MANAGING STRESS by Dr. Femi Omololu

It was about 7.30pm on a Thursday. Not my best time of the week as the work and life burdens of Mondays and Tuesdays usually peaked on Wednesday evenings/nights and plateaued from then on till relaxing Friday evenings. In the medical profession, it's hard to find such constant trends but mine was determined by the 24 hour shift I did weekly on Wednesdays. A brief rest on late Thursday morning and afternoon was always rudely interrupted by the evening locum I had taken up to make the extra buck. Stressful but I needed the extra buck to move to the stage where I would not need the extra buck, as least not so desperately. I called for the next patient.

He came in and I threw the casual greeting glance at him and fixed my plastic smile on my face to compliment it. I needed the plastic smile today as the previous day had been bruising on call. He was one of those bankers, big boys in their suave dressing, looking sharp even at this time of the day and oozing of a smell of a classy perfume, the type that lasted 24 hours.

"What can I do for you sir," I asked, as I jotted my notes on him like an inexperienced court clerk, thus looking down at the notes as I wrote.

"I have a headache," came the response.

"How long has it been?"

"A few days."

"Is it it whole head?"

"Just one side."

"Does it affect your concentration, make you feel faint, associated with any fever...."  I mechanically asked the routine questions.

"No, not really not at all, never...." etc. were the negative answers I got.

There's nothing wrong with this man I thought and looked up to subtlety dismiss him and 

push my evening faster. With a closer look at him, I had to reconsider.

His eyes were bulging, he was breathing quietly, but heavily, such that I almost saw the air go in and out. His hands were shaking.

"Why wouldn't one have a headache in this Lagos “sef” (exclamation for emphasis) with all its stress," I said changing my approach to empathize with him.

"In fact, doctor........." He started as he launched into a 20-minute monologue in which I heard the details of his stressful job with its targets and demanding boss and irritating colleagues, his commuting challenges with Lagos traffic, his struggling to be there for his wife and children who demanded his time despite his tight weekly work schedule and mounting bills, and some other things I didn't really understand.

I empathized further by agreeing with him and telling a short version of my stress story. I reassured him that his blood pressure and other vital signs were normal. I "prophesied" that this was just a passing phase in his life and things would get better.

I offered to give him some medication, mild pain killers and a light sedative, but he declined.

"I feel better, thanks doc," he said. In fact, the headache is gone.

The miracle seems complete as his eyes were brighter, the breathing more stable and his hand very stable as I shook it to say bye.

I was also feeling less stressed at that point in time. As I heaved a deep breath, a more genuine smile decorated my face.

STRESS

Stress is everywhere. It is no respecter of person or status and it is hard to quantify as it varies in intensity and tolerability from person to person. What exactly is stress?

The dictionary defines stress as "a state of physical, mental or emotional strain." The medical definition states that "Stress is defined as a process in which environmental demands strain an organism’s adaptive capacity resulting in both psychological demands as well as biological changes that could place the individual at risk for illness."

However, I like the definition that says, "stress is an individual's response to pressure." This is built on the premise that stress can be positive or negative. The human body elicits a fight or flight response to stress to tackle it. This is characterized by:

• An increase in heart rate and a rise in blood pressure
• Hardening and tensing of muscles
• Slowing of digestion and increased acid production in the stomach
• Faster breathing to take up more oxygen

In the long term when they are not controlled and linger long, these can lead to hypertension, ulcers, reduced immunity, depression and even suicidal thoughts. The effects on our relationships at work and at home can also be devastating. On the positive side these responses can help us brace up to challenges and tackle them head on.

What are the sources of stress?

Like my patient above stresses is caused by situations at work and in relationships.

Over the years, the identified top ten causes of stress are:

• Spouse’s death
• Marital Separation
• Jail term / imprisonment
• Death of a close relative
• Injury of illness
• Marriage
• Loss of job
• Marriage reconciliation
•  Retirement

However, of particular importance in Nigeria today are causes such as:

• Poverty
• Unemployment
• Violent crimes most especially armed robbery
• Kidnapping
• Political uncertainty
• Permit me to add school fees, uncertainty about the future and a fumbling football team

But then again, my favorite source for definitions says there is only one source of stress. YOU! This goes with the definition of stress being our response to pressure. The beauty of this definition is that it sets a template for us to prevent, manage and treat our stress. In order to do this, we must look at the stressors within us. These include:

• Our thoughts
• Our responses
• Our lifestyle

Controlling Your Thoughts

Our perception of events can lead to stress. This is sometimes unnecessary as the worst we fear may never happen and they are also not helpful when we indulge in pity parties when things do go wrong. We can generate new perspectives on an issue by:

1. Writing the facts of the matter on paper for clarity
2. Putting ourselves in the shoes of others to see how they might perceive the situation
3. Talking to others is always quite helpful in getting a different perspective

Having done this we can choose the perspective that reduces our pressure.

Controlling and reinforcing our positive thoughts by putting them into words with repetitive self-talk and saying them out loud is also very helpful. Our thoughts help to influence our responses.

Managing Your Responses

Our responses to pressure are crucial to our managing our stress. These responses may be:

• Physical
• Mental
• Emotional
• Behavioral

Rather than respond spontaneously to circumstances, we should always try and do the following:

• Get more information
• Be open minded
• Share our concerns with others
• Reduce pressure by learning to say No when we can and should
• Avoid blaming others
• Resolve conflicts amicably respecting the other’s opinions and aiming for a win-win situation. Listen to others.

These steps help us take control. Remember it's your pressure, your response, your choice and your life.

Correcting Your Lifestyle

Stress affects the mind and the body. Controlling thoughts and managing responses help the mind. Correcting our lifestyle will help the body. What to do?

1. Exercise. The value of exercise cannot be underrated. Exercise helps improve our fitness, clear our minds, improves sleep and prevents disease among others
2. Eating healthy
3. Cut off bad habits; smoking, drinking, excessive TV, etc.
4. Relax... Yoga, breathing exercises, meditation, prayer, just "chillax" (local slang for relax) like the new generation will say
5. Have healthy relationships; family, friends, colleagues can be very helpful when talking to relieve stress

We must create time to focus on these positive lifestyle patterns as the common excuse is not finding the time or space to do them. Truth is that we are always running out of time with each passing minute. Time to be used for good, time to be used to really improve our lives. We MUST find the right balance and it is doable.

Since excessive and prolonged stress can be very detrimental to one’s physical and mental health, a timely diagnosis, including identification of the stressor(s) and proper management using the techniques mentioned above, is necessary to avert the mentioned negative effects on our health.  If you think you are under a significant stress, you are probably right. It is time to take a look in the mirror to see the source of your stress. Talk to yourself, breathe and smile. You could also talk to someone about it. If you're lucky you may also find a not so tired or stressed doctor with a listening ear, an original smile and good counsel.

Written for Skribble Magazine, a publication of Resource Intermediaries Nigeria Limited