Our work is part of our life and how we work is also how we live. The energy that we interact with there is what creates a happy or unhappy work environment for each of us.

I love what I do and I think that I’m pretty good at it. Those two things usually go hand in hand. But last week a particular case highlighted a few things.

The case involved a female soldier suffering from a moderate cellulitis¹. The infection was from a tooth that had had a root canal started at her base. An instrument broke off in the tooth, and infection subsequently set in.

She ended up in the emerg department at a hospital and was started on IV antibiotics and narcotics. I saw her the following day.

By the time I saw her the lip and face were still very sensitive and the overall facial swelling still existed. In a nutshell I had to basically contend with an anxious patient, attempt to achieve some discharge from a tooth that was blocked internally with the broken instrument, and also get her numbed up enough to be able to do the work.

She and I worked together to manage her anxiety and fear and so I was able to achieve some positive results with the tooth and swelling.

I was fucking exhausted afterwards. Even though the work itself for this case turned out to be fairly easy, the whole management aspect just left me feeling drained.

This wasn’t the first time that this has happened. It’s happened after taking call during my pediatric dentistry and oral surgery rotations in hospital ER’s. It’s happened after other cases similar to this one.

And yet, there’s the opposite situation. I feel an emotional charge from cases and patients that arrive and leave on a more positive note.

No, it hasn’t been the first time that I’ve dealt with this sort of thing but it was the first time that I actually questioned whether this could be the cause of trouble in so many dentist’s personal lives. Could cases like this one add up over time to burn us out. Could these cases be the reason for the correlation that the profession of dentistry has with drug abuse, marital distress, and life-threatening behaviour?

• Burnout is an occupational risk for anyone who works with needy people. It is marked by three components: emotional exhaustion, cynicism, and a low sense of efficacy in one’s job².
• Burnout often occurs when a person is required to provide services for a highly needy individual who may not be helped by those services. Often caregivers perceive that they give much more than they get back from their patients³.
• High rates of burnout have been found among nurses who work in stressful environments, such as intensive care, emergency, or terminal care⁴.
• When burned-out workers go home, they are often irritable with their families. They are more likely to suffer from insomnia as well as drug and alcohol abuse, and they have a higher rate of psychosomatic disorders⁵.

So yeah, dentistry being a profession that deals with pain and suffering to some degree is prone to professional burnout. Endodontics, my specialty, is where people with pain and suffering that can’t be helped by their regular dentist get shipped to. I’m probably more prone to burnout than a general dentist.

Most people are helped by what I do, some aren’t — that’s the nature of medicine. It’s very unrewarding, and often stressful, when patients return with relapsed treatment after having spent hundreds of dollars on a tooth.

There are some jobs that, although you may love, emotionally tire you out. There are others that emotionally energize you. The practice of Endodontics, in my opinion, is not an emotionally uplifting job. It is rewarding in many other ways — intellectually, financially, altruistically — of course, but not emotionally.

To maintain a healthy personal life, then, what mechanisms have I developed over the years to deal with burnout? Here’s a list. Each point can be a post in itself, so I’ll keep the points short:

• Leave work at work. Very rarely do I bring “my patients” home with me.
• Bring home to work as often as I can. This grounds me.
• Yoga and dancing.
• Strict policies at work that pertain to management of our patients and referring offices.
• Pay a little more, hire motivated, intelligent staff who don’t mind sharing my burnout.
• An understanding and supportive wife.
• Ignore a certain man who has for years said that I should work more hours, “Do it now while you’re young”. He looks like me, only a little older.
• Maintain a cost of living that still allows me the choice to work more or less hours without feeling imprisoned in a tiring, demanding work schedule.
• Vacations.
• Pets.
• This blog.

Lastly, remember way back up at the top of this post, I spoke of energy?

Burnout is all about energy. Needy patients suck positive energy out of me. I give freely of the energy because it is my job. Other people in creative fields may find that their work involves manipulation of energy to create something larger and greater than the individual. Not so in my field.

Some people arrive in such a negative psychologic or emotional state that my energy is just barely able to get them to a neutral level — just enough that the job can get done. By the end of the day I’m pretty drained and need to recharge for the next day.

How we recharge our batteries is an individual process. For me, the first step is to eliminate as much negativity from my life as possible — lead a positive life, eliminate negative people. And then I just let life swallow me up. I take the time to stop and observe the goodness around me. I see the world for the beauty it holds.

Our dying Maple, 40 years old, lets go of its last leaf. This leaf is a vestige of the spirit this tree once knew. I watch as the wind takes hold of it and the leaf zigs away then zags towards me. I do not move. I am part of this drama.

The leaf rolls through the currents as fate inexorably pulls it down. Then it lands on the surface of our pool. It produces no ripples across the water’s face, yet it is a jagged red blemish upon the reflected sky. It floats heedless of its destiny.

The wind blows. A frog croaks. I hear. I see. I smile.

1. A painful swelling of the soft tissue of the mouth and face resulting from a diffuse spreading of purulent exudate along the fascial planes that separate the muscle bundles. [↩]
2. Maslach, C. (2003). Job burnout: New directions in research and intervention. Current Directions, 12, 189-192 [↩]
3. Van YPeren, N. W., Buunk, B. P., & Schaufelli, W. B. (1992). Communal orientation and the burnout syndrome among nurses. Journal of Applied Social Psychology, 22, 173-189. [↩]
4. Mallett, K., Price, J. H., Jurs, S. G., & Slenker, S. (1991). Relationships among burnout, death anxiety, and social support in hospice and critical care nurses. Psychological Reports, 68, 1347-1359. [↩]
5. Parker, P. A., & Kulik, J. A. (1995). Burnout, self- and supervisor-rated job performance, and absenteeism among nurses. Journal of Behavioral Medicine, 18, 581-600 [↩]