“I’m sorry. You probably weren’t expecting to see a grown man cry today.”
Echoes of a conversation last summer came back when Q’s name popped up on my schedule. Though it had been almost a year since we last met, I remembered that appointment vividly.
Q was a healthy guy in his mid 40s who only came in when he threw out his back.
“I keep forgetting I’m not in my 20s anymore,” he’d say.
This time though, his reason for the visit was: Palpitations, chest pain.
When I walked into the room, hunched over, hands in his head, Q looked like a wreck.
“My heart has been racing. It feels like it’s going to beat out of my chest, and then there’s this squeezing feeling right in the middle. I can’t eat – everything makes me nauseous. I haven’t been able to sleep…”
He trailed off as he squeezed his bloodshot eyes tightly.
“How long has this been going on for?”
“Three days.”
I notified my medical assistant I needed an EKG ASAP and ran through my list of red flags while they set up:
⦁ Difficulty breathing with activity
⦁ Leg swelling
⦁ Difficulty breathing laying flat
⦁ Waking up short of breath at night
⦁ Lightheadedness or fainting spells
Upon reviewing his recent normal cholesterol panel and diabetes screening labs, his reassuring family history and the normal EKG, I knew something didn’t add up.
“Q… what happened 3 days ago?”
Quivering lips failed to hold back the shame of his whispered admission.
“My wife told me she wants a divorce.”
Palms ground into his eyes, trying to hold the waterfall of tears back, but it was too late. Q caved into himself, hands behind his neck, head to chest, chest to knees as if to physically shield his heart from any more pain.
“She totally blindsided me… I thought everything was good but I was wrong. And I know this is all my fault too – that’s the worst part! I had been working extra so I could make things better for OUR life, OUR family, for HER… but that’s what’s actually driven her away.
… I don’t know what to do.”
What to say?
Medically, there was nothing wrong with his physical heart. But I couldn’t tell him, “Well, it’s not your heart, so good luck with that!” As I mulled it over in my mind, Q offered,
“I’ve been depressed before, and what worked for me then was prozac and trazodone for sleep.”
I hesitated.
“Q… these pills, they’re not going to fix your situation. What you’re feeling right now is an appropriate and expected response to what you’re going through.”
“Please, Dr. M. I need something to help me stop crying all the time so I can figure out what to do. I… I know I’m going to spiral.”
Bloodshot eyes were now slightly obscured by puffy eyelids. This was the first time he had really made eye contact with me all visit, pleading with me.
5 seconds passed, then 15, then an eternity.
Finally I said,
“Just promise me you’ll go to counseling. Not just marriage counseling, but counseling for yourself too. And… you need to have a real conversation with your wife about what you want your future to look like.”
Q nodded.
“I’m sorry. You probably weren’t expecting to see a grown man cry today.”
Giving him a reassuring smile, I said,
“Q, it happens more often than you think. Let’s check in in 2 months and make sure the medications are working well for you, ok?”
One year later…
Sometimes I’d wonder what happened… did they stay together? Did they get divorced? Did he actually “spiral” like he said he would? Did I miss his obituitary?
Then he popped up in my schedule unexpectedly, out of the blue.
Reason for visit: Follow up mood.
“Hi! How are things, Q?”
“Good.”
“Really? That’s good to hear…”
“Yes, really.. if you’re referring to what I had come in for last year, things are great. My wife and I decided to stay together. I took your advice and was able to convince her to go to marriage counseling with me… and I made a lot of changes. We made a lot of changes. I don’t work as much as I used to anymore. I’m spending more time with her and the kids. Life is good.
I actually want to talk to you about the meds… I want to get off of them.”
“Oh.. how are you still getting refills?”
“Well… I had about a year’s worth left over from my old prescription mail order that I found,” he said sheepishly. “I was too afraid to go off even though I knew you were right… I guess it was my security blanket, and I don’t need it anymore.
Amazing what happens when you prioritize life over work.”
As I’ve been going through my burnout journey, I’ve been so hyperfocused on what I can do to make my work situation better.
It’s been a pattern I’ve been following since I started pre-med, med school and residency. Everything about my life has been dictated by my career in 4 year increments – the cities I’ve lived in, the people I’ve networked with, how I’ve chosen to spend my down time keeping up on the most recent articles so I don’t “fall behind”, even down to this blog.
In the meantime, while I’ve been chasing my dream of having the ultimate career, I’ve been dragging J along this road through 4 different cities over almost 15 years together, 80+ hour work weeks, lost holiday time with friends and family, and grumpy rants at the end of my work day.
Fortunately he’s been willing to stay alongside me, but at what point does he have enough?
We have allowed work to become this all consuming part of our lives, and not just in medicine. It’s too easy to become married to our jobs, forgetting there are people at home who are more deserving of our time and attention.
When will I allow myself to say doctoring needs to be just a job and not my life – and when will I actually believe it?
What is life when it’s no longer defined by work?
***
Photo taken at Hurricane Ridge, Olympic Peninsula, WA
This is an all too familiar story! Many times I have pushed through, worked more, etc., with the best intention. I am seeking to better our future lives by increasing income, seeking professional achievements, saving/budgeting more, but only to find out from my partner that they felt abandoned and not as important to my as my set goal. That’s a hard one to swallow and definitely deserves looking inward and communicating frequently with your spouse about individual and shared goals, and the sacrifices made to reach these.
Absolutely! Sometimes when we push forward, we don’t realize our loved ones feel left behind.
I had mentioned to J last week I wanted to start moonlighting at the local urgent care in order to get done with student loans faster – THEN we could finally start our real lives. He came back at me with, “I thought we already were living our real lives on the weekends. When are WE going to be able to do that if you start spending weekends at work?”
Sometimes my brilliant ideas are not so brilliant 🙂
Hi M,
This story reminds me of the anecdotes sprinkled throughout “Your Money or Your Life.” One of Vicki Robins’ core messages is about figuring out what enough is for you. The enough she is primarily talking about is money and stuff, but I think the idea goes further. What is enough prestige and enough career
Everyone’s enough is unique to them. Part of the FI journey is figuring out what these enough’s are.
It is one of those life changing books that is well worth a read. I went a little nutty and documented my time reading and going through each step on my blog 🙂
~Kpeds
Haha.. I went through your steps! I definitely need to to actually read the book for myself though. Maybe when I have some elusive free time…
M, your stories are compelling, and your writing is beautiful. I think you are making great progress in your journey.
Best, VBMD
Thank you, VBMD (I like the abbreviation!)
I keep finding your guest posts scattered across the internet – when are you going to start your own blog?
Thank you for sharing this story, it’s incredibly touching. For the last two years I’ve been reading so many self help and personal development books as a way to help me cope with work. These were books a younger me would have walked past without any thought, but I’d gotten to a point where I was desperate to find anything that could give me the answer I was looking for. I just wanted to push on. I don’t think we realise how much we hurt ourselves in the process. It becomes apparent when we stop to pick up the pieces.
Absolutely. I’m in the same boat – initially I started reading all the things to help increase my “productivity” and efficiency which just ended burning me out faster. Finally I settled on Pema Chodron, Stephen Batchelor and Brene Brown which opened up an entirely new genre of “self help” books for me. Currently I’m re-reading Rising Strong by Brene Brown, and it’s amazing to me how things that didn’t land the first time around now have a totally different meaning for me.
I think the most important step is to actually allow yourself to stop and fully rest. We fill our lives with so much busy-ness, we lose our ability to maintain perspective. I probably would have continued on with my 60 hour schedule if I hadn’t realized I was turning into an asshole. Good thing I have friends and a husband who tell me these things 🙂
They don’t teach us how to handle this—balancing LIVING with working—in our training. It’s why I tell every pre-med/med student/resident that I come across to read the book Stop Physician Burnout by Drummond. Thanks for articulating your journey. If you’re not already a member of the FB group Women Physician Writers, you should join. And take a look at taking a memoir writing workshop—you got chops. 🙂 (Eckerd College Memoir class with say, Anne Hood, comes to mind.)
Thanks for the suggestions, B.C.! I haven’t considered writing a memoir before – my blog posts here are just a random smattering of disjointed events without any real linearity. Something to consider though as a second career perhaps 🙂 I didn’t realize there was a FB Group for Women Physician Writers, so I’ll definitely check that out as well!
Now for your original statement – there was NEVER any discussion about actually balancing life while working when I was in med school or residency. There were some suggestions to invest in a good crockpot so at least you’d have access to hot meals once in a while, but that was pretty much the extent of it. When I tried to search it out via mentorship with female attendings, I found they were struggling with work/life balance as well, but perhaps better at faking it.
Those who chose to cut back were judged harshly, and I was the judgiest of the judgy 🙂 It’s incredibly ironic now as my strongly held opinions were the very things holding me back from my burnout recovery.
I do think it’s important for us to foster these conversations with the generation coming after us. I’m considering a new job that allows me to get into medical education for that very reason. It’s hard to break out of the mold of being the overworked physician if we never see that alternative life modeled well for us. I am fully aware though, right now I’m the blind leading the blind 🙂
Thanks for the comment and the suggestions!
MD-You might need to be added to the FB group, so ask around to get added. I hear you about the female mentors. Sigh. I actually give a presentation to the fellows now full of “life advice I wish an attending had given me” sort of thing 😉 Maybe look at this blog post I stumbled across for further help: https://knowledgeplus.nejm.org/blog/life-after-residency-hyperspace-vocation-and-next-steps/
That’s awesome – how are the fellows receptive to your presentation?
I read the post during lunch and of course had to read it in one sitting because of the Star Wars references AND the fact that the author is a Med/Peds person 🙂 I’m still looking for my Obi-Wan.. hopefully I don’t self-destruct like Anakin in the meantime!
I got added to the FB group – I’ll probably just lurk for a while like I do with all the other Facebook groups I’m a part of.
The fellows are always very appreciative of the talk.
And yes, any blog with a Star Wars reference gets instant attention from me, lol 😉 There are a lot of Obi-wan-kanobis out there—once you start looking, you find them (kind of like ask the universe and it will send it your way kind of thing—I think that’s where Physician bloggers come in handy).
Yes, please don’t self-destruct! A gory scene by lava for a real life scenario is never nice!
And Lurking is perfectly fine—we all do it from time to time.
You got this!
M today I found your blog. The concept of work life balance and burnout did not exist when I started practicing 30 years ago. I think maybe as more women got into medicine this concept has moved in a humane direction.
Yes, I absolutely agree with that observation. Now I’m finding men of my generation have jumped on the bandwagon of this “strange” concept of work life balance and making it a priority. Perhaps with everyone on board we can make further progress moving forward.
Practice for me was like driving 100 mph day in day out, month in month out, year in year out. Entirely do-able but requiring extreme attention. As the velocity goes up the kinetic energy goes up by a squared function. My solution was to be average in things I was average and to be excellent in things I was excellent. Imagine daring to be average! To paraphrase James Carville: It’s the perfectionism stupid!
How it felt to quit working was like pulling onto an off ramp. My velocity fell to 25 mph. My first goal when I quit was to forget what day it was. The weekends are defined by the work week and I wanted nothing work related defining my life. I achieved that but decided if I ever wound up in an ER my lack of orientation to time could be problematic. I relented on that goal satisfied to know it was possible. Now it’s about riding change into the future. I had a fruitful career as a physician but that is in my rear view mirror, I now enjoy being a retired physician. Medicine is one career that is malleable. You can make it serve you not vis versa.
Perfectionism is also something I’m struggling with, but slowly learning to let go 🙂
I am searching for different options within medicine so my time and life spent in training wasn’t a total waste, and fortunately Med/Peds is something that kept many doors open for me. Perhaps I’ll find something that won’t make me feel like abandoning my career, but you’re making retirement sound awfully nice!
it’s kind of sad to see how often we need traumas, shocks or bad things to happen before we make the right choices!…
Absolutely! I see it all the time – I think we just get so used to our routines and schedules that it takes something terrible for us to decide to step back and reassess things. Some people are able to reset, others unfortunately do not.
This story is a wakeup call for everyone who prioritize work over family. In the end, only family will make someone happy. It’s difficult in today’s world with so much emphasis on careers and money, but family should always be first, because without them, a career means nothing.
100% agree! My husband and I had this discussion last night – for my entire adult life, everything has been about my career. It’s hard to shift gears when you’ve been on that train for so long, but it’s absolutely necessary.
If we’re not surrounded by the ones we love, then what is it all for?
Thanks for the comment!
Identity tied to one’s career is pretty common for many professionals that have high barrier to entry and involves many years of training or specialization.
If you’ve spent the bulk of your most youthful year invested into this one profession, how can this vocation not define you?
Not surprisingly, the more specialized a role is, the more highly compensated, more demanding, and less replaceable the individual becomes, so I’d say it’s very hard for skilled, specialized professionals not to have most of their lives defined by their work.
At the same token, many specialized, highly trained workers tend to report the highest level of job satisfaction and making an impact later in life 🙂
Cheers
After spending pretty much my entire adult life in training to be a doctor, my profession absolutely takes up a large part of my identity. However, I’ve come to discover that this cannot be the ONLY thing in my life. Just as we must diversify our financial portfolios to help navigate the ups and downs of the market, I think we also need to take care to diversify our lives.
I’ve had the good fortune/misfortune to be a part of people’s last days, and I can say without a doubt no one wishes they could have worked more. There is regret about lost connections, paths not taken and missed opportunities because of a lack of courage. I think I would fall in that camp as well, so though I may do a lot of good with my work, I also don’t want to be caught in the last days of my life regretting time lost with family and friends.
If you haven’t read Bronnie Ware’s Regrets of the Dying, it is a great read: https://bronnieware.com/blog/regrets-of-the-dying/