Tag Archives: Self-care

I think therefore I am? – Self-care needed to be prioritised, again

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I found myself having to really question myself as to what I was doing. Professionally I was promoting self-care to everyone at work, and to the audiences at the lectures I was presenting. I felt like a fraud at times as I wasn’t practising what I was preaching myself. I had to do what it said on my packet I had to stop and have a break for myself. That meant a stop to the blogging and the daily writing. It was supposed to only be for a few weeks but it ended up being three months, and it was okay. I’ve restarted things again but at a smaller scale. I started timing myself for ten minutes a day. I would write for a minimum of ten minutes a day and what would appear would appear and we would see how it all went.

I was back again, writing daily, posting to the blog daily and it felt good. I hadn’t realised how much I had missed the therapeutic aspects of the writing. Also the writing community engagement had been missing over the three month period. I was back in the swing of things again and it was good to feel more like myself again. Some of the pieces of writing ended up being work pieces or parts of assignments I was doing for online courses. Things started feeling too stretched last week and I had to release the pressure again. People all around me in the different parts of my life were struck down by non-Covid viral illnesses and I wasn’t keen to join them. Instead of writing I went to bed. Instead of doing 15 minutes of Duolingo Spanish I only did the bare minimum to maintain my run streak. No-one was going to reward me with a badge for least amount of sleep had in a week. Gamification of my own health wasn’t worth it, in the real world it’s not so easy to spawn yourself back.

I’ve had another short break from the writing and I haven’t beaten myself up too badly over it. I am back again today and will be back again tomorrow. It’s the accumulated efforts over time that add up. What am I writing? My dailies which will become blog posts, which will become who knows? And that is okay. I just need to use the writing muscles again. To reactivate the nerve pathways. To gather up my energy again and make something with it. Daylight savings, travelling between time zones in the past week, and general life stuff have affected how I lived my life in the past fortnight. Other things out of my control have happened and have had to be dealt with. It will all be okay. All we can do is keep on going. One foot in front of the other. One word in front of another. We’ll see where we end up. We’ll see what comes of it all. Take it easy on yourself. There’s a lot going on. Be gentle and kind to yourself.

I think therefore I am? – Life is too short

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Working in palliative care you would think that we all live our lives without regrets. We all live each day to the fullest and try to make the most of all our relationships. Living as if it’s your last day. But, no, we don’t. It’s not happening to us, even though we know it could happen to any of us at any time.

Is it because we become desensitized to all the suffering that we witness? In people who are burnt out or suffering from compassion fatigue they may be less able to empathize with the people they are caring for. You can’t allow yourself to become enmeshed in each case you deal with. Too strong a connection, too strong an identification and each death will be felt tragically. You can only handle so many tragic events, and certainly not on a daily basis.

The opposite can occur, in which clinicians become too detached from their patients. They are unable to connect with a fellow human being who suffers. Patients feel like they are being looked after by a robot. Would more consistent care be delivered by robotic helpers? What is it that is so special about human clinicians? Could a robot ever be a replacement?

I think therefore I am? – Professional Supervision

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I’ve attended regular professional supervision sessions, at least once a month, for over 13 years. I’ve worked full-time in palliative care for almost 16 years and it was recommended that I attend these sessions early in my training. The rest of the team attended sessions and it was expected that I attend them myself. I was recommended a psychologist/psychotherapist who supervised a number of my specialist colleagues at the time.

I wasn’t sure what to expect for the first session. For New Zealand men talking about your feelings is still a foreign concept even in this day let alone 16 years ago. I gave it a go and the first session was spent with my supervisor and I getting to know each other. The sessions were limited to one hour and I was encouraged to talk about any situations that had invoked feelings in me. At the time I talked about clinical situations I was dealing with. Helping patients and their families deal with their death and dying on a full-time, daily basis did take a toll on me. I found myself taking some of the cases part of the way home with me. I was witnessing tragic events a number of times a day and the raw emotions needed to be discussed. Professional supervision was an outlet for this necessary release to happen. Trust in the process developed over the next months and more feelings were shared.

This first supervision relationship lasted for six months. It was initially helpful and thus I continued. Following the penultimate session, things had changed and I found myself feeling upset for the following month. This was not how it was supposed to work. I was supposed to feel better after these sessions, not worse. First, do no harm was the principle that had been taught to us early in medical school. This was not right. I brought it up with my supervisor at the next session. He said he would address it, but I left that session feeling even worse. I decided to fire him. I became disillusioned and did not attend any further sessions for the next 18 months.

In my final year of specialist training, I was encouraged to give supervision another go, with another practitioner. This worked out much better and was much more helpful. It felt safe to discuss some of the situations which had triggered various emotions when dealing with patients and their families. Sometimes people reminded me of my own family members. Other times situations felt a bit too close to my own. An example was when I had to look after someone who had a similar background to me. I didn’t know him but we had gone to the same medical school, and we had become medical registrars at the same time. I was study buddies with some of his classmates. We passed the physician exams at the same time and started our specialist jobs in the same year. The biggest difference between us was he was dying of cancer and I wasn’t.

I’ve had many supervision sessions in the intervening years and they have kept me well. The subject matter changed as my role and responsibility changed over time. With growing experience, the clinical situations did not affect me as much as they did when I started. I have developed resilience and maintain firm boundaries to protect myself and those I care for professionally. When I had to take on managerial and leadership roles this was initially stressful. As specialist doctors, we undergo a long training process lasting at least 13 years. In our curricula, there are no sessions on management, leadership or education. These are all aspects of a specialist’s job and can be a source of stress. My supervision sessions have allowed me to look at things from other points of view and to reflect on my practice. Some months have been particularly tough and I may have needed more than one session in those months.

Overall the sessions have been of great value to me and remain one of the important self-care activities I do regularly to keep myself professionally healthy. I would recommend these sessions to anyone who wants to have a long-term career in palliative care. To anyone considering doing them, I would encourage you to give it a go. The raw emotional work of palliative care can make you feel like you are in a pressure cooker at times. We could all use a release valve to let off some steam and to stop the contents from burning (out). I’ve needed to focus more on self-care this year and professional supervision remains one of the anchors of my self-care practice. I believe that if I take care of myself better, I will be better able to take care of patients and their families.

SCM – Daily Dose of Suffering

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Four years ago I went on a Wellness Retreat. Some of my colleagues laughed at me once I had returned and discussed some of the activities I had paid a lot of money for. During the retreat, I ate much smaller meals than usual. I woke up earlier than usual to do yoga, followed by a tiny breakfast and then hours of hiking. Another activity was fasting for 36 hours, 24 hours of which were spent in total silence. The activities were interesting to try but I have not continued with most of them. I also learned about thermotherapy, with exposure to heat in the form of a 90-degree Celsius sauna followed by ice baths. The cold water exposure is something I have continued to this day.

I shower as usual using warm-hot water. At the end of each shower, I turn the water temperature to total cold. This feels awful for the first 10 seconds and my mammalian dive reflex is triggered, with much deeper breathing. During the winter months the water is extra cold. The next 10 seconds are less unpleasant. By the time I have reached 30 seconds, I can tolerate it, and my hands and feet have become cold at which point I turn the water off. As soon as the water stops a warm feeling surges through my body and I sure do feel alive.

The cold showers are my daily dose of suffering and I feel they have built up my resilience over the years. I will continue BBRRRRRRR.

SCM – Take a Break

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Some interactions in palliative care with patients and their families can be hard to handle. e.g. breaking bad news to younger people. Some conversations are intense and emotionally draining. In any hospice inpatient unit (IPU) the staff may need to have a number of such conversations with different patients during any given ward round. Often the team may be about to visit the next patient and may still have remnants of the previous case on their mind. This is when I would lead everyone away for a short break.

It might be heading upstairs for a hot drink and a quick snack. A short walk outside for fresh air and a dose of sunshine or it might be heading out into the rain. A reset /restart button is activated. The team is led away from the site of upset feeling for five minutes of self and team care. A brief respite from the frontline. Good role modelling, leading by example.

We might only have been away for a short period of time but on our return we feel better and more open to tuning into the next patient’s problems with our full attention.

If you are a clinician why don’t you try adding small breaks into your schedule after intense patient encounters? Do they work for you?

SCM – Self Care Microdoses – A walk in the garden

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I have had to focus on self care this year as it has been challenging at times. I’ve had to shift my focus away from saving up all my self care for a holiday as I need more regular doses of self care. In fact if I had not done self care activities on at least a daily basis I would be in much worse condition than I am at present.

I’ve been working on microdoses of self care. This might be as short and simple as a five minute walk in the hospice garden. This is a combination of leaving my usual seated in front of a computer working position and going outside. Five minutes of fresh air and occasional sunshine in between the recurrent episodes of heavy rain we have experienced in Auckland this year. A small dose of exercise for my body which is at risk of pressure injury from prolonged sitting. A chance for my eyes to focus on objects which are further away than the screens I look at while doing computer based work. To feel the wind through my hair. To smell the flowers and the trees.

There is a slightly more shaded area of the garden path I spend a bit more time in. If you stop at the right spot and close your eyes you feel almost transported into a forest. You hear the wind rustling through the trees. There is birdsong from nectar feeders who have had plenty to eat in recent weeks. I walk around the garden and I might bump into some of the many volunteers who keep the garden looking its best. I try to stop and chat to the volunteers as often as I can. To thank them for what they do for our organisation.

Five minutes, 500 steps. A short workout for my otherwise sedentary body. A couple of times per day on a good day. It all adds up, every little bit counts.

What self care activities have you done for yourself today? What can you do for yourself that will take five minutes?

I think therefore I am? – The most beautiful sound I ever heard…

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Over the past two years despite all the stressors faced there has been a sound heard increasingly throughout the corridors of the hospice. As many doors and windows have been left open to allow greater ventilation to allow viruses and other infective materials to be circulated out of the building but the sound of the wind is not the subject of this post. It has been cold at times during the winter and the sound of fan heaters has been present at times but again it is not interesting enough to merit any writing. When patients are breathless an electric fan is lent to them for them to have the breathlessness relieving air across the face which is more effective than oxygen and other prescribed treatments for people who can’t catch their breath. Our cleaning staff continue to work tirelessly to keep our premises clean, without their efforts we could not keep our operation running, and the importance of their infection control toil cannot be underestimated. The sound of vacuuming, wiping and mopping are commonly heard again and are not the subject of this piece.

The sound can be contagious. When you hear it you feel different. It is something that resonates inside you and it makes you feel more human and less alone. It can change your facial expression in an instant. It can lead to a sudden and rapid expulsion of air from your body. No, I am not talking about passing gas, that’s what anaesthetists do for a living, I work in palliative care. The brass band will not produce these sorts of sounds, but maybe the sound belongs in the orchestra’s wind section. Sometimes, playing an air guitar or the world’s tiniest violin can produce the sound.

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I think therefore I am? – Communication Skills for Serious Illness Conversations

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A little bird told me that a great combination if you are wanting to improve your communication skills when it comes to palliative care situations is to check out the resources below.

The Serious Illness Conversation Guide can provide you guidance and structure for conversations.

Whilst Vital Talk courses and their app can help you to manage the emotional content of these important conversations.

I think therefore I am? – A walk in the garden

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Photo by Kilyan Sockalingum on Unsplash

My fitness tracker died on me a few months ago and since then the wear pattern on my shoes has slowed down. The reminders to do at least 250 steps each hour were a good reminder to stay active during the day. I have the luxury of working in a place with a garden surrounding it. A few times a day I can go out for a quick walk around the garden. One orbit is 500 steps, which would add to my daily step count. 10000 steps a day was more than achievable. The fitness tracker wasn’t mine, but one I had inherited from a family member, but I wore it out.

A few minutes of self-care interspersed within busy days. The simple act of walking in some nature. The sunlight on my face, the breezes through my hair. The sounds of the insects and birds doing their thing in the trees. The wind winds its way through many thousands of leaves. Not quite a forest to bathe in but in certain parts of the garden, you can stop under a tree and imagine that you are in much deeper woods. A momentary escape from the hustle and bustle of the workplace, I am briefly transported thousands of kilometres away. The fresh air is scented with the products of the plants themselves. It’s as if I am a time traveller, going back to the wellness retreat I attended three years ago, but I am not the same person anymore. Three years older and hopefully wiser.

I return to my office and the ward feeling refreshed. These micro-breaks throughout the day help to keep things calm.

I think therefore I am? – Brazilian Jiu Jitsu as a holistic self-care practice

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I virtually attended a self-care workshop in Canberra today. I prioritise and practise self-care daily as outlined here. I still found it good to have a refresher on the importance of self-care for homo sapiens in general, but especially so for us palliative care practitioners.

The presenters pointed out the great resources available from Palliative Care Australia which have been produced by Palliverse’s own Dr Jason Mills. The downloadable PDF can help you design your self-care plan. I think all palliative care practitioners could have this as part of their personal development plans. The work we do is different, we come face to face with other people’s death and dying several times a day in clinical practice.

The session on self-compassion was another useful reminder to me, as I had completed a six-day self-compassion-focused wellness retreat three years ago. During this, I learnt to speak to myself as if I was speaking to a good friend who needed my considerate help. Our inner self-talk can be too harsh and over-critical. We are often too hard on ourselves and this can be self-destructive.

An Aotearoa/New Zealand approach to self-care would need to cover domains of the NZ Maori Health Model – Te Whare Tapa Wha. Wairua – Spiritual, Tinana – Physical, Hinengaro – Emotional, Whanau – Familial/Social. Training in Brazilian Jiu Jitsu (BJJ) has been an addition (some would say addiction) to my self-care practices and it helps me to cover all four health walls. Physical exertion has led to muscle gain and weight loss. BJJ has taught me to be more emotionally resilient and I feel I can handle more of everything. Regular exposure to the painful stimulus of joint locks and choke attempts has provided small doses of suffering. I can control myself in uncomfortable positions and it has helped with ego control. It is okay to tap out when you are beaten. I feel I have joined a family or community of practice and have befriended a culturally and age diverse bunch of people. In terms of spirituality, I feel more connected to my body as during BJJ training you have to be totally present in your body and attuned to what your opponent is doing. It can be a real escape from the daily grind of the rest of your life. If your mind wanders during a rolling session before you know it your joints might be in painful positions or your neck is being choked.

Yes, last week I did break my finger tip extensor tendon and have to wear a finger splint for 12 weeks. I returned to training this week and have been modifying my approach to protect the healing fingertip.