I began pondering this topic after I witnessed a health care professional post on Facebook her hospital system’s expectation that she return to work five days into COVID, still ill and actively symptomatic.   She needed more recuperative time but struggled to give herself permission to take it. Unfortunately, this scenario is all too common in the health care community. How did we get here?

Demoting the importance of my own health started early on in my medical career. I experienced numerous extraordinary moments in residency, but I also learned some very bad habits: How to eat a salad in five minutes by chewing less; how to hold my urine for well over 16 hours; how to condition myself not to allow and process my own emotions as patients died or my family faced medical calamities.   When my closest childhood friend was being admitted through the emergency department with recurrent brain cancer after being in status epilepticus all night, from work I coordinated her care to the best of my ability and visited her following the completion of my shift.

As an attending, I continued to live by and model this culture. I ambulated on an improperly healed ankle fracture for two years during the COVID pandemic not allowing myself to seek care. I could tolerate the pain; therefore, I did. After a very long fertility struggle, I miscarried while working. One could argue that leaving the hospital wouldn’t have changed the miscarriage, and I wholeheartedly agree. I wish I had allowed myself to go home to the comfort of my husband and have an epic sob. Instead, I shoved it away and kept on working as my dream literally flushed away.

In the physician journey, we learn and cultivate thoughts that fortify the belief that our well-being is inherently secondary to our patients and our career. This culture is reinforced with every illness.   Calling in sick means one of two things will happen:  either a colleague will work extra, or the remaining health care team will face an increased patient load which may or may not be doable from a safety and quality perspective. A colleague working extra may not seem like a huge burden, but it is a colossal request when that individual is also exhausted and deficient in self-care.

Institutional health care has no reserve and has been built on a foundation of health care workers subjugating their own health and well-being to the needs of the medical system and the patients they serve. “I can’t call in sick; there will be no one to care for my patients.”  When we repeatedly care for others at the expense of ourselves because we have no reserve, we propagate the burnout, anxiety, depression, and substance abuse issues that many health care workers face. Ill health care workers and their employers typically process the situation more through the lens of them being essential personnel than patients. Health care personnel who are ill deserve to become patients who are served by the health care system too.

Do we truly understand how to perform self-care? Are you filling your bucket, or are you emptying it? This question is inspired by a children’s book I love called Have You Filled a Bucket Today by Carol McCloud: “A bucket filler is a loving, caring person who says and does nice things to make others feel special. When you treat others with kindness and respect, you fill their bucket. But you can also dip into a bucket and take out some good feelings. You dip into a bucket when you make fun of someone when you say or do mean things, or even when you ignore someone.”

Extrapolating this concept to self-care, we see that we fill our buckets when we engage in regular and proactive promotion of our own health and well-being. We fill the bucket of another when we regularly promote the health and well-being of that individual. We dip into our own buckets when we regularly compromise and devalue our own health and well-being to promote the health and well-being of other individuals, institutions, etc.

If we regularly subjugate our own health and well-being to the health and well-being of others, a medical system, or anything else in our life, I would argue we are lacking self-care. We all choose to dip into our own buckets in service of caring for others; it’s part of the territory. Balance though is the key and can only be achieved if we fill our bucket as we dip from it. We must be proactive. We need that massage, that hot bath, good book, nature walk, or family/friend time, and we must actively choose those self-care activities in service of keeping our bucket full rather than replacing a never-ending deficit.

How do we get there? First, we must change our core beliefs about the situation, including our core beliefs about self-care. How do we change those beliefs? We must change our thoughts. Thoughts, repeated and instilled with the idea that they are true, become beliefs. We can harness our avid curiosity to examine the thought before we retain it, and then the magic happens. We can think with intention and create new thoughts more serving to our well-being. With time, these newly cultivated thoughts become the beliefs we choose with purpose. We become empowered to care for ourselves because we believe that self-care means “me too” instead of “me last.”

As Mahatma Gandhi said, “the only possible revolution is inside us.”

Cathi Whaley is a hospice and palliative care physician.

Image credit: Shutterstock.com