From NICU doc to burnout: coping with the consequences of chronic stress
It took resuscitating a baby who was born footling breech for me to finally get it.
I loved my work in the neonatal intensive care unit (NICU) because there was always some excitement, plenty of intellectual challenge, and various procedures to perform. Some days working in NICU, however, I felt like a fireman running around putting out fires – one baby deteriorating here, another baby needing resuscitation there, some terrified parents with questions waiting over there, or a high-risk delivery to hurriedly attend. The NICU required maximum energy and sustained, intense effort. The stress at work I experienced always seemed manageable to me, and I tolerated and enjoyed my life in the NICU - until I became burned out.
It snuck up on me, and finally there were too many nights on-call, too much fatigue, too many emotionally draining days, and several cases with challenging ethical issues - doctors disagreeing about a baby’s futile care. Once I recognized that my feelings of overwhelm, fatigue, and lack of fulfillment signaled burnout, I requested a transfer to a different practice location. I needed a rest, badly. I needed a break - to think, reflect, and recover.
After I began working part-time (35 hours each week) in a quiet, low-risk labor and delivery (L&D) unit I had an opportunity to better understand myself and discover what contributed to my burnout. My days in this new unit were quiet. Most babies were born healthy, and only a few were minimally ill with low blood glucose or possible infection. Parents were interested in discussing breastfeeding and safe sleep. I had time to read and reflect on medical issues and all of my personal issues. Once each week, I had lunch with friends and began playing the piano again. I listened to music and books on Audible. I exercised several days each week, took long walks in my neighborhood, and slowly began to feel better.
One afternoon, several months into my new “recovery” routine, a healthy young mother presented to L&D with her baby’s little feet hanging out of her vagina. She was pregnant at full term. This mom had just ruptured her membranes and gone into labor with the baby’s feet presenting first. So, the OB and nursing staff quickly transported the mother with her footling breech presentation back to the operating room for delivery.
The nervous mom was given an IV sedative while the OB tried desperately to deliver this baby. However, his head became wedged in the mother’s cervix (the outlet of her uterus). Fortunately for me, while I stood there waiting to care for the baby, I noticed that standing there with me was a skilled NICU nurse and a trained NICU respiratory therapist (not usually the case in this quiet unit). We had all the necessary equipment ready, which was reassuring, but we all expected an extremely depressed baby.
After an excruciating twelve minutes of watching the OB tug on the baby boy’s feet and limp, purple legs, this little guy was finally delivered—blue, floppy, lifeless, and not breathing. He had a heart rate of around 80, and we proceeded to resuscitate him. The endotracheal (breathing) tube went in correctly and was secured well, his ventilation was ideal, the nurse’s IV insertion was flawless, and meds were administered correctly. By five minutes of age his heartbeat was a normal 140 and he became pink, however he still did not move.
Cord blood gasses were obtained. Then he proceeded to gasp for a few minutes, and finally began to breathe regularly and wiggle around. This was a reassuring response to our resuscitation. About twenty minutes after birth, he looked pink and perfect, and repeat blood gasses were normal. I decided to extubate him (remove his breathing tube). Since he continued to look well and act vigorously, I took him to see his mom briefly, then brought him to the nursery for observation and some lab checks.
I returned to update his terrified parents and reassured them that he would be fine. After speaking with them and explaining everything that had happened, I walked down the chilly and empty hospital corridor alone. Then I noticed that I felt ecstatic - “high” and quite wonderful. I realized then that I had not felt that way in many months, since I was last in the busy NICU. It was at that moment, thirty-five minutes after his birth and resuscitation, that I understood that I was on an adrenaline (epinephrine) high.
It was then that I realized how intense epinephrine surges had propelled me throughout my career, always providing strength and a huge sense of accomplishment. It dawned on me that I had spent a large part of my life in the NICU as an epinephrine addict. I craved excitement and valued going from one interesting or demanding situation to another. I was addicted to busy, frenetic work and always felt that the work was thrilling and rewarding (both feelings are the result of epinephrine surges). What I had not learned, until it was too late, was the toll I would pay for a career filled with this kind of unrelenting, exciting work.
If you have a demanding, high-stress, or uncommonly busy job, I encourage you to seek an understanding of the physiological effects of your job on your mind and body. You need to understand how your body responds to work-related stress and how to best recover from it. Short-lived or infrequent episodes of stress pose little risk. But when stressful work situations go unresolved, your body is kept in a constant state of activation. This situation increases the rate of wear and tear to your biological systems. Ultimately, fatigue sets in and the ability of your body to repair and defend itself can become compromised. As a result, the risk of injury or disease increases.
If you are burned out, can you recognize the symptoms? Are you experiencing irritability or angry outbursts? Do you have disturbed sleep, inability to fall or stay asleep, or restless sleep? Do you feel overwhelmed or hypervigilant? Are you having difficulty concentrating? Have you noticed social withdrawal or problems with friends and family? Are you experiencing feelings of worthlessness? Headaches, upset stomach, and indigestion are signs of stress. Are you using alcohol or other substances to cope with your stress? I experienced many of these symptoms of work-related stress off and on over the years.
If you have a stressful job, it is important to set aside adequate time to recover, restore, and replenish. These are some helpful techniques that worked for me, and most assuredly will help you cope with work-related stress:
Time alone is crucial. Most of us need time to be alone, reflect, and explore our feelings.
Writing in a journal is a great way to get in touch with your subconscious mind and your creative, right brain. Journaling distracts your left brain from thinking about your worries.
Take a break to escape into nature. Take the kids to the playground. Walking outside in sunshine and green spaces is a great stress buster. The natural environment is calming.
If you have a quiet moment, try meditation. Keeping the Calm app on your phone will provide at-the-ready calming music and guided meditations.
Deep breathing practice is a stress relieving technique. Triangular breathing is very helpful: breathe in deeply to a count of 4; hold this breath for a count of 7; and then exhale to a count of 8. Breathe this way several times. This 4-7-8 breathing pattern engenders relaxation and lowers stress hormones.
Exercise is a crucial part of continual self-care and stress recovery. Exercise boosts your mood, lessens stress, and lowers anxiety.
Pleasant social interactions with good friends - telling stories and laughing - all relieve stress effectively. Watch for opportunities to show physical affection & give your friends a hug.
Playing and listening to music is well known to relax you and relieve stress. I started to play the piano again, which took me somewhere far away from my stress.
Confiding in your spouse or partner about your stressful work can be helpful as well. When you are ready, you might ask them to listen quietly while you just unload.
Burnout is a serious condition, and you need to know the signs and symptoms of it, as well as effective ways to manage your stress and recover from possible burnout.
For more information, please see the Resources page of my website: https://susanlandersmd.com/resources