I recently had brunch with an emergency medicine colleague who told me she felt dread going into every shift. “I feel fine once I get there. I do my job well, but leading up to it, all I feel is dread,” she said.

Merriam-Webster defines the term dread as “to fear something that will or might happen.” This was a feeling that had become increasingly familiar for myself as the preamble to every shift and that I explored and understood well. My colleague was judging herself for having the same feelings of dread, so I pushed her on it a little by asking, “What if Mary [a mutual nonphysician friend] was signing up to spend eight hours witnessing and attempting to mitigate human suffering and pain—would you judge her for dreading it and still doing it?” 

Mixed Messages

The current culture of our world asks us to be positive and excited except for in a very narrow window of circumstances that are largely related to personal grief. That feeling of dread my colleague was describing comes from our internal voice saying, “I should be able to be positive.” When we fail at that forced positivity, we feel dread. We can continue to judge ourselves for not being able to force a smile on our faces with our kept-up chins, or we can instead acknowledge the weight on our backs and honor ourselves for continuing to march uphill despite the many obstacles we face. In these challenging times when we are divided as a nation, confronting the consequences of failed social safety networks, sound education, and climate policy, what if we are not supposed to strive to stay positive?

Staying positive is the wrong goal; it feels burdensome and impossible. Can parents who are struggling with how and when to send their unvaccinated children back to school, while they’re also working from home, be expected to stay positive? Is it actually human to be positive in the face of tragedy? Do we want to be waltzing around in a beam of sunshine as many lose their homes and lives of this pandemic?

Strive to Stay Effective

To stay positive in this current phase of the pandemic—as a mother to young unvaccinated kindergartener twins and an emergency physician in the wake of a fourth wave of a more contagious variant, along with a nursing shortage that is likely to be worsened with vaccine mandates—is to be delusional. Perhaps what’s being alluded to when people ask for us to stay positive is that they want us to continue to be able to function and be kind, but they are making the wrong ask. We don’t need to strive to stay positive, but rather we should strive to stay effective. 

Striving to stay effective is more realistic and empowering. When we frame our goal as staying effective, it allows us to reflect on what creates effectiveness in our lives. It is also important to realize when we ask ourselves to stay effective, just like positivity, we can only be responsible for own effectiveness, not that of others or institutions. The question then becomes, what do I need to do to stay effective as a person? To show up to my shifts ready to face the challenges? To be kind to my patients and my ancillary staff? To be a parent? To be a partner?

The Practice of Effectiveness

The answers to those questions for me are simple: I need enough sleep, nourishing meals, time with my family and loved ones, time to exercise, help with childcare, and time to reflect.  The priority then shifts to making sure those needs are met, not just for myself, but also for the greater good of our community that needs effective doctors.

In practice what this looks like for me is having a bedtime for myself, making a lot of grilled chicken salads, playing tennis with a colleague at least once a week and hopping on the Peloton in between, declining evening events when I have worked too many evening shifts, allowing myself to hire and ask for help, and taking the time to journal and write.

It is vital that we, as emergency physicians leading through a pandemic, take the time to reflect on and clarify what we need to stay effective. Once we have those answers, we then need to prioritize those needs. When we know how to take care of ourselves so we can be effective managing the myriad of other off-shift responsibilities we hold becomes doable.

When striving to stay effective, the goal becomes self-care and preservation as opposed to numbing ourselves into the next day so we can show up “positive.” Being effective means speaking to ourselves with kindness and compassion so we can show up for our communities. It means understanding that our colleagues and partners need rest, community, and time to unwind, as do we. Being effective allows for our humanity and the heaviness of the situation while still showing up and serving our patients and communities.

Part of Our Humanity

It is true that my dear colleague and I might feel dread as we prepare to go into our shifts, knowing that we will witness the many holes in our society’s infrastructure, the mistrust of science driven by politics and poor preventative health education, human suffering, and tragedy. But isn’t that part of our humanity? Perhaps dread should be expected in such instances, and we can all applaud ourselves for showing up despite it while staying effective. 

Dr. Shafie is assistant professor of emergency medicine at Brown University’s Warren Alpert Medical School of Brown University in Providence, Rhode Island.