President's blog --- February-March 2020

Sleepless nights

As the school summer break drew to a close at the beginning of this month, I was haunted once again by the bug of insomnia. Always a sign of stress, and often occurring before I have even realised I’m stressed, the dreaded difficulty with sleep initiation and remaining asleep has weaved its way back into my life. As I reflected on the possible sources (was it just the return to work? the upcoming meeting with the Ministry of Education? the next long-term roster waiting to be written? or the multitude of reports and work that will ramp up in my NZSA role as the year well and truly gets under way?  Who knows?), I was reminded of the awful events over the Christmas period in Australia. How extraordinarily stressful and terrifying to have the threat of fire surround you. The weird, gloomy afternoon where Auckland experienced the apocalyptic, foreboding feeling that accompanied the red sky was scary enough. It is hard right now to think of Australia as the lucky country.

Knowing your own stress signals is an important aspect of maintaining your wellbeing. If you’re able to recognise and identify the first signs of disturbances to your equilibrium, then I think that is a great way to highlight that you need to ramp up the wellbeing focus of your day and figure out how to bring things back into line.  Is more alone time needed? Or is it that the garden needs weeding and I feel like I have not been given, or am able to find the opportunity to fit in such soul feeding maintenance? Whatever it might be that fills your metaphorical work-life-balance cup, identifying and fulfilling that need may be crucial to family and workplace harmony. If you have a partner, or older children, they are often very reliable resources to ask if you’re not sure what your first behaviours of stress are!

Maintaining balance comes more easily to some than others. We work long days, and for me fitting in exercise before heading off to work would mean a very early start, so I find myself envying those out exercising at 7am, when I am fed and showered and already making my way to work. Coming home after 6pm, as many do, doesn’t leave much room for play if you’re like me and need a good 8-9 hours of sleep a night. Often, it’s a hello/good night to the children, dinner, and then bed in quick succession! If only there were 26 hrs in a day…

Physician wellbeing is finally being discussed, reflected on and appreciated as being a necessary part of providing good patient care, and it is a welcome change to the adage “Physician heal thyself.”  Having the backbone and self-awareness to admit to vulnerability, and possibly needing help, takes strength and courage. Probably the worst insomnia period I have experienced so far was prompted by a high-stressing parenting situation. As I was still on maternity leave, the time taken for visits to the doctor and putting a management plan in place did not disrupt clinical work – this was fortunate only because I didn’t have to add feelings of guilt about not managing after hours clinical work to the already aforementioned difficulties.

We do a very stressful job; most anaesthesiologists develop an incredibly thick skin when it comes to witnessing the very worst life can throw at you. From neonates to nonagenarians, from self-inflicted wounds to volcanic eruptions, we manage it all, and when it turns to custard we tend to blame ourselves.  Occasionally we are present for awesome events – the birth of a much-awaited baby, or a moment of awesome teamwork where a seemingly hopeless resuscitation miraculously leads to a return of spontaneous circulation.  That many more anaesthesiologists don’t suffer from PTSD is a surprise to me.

One thing I would like to try out in 2020 is clinical peer supervision. My mother worked as a family guidance counsellor, and I have very clear memories of her heading off to supervision sessions with another colleague. This kind of counselling is mandatory in many allied health professions, so it is hard to understand why physicians have been so slow to recognise the value of peer supervision. We may use different ‘pressure-relief’ valves; often informal peer networks that function in a similar fashion to allow for reflection of the processes, not necessarily the actions or outcomes.  However, such an avenue requires a set of empathetic ears and they are not always easy to come by. Supervision allows for reflection without judgement.

We discussed Clinical Supervision at our recent NZSA Executive teleconference, with one member describing how effective it has been for her. She detailed how, in the past, she may have perseverated over a difficult case or poor outcome, but since commencing regular supervision, is able to park those negative thoughts, knowing she can process them in due time at her next meeting with her clinical supervisor. Preventative medicine indeed!

I would like to take a moment to acknowledge the work of those who looked after the Whakaari victims. From Whakatane to Auckland, Middlemore to Christchurch, Waikato to Wellington there was a massive and impressive response by our New Zealand community to maximise the chances of survival by those affected. For some in the community it meant the cancellation and postponement of their scheduled elective surgery. For others, it meant the loss of a loved one. Australia’s response to repatriation was very impressive – they clearly learned a lot from their experience of the 2004 Bali bombings. Australia is used to long distance transfer and their mostly centralised service is well used to transferring critically ill patients for long distances – there is a lot we can learn from them.

As autumn beckons and parts of Australia have gone from fire to hail, I hope you have all had a reasonable start to 2020.

Ka kite ano,
Kathryn Hagen