Healers need healing too: Q&A with Dr Jade Kua

Rany Moran speaks with senior paediatric emergency medicine specialist Dr Jade Kua about the mental healthcare, empathy and support sorely needed by medical professionals.

[TW: This article discusses topics such as depression and suicide. If this brings up any issues for you, please seek help by calling one of the hotlines listed at the bottom of the page.]

By Rany Moran

“If you’re a doctor, why are you sick?”

This is a question that doctors actually face—as if medical professionals are immune to all illnesses or, even worse, ‘not allowed’ to fall sick—just because they’re in the business of prevention and cure.

This is a common expectation of nurses and fellow health practitioners—to constantly be in tip top health—despite being exposed to infection and disease on a daily basis.

This is just one of the many unrealistic standards placed upon medical frontliners.

Besides the expectation to never be sick—let alone ever taking an MC—they are also expected to perform flawlessly in high pressure, high responsibility environments that require extensive knowledge, composure and strength (both inside and out) for long hours.

Extreme burnout, risk of sickness, compassion fatigue and work-life imbalance are some of the most jarring effects faced by healthcare professionals—but we tend to forget that healers need healing too.

Read on as I speak to Dr Jade Kua—senior paediatric emergency medicine specialist, professional life coach, mother of six and published author—about the physical and emotional labour faced by medical professionals, as well as the mental healthcare, empathy and support that is sorely needed for the industry.

On unrealistic expectations—such as not being ‘allowed’ to fall sick or take MC when needed

Rany: Jade, as a healthcare practitioner yourself, how do you deal with such expectations of not getting sick? Is it true that people in this line of work can sometimes view getting sick like accepting failure? Having to accept illness in yourself while curing others is the daily job? What are your thoughts on this?

Jade: Indeed—it is very, very hard for us to say, take an MC. Today, because of the fact that anybody with a fever or slight cough has the teeny tiny possibility of maybe having COVID-19—which is super infections and could have great implications on the workforce—most of us just take an MC now the moment we don’t feel well. But three, four or 10 years ago, you would never take an MC if you just had a fever or cough because you wouldn’t want to be seen as weak or lazy—and you wouldn’t want to put that burden of extra work on your colleagues either. So I think a lot of us worked through such instances for a long time. It was something some would almost boast about, like “I’ve been working for years without having to take a single sick day off”. The COVID-19 situation has really made us realise that if you don’t look after yourself, you might in fact, be putting your colleagues, patients and the public in danger. And if you need to rest, you should, because you need to get better fast to be an effective healthcare provider and because you are entitled to take time to recover.

On work-life sacrifices—by putting themselves and their families at risk of infection everyday by going to work

Rany: During this pandemic, on top of having to deal with an extreme healthcare crisis, healthcare professionals have had to make many personal sacrifices—like time away from family and isolating yourselves away from them to keep them safe. How was that for you?

Jade: Definitely. I think a lot of us healthcare professionals had to be super careful. Many who have elderly parents or in-laws had to actively segregate ourselves from them. Many doctors actually rented rooms, away from their families in order to have that layer of security. For me, it was a little hard because I have six, so I had to stay home. But I was extremely careful. I followed all the protocols, wore all the protective gear—yes the suit that makes you look like an astronaut but is very, very uncomfortable—and took showers and changed clothes and shoes before heading home. We had to check many steps off a list to be careful, every little thing every single day, and that added another layer of stress daily. Then when you’re with your family, you also feel like “don’t come to me”, “don’t help me”, “don’t hug me”, because you want to protect them at the same time, even though they can see you’re going through a hard time.

Rany: How do you navigate that with your children, so that they understand why you have to go out to work when everyone is told to stay safe inside?

Jade: Yes, my kids asked a lot of questions about that—and in general too. They asked me if I’d see COVID-19 patients at work, if I had to wear a hazmat suit, if people die at work. I found the best way to deal with all these questions was to answer them—honestly. I speak quite openly with my children, and I don’t sugarcoat my stories so they grow up understanding risks, doing what’s right for the greater good, life, and more importantly, about death. They also asked me if I was ever afraid about the vaccinations that I received, because they were rolled out so quickly, and of course, I have to explain that this is something we need to do, especially as healthcare professionals, and for the general population because this is a global pandemic.

On emotional labour—such as the lack of closure or guilt when faced around deaths at work

Rany: One of the greatest challenges (I believe, talking to my friends also in the medical field) is the emotional labour doctors and nurses face daily—like the stress, sense of guilt or lack of closure if one of your patients passes away. On top of this, you have to deliver the news to the family, who can sometimes be angry, fault-finding and just really upset. This must be extremely taxing, physically, mentally and emotionally?

Jade: It can be, you’re right. It’s definitely super hard in these situations—and there are so many patients and so few doctors and nurses. I think as a community, we’ve become a lot more aware (compared to previous generations) of the need for time and space after going through such tough cases, and now we have things like a buddy system in place where someone can have your back if you need a breather, and we also have mentors at work, which is becoming a lot more common now. Especially because of my background in coaching, when such instances happen at work, I feel my colleagues are less afraid to seek help or reach out to say, “hey, we need to talk about this” or “hey, I (or you) need a time out”. Any of us shouldn’t be seen as weak if we need to take some time out to grieve a patient, or catch our breath. I also think the more senior we become, the more vocal we are about changes we want to see. Such breaks were unheard of in the past, say 20 years ago, and everyone would’ve been expected to go right back to work but today, there’s a bit more acceptance—even though it’s something you’d still need to make a special request for, and not a given. But, you know, we have to start somewhere to make significant change and get that conversation growing.

Rany: Indeed, being a medical professional—and like me, a counsellor—we are constantly faced with emotional labour because we have to deal with so many different emotions—be it from the patient or patient’s family. And often, we need to put ourselves in our ‘client’s’ shoes to put their feelings before ours, which in turn sees us dehumanising ourselves, and our feelings, which isn’t healthy. At the end of the day, we are all only human.

Jade: Exactly. Whether a doctor, a counsellor or a businesswoman, you will always have a ‘customer’ complaining about something—there are outlets for that. But you can never ever complain about your customers, can you? Patients can give feedback about doctors as well, but it’s only one way, and never the other way around no matter how difficult a patient, or customer, can be.

Rany: Do you feel like you constantly need to be composed and have to compartmentalise or suppress your feelings?

Jade: It’s definitely quite tough. Because we’re not supposed to be the patients, we’re the doctors, we’re expected to have all the answers. And you’re right, a lot of people in this position have to deal with expectations by suppressing or ignoring feelings, not taking time off when they have to, whether they’re physically or emotionally unwell. Not having such boundaries can lead to a work culture that’s almost toxic, if not careful. Like on my part, I can make a personal arrangement to speak to a junior doctor who has been involved in a death of a patient or who is stressed about COVID-19 or medical exams, but ultimately there needs to be a system change, a cultural and mentality shift. It’s a much bigger movement that needs to start with individual efforts.

On extreme burnout and secondary trauma—from high stress work situations with barely any boundaries

Rany: Working in a healing profession has many negative impacts—like experiencing extreme burnout or secondary trauma that can lead to PTSD. This is a result of being too involved in a client’s case, because it is hard to have any boundaries when dealing with high pressure situations where lives are at stake.

Jade: Yes, I’ve been in the healthcare line for a couple decades now, in the intense field of critical care. I’m constantly on the frontline and have definitely been on the brink of burnout many times. And I know that it doesn’t just negatively impact me, it also makes it quite difficult for me to be an effective mom, wife or friend, and it can get very, very hard for me. And that’s already when I have a strong support system. I can’t imagine what it must be like for someone who doesn’t have great people to lean on, like a supportive husband or in-laws. What’s worse is when doctors actually do suffer from burnout or depression and commit suicide, the response from the public is more shock and horror rather than empathy. It’s like, ‘how can a doctor be tired, or sick, or sad?’, you know? We’re aware of the expectations of this job, but that doesn’t mean we’re immune to the struggles of it.

On mental wellness—the need for mental healthcare for healthcare professionals is crucial

Rany: Even amongst doctors there’s a misconception about burnout. Some think burnout directly equals stress, but it’s not just stress. Burnout is a multi-dimensional syndrome that encompasses the state of emotional, mental and physical exhaustion due to excess and prolonged stress, like working long hours for days on end. It’s important for healthcare professionals to recognise when mental healthcare is needed before any issues start to escalate.

Jade: What’s so frightening is that it’s not the kind of thing you can just take a course of antibiotics and it goes away, or something you have a cry over or have drinks with your girls to get it all out. It’s so much more than that—and many don’t see if for what it really is, a monster that looms over so many aspects of your life, not just work. This is why a support system is crucial—it could be a coach, a counsellor, friends at work who can catch you in time and ask if you need help, want to talk about it, and how to make you feel better.

Rany: Yes, a “how can I help you?’—as simple as that—can make a world of a difference and suddenly make one feel valued. The problem with burnout is the feeling of emptiness and being undervalued. But what about compassion fatigue? When practitioners take on too much of the patient’s pain and suffering?

Jade: It’s something that’s quite common. Like in the ER, you’re not just dealing with a seriously injured patient, you’re dealing with the extreme emotions of the family as well, and it gets really hard when a resuscitation is not going well. There are a lot of emotions, so it’s important to draw some boundaries. I often say to my juniors that being a good doctor doesn’t mean you have to get completely emotionally involved in the situation. In fact, sometimes it can be harder because sometimes we need to make a very impartial call on something. And that requires you to maintain emotional boundaries. It doesn’t mean you’re a better or worse doctor if you cry—cry if you feel like you need to. But in this line, good decision-making requires a data- and science-driven response, not an emotional one.

On the importance of reaching out—it’s ok to not be ok, as long as you have someone to lean on

Rany: It’s a fine line between being emotional enough so as not to suppress your own feelings, but at the same time not being too involved that it affects your decision making process or professional judgement.

Jade: I’d say I’m quite good at drawing boundaries, except for when I was pregnant. I was already quite hormonal, and I was at work resuscitating babies smaller than the baby that was actually in me, and that would just blow my mind. It was very hard because then I’d start thinking and worrying about what could happen to me and my baby, and get all worked up. But generally, I do draw boundaries and it really helps me when I get a few minutes of meditation before a shift, or have time to journal after. It’s the small things, for just a few minutes a day, that really help to untangle any emotions inside. But then there are times when things get a little tougher, like last month when a friend of mine passed away. Of course, I showed up for work and was as professional as possible, but you now, there was a certain sadness in my eyes. And a colleague of mine offered to get me a coffee. Now, I can get my own coffee, but for someone else to recognise that I was in a place of need made me feel like someone was there for me. That really made me feel better, for someone to offer a gesture of kindness like “do you need help?”, “can I help you?”. It made me feel like “wow!” because nobody ever asks how they can help me.

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