if all the evidence suggests we are muddling through as the walls crumble around us

So what can we do to help ourselves? There is no one simple prescription. However, one thing is clear: our attitudes about stress, fatigue and self-care are either our best friends or our worst enemies. For example: “I hope so-and-so is reading this, but it doesn’t apply to me; I’m strong, I’m invincible, I’m okay.” Or: “My goodness, this can happen to anyone, because we are all vulnerable and at risk.”

The first thing we need is to recognise that we work in a field that is at high risk for burnout. Everyone associated with this profession is a caregiver. We deal with people at the most vulnerable time of their lives.

Our job, quite simply, is to help. But while helping other people has its rewards, it also has its dangers. But on the other hand, who better to point these things out than someone who cares and who knows you better than most?

It is never easy for a professional person to admit that they are not handling things well. And it is even more difficult when the alarm is sounded by a family member. Recognising that you are ‘at risk’ for emotional fatigue is the beginning of wisdom.

So go back to the questions at the beginning of this article and take another, possibly more honest look. But if you want to know what your real score is, ask your spouse – or a trusted colleague or friend – to answer the questions on your behalf. Go on, I dare you.

Are their ideas of your current status the same as yours? If not, maybe you are not being realistic about the cumulative effect of the stress of doing your job well.

Make your times of rest and renewal a priority. This is more than the occasional day off, or an infrequent game of golf (which can often cause more stress than relief ). It means deliberately sitting down and planning your self-care.

Put a ‘time for me’ category in your diary like you would any other important appointment. The people who burnout are the ones who try to spread themselves too thin. They do too much; try to help too many people; they never say no to anything.

Have you ever heard of the Pareto Principle? It states that 20% of what you do nets 80% of your results. By implication, it suggests that 80% of our time and effort is spent on a mere 20% of what we accomplish. So think about how much time and energy we could save if we focused on our 20% and delegated the rest to others. We need to learn to respect the messages our body, mind and spirit give us about our need for renewal.

Try to identify the unique ways your body tells you that you are under pressure, tense or stressed. Headache? Tightness in the neck or shoulders? Have you learned to recognise that inner voice, and to listen?

Above all, be compassionate with yourself about not being perfect. Having a score of 5-10 on my questions is not a sign of weakness or failure, it is simply an indication that you need to take better care of yourself. Failure is when you don’t listen and do nothing about it.

That is why I decided to share my experience. I am concerned about you, because I am thankful that someone was concerned about me. Sometimes we are tempted to think that our helping efforts should always be successful.

Often they are, but other times people just don’t appreciate all we have done, or minimise and even reject our efforts. Even when we don’t do a perfect job, we need to remind ourselves that mistakes are an integral part of growth and learning, and should never be measures of our self-worth. As my grandfather used to say: “The man who never made a mistake, never made anything.”

I usually fill up my car with fuel on Thursday evenings on my way home. Recently, I had driven more miles in the week than usual. I was travelling along, lost in my own world, when suddenly the motor sputtered, the engine died, and I came to an ignominious stop at the side of the fortunately not too busy road. What could be wrong?

Imagine my embarrassment when I looked at the fuel gauge and realised I had run out of petrol. Thank goodness for wives, mobile phones and second family cars.

Cars need fuel to run. When they have gone a few hundred miles (or less) the fuel tank needs to be refilled. The petrol need to be replenished or the car just ain’t going to run anymore. It’s that simple. You and I are no different.

Burnout doesn’t just happen to busy people. It happens to people who don’t replenish themselves.

So may I ask you? Have you checked your fuel gauge lately? Is it time to ‘fill up’ before you ‘run out’? And if you are running on empty, where’s your nearest service station?

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