How doctors use Twitter to battle emotional fatigue

As a member of the Integrated Media and Technology Committee of ASCO, I have tried to champion the benefits of social media, whether it be on blogs, Twitter, LinkedIn, or otherwise. As I have become more engaged in various outlets, it has become apparent that these channels offer more than an opportunity to discuss the latest research and meet or keep up with colleagues. I have learned (and benefited) from the support that can be found online.

It came to mind recently when a tweet from Dr. Merry Jennifer Markham came up on my twitter feed: “If there was an oncologists’ support group, I would totally join it, especially after this week.”

“I love practicing oncology and caring for cancer patients, but some days, the bad news outweighs the good, and it just gets to me,” Merry Jennifer wrote me. “The week that I sent out that tweet, only half-jokingly wishing for an oncologists’ support group, I seemed to have given more bad news than in the last three months prior, combined.”

She did not need to say more—it reminded me of my time as a new attending in oncology; when my first few patients almost “broke me”: the 19-year-old presenting with inoperable ovarian cancer, the young mother diagnosed with ovarian cancer three months after she had delivered her first daughter, and the young wife who underwent a hysterectomy during pregnancy in an effort to cure her of cervical cancer. I am certain I had more “textbook” patients with cancer, but these were the ones that have stuck with me after all of these years. I still can recall meeting each of them, discussing options and prognosis, and seeing them all respond to treatment initially, relapse, undergo re-treatment, only to relapse again. I remember each conversation I had when I had to look them in the eye and tell them: “It’s time to stop. You are dying.” I also recall exactly where I was when I was notified of their death.

What stays with me is the sense that they seemed to mirror each other’s disease course. With each change of season, these three women would experience either joy or sorrow, as their cancer responded or recurred. And these women also had died fairly close in time. That is what made it so hard. The proximity of events between patients within my practice took an emotional toll on me. I recall being immersed in the grief of the situation, mourning the loss of one, then the other, and then the other. I remember feeling helpless, that I did not do enough. I also remember feeling angry because no one had told me how difficult oncology practice could be, or that events in my own clinic could occur in waves. In the lowest emotional point of my still nascent career, I had only one thought in my head—HELP.

Faced with these recollections, I felt a need to respond to Dr. Markham. “Hang in there,” I tweeted. It was all I could think of.

Moments later, she tweeted back: “Thank you. It’s one of those everybody-is-getting-bad-news times. Depressing all around.”

“When I sent this tweet I was attending on the oncology inpatient ward,” she later wrote, “and not only were the hospitalized patients I was caring for receiving devastating news—of their cancer’s progression, of a nearing death, of no treatment options remaining— but several of my own personal clinic patients were not doing well. I don’t shy away from the end-of-life discussions, and I’ve become expert at breaking bad news, but it still hurts to have to do it.”

Back when I was a new attending, I was fortunate—I was part of an amazingly supportive team who treated each other as family rather than colleagues, and my division head was also my mentor. Each of them saw me in trouble and they all pitched in to quite literally save me. Weekends on call were covered, new patient visit slots were blocked, and I was encouraged to take some days off. I felt appreciated and cared for, realized that I was part of a professional cancer community and they cared. With their assistance, I was able to persevere.

That was nearly ten years ago. I have faced similar times in my career since then, but I’ve not fallen in to such a desperate hole since then. Call it “self-protection” or “professional adjustment,” I think oncologists learn to adapt to the practice of oncology. But, I don’t think it is something we can do alone.

“I’ve recognized that I struggle with becoming emotionally fatigued when the bad news I have to give seems to happen in discouraging waves,” Merry Jennifer continued. “I tend to form close attachments with my patients over time, and while doing so allows me to care for them empathetically and passionately, it’s not ideal—or sustainable—for my own emotional self-preservation. Having colleagues who understand what I’m experiencing, who are going through the emotional ups and downs themselves, is immensely helpful. I regularly have lunch with a close friend, also an oncologist, and those minutes shared over a salad are like a mini-therapy session for us both. And finally, I’ve come to understand that my sense of well-being is improved (and preserved) by engaging in activities outside of oncology—spending time with my husband and two children, cooking and baking, and writing.”

For me, I have learned longevity as an oncologist relies on the recognition of the signs of professional trouble early and then when faced with that situation, finding help. It is a lesson I teach to those who became attendings after me. Most importantly, as my mentors did for me, I try to watch for signs of darkening skies among my colleagues in the hope I can lend support if needed.

In the modern era of social media, I have realized that another outlet has opened up—one that draws on the international experiences of oncologists, patients, and allied health professionals. It is on Twitter, on Facebook, KevinMD.com, and ASCO Connection, among others. While we must be cautious in how we engage, it has become a source of strength for me, and a source of community.