It was a sunny autumn day in April 2020 when the reality of the first wave of the COVID-19 pandemic was starting to hit home in Australia. I’d just eaten breakfast with my family when the news reported on an emergency physician from New York State who had jumped off the roof of the hospital she was working in. This really shocked me. My heart sunk for the poor doctor and her loved ones as I reflected on the fact that this could have been me.
Twelve months later, I’m putting the finishing touches on this book. Needless to say, COVID hasn’t gone away. It has affected us in so many ways. Some of us have lost loved ones. Others have lost jobs or businesses. The politicians are talking about their roadmaps to economic recovery. But it strikes me that very little is being said about emotional recovery.
My name is Dr Olivia Ong. I am a pain physician working in public and private practice in Melbourne, Australia.
As a pain physician, I’m in the position of witnessing my patients not only having to deal with physical pain but also emotional pain. I can say, from firsthand experience, that the mental health impacts of COVID have been massive. In fact, it is the emotional impacts that worry me the most. Social isolation, loss of loved ones and livelihoods and increased levels of uncertainly in general, have led to higher levels of anxiety and depression. The flow on from that is a spike in the consumption of opioid medications. This is a problem because these are highly addictive substances and people can get into a lot of trouble with them if they’re not careful.
My particular focus is on the well-being of doctors. The question of who is caring for the carers is top of mind for me. The truth of it is that physician burnout was at epidemic proportions before the COVID-19 pandemic. According to research presented at the 2018 American Psychiatric Association Meeting, 400 physicians die by suicide each year in the US. This is double the rate of the general population. In fact, doctors have the highest suicide rate of any profession in the US – including combat veterans.
One thing the pandemic has done is expose the cracks in the healthcare systems around the world. From inadequate testing and personal protective equipment (PPE) to overcrowded emergency departments, frontline staff are putting their lives at risk to care for highly infectious patients. Regardless of the fact that the odds are stacked against them, medical professionals are responding to the crisis with characteristic selflessness, resilience and compassion. It strikes me as profoundly unfair, not to mention strategically unwise, for the people who are being relied on so much to be left to suffer in silence – to the point where jumping off a building looks like the best option.
For many physicians, COVID-19 was the straw that broke the camel’s back. Being isolated physically from family and friends, and overwhelmed by the surge of sickness and death they face on a daily basis, means that depression, anxiety, post-traumatic stress disorder and secondary trauma are reaching levels that have never been seen before.
I had several conversations with my brother, Andrew, during the second wave of the pandemic in May last year. Andrew is a gastroenterologist in Singapore. He was deployed to the frontline and socially isolated from his family. He told me about the stress and anxiety he felt around the PPE process in particular. The reality for him was that one wrong move in putting on or taking off his PPE could result in him contracting COVID. I was really worried about him after this conversation. The long hours wearing PPE, with equally long gaps between meal and comfort breaks, had definitely taken a toll on him. I could only imagine the emotional pain he was experiencing because of the extended separation from his wife and two young kids.
I also had a conversation with one of my friends who is an anaesthetist in Australia. She told me about the stress she was under as part of the intubation team looking after patients who were severely ill with COVID and in respiratory distress. My friend is the mother of a 4-year-old girl and was constantly worried about getting COVID and either passing it on to her daughter, or (worst case scenario) leaving her daughter without a mother. On one level, I know that kind of fear, but on the level of day-to-day lived experience, I can only wonder about what resources my friend needs to just get through each day.
I had another conversation with one of my patients who I’d been looking after for about two years. Among other things, he lost his job during the pandemic and the state of his mental health forced him to reach out for help. He was particularly distressed about not being able to say goodbye to his father who was in palliative care during the pandemic. The day he received the call advising him that his father had passed away, he was actually with us in the clinic. He dropped to his knees and just sobbed and sobbed. His emotional pain was so palpable we were all vicariously impacted with a sense of loss and grief.
For my own part, I fell hard during the pandemic. I was at my worst in July 2020 when we went through a stage 4 lockdown in Melbourne. Melbourne is the part of Australia that has fared worse for one reason or other. However, comparatively speaking, the death rate from COVID in Australia is fantastically low, with less than 1000 deaths being recorded up to the end of May 2021. I had not long given birth to my daughter, Jacqueline, when we went into lockdown. My hormones were all over the place and I was recovering from a caesarean section when I found myself socially isolated at home with a newborn baby and my 5-year-old son, Joseph. Before long, I found myself spiralling down into a vortex of despair. To get through this, I had to dig deep and access resources I didn’t even know I had.
The silver lining of the pandemic, from my point of view, is that it brought virtual mentors to me. I signed up for a life-changing, online intensive course held by the Center for Mindful Self-Compassion. My virtual mentor, Kristen Neff, taught me the practices of self-compassion that enabled me to deal with difficult emotions and put an end to the kind of negative self-talk that was particularly prevalent when I was at my lowest ebb. The most significant result of putting what I learnt into practice was that I started to love myself more. That happened as I was implementing a number of simple but profound internal and external self-care strategies that helped me to be a much more mindful, self-compassionate and patient mum to my children.
Self-compassion entails acknowledging that we are suffering, that we are all in it together and that we need to love and be kind to ourselves before we can really do the same for others. For the first time in my life, I found a place of peace and power within myself through self-compassion. I believe that creating a ripple effect from self-compassion is the best way forward for us as a collective. Essentially, that is what this book is all about.
Medicine is a calling for most doctors – but is it worth dying for? I don’t think so. The way I see it, we all have a role to play in stemming the tide of physician burnout and suicide. The time has come to reaffirm the humanity of doctors and acknowledge their value to society. Medical culture and the healthcare system both need to change – that’s the bottom line.
Doctors must first acknowledge, and then heal, their pain and suffering with self-compassion. They have to do this for their own sake first and then for the sake of their patients and communities.
I have learnt a number of heart-based tools that helped me find my way back home to my heart and I’m sharing these with you in this book. My mission is to arm doctors and other medical professionals with the tools they need to tap into the heart-centredness of medicine.
As a nod to my love of food, I decided to structure this book around the idea that each of the principles or tools are an ingredient in the dish of life. Self-compassion is the hero ingredient. The other ingredients are Faith, Intuition, Mindfulness, Freedom, Vulnerability, Gratitude, Energy, Alignment, Boldness, Love and Belonging.
I look forward to taking you on the journey to the centre of your heart through self-compassion.