The Art of Caring Too Much

Is over-caring still overworking?

Photo by Ani Kolleshi on Unsplash

I shouldn’t take time off from writing. The thoughts pile up inside the attic of my mind until they are forced to spill out and make room for new ones.

Sometimes they are scribbled out on a to-do list or shared with a friend over snapchat, other times they flow in the form of tears in the FedEx parking lot. Most of the time they swirl around in my mind as I fall asleep. Not causing insomnia but being active enough to leave no doubt that they are still alive.

The FedEx parking lot scenario may or may not have occurred last week. Whatever happened, I was forced to confront my bottled-up emotions as they tumbled out around me. In an attempt to process them in real-time, I have taken to “mind-dumping” into a journal at night.

This was night #1. And I already have some thoughts to share.

I’ll spare you all the details, but a brief overview of what I process through includes a plethora of patient cases that weigh heavily on my mind. As a methodical, more-type-A-than-I-care-to-admit, perfectionist I find it hard to release these thoughts for fear that nobody else will make sure things are done right. (Yes, I heard myself and yes, I am working on that).

“Did the CT scan order for Jim get authorized by insurance?”

“Did Bill go to the ER for his transfusion like I told him to? Is he still at the hospital?”

“Is Kristin’s pain better? Has she been trying to get ahold of me but can’t reach me at work?”

“Oh, I need to check those repeat labs we ordered on Diana…”

“Hey Siri, remind me to refer John to cardiology tomorrow at 8AM.”

Mental congestion, that’s what it is.

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“There is no badge of honor for overworking…”

Dr. Sarah Nicholls

I heard Dr. Nicholls say this last week. She was referencing those in medicine who try to go above and beyond to the point of overworking themselves. Ultimately this leads to burnout because recognition is rare by administrators, and it would also be somewhat misplaced if it did show up every time someone was overextending themselves.

I think we can all admit we are grateful for the providers who work 80-hour work weeks in the hospitals caring for sick patients or the nurses who are there for 3 overtime shifts covering for a sick team member.

Yes, thank you for being here to take care of me when I need it.

But, YOU SHOULD NOT BE HERE.

I do not want to reinforce this system of overworking. It is not healthy for the human doing the work, no matter how sacrificial.

I can speak that point all I want, yet my inner dialogue is in conflict.

I think I praise myself for overworking.

Not outright saying “great job, Cheyenne. Those 2 extra hours at home each night working on patient charts really shows you work hard.”

Instead, it sounds more like, “It’s okay that you had to work 2 extra hours a night on those patient charts because you were able to spend more time in the rooms explaining a diagnosis, going over a scan, discussing treatment plans…caring for your patients. They needed that.”

Nothing changed in my habits or workload in those two scenarios. Yet the latter pins a badge of honor on my lapel for caring rather than for overworking.

So…if my over-caring leads to overworking, is it still harmful?

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We came to work in medicine because we care (at least I would hope that was one of your reasons). Being overworked and burnt-out can rob a person of this and harden them towards others, it’s true. But I believe that if we catch ourselves before that point, we can use our care to be our greatest ally.

This opens up a different conversation regarding self-care, boundaries, and ways to avoid burnout. All valid, necessary, and will likely follow at a later time so stay tuned.

These boundaries are necessary to keep us from ending up a hardened, emotionally empty, shell of a person left staring into space.

Photo by Henrikke Due on Unsplash

I, like many, find these boundaries very difficult to draw, mainly because they require me to assert my own needs. Sometimes you can care for others to a fault, which is losing the ability to care for yourself.

Dr. Nicholls’ statement aligns with both overworking and over-caring. Both are good things. Care and work. But if you pursue these to the point that you lose yourself, your sanity, your health, or your desire to care at all then what have you gained?

The poet Tennyson penned the famous words “‘Tis better to have loved and lost, than never to have loved at all.”

I was going to use this as an example of why I choose to care so much. Ultimately my conclusion to this post was going to be how I decided to care as much as possible, no matter the cost. I literally typed “I would choose to care and be worn out, then to never care at all.”

Herein lies the heart of the matter. It is not black and white. I do not choose between caring or being apathetic. There is a middle ground that is arguably a wiser alternative. That is, to care within healthy limits.

I should make a badge for my white coat that says, “health care has boundaries.” Too niche? Possibly.

Dr. Nicholls is right. There is nobody who will honor me for lying in bed at night thinking about a patient’s treatment plan. And no-one should be praising that behavior. Instead, it is on me to practice limiting the mental energy spent on such thoughts.

I choose to care, to care deeply and even emotionally. But for the sake of my own health and subsequently the health of my patients who I want to be there for, I will choose to pursue a better balance with work and my life outside of it.

Here’s to taking that first step.

Let’s keep journeying together!

~Cheyenne

(All names are hypothetical and not linked to real patients).