The Pre-brief
As we pivot from the holidays, the winter promises devastation unlike anything our specialties have faced. Within the context of an already strained system, healthcare workers are working more, earning less, and repeatedly putting their lives at risk to care for the sickest patients in the hospital. Vacations and seasonal gatherings could not happen, and many of us continue to fill extra shifts. If professional burnout was a problem before, it is almost certainly now a catastrophe. However, an unaddressed area of burnout may well be taking place at home rather than at the workplace. Since most of us worked shifts or worked long, consecutive strings of days before 2020’s mayhem, COVID-19 might unmask foundational cracks many years in the making. This post explores the burnout our families feel, and the hole left by our empty seats at the dinner table.
We are no strangers to burnout, but how often do we ask if our significant others have endured the same issue? It is commonly agreed that long term career burnout is the result of 6 major expectation/reality mismatches:
- Lack of Control: You have no say over what you do, no control over what happens next.
- Lack of Reward: Successes, challenges overcome, or “correct” actions go unappreciated.
- Lack of Community: Nobody understands your experience; there is nobody with whom to debrief.
- Lack of Fairness: expectations, reward, and penalty do not fall evenly.
- Inconsistent Values: someone’s values don’t match the core values of the group.
- Work Overload: there are consistently not enough hours in the week to get everything done.
Many organizations recognize and implement mitigation strategies specific to the list above to preserve staff and institutional longevity. But what about taking steps to prevent similar deterioration at home? How sure are you that your husband feels rewarded for his hard work (e.g. “just” keeping the house clean)? Is your contribution to household chores truly understood to be “fair”? Does your clinical schedule allow for family priorities, or does the schedule control the family?
The truth is that our job never was an acceptable excuse for our absence in the lives of those we hold most dear…even if they tell us, “it’s fine.” They have their own needs/wants to balance against the chores of daily life, and our truancy makes that balance difficult and lonely. Kids or other dependents multiply that struggle exponentially. Put differently: Even though our family members support and love what we do, they signed up to be partners, not support staff.
The good news? Once domestic burnout exits the blind side, we can check destructive tendencies with good habits, mitigate damage, and even preempt long term strife. While no solution is perfect (and everyone is different), here I submit some lessons I’ve learned to support the people I love.
Communicate and Check In
A lot of stress stems from not being around at “normal times:” meals, special occasions, the nighttime routine. It’s imperative to communicate those expected absences, upfront and often. That does not just mean having “the talk” after a few serious dates; it means keeping people you care about in the loop, especially when you have shift swaps. There are many ways to do this but one way is the creation of a shared “living document” that both of you can edit/see. My family uses a google document to arrange our crazy lives: I update it with my shifts/swaps, and my wife does the same (she works weekdays 9a-5p with volunteering on the side). We also use a paper calendar on the refrigerator for easy access and redundancy in the kitchen. Having a common understanding of “where the schedule lives” is a critical way to communicate what time is available.
Along with communicating your off days, communicate sleeping or recharge needs, particularly for post-nights/second shift. Need white noise or noise-canceling earplugs? Tell your person. Need blackout curtains? Explain why. Do you expect to be a little “crispy” because you are working 20 shifts per month instead of your normal 14? Try to figure out when that fatigue will be at its worst and tell your family. They will likely understand, but not without you explaining.
Actively Request Time Off and Vacations
You may not have an idea of when (or what) to do something with your family, but it can’t happen unless you make shared time possible. Most of us can submit time-off requests a few months to a year in advance. For my average vacation-free month, I usually request 1-2 weekends off just to make sure that we at least have those days together. Remember, just because you may be off 3-4 days per week does not mean that your boyfriend or kids do. Quality time means you both have to be free to enjoy each other. Your Tuesday-Thursday time “off” may not count as much as you think, so take the time upfront, and the specific family activity plans can come later.
Being Present When You’re Absent
You may not be around during important times, but that doesn’t mean your presence can’t be felt by others. Doing things when you are home preemptively or at odd times can really take the load off your family or domestic partner.
Routine Chores:
Like so many things, it’s important to distinguish chores with your family unit as to whether or not they fall under the category of an obligation (for which one is responsible) vs. a favor (for which you get “credit”). Spoiler alert: your partner likely does not think it’s the latter (eg. it’s not actually a favor to put away dishes). So, when you come home at 2am or have off on that random Tuesday, it’s important to take stock of what needs doing around the apartment to offload your companion’s to-do list. Here are some examples:
- Laundry
- Groceries
- Dishes (cleaning and putting away)
- Cat litter duty/dog walking.
- Vacuuming, sweeping, and cleaning bathrooms
- Bills
- House and vehicle maintenance
- Kid duties (eg. can you pack lunch at 2am? How about at 5pm before your 6pm shift?)
The list goes on, but you get the gist: small things add up to create massive time/energy sucks, and taking care of them can really help. Moreover, they are also burdens to which you specifically contributed (unless you somehow don’t generate fecal matter). Sometimes couples/families will arrange to-do lists (a.k.a. “honey-do” lists). While these can be helpful, keep in mind that sometimes the simple act of making a list of chores becomes a chore itself. Whenever possible, anticipate needs instead of reacting to them being expressed by others (just like in medicine).
Cooking and Meal Planning:
When I was a fellow it became clear to me that I needed a hobby that was (1) cheap, (2) accessible at off hours, (3) allowed bonding with my fiancé (now my beautiful wife). Cooking ended up checking those boxes. While sharing a hobby with your true love is always a good idea, cooking supplies one of the most crucial needs for a household; feeding people with healthy and good-tasting food. Snacks, dinners, a surprise breakfast; people look forward to their next meal on an hourly basis. We need it to survive, but it’s also a salve, a way of making the day special (or sometimes just bearable). That takes work.
Taking some ownership of cooking and meal planning really supports your partner and doing so is possible both on days you are free and when you are gone. Researching recipes, making sure ingredients are stocked, doing meal prep or batch cooking; you can actively address all these things before you leave for your night shift or when you have time on a weekday. For those unfamiliar with cooking lingo, one of the most important and time-consuming parts of cooking is called the mise en place: measuring ingredients/preparing equipment before cooking the meal.
Like setting up for a chest tube, the recipe to success is good preparation. Prepping ingredients and having a recipe ready for your husband to follow once you’re gone can be a huge deal for them, even if he is the one cooking. That’s because a significant part of the effort and time spent in cooking is the planning and prep stage, not the execution itself. The closer you get to your wife being able to press “start” on the slow-cooker or just setting a temperature on the oven, the better. Here is a sampling of recipes that lend themselves to this approach.
Slow Cooker Meals:
- Pulled Pork
- Easy 30 min prep: sliced onions, spices, vinegar, and pork in the slow cooker.
- Example Link: https://www.delish.com/cooking/recipe-ideas/recipes/a51267/slow-cooker-pulled-pork-recipe/
- Slow Cooker Beef Stew
- Similar prep to pulled pork: probably less than 30 minutes of effort and 8 hours in the slow cooker
- Example Link: https://cooking.nytimes.com/recipes/1019691-slow-cooker-beef-stew-with-maple-and-stout
Mise en Place Meals (you can prep these meals to a high degree, and then have someone else put everything together at dinner time).
- Coconut Red Curry with Tofu
- The mise is pretty straightforward, and it’s a pretty easy weeknight meal.
- Example Link: https://cooking.nytimes.com/recipes/1016196-coconut-red-curry-with-tofu?action=click&module=Local%20Search%20Recipe%20Card&pgType=search&rank=1
- Shrimp and White Beans With Fennel and Pancetta
- Fennel and pancetta are nice, but celery and bacon works fine. Pretty filling and very tasty. Having this on a weeknight is easy, but the mise makes it even simpler.
- Example Link: https://cooking.nytimes.com/recipes/1020010-shrimp-and-white-beans-with-fennel-and-pancetta?action=click&module=Global%20Search%20Recipe%20Card&pgType=search&rank=1
The Debrief
- Your loved ones love you, but the garbage doesn’t take itself out. Your paycheck/profession does not equate to a “hall pass”. They are working hard at home and/or at their own jobs too.
- Communicate your schedule to those you love. Find a way to make it accessible and up-to-date.
- Some simple ways to be present when you are absent:
- Participate in chores (there is no dishwashing fairy).
- Be proactive with thinking about home/relationship needs.
- Mealtime is a team sport, even when you aren’t there. If you can’t cook together, think about lending an assist (even if that just means calling for pizza ahead of time). Also consider:
- Helping with meal planning
- Organizing nights out/take-out nights
- Preparing a meal in delayed fashion (e.g. slow-cooker meal)
- Preparing a mise en place with a recipe you selected
