PharmacyU Toronto was an absolute blast! The event was sold out and response was incredible. Many thanks to my friends at EnsembleIQ for the incredible opportunity. That’s me onstage BTW holding my arm in a very dramatic fashion. For the story that goes with this picture please go to PharmacyU !
My wife and I were on the couch. She looked over at me with wide eyes. Something either really good or really bad was about to happen. I had no idea which one. She held me in a steady gaze. “Honey,” she said “That was the best damn pork chop you have ever made!”
Kaboom! I had made my wife an awesome pork chop! I know this might sound trivial but I take my pork chops seriously. I marinate in garlic and soy (not me but the pork) and then BBQ (yes even in winter-because it make me feel extra manly). For some reason, these particular pork chops kicked ass more than usual. I was thrilled. I had levelled up on my pork chop cooking.
It feels great to level up. We all have sets of skills that are important to us, things we do that feel particularly good. That’s how I feel about pork chops. I seriously think I could out pork chop Gordon Ramsay. (Ok, I actually couldn’t-but it’s fun to dream).
Levelling up feels great. When we know that our skill level has jumped and we’ve made significant progress we need to recognize it. That’s why I think it would be brilliant to have Terry Crews appear magically whenever we level up, tear off his shirt and yell at us “You just levelled up! Right on!”. Then he would give us a monstrous high five and disappear in a masculine mist of old spice. That would be awesome. I think this would be a great deal for Terry as well. He’d meet all kinds of cool people who had just accomplished something, and he’d get to travel. OK, we’d have to work out the whole “Magically appearing” thing (I’ve got an email in to Stephen Hawking) but after that, it would be a breeze.
Imagine: you’re going through your day and you do something awesome. Maybe you’re especially great at your job, maybe you hold your temper for another five minutes, maybe you make a great pancake. All of a sudden the air around you crackles, there is a rip in the fabric of time and space and Terry Crews appears with a 40 lb dumbbell in one hand and a protein shake in the other. He looks at you with a mixture of admiration and positive ferocity and yells “You just leveled up ! Nice looking pancake. The world needs more badasses like you.” Then he drops the dumbbell. Give you a blistering high five and disappears again. Leaving you with a ridiculously heavy weight and an improved sense of self-esteem.
That would feel awesome. While I work the details of this out and get Mr Crews and Mr Hawking on board, we can do this ourselves. When we’re great at something, acknowledge it. When you level up allow yourself to feel terrific.
You do a lot of good over the course of a day and the world does need more badasses like you.
U of T Med Magazine has done a great edition on humour in medicine. I was honoured to be included. To have a look at the other articles please go to UofTMedmagazine.
I’ve been an improviser for a long time, worked for The Second City in Canada and abroad, and to me there is something almost magical about improv.
When I was recovering from cancer, I noticed that when I went to improv shows, good things happened. I would laugh with friends, and then feel noticeably better for days. I had been in and around improv for years of course, but I wondered if this was having a positive effect on my ability to cope with life after cancer. Improv became a tool for me to deal with my condition.
I started making jokes and shows out of my situation and I was invited by some very generous people to teach workshops at Princess Margaret Cancer Centre for patients, and at the Faculty of Medicine for second-year students.
What could improv possibly do for physicians in training? Picture this: You’re in the centre of a windowless room and all eyes are on you. Sweat glistens on your forehead. You’re part of an intense improvisation game called Zulu, where the participants have to make up names for imaginary products on the spot. There’s no right answer and you can’t study for it. You have to get an idea and blurt it out. In other words, you have to be vulnerable.
I know you hate not having an answer the way my dog hates squirrels. I continue to point at you and wait for a response while 40 colleagues look on. I can see your intense desire to win but I wonder if you have difficulty connecting with people. Unfortunately, this lack of vulnerability reads as arrogance. And, as patients, we know it the instant we feel it.
I had an oncologist who shared this characteristic. He was technically competent but so arrogant and distant that he literally dismissed me from his office because he had a dinner reservation at Centro that evening. He wasn’t a bad physician, he had just forgotten how to be a human being. In that moment I felt a desperate sense of isolation. Later, I realized that the worst part about being sick for me was not feeling pain or discomfort, but experiencing isolation and fear.
That’s how I got the idea to bring improv into medicine: It came from my intense desire to increase the sense of connection between people in health care.
I’ve seen improv comedy in medicine do incredible things. I’ve seen it open up a room of physicians, patients and their care givers so that they can actually talk to each other in a meaningful way. I’ve seen cancer patients in real trouble somehow laugh at their situation and then share resources they didn’t know they had. I’ve watched as med students realize that they can relax a bit with patients; that they can (dare I say it?) be a human being with the people they serve.
Many times the laughter itself is enough to help us. Heck, who can argue with something that has been proven to increase serotonin and dopamine levels? Often though, it’s the good stuff that comes afterwards that has the real payoff. After people laugh, the natural release of oxytocin that occurs helps people bond together in an almost tribal way. They are more prone to trust each other and be generous to each other. What does this mean in medicine? It means that by using improv comedy to sneak by the sometimes brittle facade of our intellects, we find a way to our silliness, our vulnerability and our humanity. It creates a safer space for us to collaborate in a meaningful way.
To simply say that “laughter is the best medicine” is a platitude that floats by too quickly. These simple things called laughter and improv comedy can be the doorway to feeling better. There is profound good here that we can use to great effect and we have just scratched the surface.
That was a real person in my improv class, by the way — a terrified second-year medical student. I stayed silent and the group didn’t even breathe. There was no way out for him but to say something, anything. The question swirled in his brain: “What is the name of a car that should be invented?” He looked at me. I saw the light of an idea flash in his terrified eyes. “The Fartinater!” he cried.
The class roared with laughter. I applauded and declared him the winner. His face lit up like a 10-year old who has just had the best birthday ever. He was connected, with himself and those around him. Any sense of arrogance was demolished in the joy of experiencing a huge laugh from his peers. I saw a crack in the protective facade he presented to the world and I hoped that would translate to his work with patients in the future. ■
Have you ever had a hard time leaving work at work? Have you ever given all the emotional juice you have to your job and you finally get home only to have work thoughts creep back into your consciousness? It can be a lot like dealing with that creepy clown with the red balloon from IT. You’re having a nice supper with your family and you go to the fridge and the creepy clown is sitting next to the broccoli ready to hand you a red balloon full of troubling thoughts about work. You load things in the dish washer and there he is again with another balloon you don’t need.
Later when you go for a walk, you leave the house and right next to the mailbox you see the creepy clown again. All of a sudden your thoughts go back to your day and all its unfinished business. You try like crazy to ignore the clown but he keeps coming back again and again. How do we fix this? How do we separate our challenging work from our precious time at home? Is there some magic technique to help us shut off the endless stream of work related thoughts that can pollute our time off?
I was running my workshop The Wellness Solution: Help Yourself Help The World for a group of caring professions and we were collaborating on ways of helping ourselves deal with stress and burnout. I asked “What specific challenges do you face?” The stakes were high for these highly skilled pros. They work in a beautiful but isolated community, their caseloads are heavy and burnout was starting to take its toll.
Somebody said “I have a hard time leaving work at work! I take all of these worries about my clients home with me!” I asked the group if this was a common problem and there were nods all around.
The room came alive and we immediately collaborated on solutions. One person said “After
a tough day I gather up all the files I’ve worked on, stick them in my filing cabinet and lock them up.” Somebody else offered, “I drive home by the lake and let myself think about work until I get to the end of the road and then I’m done!”
Somebody else said “I go for a really fast walk and when I get to a certain point, I act like I’m dropping all of my work troubles out on the road.” Another one was “I put all my papers away and then say goodbye to my plants, turn off the lights and I’m done!” What useful tool had we stumbled upon? Transition rituals! Transition rituals provide a definite end to our day and let us know that it’s OK to leave our concerns behind. We are creatures of habit after all and our brains like nothing better than following a pattern. So by using our transition ritual on a regular basis we get better at it. Our psyches embrace the idea that we have ended one part of our day and begun another. By using this technique and doing something after work as simple as going for a walk or driving down a certain road; we are literally training our brains to relax and to switch gears from one way of being to another. This can help us leave work at work so we can reduce our stress and chase away that evil creepy clown.
Here are some transition rituals that we came up with that day.
1: Go for a brisk walk after work.
2: Go to the gym and do a brief workout.
3: Have a specific way of leaving the office “Turnout the lights and say goodbye to the plants”
4: Say out loud, “I’m done playing in this sandbox. This can all wait until tomorrow”.
5: Say out loud “This is yours, not mine.”
6: Take a specific route home, allow yourself to think about work until you get to a certain point, then stop.
We all know that being in the caring professions takes a lot of skill, empathy and emotional juice. All of that giving can wear out our bodies and psyches. Transition rituals can be a useful tool to help keep the creepy clown away so we can recharge our batteries and give ourselves a chance to serve not just our clients but ourselves as well.
Recently I presented The Wellness Solution:Help Yourself Help The World to a group of cardiovascular pharmacists at the 20th Annual Contemporary Therapeutic Issues in Cardiovascular Disease Conference.
To recap, compassion fatigue can affect virtually everyone in the caring professions. It’s only natural that when we use our “muscles” of compassion and empathy every day that they can get worn out. The implications of having compassion fatigue on a regular basis aren’t great. It can lead to burnout and even a decline in the effectiveness of our service. So how do we counteract this? How do we help ourselves stay engaged in our work and help the people we serve in a way that is actually sustainable? In short, how can we keep caring?
We threw this open to the group and here are a few of the answers that we came up with.
1: Go for a quick walk. Sometimes when we are a bit overwhelmed by our practice, getting even a few minutes of fresh air and physical activity can act as a reset for us in the middle of our day.
2: Have a “Burnout Buddy”. Find a colleague in a similar situation to talk to on a regular basis. Set a time with them to support each other in a non-judgmental way. Because you are probably facing similar circumstances, you and your partner will be able to relate and realize that you are not the only ones facing this issue. As well, you get to drink coffee, which is always a bonus.
3: Pretend your client is a member of your family. I thought this one was terrific. Sometimes if we are dealing with someone who is particularly challenging and we lose our patience (pun intended), it can be a great idea to pretend that the person in front of us is actually a family member. If we think of our family member being a bit confused or needing a bit more help it can really help us find more compassion for the interaction. Heck, if your Mom or Uncle needed a bit of extra help, you’d give it to them in a heartbeat wouldn’t you? Of course you would. However, make sure you don’t slip up and refer to them as “Mom” or “Uncle Reggie” as that might get a little weird.
4: Get a Massage! Ok, this wasn’t one of the suggestions for dealing with compassion fatigue but I am all for getting a good dose of RMT on a regular basis. Published evidence shows that getting a massage can make an immediate and positive impact on our health and level of happiness. I’m guessing you have some unused health benefits just sitting there gathering dust. Time to make use of them and schedule a massage!
A few more are:
5: Meditate, centre yourself or do some deep breathing.
6: Recognize that you’re not seeing your patient at their best.
7: Think “I could find myself in the same situation as a patient”.
One of the great things about all of these strategies is that they are accessible to you right now. Virtually any one of us can go for a brisk walk at lunch and clear our head, or have a chat with a colleague about how this job is pretty tough sometimes. Heck, you can even go completely crazy and go for a massage! Once again, it was an absolute pleasure to meet all of you and to hear your great stories during “You Can Own The Room: Lose the Fear and Present like a Pro.”
All the best!
When I said this to a participant at The Canadian MPN Network Conference, it got a huge laugh. One of the great aphorisms of comedy is “Its funny ’cause its true!”
In this case, the lady I was speaking to was telling me that as a result of her being sick, she said she felt more empathy for people. She could understand others’ feelings more and she could cut other people more slack. Isn’t that fascinating? You would think that after a tough time, a lot of people would become bitter or resentful.
Often we have a chunk of adversity in our lives and somehow we manage to keep on keeping on, but after getting through the stress and navigating our way through a very difficult time often we are different. You could even say we are transformed. Some of us develop more empathy, others of us (like myself) get unreasonably pissed off for a while and pray that someone will steal candy from a baby on our street so we can start a round of fisticuffs. (After a while this anger calmed down into a state of assertiveness. I am really glad because fisticuffs are inconvenient.)
But what I have found after working with healthcare professionals and people going through life altering diseases is that our most arduous experiences change us.
One of my favourite questions to ask during a keynote is “In the experience of your journey with cancer (or another issue) what learnings or insights have you made?” People always have an answer. Nobody ever says “I feel exactly the same!” I have heard people say they are more sympathetic, more adventurous, more thoughtful, less resentful, more independent, more open to new ideas, more resilient and that they eat more dessert– to name a few.
All of this is good stuff don’t you think? I do. I love all of those things (especially the one about dessert).
So, where does this come from? Well, you may heave heard of a friend of mine called Joseph Campbell. (OK, He’s not my friend, but I like to pretend he is.) He came up with the idea of The Hero’s Journey which in a very tiny nutshell, is the idea that when we go on an adventure and face challenges and adversities that we are transformed and even improved by the experience.
I really think that is what happens to us when we deal with a transformative experience with our health. Our experience changes us, it molds and shapes us until we can look at who we used to be in the past and say “Hey, I’m a better person than I used to be.”
Hey Patients, Come meet other people just like you and get some terrific resources. I am thrilled to co-host and speak at the Self Care Movement Summit at the MARS Building in Toronto.
At a recent event for The Canadian Mental Health Association Waterloo Wellington Dufferin, I was thrilled to present The Wellness Solution: Help Yourself Help The World. During one of the breaks, I was lucky enough to meet Laura McShane and we got talking about compassion fatigue. She agreed to a brief interview for this blog. But what does any of this have to do with AC/DC?
Rob: So, we’ve talked about compassion fatigue and I’m wondering could you just tell me at a very basic level what it is?
Laura: Yes, compassion fatigue is the cost of caring. It impacts the caring part of us that brought us into the helping field.
R: Is it just Mental Health Professionals who suffer from compassion fatigue?
L: Gosh, No. Everyone in the caring professions can be affected. Nurses, physicians, first responders and therapists can all be impacted by compassion fatigue. It goes beyond professions too. Parents looking after a sick child or caregivers of family member can be affected as well.
R: I read in some of my research that people who are affected by compassion fatigue sometimes take on the feelings of the people they are helping.
L: Caring professionals can be impacted by listening to the traumatic experiences and details of a client’s life and it can be very distressing for them.
R: Is there stigma in talking about it?
L: Well, I don’t know if I would call it stigma, but I would say that sometimes it might be difficult to address it because of a worry people might think that they aren’t capable of doing their jobs, which isn’t true. Compassion Fatigue affects the most caring, hard working people.
R: How did you learn about this and then become a trainer?
L: Well, I took a terrific workshop called “Walking The Walk” by Francoise Mathieu, which was really amazing. (link here) she has done some great work on compassion fatigue and vicarious trauma . The management team of CMHA WWD believe it is important to acknowledge that it exists and help provide staff with some strategies to cope with the impact.
R: What is one of the ways to deal with compassion fatigue?
L: Having a transition ritual is a great way to help cope. A transition ritual helps you make a separation between your work life and your home life.
R: How does that work?
L: Well, when you’re done for the day and you’re going home, you might want to crank AC/DC on your car stereo and sing sing sing!!!
R: That’s hilarious! And that’s a transition ritual?
L: Yes, it can help us draw the line between these two worlds so we don’t take the concerns of our work home with us.
R: What are some others?
L: Well, some others might be allowing ourselves to think about work up until a certain point in our drive home, say up until a marker on our drive, like a Tim Hortons. And then after that spot, we only think about our personal life and we leave work behind.
R: Any other ones?
L: Sure! A really great way of transitioning from work to home is to get out of our work clothes immediately after we get home and then getting into a more comfortable outfit. It can really help us change our mindset.
R: Do you have any stories from your own experience about dealing with compassion fatigue?
L: Yes I do. It was earlier in my career and I came home from work one day and I had a really rough day. There had been endless appointments and I had helped people all day long. I was exhausted. When I walked in the door, my daughter was so excited to see me and she wanted to go outside and play, bike ride, catch frogs, colour, and do all kinds of things. I said “Oh honey, Mummy is really tired right now, can I just have five minutes of quiet please because I have been helping people all day.” She looked at me and said “But Mummy, you’re my Mummy.”
L: And at that point I knew I had to make some changes.
R: Sometimes kids can have such clarity.
L: (laughs) Oh yes.
R: Is compassion fatigue something that we ever solve? Or is it something we have to deal with continually?
L: Well, I suppose it’s different for everyone. But, I don’t think we’re ever done. It’s part of the price of being a caring professional. One thing that a lot of people don’t realize is that this builds up over time and has a cumulative effect. So, you can be in one job and then take another position somewhere else and your level of compassion fatigue might become more and more intense. Just because we have changed jobs doesn’t mean that we have solved the issue. It’s really important for us to keep looking after ourselves and making sure that we are making our self care a priority. That way, we can continue to do the work that we love and finish our day experiencing compassion satisfaction.
R: Thank so much for talking to me about this today! I really appreciate it.
L: You’re welcome! Thanks Rob.
R: To celebrate the awesomeness of this interview, let’s all crank “You Shook Me All Night Long” By Angus and the boys.
You’re in a caring profession. You care.
However, sometimes our “muscles” of compassion and empathy can get tired. You might be easily distracted when you’re with the people you serve. You might not care as much or be using your skills to the best of your ability.
It can be hard for us to admit that this is happening to us. We’d rather just push through it and pretend it isn’t there.
Then kablam! You realize “I’m suffering from compassion fatigue!”
It can feel like everyone is dealing with this better than we are. I’ll tell you a secret about humanity though, we all have our issues. Even the well adjusted “superstar” of your team can have a hard time with compassion fatigue.
So, how do we help ourselves through this? One of the great ways is to collaborate with our peers.
Really. Collaborating with our peers can help us like crazy.
It struck me that that there are literally thousands in the caring professions who are working really hard, giving generously of themselves and sometimes feeling really worn out in body and psyche because of the nature of this demanding work. I am guessing that no one in the world has this whole thing solved. Yep. No one. However, if we have one small piece of the puzzle worked out, shouldn’t we share what we have?
I had the honour recently of presenting my keynote “The Wellness Solution: Help Yourself Help The World” for The Canadian Mental Health Association: Waterloo Wellington Dufferin. I asked people to share how they dealt with this when they were having a tough day.
What happened my friends, was significant.
People stood up, talked and joked. They shared solutions and strategies to help each other with this tough issue and the energy of the room took off. As a speaker, it was so much fun to see more than a hundred people dive in and collaborate. In fact, folks were so pumped about helping each there that I had trouble ending the exercise and getting on with the show. It was a real testament to how generous people in the caring professions are and how, when we share what we have, everybody wins.
When the day ended, people were happier knowing that they helped their colleagues and that they had learned some valuable tools they could use the next time the elephant tried to sneak back in the room.