Because sometimes, not even chocolate is enough.

When your day is long, and the night, and the night is yours alone. When you’re sure you’ve had enough of this life, hang on. Don’t let yourself go, ‘cos everybody cries, and everybody hurts, sometimes.’

R.E.M

Every now and then a day comes along which is just too much – when the demands put upon us exceed those with which we are able to cope. There is just too much need and we simply can’t meet it. You get days like this in many walks of life, wherever individuals make themselves available to others who require assistance, but those working in general practice are, perhaps, particularly vulnerable to days such as these since those on the front line are so accessible to those in search of help – the only barrier to the one seeking assistance being the queue of needy people that stretches out in front of them.

The result is that too often we are drained of every once of energy that we posses. No wonder then that, as has been reported this week, full time GPs are becoming increasingly hard to find with, according to the King’s Fund, only 5% of current GP registrars planning to be working full time 10 years after they qualify.

And of course it’s not just work – family life with the needs of young children and elderly parents add to the burden, regardless of how willingly that burden is borne. We can be so overwhelmed that it can feel that our inability to deliver the impossible reflects negatively on us, that our failed attempts to solve every problem suggests some moral deficiency on our part.

But this is not the case.

Sometimes the problems are too many for even the most capable
Sometimes the problems are too complex for even the most wise.
Sometimes the problems are too heavy for even the most strong.

There is no shame in being asked for more than we have and only being able to give all that we’ve got. We are, after all, only human. Our mistake is to imagine that we could ever meet every need – to imagine that we could do that would, in truth, be the height of presumption.

A while ago, Amazon were kind enough to email me, informing me that here at last, on ‘Black Friday’, were the deals I had been waiting for. 40% off exclusive Le Creuset Cast Iron Round Casseroles, 45% off a Braun Cordless Epilator and 33% of a giant bar of Toblerone. Admittedly that last one did have some appeal, but do Amazon really think this is what my life has been reduced to, an anxious wait for a bargain priced gadget to remove troublesome hair from undesirable places. Amazon, for all their recommendations ‘just for me’, don’t know me very well at all for they have never offered me the thing that I’d really like. Rest. On the contrary, by trying to convince me that these are deals that I really didn’t want to miss, they seek only to add to my stress by encouraging me to strive still further to avoid missing out.

It’d be good, wouldn’t it, really good, to get some rest?

For me rest is not so much an absence of work but rather an end to struggle, the gaining of some satisfaction from what one does rather than finding work reduced to no more than a fight for survival whilst dutifully adhering to protocol. In an episode from the third series of ‘The Crown’ [minor spoiler alert], Prince Philip is portrayed as having a mid-life crisis. Bored by an endless cycle of uninspiring royal engagements he is seen briefly taking control of the plane in which he is travelling and climbing to an altitude that stretches the limits of the plane’s capacity. Criticised for his unsafe behaviour, the Prince, marvelling at the beauty of the view above the clouds, responds by remarking how, for a minute at least, he has experienced what it is to really live. Later he meets the first lunar astronauts and is disappointed to learn how even those who first landed on the moon were so caught up in following protocol that they had little time to appreciate what they were experiencing. It is, no doubt, an account that is more fiction than fact but the point is well made that there needs to be more to life, and work, than simply going through the motions, if we are going to be able to ‘hang on’ in there when times are hard.

How then might we find some rest in a world where there is no sign of any let up in the overwhelming demand? How might we find some satisfaction in a life which is often a fight for survival accompanied by a threat of censure if our actions are deemed to have deviated from approved procedure?

The answer is not by looking within ourselves. Accepting that we are not as able as some, including ourselves, would demand us to be, and giving up the pretence that we are capable of meeting the overwhelming need, is always the first step towards making things better. Instead we need to rest in the truth that satisfaction comes, not from proving our worth by our performance but by appreciating what is out there for us to see. Nobody this week will have gone home with a smile and a sense of satisfaction that a job has been well done on account of a particularly impressive piece of statin prescribing. But many will have been cheered by a connection made with a patient which has visibly made a difference even if it may not be clear quite how that difference has been made.

Our worth isn’t merely a measure of our ability, or otherwise, to deal with the innumerable problems to which we are exposed on a busy on-call day. And simple survival is never going to bring us satisfaction. We must endeavour to rid ourselves of the heavy burden of constantly trying to prove our value by religiously following procedure and instead, by straying off limits if necessary, experience what it is to live. Therein lies the root of resilience.

Not so long ago I saw a T-shirt. Emblazoned across it were the words: ‘Don’t forget to be awesome’. Such advice is dangerous for a number of reasons. Firstly it puts an onerous burden upon us and requires us to be so much better than we know ourselves to really be. It encourages us to pretend to be something we know inside we are not and it forces us to compare ourselves unfavourably to others who, seemingly, are so much more awesome than we are.

Secondly, if we genuinely believe ourselves to have achieved a level of awesomeness, we will, inevitably, arrogantly imagine ourselves to be far more important than we really are, and so much better than others. We may even be foolish enough to consider that what we think, do and say has intrinsic worth simply because it is we, the allegedly awesome, who have thought, done or said it.

And thirdly our having to be awesome will make us unhappy because satisfaction doesn’t come from being awesome but having something awesome to find satisfaction in. Resting in our ordinariness is where real happiness begins.

Having accepted our ordinariness we would then do well to learn to lean on others – and allow others to lean on us. Bob Dylan had it right in the song ‘Forever Young’ when he sang ‘May you always do for others, and let others do for you’. Medicine is a team game. For best result we must be prepared to pass the ball to others when they are in a better position than ourselves and be content to not always be the star player. If, as has been said, ‘A man may do an immense deal of good, if he does not care who gets the credit for it’ then the corollary is also true, that a man who cares too much about getting the credit, can do himself an immense deal of harm. Insisting on pursuing a go it alone individuality will only serve to produce a lonely and exhausted isolation.

Thinking about ‘compassion fatigue’ this week, I wonder if it is something more likely to be experienced by those who constantly feel they must be the answer to every problem that they encounter and who then get weighed down by a burden that it is not really for them to carry. Whilst it’s good to do what one can, we need to accept that we are not the answer to everybody’s problems and can simply offer only what we have. To feel guilty for not being omnipotent is a subtle form of arrogance, implying as it does that, part of us at least, thinks we ought to have the God like qualities that we obviously do not. When things are tough, it is, I think, better to share the sadness with the one who is suffering than proudly, and perhaps selfishly, feel guilty for not being the answer to their problems.

We are all part of something far bigger than ourselves. This is the case, not only in work, but also in life as a whole. Endlessly having to promote ourselves as more significant than we really are is exhausting and, ultimately, soul destroying. If we are to find some rest, we would do well to be content to be less important than we are generally encouraged to consider ourselves to be and take some time to enjoy something that has the genuine capacity to give satisfaction. As John Piper has said,

‘The really wonderful moments of joy in this world are not the moments of self satisfaction, but self-forgetfulness. Standing on the edge of the Grand Canyon and contemplating your own greatness is pathological. At such moments we are made for a magnificent joy that comes from outside ourselves. Do people go to the Grand Canyon to increase their self esteem? Probably not. This is at least a hint that the deepest joys in life not from savouring the self, but from seeing splendour.’

Bearing the burden of everything that work throws at us will eventually crush us and cause our hearts to sink far lower than any single encounter with a trying patient ever will. When we find our hearts cast down we would do well to acknowledge our smallness and consider the truly great, just like J.B. Priestly who said of the Grand Canyon,

‘It is all Beethoven’s Nine Symphonies in stone and magic light. Even to remember it is still there lifts up the heart’.

Not so far from the Grand Canyon is another, perhaps even more beautiful canyon named after Ebenezer Bryce who, on discovering it whilst out searching for his cattle remarked, ‘It’s one hell of a place to lose a cow’. When work wears us down, as it inevitably sometimes will, and exhausted we find ourselves reaching the end of who we are, that is the time when we all need something big enough in which we can lose ourselves. We will find some rest at last only when we stop thinking about ourselves and start finding our satisfaction elsewhere.

In something even more satisfying, surely, than an oversized bar of Swiss chocolate.