A night shift doctor explains how he finds mental fortitude

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In the middle of a recent overnight shift, Al’ai Alvarez, MD, got goose bumps after resuscitating a patient involved in a motor vehicle crash. He reminded his team during the debrief, “This feeling you’re having right now, this is what it feels like to save a life.”

He pointed this out because he knows that while we’re good at remembering when we make mistakes, our memories of what goes right tend to fade quickly. Remembering these good moments is a key to practicing self-compassion — the ability to be kinder to yourself during tough times, said Alvarez, a Stanford School of Medicine clinical associate professor of emergency medicine and a national expert in teaching wellness practices to medical professionals.

Alvarez is also a member of the emergency department’s nocturnist team — the crew that works nights. He loves the sense of continuity found by working within the nocturnists’ tight-knit, smaller community, he said, but the schedule can be straining. Learning to set strict boundaries with his time inspired his work in physician well-being.

The field emerged out of concern over rising levels of physician burnout, and solutions like Alvarez’s approach are gaining traction.

Among his physician wellness leadership roles are posts as the director of well-being for the Department of Emergency Medicine, chair of Stanford WellMD and WellPhD’s Physician Wellness Forum, and chair of wellness committees at two leading emergency medicine societies.

In a recent conversation, Alvarez shared lessons he’s learned about caring for oneself while practicing medicine.

How do you cultivate self-compassion?

According to Kristin Neff, a pioneer researcher on the topic, there are three parts to self-compassion. The first is that we must be kind to ourselves. The second is knowing that suffering is common. And the third part is practicing mindfulness, micro-moments of self-awareness of what we’re feeling and experiencing.

In the emergency department, we work with patients who are at their worst. When bad things happen we, as physicians, need to lean into self-compassion so we can understand our role versus what is beyond our control. Then we can be kinder to ourselves, including forgiving ourselves for not having all the answers.

Why is self-care key to your work as a physician?

What most people don’t see is the list of failures I’ve had, the embarrassing moments, things physicians experience yet feel shame or guilt sharing. There’s this idea in some professions of failing fast and often, so you can iterate and find the best solution. But failing is not an event to embrace in medicine, because failing fast for us can mean that patients die.

When I practice self-compassion, I own what I can change. And while the notion of embracing failing that may be associated with someone’s death is a challenging moral dilemma, I can still be kinder to myself.

I understand that even though I’ve been an attending doctor for more than 10 years, I still have room to grow. And I know this growth mindset is what we need to be better physicians for our patients and to be better colleagues.

How does caring for people help you find compassion for yourself?

It helps me recognize our common humanity: Just like me, my patients experience suffering. Knowing this gives me a sense of empathy. I also practice taking care of other health care workers, because they have been trained not to prioritize their own suffering so they can take care of others.

To sustainably care for our patients, we need to understand that it’s OK, and in fact necessary, to care for ourselves while also taking care of others. This includes allowing ourselves to pause and acknowledge the many goose bumps moments of simply doing good.

Related reading: Tips for night workers from an emergency department physician