By Mark E. Robson, MD, FASCO
Originally published on February 14, 2021, in On Service; reprinted with permission.
Everyone who has run a marathon knows the feeling. Knows it well. There is a point, around 20 to 21 miles, the legendary Wall, when one is so tired, in so much pain, that it is hard to believe that one can go on. It has been so hard for so long. The end is not yet in sight. And the remaining distance seems insurmountable.
It has been 390 days since the first case of COVID-19 in the United States, 350 days since the first case here in New York [as of February 14, 2021]. Like marathoners, we started with a burst of reactive energy then found our groove and cruised through the summer. But now many are struggling with The Wall.
Resilience v. Stamina
Much is being written about “resilience” and how team leaders can promote it. My sense is that this writing doesn’t really address the problem that we are facing at this exact moment. The concept of resilience has a strong connotation of rebound after a stress or trauma. The Oxford Dictionary defines it as “the ability to recover quickly from difficulties.” Merriam-Webster adds another dimension: “an ability to recover from or adjust easily to misfortune or change.” And Martin Seligman, in his classic article about resilience, focuses on post-traumatic response and growth. Sadly, our current trauma is not yet past. While leaders absolutely need to be setting the stage for recovery and post-traumatic growth, what is sorely needed right now is stamina, “the ability to sustain prolonged mental or physical effort.”
Psychological stamina is a difficult thing to promote in medicine. Our cultural self-concept works against us. There seems to be a perception that psychological stamina is inherent in being a physician. “I am a doctor, therefore I have psychological stamina (or should).” I think this is wildly optimistic. There are individual characteristics that are correlated with the ability to withstand psychological stress, such as an ability to accept situations as they are, find meaning, and continually improvise. We often try to help our patients develop these attributes in the face of their illnesses. But there is nothing about being a physician that confers these capabilities upon us. In our present adversity, physician leaders can and should try to coach their team members in development of these skills. But medicine values self-reliance and individuality. It can be difficult for us to accept coaching, especially from our leaders, without suspecting that we are being judged. Even though flagging psychological stamina is a hallmark of burnout, admission of such can be viewed as a personal weakness, a failure, which can in turn result in resistance to coaching and support just when it is the most needed.
Head Down but Eyes Up
While looking for opportunities to coach and mentor their individual team members in the attributes of psychological stamina, leaders can also proactively fortify the stamina of their teams by laying out a vision of what can lie on the other side of The Wall, on the other side of this struggle, and enrolling the members in a movement towards that vision. We have been in a reactive posture for a year, hunkered down under the non-stop pressure of a rapidly evolving situation and of loss after loss after loss. The feelings of loss of control and uncertainty about the future can lead to learned helplessness, to involution and withdrawal into a survival mode. But this is the equivalent of ceasing forward motion and stopping at mile 23. Businesses certainly do not have the luxury of waiting for the future to arrive. Neither do we. Medicine will doubtless be different in the fall of 2021 than it was at the end of 2019. Laying out a positive vision for the future is a way to build meaning for the team, re-energizing them and giving them a reason to keep moving forward rather than just waiting passively for the situation to resolve.
As a rule, physicians have a high degree of agency—they are used to working very hard to drive positive outcomes for their patients and for themselves. But many people are having a hard time seeing how positive outcomes could follow from the situation as it is today. Leaders have an opportunity to help their teams by working with them to develop a shared picture of what a positive outcome could look like, what the path would be from here to there, and what concrete action steps should be taken to progress towards that vision. “What do we want things to look like after this is over, and what do we need to do to get there?” The disruption of the pandemic presents an opportunity to re-imagine the future. Giving the team something meaningful to move towards, and helping them to see the path there, can also help the individual members find the energy to move through their current circumstances and to create the conditions for the post-traumatic growth that is the hallmark of true resilience.
Know Who Is Being Overrun
An important point needs to be made here. Not everyone is being held back by learned helplessness and uncertainty about the future. There are some who are under so much pressure (thinking of ED and ICU teams), so engaged with this crisis, that they need breathing room before they can even contemplate the future. These teams are essentially in a never-ending war and the analogy for them is not The Wall, but Bastogne or Stalingrad or Passchendaele. There are also many who are experiencing very real, even life-threatening, mental health challenges. Leaders have to be hyper-aware of who on their team needs more than a vision to keep them moving. There are people who collapse during a marathon from exhaustion, and there are people who collapse from hyponatremia. It’s critical to know which is which.
The Only Way Out Is Through
Despite The Wall, nearly 99% of runners who start a marathon cross the finish line. My sense is that with vaccines and the coming of spring, we are moving through The Wall. But not everyone breaks through at the same time. And making it to mile 23 doesn’t mean that the marathon is over. Leading right now means helping team members adapt to the losses that all have experienced and supporting them with more than exhortation and reassurance. It means helping them move towards the new world that we will inhabit by giving them a vision of what that world can look like and how it will align with their core values, perhaps better than the old world did.
The only way to finish a marathon is to reach 26.2. And then to walk through the chute with a medal around your neck, as someone different than the person who started. We will all be changed by this experience. The direction of that change, for better or for worse, is very much up to us.
- "How to Lead When Your Team is Exhausted—and You Are, Too" by Merete Wedell-Wedellsborg
Dr. Robson is chief of the Breast Medicine Service at Memorial Sloan Kettering Cancer Center. He is a medical oncologist who concentrates on the care of women with or at risk for hereditary breast cancer. Dr. Robson writes about medicine and leadership in his personal blog On Service. Follow him on Twitter @MarkRobsonMD. Disclosure.