Recently, I had the privilege of being shadowed by a medical student who is interested in becoming a pediatric critical care medicine physician like I am. On the day she came to observe me, we were navigating a busy and heartbreaking time in the pediatric intensive care unit (PICU). I was curious how the experience would affect her and her decision, but I figured it was as good of a time as any to show her what the job is really like.
Not long after we sat down to talk, she asked me the million-dollar question.
“What’s it like to do your job?”
I paused for several moments and contemplated how best to answer.
We certainly didn’t have the time to explore this question fully. And even if we had, I’m still not sure how I would truly capture the experience. Words are mostly inadequate to describe the highest highs and lowest lows of this work. I don’t think you can truly understand until you’ve experienced it for yourself.
Still, she was there to hear what I had to say. So, I started with the easy part.
Every day I am in the PICU, I have the opportunity to work with a team of highly intelligent and skilled people to deliver care to some of the sickest children in the hospital. In doing so, I get to use my brain to attempt to solve the puzzles of the patient’s medical diagnoses to help them get better. Because it’s impossible to know everything, I get to collaborate with and learn from others to grow my own knowledge. Every time I collaborate, I have an opportunity to become a better leader and teammate and increase my own emotional intelligence.
Often, the work we do has a happy ending.
Heartbreakingly, it sometimes doesn’t. In these cases, I get to use my own humanity to connect with the humanity of other people and to try to support them in their darkest moments. Unlike other people who may run from pain or inanely offer platitudes like “everything happens for a reason,” I sit with people whose hearts are breaking, and I don’t look away. Often, I don’t say much of anything. I let them pour their grief into me, and I lighten their load a little. Then, I help them plan what they should never be asked to plan. By doing so, I estimate that I make the worst experience of their lives a fraction of a percent better than it otherwise would be.
And that’s what we were experiencing on this particular day.
So, how do we address that?
So far, my career has taught me a series of lessons, many of which I learned the hard way. In our limited time together, I began to share them with her. I share them with you now in hopes that you can reap the benefits without also having to experience the hard way.
1. Don’t take life or health for granted.
“Don’t it always seem to go
That you don’t know what you’ve got
Till it’s gone”
—Joni Mitchell, “Big Yellow Taxi”
Every day in the PICU, we see people whose lives have been rocked by unexpected events. This does not mean that you should live your life in fear that the worst is always around the corner. It means that we should appreciate what we have while we have it and try as much as possible to live in the moment.
Take stock of what is going right in your own life and enjoy it. When possible, find a way to create more of it.
Doing this in my own life means that, on good days, I am able to let the little annoyances of life slide and to savor the fact that (for now) the people I love are healthy.
2. Love and heartbreak live side-by-side.
There is no heartbreak without love. Even in the darkest moments, love is there. A life without love and connection with others is no life at all.
If you’ve been keeping yourself at a distance from other people in order to avoid heartbreak, you are keeping yourself from living a full life.
3. Joy is always there if you take the time to find it.
When the PICU has several heartbreaking cases going on at once, I often hear people lament that the whole unit is terrible. While I understand that it is easy to get weighed down in these moments, I know that seeing the unit only as a terrible place is a limited view.
Most patients in our unit get better. And we are privileged to be a part of this.
When you’re experiencing hard times, you don’t have to turn to toxic positivity to block out the difficulty. But it might be helpful to zoom out and consider the broader landscape. Think very small when you do this.
Is your coffee hot? Is there a new episode of your favorite podcast? Did you get to sleep in your own bed instead of at the hospital?
Consider the microjoys in your life as a path to help you navigate through hard times.
4. You can’t care for others if you don’t care for yourself.
This was definitely a lesson I had to learn the hard way. Multiple times.
For years, I saw myself as a helper, not someone who needed help. This directly contributed to my burnout and experience with depression. I watch so many other people have the same experience, and I’d love to encourage you to find a different way.
The truth is, we all need help. We all need to be cared for. And the only person who can truly know what you need is you.
So, start by admitting that you are a human being with human needs. Then, ask yourself what you need in terms of self-care. Finally, find a way to get some of it.
I say some of it because it’s often not possible to get everything that we need when life is busy or hard. The feeling that it needs to be all-or-nothing often acts as a barrier that gets in the way of us getting any self-care at all. So, put down this unhelpful practice and just do something. Something is the gateway to doing more.
5. Feel your feelings and find a way to process them.
I spent years pushing down the secondary trauma I experienced while working in the PICU. I forged ahead without stopping until my life started to unravel while I was in fellowship. It took time and therapy to put it back together.
Secondary trauma can occur with one exposure to someone else’s trauma. Unlike burnout, it doesn’t need time to build up. This is why I recommend therapy to most people who work where I do. It is important to work through trauma with a licensed professional.
It is also helpful to have a practice that allows you to experience grief and other negative emotions. One method to preventing secondary traumatic stress calls this “Experiential Engagement” aka “feeling your feelings.”
While I sometimes cry at work (I know all the best stairways), I prefer to process alone. I practice going to the lake by my house and listening to sad music, and then I cry.
My playlist is called “Songs to Cry To,” and it’s available on Spotify if you need it. I often hear from people at work that it’s helpful, so I share it with other people as often as I can. As of this posting, 58 people follow it. I think it’s helpful for them, and it could be for you as well.
You don’t have to be considering a career in pediatric critical care medicine to take advantage of these lessons. Putting the knowledge into practice will help you experience a fuller life with better well-being. Who doesn’t want that?
Jillian Bybee is a pediatric intensive care physician.