The Doctor is NOT in. He is on sabbatical; what about you.
Continuing with our theme on burnout Professor Peter Brindley, Honorary ICS Senior Travelling Fellow, talks about how a trip to India acted as a “breathing space” away from a demanding career and “clinical nonsense”. The ten lessons he learnt are pointers to us all.
by Peter Brindley
“Travel is fatal to prejudice, bigotry, and narrow-mindedness.” –Mark Twain
In 2017 I was delighted to be appointed the first Senior Traveling Fellow for the United Kingdom’s Intensive Care Society. As I could not carve out a full year away from clinical, academic, or family commitments, I set out to pursue an abridged Intensivist’s version of “Eat Pray Love”. With deference to Elizabeth Gilbert’s book of that name (1), I would have three-blocks- each six-weeks long- and my goal was to “Travel, Learn, Reconnect”. I felt I needed a break from local University demands and clinical nonsense. I suspect many feel the same. I offer the following as part mea culpa, part self-reflection, and part how-to guide.
My first breathing space was to simply get away; hence I was off to India and Nepal. The second will be to explore Britain’s ICUs, in order to lecture, to learn, and to listen. The third will be to reconnect with family and kitchen; hence I will remain in exotic Southwest Edmonton, Canada. The plan is to re-discover the simple joy, peace and gratitude of my early career. While I still love clinical work -during the daytime at least- if I am honest I have become increasingly grumpy and inexcusably short-tempered. I’m only half way through my career and I have been finding less that is novel, and more that is exasperating. Disruptive innovation was needed.
I was approaching academic projects with a sense of been-there-done-that, and with the fear that I was a has-been, or partial fraud.
I had used all the traditional smokescreens to secure my time away: academic enrichment; academic retooling etc. As well as this time spent ‘doing’, I was eager for some time to simply ‘be’. I felt that I had mostly mastered the “dark arts” of publishing and presenting, such that neither felt as authentic as they previously had. I was approaching academic projects with a sense of been-there-done-that, and with the fear that I was a has-been, or partial fraud. Despite every advantage and success there was something immaterial missing. Fortunately I had the means, the colleagues, and the wife to do something about this. Whether I have the humility or capacity for reinvention, is less clear.
Travels and Travails in the Indian Subcontinent
Before leaving for India, I had done my pre-assigned reading (2-4). For example, I knew that India is the world’s second most populous country (a mere 1.3 billion souls- or another United Kingdom worth of people every three years), the world’s most populous democracy (over 50 registered parties), and home to eye-watering diversity (at least 20 official languages, and four major religions). To borrow a British expression, I also understood that it could be a “marmite” country: you love it or hate it. I was told it would rattle my brain. It therefore seemed ideal for my needs.
It was 2am when I arrived at Delhi’s Indira Gandhi Airport and- as I would imagine it is at 2pm- the place was heaving. While en route I had struggled mightily through “Eat Pray Love”. More my speed was “Hector and the Search for Happiness”,(5). This book is about a doctor who travels, reflects, and creates his own rules for happiness. I decided that I could do similarly, and my Lesson One was to simply relax. This helped during the further two hours I spent in the immigration line. I was eventually escorted to a hotel room with square-footage to match my family home, and a swimming pool for each guest. The hotel was located less than 250 feet from slums. What followed was the best sleep possible, given guilt, jet-lag, imovane, and anti-malarials.
Little prepares you for seeing cows crossing the road, wild dogs sleeping in traffic, people washing in streams, and five lanes of traffic where there should be two. Just as shocking is Lesson Two: anything can become normal. However, I never witnessed a horn sounded in anger, nor any collisions. Therefore, Lesson Three is that most systems will find equilibrium. In India, families of four plus luggage will grin from the back of a single motorbike. In the West we are often outraged when a cyclist foregoes their helmet. Clearly, we could dial down the Nanny State.
As a sucker for all things “British Raj”, I loved the madness of Delhi’s train stations and the majesty of its India Gate. I wondered at the tranquility of Gandhi’s shrine. However, it was Old Delhi that was the most gob-smacking. It dates back hundreds of years before “the Britishers”, to the Moguls and Persians. Each invasion left its mark.
Enteric nervousness grows as lunch approaches. Lesson Four was to just go for it. Whether prudent or not, my taste buds were rewarded. My bowels were resilient and remained ‘solidly behind me’ throughout my trip.
This avowed secularist was certainly moved, if not to reconsider, then at least to apologize for the times I have mocked others’ beliefs.
Old Delhi is resplendent with forts, temples, and mosques. This avowed secularist was certainly moved, if not to reconsider, then at least to apologize for the times I have mocked others’ beliefs. Accordingly, Lesson Five has to be that science and logic will only help so much. My secularism presumably reflects my upbringing, my education, and my profession. It likely also reflects my easy Western life, and the sense that I own my future. Who knows where I would turn if I had nothing but hope to get me through the day. I have long suspected that avoiding unhappiness is NOT the route to happiness. Delhi left this assumption- now offered as Lesson Six- firmly in place.
From Delhi I flew to Nepal. Tragically, while the earthquake was two years ago, rubble is still everywhere. Moreover, restoration work is all done by hand, this being one of the world’s poorest nations. Soon after the shaking stopped so did the west’s attention. Accordingly, Lesson Seven is that sustained effort is required long after an issue is no longer trendy. While on the subject, Lesson Eight can be to champion less popular causes. With no disrespect to the magnificent fundraising success around Breast Cancer and Heart Disease, we could also donate more to causes unrelated to our own experiences and fears.
Nepal had a calming affect, and I made my first serious attempt at mindfulness and meditation. By Western metrics of “success” and “failure” I was rubbish. However, I stuck with it mostly because others were not around to mock. While I am still incredibly prone to distraction, I can at least now “Namaste” without smirking or eye rolling. The term loosely translates as: “The Spirit within me salutes the Spirit in you”. My Lesson Nine is to become the clinician that brings this attitude to the bedside.
Burnout is not a project that you tackle in an hour.
Back in India, and deep in Kipling’s Jungle Book I travelled from park to park through rural India, where village life is clearly lived in public. This includes washing, eating, playing, and more public urination than you can shake a stick at (pun intended). On safari game drives I saw all the beasts of the forest including deer, bison, peacocks, vultures, and tigers. The last week was carefree because I was finally relaxing. Others complained that the internet was erratic. I was delighted. Lesson Ten is that it takes time to truly unwind. Burnout is not a project that you tackle in an hour. It is also a project that does not end when your trip does.
I have returned to the cold of home and the warmth of family. Travel can make anyone a self-indulgent bore. My goal was the opposite: to be more grateful and more patient. Despite every advantage in the world- or perhaps because of it– I had lost my sense of wonder somewhere in suburban life. India was hot, crowded and ludicrous. It was also reinvigorating, provocative and necessary. Clearly, a short break, such as this, is never a panacea. However, I do not mind admitting that I connected spiritually, perhaps because I disconnected electronically. I feel more excited, which is a good job because clinical work restarts tomorrow. I have a long way to go, but every journey starts with a single step.
- Gilbert, E. Eat, Pray, Love: One Woman’s Search for Everything Across Italy, India and Indonesia. 2006. Penguin Books.
- Prasad A. In the Bonesetter’s Waiting Room: Travels Through Indian Medicine. 2016 Profile books.
- Macdonald S. Holy Cow: An Indian Adventure. Broadway Books
- Kipling R. The Jungle Book. Harper Collins. 2016
- Lelord, F. Hector and the Search for Happiness: A Novel. 2010. Penguin Books
Peter will be speaking at State of the Art 2017, Liverpool this year.
You may also be interested in our seminar Wellbeing and Burnout in the ICU, 4th September 2017 (Click on link for more info and registration)