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  • Writer's pictureValerie Brooke, MD

Emotional Exhaustion

This was a vivid dream I had in August of 2020, after a 10-hour day of work, on day 4 of a 12-day stretch at the rehabilitation hospital. It left such an impression on me I wrote it down in my daily journal.

I dreamt I was taking care of patients at a new rehabilitation unit. I was on call and didn’t know any of the patients. I had trouble finding the patients I was supposed to see and was stressfully running around a hospital I was not familiar with. Eventually I ended up in a patient room with a baby and her father. Another physician, who I think is the primary attending, leaves the baby on the bed and walks away, saying nothing to me. I’m watching from just inside the doorway. The baby bucks up her back, rolls close to the edge of the bed and then falls to the hard floor. I do not get there in time. I hear a loud crack of her skull. I examine her and she has a lump on the back of her head. Her father tells me that this lump has been there since her birth, but now it’s covered in blood. I call EMS [emergency medical services] and I go with them to the hospital. The baby has a Head CT and she’s bleeding in her brain. She dies. I am devastated. I am sobbing in the dream so hard I wake up with real tears on my face.

In retrospect, I know the dream was about an actual patient I had sent to the emergency room the previous day, after I discovered her on the floor in her room. She was admitted to the acute hospital and was found to have a brain bleed. The day before that I had also sent out a patient, this one with intractable hip pain, and still remember his screams from the radiology exam table at the rehab hospital. The day before that I sent a patient to the emergency room with a severe intractable headache, as she was unable to participate in any therapies. The day before that it was a patient with severe leg pain from a car accident that fractured his pelvis, his femur, his ribs and his spine.

I was unable to take care of these patients. I felt my lack of competence as a physician. My dream was a way for me to process these feelings of inadequacy and my grief over the suffering of these patients. Somehow my brain knew, even if it had to happen in my sleep, that I needed to discharge some of this grief with actual tears.

I am so aware of how easy it is to celebrate the wins of our healthcare profession. Yesterday the local news showed up to document a patient leaving the rehabilitation hospital who had survived COVID. Claps and cheers, balloons and smiles all around. It is so much harder to share the losses.

Not having a place to share our grief, our stress, our frustrations and our limitations, during not just a regular workday but even more importantly during this pandemic, is one reason that healthcare workers like myself develop emotional exhaustion. It is just one of the symptoms of burnout. We need to be able to recognize how we are feeling, find words for them and then find a place to express them. This will allow the stress cycle to complete itself. So that our battery is recharged to go back to work the next day. So that we can show up for our patients ready and eager to take care of them.

But first, we have to show up for ourselves. If we don’t do it consciously, these emotions will rest in the unconscious, until they bubble up into our dreams or into maladaptive coping mechanisms. To feel is to be human. To feel is to heal.

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