“You’re done.” This pronouncement that Dr Hilton Koppe received as a patient in a GP surgery brought his own career as a community doctor to an abrupt halt.
Shocked to be told to give up his medical work immediately, Dr Koppe’s first dilemma was: would he, a GP, follow his own GP’s advice? Maybe he could keep going at least until the following week, as his own practice was a doctor short.
His GP was adamant: “You need to not go to work tomorrow.”
But that was only one doctor’s opinion, so Dr Koppe went home to talk it over with his wife Sharon. Would he be a “good patient” and act on that advice, or not?
“In the end, I thought, well, for all my working life, I’ve encouraged doctors to have a doctor and then be a good patient. I thought I’d better do it myself,” he says. With huge trepidation, he rang his small-town practice on the east coast of Australia to say that he was not coming in that day and did not know when he would be back.
“Once I made that call, I felt the relief instantly,” he says. “A mixture of guilt and relief.”
In truth, that sudden crisis point in 2019 had been a long time coming.
While serving the community in Lennox Head, New South Wales, as a GP for more than 20 years, he had gone from caring enough to do to his job to, arguably, caring too much. “I’ve had the opportunity to care for people over a really long period of time, through good days and bad days, and I became fairly attached to some.”
As his patients grew older, many with chronic illness, “I would sit and bear witness to that suffering. Then, of course, some of them started to die.” Not because of medical error on his part, he hastens to add, “but just because it was their time”.
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Yet, he found himself becoming “hyper vigilant” about his GP work, which he combined with being a medical educator, and patients haunted his sleep at night. “I think because of my personality those things built up on me.”
What he sees now as an accumulation of multiple, mini traumas into collective trauma, started to have an impact on his physical health and “probably on my psychological wellbeing as well”.
After a long period of neck pain, one side of his face suddenly went numb while he was talking to a patient. Fearing a stroke, he went to hospital for an MRI scan. The consultation at which his GP told him the scan was clear then triggered a frank outpouring about how stressful he was finding work, which led to his doctor’s conclusion that he could not go on.
With his life as a GP finished at the age of 60, Dr Koppe used writing – which he had already found to be therapeutic – to try to make sense of what had happened to him. It led to the initially self-published, One Curious Doctor: A Memoir of Medicine, Migration and Mortality, which was soon picked up by mainstream US publisher Wakefield Press (and can be ordered through Irish bookshops).
His condition ticked all the boxes for post-traumatic stress disorder (PTSD), a label that he could live with, “whereas ‘burned out’, to me, rightly or wrongly, felt like a failure”. Not only had he done “all the things you’re supposed to do” to avoid burnout, but he had also not felt the typical symptoms of detachment and not caring. “It was the opposite,” he says.
He also explored the possibility of intergenerational trauma, as both sets of his Jewish grandparents had had to flee from Europe. As a child, Dr Koppe experienced migration too when his parents moved from South Africa, where he was born, and he always felt like an outsider while growing up in Sydney.
Six years on from that life-changing appointment with his GP, Dr Koppe is in Ireland for the first time – to lead a series of reflective writing workshops around the country with doctors and other healthcare professionals. His visit has been arranged by Attuned in Practice, a voluntary organisation that strives to give those working on the frontline of health and social care a chance to pause and reflect – so that they can go on.
“It’s very difficult to slow down and to think about how the work is affecting you,” says social care consultant Dr Nicola O’Sullivan, co-founder with former GP Dr Maeve Hurley of Attuned in Practice. “I think especially when you are in the middle of a busy A&E or a busy child protection team, because there is a worry – and staff will say to me – ‘If I stop, I might not start again’; or ‘If I cry, will I stop crying’?”
There is, she agrees, a very fine line between caring enough and caring too much. “In order to be good at this job, you have to have empathy, and of course there’s a cost to being empathic. Our hearts are open, and so things get in.”
It’s vital for frontline staff to find space to process trauma and then let it go, rather than letting it in.
There is no one right way to cope with work-related upset, and counselling may not be the answer. “If you tell somebody in the healthcare profession they need personal therapy, then that misses a vital part because what you’re telling them is the problem is with you as a person,” says Dr O’Sullivan. “That’s not true. The problem is in the work.” The work the rest of society depends on them to keep on doing their job.
Attuned in Practice has welcomed the openness of healthcare settings to offer staff the benefit of Dr Koppe’s workshops. Dr O’Sullivan believes it is indicative of a growing awareness at organisational level of the impact of trauma and that more has to be done for the wellbeing and retention of staff.
“The people that Hilton will be meeting are those that are looking after some of our most vulnerable members of society, and we have to look after them,” she adds.
At the Rotunda Hospital in Dublin, where Dr Koppe will be working this week with members of the sexual assault treatment unit (SATU) teams, Prof Maeve Eogan says there is a critical need for this type of emotional support. This event is part of a programme that the hospital has been running for a number of years. “Frontline working can feel relentless, and these initiatives have been really valuable to support and sustain the SATU team,” she says.
Dr Koppe’s two-week tour started in Cork University Hospital on March 3rd and will conclude in Naas General Hospital, Co Kildare, at the end of this week.
His engagements include a one-day Regional Trauma Network (RTN) conference in Belfast. This network is made up of staff within both the North’s statutory services and the community/voluntary sector working together to address the trauma of victims and survivors of the Troubles/conflict.
Speaking in advance of the RTN’s Day of Reflection, Learning and Connection on March 10th, Nicola Doherty, senior psychologist with the network, says she believes it will give staff time for reflection and encourage self-compassion, which helps promote overall psychological wellness. It’s not just about the people that the staff see, she says, “it’s about looking after themselves too, because when they look after themselves they also do a better job”.
Giving staff this opportunity is acknowledgment by the leadership that their wellbeing matters, she adds. “I think it’s a really important message for all staff to know that they’re valued.”
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What does Dr Koppe expect Irish health professionals to get out of his workshops? “I think the first thing is that they will have fun; even though we might be talking about things that are a little bit challenging, that’s done in a fun and lighthearted way.
“The second thing is that they will have learned ways to reframe some of the more challenging aspects of the work, to enable them to see it through a different lens or in a different light.”
There is a big focus on the emotional impact of relationships, he says, not only with the people they are caring for but also with their colleagues. In GP work, relationships with patients are formed over time, but even in an emergency department there can be very intense relationships with, for example, a stranger injured in a car crash, he says, even though patients are just passing through.
The idea behind the writing workshops “was that as health practitioners, we experience a lot and hear a lot of things. There are not always great avenues to try and understand our responses to what has gone on.
“The usual complaining in the tea room that happens at hospitals and medical practices is not always very helpful. The writing offers a different avenue; I talk about it ‘relieving’ the distress rather than ‘reliving’ the distress.”
Writing gives thoughts a forward direction, instead of having them on a loop in the mind. “It can sometimes lead people to a place that offers a new perspective.”
Dr Koppe discovered this for himself through a depressed patient he had worried greatly about over nine months of consultations. When she told him writing poems about her journey with depression had cured her, he asked if he could read some. She seemed delighted to be asked and delivered a bundle to the surgery that he took home.
Months later, at the end of a long day, he started to read them. Then one entitled And You caught his eye and he recalls, with his trademark, self-deprecating humour, that he wondered if this might be in praise of his dedicated care for her. It turned out to be about him all right, but was far from complimentary.
Hurt and angry, he took pen to paper himself that night to write a poem in response before going to bed. Feeling the better for writing from the heart, without thinking, he repeated the exercise after other stressful episodes. Curious to see if it might help other doctors, he introduced it into his educator work. The response was positive, demand grew, and when he had to walk away from the GP surgery, a new path beckoned with his memoir and reflective writing workshops.
“Healing and helping has given my life meaning over the years, and so to be able to continue that, even though it’s not one-on-one in the clinic room,” he says, “feels very good.”
Dr Hilton Koppe is far from done.
