Reviews

Surfacing after burnout

Chris Johnstone's Career Focus article on burnout (BMJ, 1 May 1999) struck a chord with me as I had recently downshifted from the chaos of trauma surgery.

Unlike Dr Johnstone, it was not a respiratory tract infection which took me out of the fast lane; it was the discovery from a long overdue medical check up that I was hypertensive. Sadly, I am unlikely the first or the last professional person who has demanded a nice, unequivocal diagnosis before accepting that physical and emotional resources were buckling under the prevailing demands.

For 12 years I headed a paediatric trauma unit. The profile of trauma care in South Africa is well known, and the substantial cohort of British students who visit our hospitals no doubt return home well equipped with ripping yarns of rivers of blood and guns hidden under hospital gowns. When local trauma surgeons gather at conferences or advance trauma life support courses, the fishing stories are no less melodramatic.

Sadly, all this guff serves primarily to shut out the cumulative emotional strain which we all feel. Trauma surgeons are the epitome of medical warriors, and would sooner drink hot chocolate down the pub than admit that their emotional resources had been tested once too often by gruesome scenarios, working routines which are no routine at all, or being overwhelmed by the enormity of the societal ills which feed our resuscitation areas night after night.

The decision to slow down followed quickly if not painlessly on the shock of my first three figure diastolic pressure reading. That evening, the urgent need to alter my lifestyle seemed as clear as it was daunting. I slumped on a couch for hours, unable to hold back tears divined out of relief, anger, grief, and recrimination.

Twelve years of tension foamed out, only to be interrupted sometime after 11 pm by a telephone call from my registrar on duty, calling for assistance. I composed myself quickly, and drove off to fight the dragons once more. Whenever I reflect on that night, I am frightened by the ease with which the call to duty could evoke the brittle persona that I had unwittingly adopted in the quest for career satisfaction. I handed in my notice the following day.

It was not easy to bow out of the workplace. I imagined that every face, every innocent comment, screamed "Judas" at me. After all, I was deserting an institution already strained by the double whammy of staff cuts and a steadily increasing workload. Self recrimination often resurfaced, sweeping personal needs like dander under the perceived demands of the greater good. I simply retreated to the relative safety of my office, and did my best to sabotage farewell functions in my honour. As in a bad dream, I was vainly trying to escape my own demons, my feet glued to the ground.

It has been two months since I finally walked out of the hospital. I still grieve for the loss of a professional lifestyle which ran amok, the void now filled by a non-clinical job with regular hours and a much slower pace. My life is less exciting, but there is more of it now, and it is still worth livingperhaps more so. It has been a major adjustment learning to do less without feeling unfulfilled. I often have to remind myself that kudos carries a price that I can clearly not afford.

I sometimes reflect on the way that I have seemed to my ex-colleagues on the many occasions when stress got the better of me and I began to bounce off the wall like a Tasmanian devil on amphetamines. Did anyone ever realise that my coping mechanisms were exhausted, a potential danger to my patients? If so, did they hold their counsel out of tact, embarrassment, or the time honoured resolution not to interfere?

I reflect on these things not because I am seeking scapegoats. After all, it was I alone who made myself indispensable, snapping up any additional obligation which could have been delegated elsewhere. It was my idea to provide senior cover almost every day, night, and weekend, ostensibly "to ensure continuity," but in fact such apparent largesse was just another symptom of an insatiable and obsessive need to feel needed. It was me who fooled myself every step of the way. I shall have to be very careful that it does not happen again.

Footnotes

If you would like to submit a personal view please send no more than 850 words to the Editor, BMJ, BMA House, Tavistock Square, London WC1H 9JR or e-mail editor{at}bmj.com

David Bass, former trauma surgeon. 

Cape Town