So it’s been a tough past month here in the headache program. And experience shows that this rough patch will continue for another month toward the end of the school year. This time of year triggers lots of stress for our patients, especially the high schoolers.
Lots of stress = lots of headache = lots of phone calls and office visits for patients and their parents in distress.
The high school seniors start becoming distressed first (late March through April), since their school year ends earlier. Some school systems play nice, and do not have seniors take final exams. Other schools load up on the senior projects and add finals too. I do have to wonder what the point is, since by this place in the year, the kids know what they are doing next year and their final grades do not matter that much.
The college kids are going through this at the same time, but hopefully they have the tools to cope and the resiliency to thrive despite the pressure. There are always a few who have not adapted and are not great at self-care. These are the kids who call (or their parents call and call), wanting you to intervene with college issues. There is a lack of resiliency that you had hoped would have developed during their high school years. For most patients, the college years are better than high school. But for some, they are still dealing with the same issues, just far away, perhaps with their parents helicoptering in, trying to rescue instead of trying to foster independence. And calling you to help, write letters and on and on……….
Then in later April and May, the rest of the high schoolers get into the action. We work with them to develop coping skills, figure out a good rescue plan and, most of all, make an effort at a headache healthy lifestyle. It’s a constant refrain: are they drinking enough? Staying up too late and not enough sleep? Are they eating a healthy diet or just a lot of junk? Any exercise? How about stress management? There is always something that can improve, and you always hope that the changes will stick.
There are predictable patterns for an uptick in headache frequency, generally corresponding to events in the school year. Things are usually OK at the start of the school, then reality hits and the coping fails around October. Things will level out November/December, time off and excitement around the holidays. Then it’s midterms around mid-January and the wheels come off the school bus again. There are some winter breaks in the action, and then the stress and non-coping starts again in April, as above. Things get better by June. There is a noticeable drop off in migraine, headache and distress calls over the summer.
As you might imagine, it can be exhausting to deal with the same issues, the same distress over and over. Weeks will go by and the same families will call at least once or twice per week, reporting, “nothing is working”, “we need a new plan”, “she needs to be excused for this week of school”, “we just don’t know what to do”. There is always something to improve on and you go over it with them, again. I think I would faint if someone called and said “Mary is hydrating and doing stress reduction exercises like you recommended, and she is so much better!” It might have happened once. You never hear from them when things are going great.
Compassion fatigue is a real issue among health care providers, especially those dealing with a difficult patient population, such as those with chronic pain and headache. It is characterized by physical and emotional exhaustion and a profound decrease in the ability to empathize.
So what can you do to keep from succumbing to compassion fatigue?
First you have to recognize the signs:
- Chronic exhaustion (emotional, physical, or both)
- Reduced feelings of sympathy or empathy
- Dreading work or caretaking and feeling guilty as a result
- Feelings of irritability, anger or anxiety
- Depersonalization
- Hypersensitivity or complete insensitivity to emotional material
- Feelings of inequity toward the therapeutic or caregiver relationship
- Headaches (!)
- Trouble sleeping
- Weight loss or weight gain
- Impaired decision-making
- Problems in personal relationships
- Poor work-life balance
- Diminished sense of career fulfillment
Practicing self-care is a critical method of protecting yourself against compassion fatigue. It is not uncommon for those who are constantly concerned with the needs of others to wind up neglecting their own. Folks who practice good self-care are less vulnerable to stress and compassion fatigue than those who do not.
What is good self-care? It looks different for everyone, but will include things like:
- Balanced, nutritious diet
- Good hydration
- Regular exercise that you enjoy
- Routine sleep schedule with good sleep hygiene
- Maintaining a balance between work and free time/play
- Taking care of your emotional needs
- Socializing with friends and family
- Set emotional boundaries
- Get engaged in outside hobbies
- Have friends outside of work
- Use positive coping strategies, such as deep breathing, meditation or prayer, taking a walk, talking with a friend, watching a funny movie, or relaxing in a hot bath
We owe it to ourselves to practice self-care as much as we can. We cannot help our patients and their families if we are feeling overwhelmed or even resentful of their needs. Sometimes it is hard to recognize it in ourselves but others may notice. If you notice one of your colleagues is under stress and strain, feeling overburdened by their caregiving role, let them know in a compassionate way and then offer to help in whatever way you can.
I know in my office that sharing the endless phone calls from frequent callers is much better than facing them alone. If my schedule is not completely full, I make a point of asking our administrators to direct some of the calls to me, instead of all of them going to the same person in clinic. We are in this together and work to support one another. This is good for everyone’s mental health.
I try to keep my diet healthy (and avoid eating my feelings) and exercise as often as I can. I try to meditate but have trouble finding much more than 5-10minutes daily- better than nothing.
I am totally looking forward to the warmer weather and going kayaking out in the lake, my favorite mental health activity. Here’s looking forward to summer!
HeadFirst PNP 