These past 6 months have not been easy, I tried to think of an analogy with which to compare it. Initially I thought of an emotional rollercoaster, but that did not feel accurate as for me a rollercoaster is associated with excitement and fun as well as ultimately trust that it will end well. A more accurate comparison would be to a reluctant participant in a potentially life-threatening expedition, where you tried to plan for the journey as best as you could, but you and your crew were not equipped with the correct skills and gear at the offset. To complicate matters, the map or GPS is faulty and within the ups and downs there are unexpected twists and turns that often take you on a detour. The movie “Jumanji” comes to mind, which I naively hope also points to a happy ending.
I reckon it would have been easier for someone who has completed the expedition and survived the journey, but as I am sitting here, we are still very much in the midst of the pandemic despite the lockdown regulations being at level 2 and going to level 1 soon. It seems a bit surreal and unsettling; on the one hand, things are opening up, the public is interacting more and people have more freedom; on the other hand, there is the looming threat of a second wave, which could potentially be worse than the first one, so there are still significant restrictions on visitors and patients’ leave of absence within the hospital setting. We are again confronted with difficult decisions, which could potentially put others at risk. Ironically, throughout this period the most consistent and probably the most challenging aspect has been the constant uncertainty and pervasive sense of the unknown. This has inevitably led to decision fatigue, burnout and for some healthcare workers moral injury.
As a Child and Adolescent Psychiatrist, I was acutely aware of how difficult it was for most families and children to cope during lockdown without the structure and support of school. On the other hand, there were children who flourished with “home schooling” and really struggled when they had to return to onsite schooling. Most were struggling with the restrictions on breaktime playing and organized sport. The discrepancy between what was offered by different schools was glaringly obvious. Parents were expected to manage their own work and supervise online schooling while juggling babysitting, cooking and cleaning. They were also confronted with decisions of children returning to school or remaining online. Both options came with potential benefits and risks and again information appeared to be conflicting. To complicate matters, parents and families were often judged or criticized for the decisions they made. Families who required assistance from courts and external social workers were struggling to get access and programs which previously supported youth with behavioral difficulties were not functioning due to lockdown restrictions. Some parents assumed that outpatient departments were closed or were afraid of the risk, so did not collect medication. We were doing telephonic check-ins and giving two month repeats to reduce the number of patients seen on a daily basis. Soon it became evident how much we rely on non-verbal communication and reading facial expressions. This made telephonic check-ins challenging and during face to face consultations masks and visors became an additional barrier to overcome when engaging and trying to build rapport. Suddenly a space that should feel safe and supportive became threatening as we were a potential threat to our patients and our patients a potential threat to us. Fortunately, our patients and our multidisciplinary team were adaptable, thoughtful and supportive of each other despite the chaos and uncertainty. Again, the importance of honest and transparent communication needs to be emphasized. We should never underestimate the value of listening attentively within a safe and containing space. During our training as doctors we learn to assess, diagnose and fix and it seems important to appear competent and in control at all times. Often with these children, adolescents and families the opposite is needed. By jumping in to fix we don’t acknowledge and validate feelings and experiences. There is an unintentional communication that they are not capable. It is often more valuable for our patients to sit with these difficult feelings and “survive” them. We can support by being present and connected.
Probably the most important part to reflect on is more difficult because it would mean looking at myself as a person who is also as a mother, a daughter, a friend and a colleague. It is so important to remember that we bring our own personal thoughts, feelings and experiences into our professional and personal spaces and that we should be aware of them and how they potentially impact on our interactions. Throughout the past few months I experienced several points at which I felt as if I was drowning. During these times I would feel resentful and irritable with every added demand or request. I would be upset with myself for not being able to cope better, for not being able to find a balance between all the demands. I would also feel guilty for not being able to be more supportive and understanding of colleagues, friends or family. I would feel jealous of friends who could spend more time with their children doing things I was desperate to have time for. This would then quickly change to feelings of guilt because I was lucky to be healthy, have a supportive family and an income. We all know that research shows that we will cope better if we sleep enough, exercise regularly, eat healthily and make time for self-care. These recommendations or suggestions would make me feel even worse because it felt like it was something else that I could not fit in but should be able to. I would also feel like a hypocrite when discussing the importance of these with parents and families.
Fortunately, within these times I would receive an unexpected message or delivery from a friend, have a conversation with a colleague, an online catch-up or celebration with friends, join a discussion on a training or coaching platform or spend time with my family. These moments of connectedness would allow me to see the world from a different perspective and enable me to acknowledge that in that moment I am making progress. It might not be at the speed or quality that I hoped for, but I am still moving forward and for now that is good enough. Throughout these past few months, I have been fortunate enough to engage on different platforms with a variety of groups. Some related to work and others social. Often individuals would comment afterwards that they nearly cancelled but they are so glad that they didn’t because they felt much more positive and energized following discussions and engagement with others in the group. We can’t underestimate the importance of feeling connected and belonging. Social connectedness does not refer to the actual time we spend with others but rather to the subjective psychological bond that we feel in relation to them. I believe that may be why so many people started having weekly online meetings with family and friends across the world. Social relationships and especially social group relationships, where we have a sense of belonging is a psychological resource that can be drawn upon in times of adversity. I believe it is something we should consciously invest in.
I suspect that in a world where we don’t always have the luxury of spending lots of time together it is essential to ensure that when we do engage with others (friends, family, colleagues, patients) we make an effort to connect. One way we can achieve this is to put everything else aside (including phones), have a non-judgmental stance, pay attention and be present. Maybe finding a balance is not about being able to find time to do everything perfectly all the time but rather each day reviewing our priorities and being present in what we end up doing.
For the rest of the year, I am going to try and be more mindful, find some sort of balance and appreciate the individuals and groups that makes me feel as if I belong. I suspect some days will be easier than others but hopefully I will be kinder to myself and others. My goal is to have more moments of awe and acknowledge and celebrate achievements, however small.