Why Advocacy is Critical
Sometimes you don’t notice how far you’ve come until you discover you’re responding in new ways to an old stimulus.
When Dr. Sree Morton was told by her nurse practitioner, Kathy Engel, that one of the preemies in the NICU would probably need a medication change promptly, Sree noticed that something was absent in her emotional response: dread.
Yes, the dread was gone. In its place was concern, energy and self-confidence. Thinking of it, dread had been absent for a while when difficulties arose in Sree’s work. The reason was not far to seek: in the previous six months, she had been getting coaching and counseling for what she had dubbed the heaviness.
Insofar as Sree could analyze and understand it, the heaviness was a sense that her life had lost meaning and purpose. Deep fatigue from overwork was part of it—McKee Memorial Methodist hospital was short-staffed—and a rough patch in Sree’s marriage contributed to it, and so was real sadness and slippage in self-confidence that had resulted from losing two babies in less than a year. Given all of that, medicine itself with its many, many daily demands, had become a slow crawl over broken glass. Every problem felt too hard to solve, every mistake, no matter how minor was a reflection of her skills. But Sree soldiered on as she was trained to do.
The break had come when her long-time mentor Dr. Kerry O’Hara intervened. After a long talk Sree had admitted that contrary to the physician-as-Superwoman model that had been held out to her in medical school, her internship and residency, she was at a loss, needed help, and was just about ready to ask for it.
Confiding with colleagues, Sree learned the heaviness was something others had felt too, and that MMM had resources she could call on for support.
One of those resources was the wonderful Dr. Larry Monteanu, her peer coach. Larry was an internist and a certified personal coach who worked part-time for an external organization devoted to physician well being that had a contract with MMM. With Larry, she discovered coaching isn’t psychotherapy—it helps with the practical issues of life, rooted in an understanding of who the client really is and who they want to be. With a sly good humor, Larry encouraged her to reconnect with what he called her “non-negotiable values”—including her deep love of medicine—helped her set achievable goals in clear time frames and guided her as she learned to discriminate between the things she could control in her life and work and the things she couldn’t.
That distinction alone had made a huge difference, she recalled. She realized that so much of the heaviness had to do with things she was clutching tight so they would go right. Her husband, David, had to see her point of view and drop his complaints about her long hours. MMM leadership had to realize how insanely hard everyone was working. Babies had to get well when they were supposed to.
How heavy those unspoken demands were, on her.
To make requests and have hope was so different from making demands. Letting go of what she could not change released energy for paying attention to what she could control: dosages; interventions; alert, professional responses to crises.
She was also seeing Maria Esposito, a psychologist in private practice with whom Kathy Engel had connected her. In these sessions, paid for by MMM’s well being program but offsite too, and entirely confidential, Sree went deep into the feelings about herself that had contributed to the heaviness—among them, her sense she wasn’t lovable or worthy of esteem if she wasn’t successful—successful in the eyes of powerful others.
The results were in—the heaviness had lifted. Sree still felt anxious from time to time; she still got angry with herself, with David and with colleagues; she still bridled sometimes at her workload and the other demands made upon her. But there was a subtle difference: under the weight of the heaviness, she had felt everything negative and difficult in her life as a physician was simply imposed upon her. But with Larry and Maria’s aid, she was coming to see she had choices in how she responded to problems, and her responses represented her power.
She could notice her anger, take a pause and a breath and choose kindness. She could notice an institutional problem, like a difficult-to-achieve productivity goal and rather than simply resent it, she could bring it to the intention of the CMO. Above all, she could see areas where she needed more help, whether that was psychological, professional, or collegial and—since she had taken off her medical-Superwoman suit—she could ask for it.
The lift she felt propelled her, one day, into the office of Connie Delisle, the HR professional in charge of the well being program that had done so much for her. She told Connie a little of her story, and added she wanted to do what she could to make the program better known at MMM.
“Connie,” she said, “what you guys put together for us has probably saved my career. But most of the physicians, APPs and the nurses out there on the floor are struggling—they don’t know about these options, or they don’t think they work, or they think they’ll be hounded out of the profession if they admit they need them. I want to tell them they don’t need to suffer any longer. You know?”
“You want to be an advocate,” said Connie with a smile.
“I guess so,” said Sree. “I guess that’s what I want to be, but I don’t know how.”
“It’s not hard,” said Connie. “All you have to do is keep your eyes open for a colleague who might be struggling. Somebody who looks hopeless, or who seems to be angry all the time, or who has that look—deer in headlights. And all you have to do is ask, ‘How are things going? You look a little down today.”
“What if they don’t respond?”
“If they don’t respond, they don’t respond. But you’ve shown you care and they just might circle back to you later. If they do respond, you know what to do—you’re honest about your struggles and then you just lay out the options you chose and what they did for you. You don’t have to give an opinion—you just tell your story. They can argue with your opinion, but they can’t argue with your story.”
I can do that, thought Sree—and I have a candidate in mind.
Next afternoon, Sree spotted Dr. Maurice Ames coming out of one of the pediatric examining rooms. He was wearing an expression she had seen on him many times in the past few weeks—a look she recognized from looking in the mirror during the heaviness. There was talk about Mo Ames—that he was making errors, that he was absent from meetings, that “the people upstairs are on his case.”
He turned to head down the hallway. Sree picked up her pace a little and drew up beside him.
“Hey, Mo, do you have a second?”
He stopped, and blinked his eyes as if he were waking up.
“Uh, yeah. I guess so.”
“I just wanted to check in with you. You’ve been looking a little down lately, and I wanted to see if everything’s okay and if there’s anything I can do.”
There was a long pause. Mo looked left and right, maybe to see if there was an emergency exit from Sree’s question.
Finally, he made eye contact with her and said, “Sree, everything isn’t really okay, but I doubt that you can do anything for me. You’re jammed, I’m jammed, we’ve gotta work, and that’s how it is, right?”
“I wouldn’t be so sure, Mo. Come on, I’ll walk with you, and I’ll tell you a little story about myself.”
For more on The Stigma for Seeking Help in Healthcare and how to help fight and dismantle it, read our article, Physicians and their Experience with the Stigma for Seeking Help.