By Dr Manali Sankhe
I still remember how my first dying patient made me feel. They were terrified and struggling to catch a breath, all alone with no family by their deathbed. They kept asking me if they were going to die and asked me to call their neighbour who was listed as their ‘next of kin’. I still remember the first time I informed a patient that they would not survive the next few days, and the first family I told that their loved one had dementia. With my own history of mental illness, I often struggled to process these moments, ruminating on them in my mind, wondering what I could have done differently and struggling to draw a line between work and home – never feeling quite rested. One isn’t taught or even warned about these emotional struggles that come with being a healthcare professional during their undergraduate training. And navigating these? Sorry, you are on your own.
I have been working in Care of the Elderly for nearly two years as a doctor. I wish I could say heartbreaks were few and far between, but alas, it’s something one encounters nearly every day here. And often, one is left to fend for themselves. Not in the sense that one does not have enough oversight or clinical supervision, there is often plenty of that. However, dealing with those heartbreaks, coping with situations that test one still leaves much to be desired.
I have come a long way in dealing with difficult situations and though it hurts all the same, I’ve found myself coping a bit better – shockingly, without losing that bit of myself that feels. I can’t say the same for the new doctors and nurses joining us. In our organisations, I rarely see resources that support one to recover from setbacks, death and hopelessness. And before one has the chance to get their bearings, another day hits you harder than the one before.
Sure, some organisations do Balint groups and Schwartz rounds, especially specialities like palliative care where healthcare workers are expected to see pain and death, but how often are these resources encouraged or given protected time? There is a culture of ignorance and indifference brewing, and time passes by with barely any change. We barely communicate our feelings within a team, among colleagues. Perhaps, one of the reasons may be that we are constantly busy tending to the next patient and pouring from a cup that has long been empty.
I am now in a teaching fellow position that has provided me the opportunity to witness medical curricula and its evolution, but I am still appalled that no students graduating have been taught skills by their educational institution to navigate the muddy waters in which they will soon be knee-deep. I was privileged enough to have a support system when I newly joined as a doctor, had access to mental health services and my own lived experience in dealing with challenging emotions. This begs the question: why must one rely on their own support system, which they may or may not have, or even reach a breaking point before an organisational change is brought about to support employees in one of the most emotionally taxing jobs there is – healthcare.
I tried to think of solutions to prevent burnout for a long time. I sought support from wellbeing teams and mental health crisis teams, but when a system is designed to push you to a point of burnout, how sustainable are these auxiliary resources? This job is riddled with self-doubt, challenging diagnoses and circumstances, and sometimes even challenging patients and families. One is taught to communicate with patients and their families, break bad news and discuss advance directives; however, no sustainable framework to process
emotions is in place to support those who are expected to do these things.
It is true that the NHS is overworked, pushed to its limits and to be honest, crumbling. Doctors and nurses are leaving in hopes of better mental health, job satisfaction and appreciation of their work. I doubt that they want to leave a career they chose except out of desperation, because caring for people is as rewarding a job as any. I’m sure many of my colleagues, like me, value their job in healthcare, offering their services and trying to make even a small difference to someone’s quality of life or sometimes doing their best to give their patients a good death. Yet, I see these same healthcare workers every day overwhelmed, emotionally distraught by how stretched they are, with no respite in sight.
We need a culture of openness, vulnerability, and community. Why must this precious vulnerability be treated as a weakness when instead it just shows one is human? We expect our patients to tell us all they feel, do, need, and yet, we stare back at them pretending to be unaffected by the ebb and flow of life. We need to process the conveyor belt of emotions we experience daily as a community. Sometimes, I see hope of this happening – when colleagues discuss in M&M meetings how they felt unsure about a certain plan they made for a patient, or when others tell you about all they avenues they explored to help a patient that did not work out or when a patient dies and your team tells you a few bits about them, their family and what they loved.
As someone who sees patients bare their whole life to me, share their fears and comforts, I want to feel comfortable doing so in my medical community, and I imagine so do many of my colleagues. I want us all to feel safe, our humanity treasured and our experiences appreciated. I know I offer no solutions. I believe what needs to happen is a systemic change, not an individual one. Maybe today we can share things that trouble us, encourage others to do so, and listen when our team needs us. For now, being aware of our collective humanity is a start.
Dr Manali Sankhe is an Education Fellow in Geriatric Medicine at East Sussex Healthcare NHS Trust, currently preparing for a career in psychiatry. With a strong interest in reflective practice and medical education, she values the human side of medicine as much as the scientific. She is passionate about fostering critical thinking through initiatives like founding her departmental journal club. Outside of work, Manali is a keen writer and finds joy in creating art.
Photo by Masood Aslami on Unsplash
The Odyssey Journal 
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