Intensive Care is a demanding and stressful workplace. Staff are regularly exposed to medical emergencies, patient deaths and time pressures.
Brisbane-based Intensive Care Physician Dr Kristine Estensen says it takes a toll on the mental health of physicians – and not enough is being done to address this.
Dr Kristine trained as a scientist and a dietician before a stint working on ICU wards at the age of 21 made her realise that she felt most at home in ICU. She loved the teamwork, the intellectual challenge and the problem solving involved.
She trained to become an Intensive Care physician and still enjoys the challenges of the role; “connection and love are really the essence of what being an Intensivist means to me,” she says.
But she adds that there’s no focus on health and wellbeing for doctors working in intensive care. From her intern and resident years, she was told to “just get on with it” and though she has seen an improvement in awareness of emotional health in general, it hasn’t reached ICU wards yet.
“Intensivists were always seen as superhuman beings that required no sleep, were always grumpy and everyone was afraid of them! I think that many doctors and nurses in the ICU are deeply caring individuals who are at high risk of disengagement and depression and anxiety. We see really terrible things, day in, day out. There were no such things as ‘debriefings’ or wellbeing officers or welfare advocates when I first started my training. You could ‘cautiously talk’ to your RMO mates, but always with the fear you would be judged.”
“We know from recent studies that the critical care areas of medicine have the highest risk of mental health diagnoses. No surprise there. What always has made me a bit frustrated is the constant mentioning of first responders, police, ambulance officers with the ‘trauma’ they see and risk of PTSD. You NEVER see doctors mentioned. It is like doctors are not meant to feel or be deeply affected by what we see. I have witnessed the most horrific things in hospitals (hangings, a patient exsanguinate in front of me at MET call, a patient hitting me to the ground while spurting blood from his radial artery). I have a long, long list and many years of witnessing and experiencing ‘trauma’.”
Who cares for those who care?
Dr Kristine notes that doctors, and specialists in particular, are rarely asked about their mental health. They’re seen as the person responsible for helping others – but who cares for the care giver?
“I think this contributes to doctors having to hold in things they may find distressing and discourages communication.
“The College of Intensive Care has formed a SIG (Special Interest Group) for Welfare for both trainees and Fellows. It is a magnificent initiative. The members are ‘Welfare Advocates’ in their respective ICUs and are very separate to the SOT (Supervisor of Training) or Mentor. We have meetings and a great section on the college website with articles. In the future, the committee hopes to organize an intensive care doctors’ wellness retreat. The mix of committee members is really broad and across both genders and it is SO helpful to hear others have the same struggles or thoughts as you.
“I found that even before I took on this formal role of Welfare Advocate in my ICU, that medical students at UQ when I was tutoring, and junior doctors, would approach me for confidential chats. I am very proud that they see me as a safe colleague who always has her door, ear and heart open. Even if I can make them feel someone cares and has listened and they are not alone.”
Managing depression and trauma in ICU
Dr Kristine’s battled many challenges and this has made her stronger and helped realise the importance of self-care.
She suffered from depression, triggered by a severe trauma, after medical school. Later, when she became a mother, her marriage deteriorated and she lived in domestic violence. She continued to work and study but this was a time when sexism in medicine was particularly rife and older (often male) doctors told her to “go home and look after your kids”; and “you’ll never complete the training with kids”.
But with the support of her parents – and a couple of great intensivists who were encouraging – she managed to get through. She’s channelled this pain and the coping mechanisms she’s learned into her work and it’s grown her love and enthusiasm for working in ICU.
Prioritising mental health: just do it!
Dr Kristine prioritises her mental health and in the past, has seen a psychologist for what she calls ‘tune ups’ to talk through things. Her advice to others is to do the same:
“Please don’t think you are different or failing if you need to overhaul your mental and physical wellbeing. Ensure you are surrounded by support and throw GUILT out the window, then reverse over it! Take a day off to see your GP. Do a meditation course. Learn what areas you want to change. Find colleagues who are safe to chat to and ask them where to start. Just starting is the key.
“If you have the scaffolding of self-care and supports in place, then it is really that buffer that will prevent you from crashing to the ground in really challenging times (in your personal life or medical life). There have been times in my career that I was just a complete lunatic machine. It is not good for our minds, bodies or long-term health. There are some brilliant resources for doctors available now both online, through colleges or private organizations.
“By self-caring consistently and regularly you build up a ‘reserve’ that you can draw on when you need it most. If you run on fumes constantly when the big challenges come you will find having no reserve is the real danger zone. That is when I think doctors risk some major physical and mental illnesses.
“The first step is just making the decision to look after yourself so you can look after patients at an excellent level.”
When it comes to self-care, she says you should think of the Nike advertisement: JUST DO IT.
“… and STOP worrying about what anyone else thinks!”
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