I’m starting to look old. I noticed it quite by accident recently when I thought I had a mark on my neck, running lengthways from the top to bottom. Tipping my head back, I tried to wipe the mark away but then realised it was a fold in my skin, which looked deeper and longer when I leaned towards the mirror for a better look. Loose skin? Wrinkles? I’m only in my mid forties! What in earth had happened?

Taking a closer look at myself I saw my eyes look tired and I have those classic dark rings. My irises are not as bright anymore. Not as lively. How did this happen? So quickly too. I asked my husband if he thought I looked older; “Yes“ he said, “noticeably since starting your job”. A senior job, running the whole show.

I decide to ignore it all. I slap the makeup on, bit of bronzer for colour, pink on the lips, concealer around the eyes and rush off again, to my job that will keep me away from my children and husband. I make a mental note to not look in the mirror too hard again – only misery lies there! Just ignore it. Cope. Keep going. Don’t be soft, don’t get maudlin, cope, don’t whinge. Don’t become “that” clinician, the moaning one everyone hates getting stuck conversing with. But it is so exhausting. Everyone needs a bit of me; colleagues for direction and help, patients for care, administrators for updates, reports and project guidance. Stay bright and cheerful. Keep smiling. Stay calm. You can do this!

As I leave my three year old starts to cry and pulls at my legs. “Please just take him upstairs”, I say to my husband. Oh hell, this is awful. Poor little sod. He’s going to grow up hating me, or likely my job more. I hope he hates my job more…

I get to work. Ward round first. Everyone is expectantly waiting for me, literally queuing, lining up to ask me questions, give them advice, guidance, suggestions. So many questions, wants and needs. When will it stop! I want to shout “Work it out yourselves – you are intelligent people!” but of course I do not. I smile, listen, sympathise and decide what we are all going to do.

There are some problems to deal with. A little old lady had an MI in the night and has developed worsening CCF and is not really responding to treatment. I know her. I looked after her last time she came in with failure and she’s been in this time for a week already, gradually deteriorating. She’s a lovely old lady. One of those patients who turns the conversation from herself back to you – asking me how I am, and how my family are. I like this old girl. I don’t want her to die, but it sounds like the night team have had a fight to keep her going. She has expressed her wish many times for “no heroics” when her time comes. She has a deep faith and has told us all, “When God calls for me, you’re all to send me off gently.” She has no family. Her husband died years ago and she never had children. She was an only child. She is alone.

After the ward round I sit by her bed and try to have a chat with her, although talking is not easy for her now. She looks dreadful. She smiles at me and tells me I look tired and did I get any rest last night? I feel embarrassed. This lady is dying. She knows she’s falling into the abyss, yet she is kind enough to worry about me. I reassure her that I’m fine and how is she? Is she comfortable? Any pain? No, she says, I’m fine, just ready for a good sleep. I plump up her pillows feeling absolutely useless. I can’t do anything for this lady, nothing medically useful at all. She looks at me. Really looks at me and says, “You know, you work so hard for everyone else, don’t forget about yourself. All of you do a wonderful job and have looked after me so well. Tell your family what you do, and how you do it, and they will forgive you for not being there.” I didn’t really know what to say, so said nothing. How is she so intuitive? I held her hand for a bit and left quietly when she shut her eyes.

She died a few hours later. She fell asleep and I’m pleased to say she went off gently, as she wanted. I hope she found her God waiting for her.

Burnout. Emotional exhaustion. We hear so much about it but totally ignore the signs until it’s likely too late. Let’s be honest. People we know who have suffered burnout never really come back, not properly to the same levels, do they? They’re always a bit slower, become quieter, take more days off. I’m not like that. I “just have to cope”. In reality though, late at night, feeling out of my depth and scared, I know burnout is within touching distance and my bravado is a façade.

How to fend it off then, particularly as it’s having a clear and physical effect on me? Wrinkles, dark circles and the fact everyone jokes about me being “so angry” these days.

My advice, which I do try to follow myself, is to take time to think. Really think. Find space for yourself and take time to focus on those little gems that happen to all of us each day such as my old lady being kind to me when I was tired and focused mainly on my own woes. Or a beautiful sunset – watch it for a while. Breathe it all in. A large, natural view can often remind us that things aren’t really that bad, are they? I have a mantra that I say frequently and regularly to myself and to others who are having a moan. I say, “Well, if this is the worst thing that happens to us this week, we’re doing O.K. aren’t we?”

If we decide that yes, things really are that bad, then we must seek professional or personal help. We need to recognise that if we were advising our best friends, we would be urging them to do that. We spend all our time helping others: patients; colleagues; relatives; family, and we cannot do that if we continue as we are.

We need to reconnect with the caring side of medicine and humanity and take time to be kind to those around us, even if they are moaning. But at the same time, we need to ensure we don’t soak up too much of their misery and sadness. We must protect ourselves and keep the needy at arms length. If necessary, say that we cannot help at this time and signpost where they might go for support.

When we approach burnout, we become angry and cynical. A little bit of cynicism is O.K. and is necessary to keep a sense of perspective, but when too much leaks out, it will be us who becomes that “moaning, tiresome old fool.”

If we have them, we need to tell our family that we love them, frequently, and remind them that we do an important job. Share some of it with them, but don’t drown them in it. Help them to understand. So many of our patients do not have family to care for them and we are proud to be their substitute carers, but we mustn’t let our own families think we have abandoned them in favour of strangers. I hope I can articulate this with my three year old in time; my older children do get it, I think, and maybe they can help the three year old to do so.

And finally, if all else fails, wear make-up.