I always believe that going to work means putting personal issues aside. As physicians, we have a role to make every patient feel welcome, cared for, and heard. However, being in the ER can be stressful. Not only can stress impact our job performance, but it can increase the burnout rate. So begs the questions; how you handle stress, why is it important and what happens when you lose your main source of stress reduction, is there a back-up plan. For my wellness series, I hope to discuss my own experience of losing my main outlet for stress so you know who I am and why I am writing about this topic, the importance of physical fitness, effective quick workouts for a busy ED lifestyle, and a favorite topic of mine, imposter syndrome. As medical students, aspiring ED physicians or an ED physician, I believe we have a role to protect our own health, so that we may best support our patients.
My name is Brenda-Maricela and I have just finished my first year of medical school at Central Michigan University as an international student, having done all prior education in Canada. While, academically, I had performed well in medical school, mentally, I was burnt out. It is not that I was not used to difficult schoolwork, I had graduated from the University of Toronto, where I was quite accustomed to immense workloads, working part-time jobs and juggling extra-curriculars. It was the fact that I had no outlet for my stress.
You see, prior to medical school, my outlet would be running. I was a modern-day Forest Gump. I craved the long runs that would allow me to shake off any stress I was holding onto. The longer the run the better. I was addicted. During my MSc, I was training with the University of Toronto Triathlon club, running road races and trying to win my age group and felt I could face any challenge that crossed my path. However, I would never have anticipated that I would not be able to run for 2 years.
In the summer of 2018, I recall the moment where I was getting off of a chair at a conference. I felt a twinge in my right knee but thought nothing of it. I had a minor limp, but nothing too severe. A week later the pain grew, and before I knew it, I was in the ER. “I believe you have Patellar Femoral Pain Syndrome,” the doctor told me while reviewing my X-Rays. Patellar Femoral Pain Syndrome (PFPS) is a clinical term to define anterior knee pain, which often shows no structural damage in imaging.
It is most common in female athletes, and given the multifactorial nature, there is no single treatment. However, it often resolves with physical therapy and reducing activity. Reading about PFPS is one thing, experiencing it is a nightmare.
What would I do without running? The most common advice that I had received was to switch to biking and swimming, something which was a lower impact. These strategies worked, but as time had waned on, my knees became worse and soon, even the pool became a source of pain. I was in a rut. I would do anything to get the endorphins, but nothing would suffice. I would do anything to run again, let alone kneel in a yoga class. I saw multiple doctors, physical therapists, chiropractors and each time, I got the same diagnosis and was told it would resolve on its own.
Spring 2019, I got the phone call informing me of my acceptance to medical school. It was something I had dreamed of since I was a little girl. On one hand, I was ecstatic, but on the other hand, I was drained, depressed and couldn’t look at a jogger on the roads without feeling a sinking feeling in my stomach. How on earth was I going to get through medical school? During my undergraduate degree, I had exercising to sharpen my mind and combat stress. I knew medical school would be intense. How would I deal with the stress? What if my knee got worse? I would be in a new country, without friends and family. Would I draw too much attention if I limped, sat all the time, didn’t participate with social outings? I almost wanted to defer a year. However, my father and biggest mentor reminded me that I had managed to get through the application process without my exercises, perhaps studying would be a good distraction.
My father was right about studying being a distractor. At times, I would be so focused on learning the content, that I forgot about the pain. Other times, my brain would be so fried that I needed a distraction. But what could I do? Sitting for so long, my body craved movement, but my knees would be hesitant. During this time, I did educate myself on other exercise styles such as High-Intensity Interval Training (HIIT), or As Many Reps as Possible Workouts (AMRAP), both with weights, and both focusing on the upper body and core. I will discuss the concept of AMRAP and HIIT in my second article, where I talk about quick and effective workouts. I believe that a sound body and mind are critical to perform well and avoid burn out in, school, the ED and beyond. However, the busy lifestyle as a medical student or a physician may make the time a limiting factor. Therefore, short effective workouts may be of use, and I hope to share my research and experiences.
So, while AMRAP and HIIT didn’t replace running, it would provide some mental soundness on days when I felt particularly on edge. Over time my knees improved, and I owe thanks to some wonderful healthcare providers in Michigan. Unfortunately, while volunteering with Special Olympics in November 2019, I got a hockey-related injury to my knees, setting my progress back a few weeks. I was devastated. Mentally, I was fried, emotionally I was drained. However, the schoolwork was still there, and I had to study. So, what did I learn from November 2019 to present? I learned how important mental health and physical wellness is. This has been a topic among peers who lost their gyms due to COVID-19, thus experiencing a loss of an outlet for stress. Personally, I saw the difference that stress made in my productivity, wellbeing and ability to retain information. So, I started exploring different outlets, many of which will be discussed in upcoming articles.
Exercise is still my favorite outlet, and I think it should be a part of a daily regimen. So, for my next two articles, I will discuss different styles of exercises and free resources I discovered on the web, such as timers, YouTube Channels and websites. Following my articles on exercise and fitness, I would like to dive into the science of yoga. I remember being told about traditional meditation, however, I found that my mind was too busy, and ironically, meditation caused me stress. Many of my ED-oriented friends similarly need to keep mentally busy, and one had recommended yoga as an active meditation. This being said, traditional mediation is effective, and my ED mentor loves it. Therefore, meditation will be discussed, most likely through research and interviews with those who have benefited from it. Finally, I intend to write about imposter syndrome. A lack of self-love can be a mental stressor. If we can learn to love and appreciate all that we have accomplished, I believe that the stress will go down. To show some self-love sounds simple but is often something that so many medical students struggle with. I know I question my own acceptance into medical school, being my own worst critic.
To conclude this article, I want to say I am passionate about medicine, and in seeing my colleagues succeed. Given my enthusiasm for exercise, and having done some personal training in the past, I am eager to share all I know. Maybe I’ll be running when I write my next article. If not, I know there are alternatives, and I hope what I share can be of use to my colleagues around the world. As I tell my friends, even if life clips your wings, just know you have all it takes to fly.
References and Further Reading
LaDonna KA, Ginsburg S, Watling C. “Rising to the Level of Your Incompetence”: What Physicians’ Self-Assessment of Their Performance Reveals About the Imposter Syndrome in Medicine. Acad Med. 2018;93(5):763-768. doi:10.1097/ACM.0000000000002046
Moukarzel A, Michelet P, Durand AC, et al. Burnout Syndrome among Emergency Department Staff: Prevalence and Associated Factors. Biomed Res Int. 2019;2019:6462472. Published 2019 Jan 21. doi:10.1155/2019/6462472
Petersen W, Ellermann A, Gösele-Koppenburg A, et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2264-2274. doi:10.1007/s00167-013-2759-6