Click on these links if you missed out on: Act One and Act Two
“When do you want to see me again, Dr. M?”
“Well, everything’s looking pretty stable in terms of your diabetes and high blood pressure – 6 months should do it.”
“Great! Have a Happy Thanksgiving and Happy Holidays – I hope I don’t see you til then!”
Helping my patient shrug her coat on, I held my tongue as I recalled the conversation I had with my clinic owner.
“Please don’t tell anyone you’re leaving yet. We want to have a game plan before we start telling the staff and patients.”
Seemed reasonable at the time. Seeing that I had to give 120 days notice before my end date according to my contract, telling people now seemed like it would be a little too preemptive. That is, until I started scheduling people 6 months out into the future.
“Thanks for helping me with this coat, my dear. You know, I tell everyone about you! I say, ‘I’ve finally found the doctor I’m going to die with!'”
Cackling, she patted my hand and walked out the door.
On the way back to the work space, A, my scribe, chimed in,
“Well, that’s nice of her. In a dark, heart-warming way.”
If by dark, heart-warming way you mean clamping my heart in a vice to squeeze all the guilt out… yeah, that was effective.
Plastering a smile on my face, I turned to A and deflected per my usual.
“Who are we seeing next?”
Guilt
As the morning and afternoon rolled on, I continued to schedule several more patients in to an uncertain future. All the while, my guilt grew along an exponential curve.
Why, M? Your partners will absorb them into their practices. They will start looking for someone to replace you. It’ll be OK.
Yes, but my patients built these relationships with ME, not with someone else. And I don’t know who this person is they’ll be hiring. I don’t know if they’re good! And then they’ll probably expect me to vouch for this stranger!? Fat chance.
Then stay. Your choice.
Glancing up at the schedule in an attempt to practice avoidance with my logical self, I spied L’s name next on my list for a routine physical. The last time I had seen her, I struggled to find the right words to empower her through her journey through domestic violence.
How was she doing now? Did she find a way out? Was she safe?
These are the sorts of questions you won’t be able to find answers to once you go into the hospital, M. Are you really ready to give this up?
Pushing my wayward thoughts aside, I collected A and entered the exam room.
“Dr. M! I have so much to tell you!”
The joyful exuberance I had come to expect from L was back. The weariness of carrying her shame was gone. Instead, she was bursting at the seams to tell me her good news.
“The divorce has been finalized. Everything has been settled. I can walk in my own apartment and make as much noise as I want and know that I’m safe! No more living my life on the edge of another fight or argument. Thank you so much for giving me the strength to push through this!”
“Oh L, I didn’t do any such thing. You had the strength in you all along. We just found it together.”
Laughing at me, L turned to A.
“Can you believe this woman? She doesn’t even know how great she is. I mean no disrespect, Dr. M, but I’m right in this situation. Anyway, are you going to go through your healthy habits spiel?”
“Am I that predictable? Of course I am,” I smirked as I turned the page to the healthy food plate.
After going through my handout, kicking A out of the room and completing my physical exam, L turned to me and asked,
“So when should we see each other again?”
She’s young and healthy, M. No reason to have her come back sooner than her yearly physical. Are you OK with her just getting a letter in the mail notifying her that you’re gone?
The thought of her discovering I was leaving via an impersonal letter on clinic letterhead filled me with dread. She deserved better than that. To hell with my promise of keeping my mouth shut.
Steeling myself for the first of many hard conversations to come, I pushed forward.
“You’re doing so well, L. You really don’t need to come back more often than just once a year for your physicals…
Except I won’t be here next year when you come back.”
L nodded her head up and down as she processed my response.
“Ok. So where am I following you?”
“You can’t. I’m moving into a hospital position where my patients can’t follow me,” I broke the news gently, but it still didn’t stop the flood of tears L tried to hold back.
“Whew… alright. Wow. I told myself I wasn’t going to cry today because I cried last time, but I wasn’t expecting this!”
My brow furrowed – or perhaps it was permanently creased in that position these days.
“I’m sorry, L.”
“Sorry? Oh, Dr. M. Why do you look so guilty? If this is a good thing for you, then I’m happy for you! Truly, I am! I’m just sad for me.”
Wiping her tears away, L reached out for my hand.
“If I ever had a crisis, you’d be the one I’d want there holding my hand.
Your compassion, your empathy, your strength, your ability to empower people – it would be selfish for me to keep you to myself. I know you were meant to guide people in their darkest hours. And you’re going to be brilliant at it. You are going to thrive.
So no more guilt, Dr. M. Those of us who love you as our doctor will understand. And those who don’t understand didn’t deserve you to begin with. You deserve to be happy too.”
A veil of peace descended on me in this unexpected moment of absolution from one of my favourite patients. Through choked tears, I replied,
“Thank you for your kind words, L. And for your trust. You’ve helped me become a better doctor. I will always remember you.”
“Well, maybe I’ll just have to skip out on the flu shot then and get the flu so I have a reason to come back to see you before you leave!”
Laughing while hastily wiping away my tears, I shot back,
“Nice try. But you’re still getting it – besides, enduring the flu just to see me is absolutely not worth it. You take care of yourself, ok?”
“You too, Dr. M. It’s high time for you to start taking your own advice.”
Absolution
There has been so much guilt, dread and doubt on this journey as I prepare to transition on to a new career path as a hospitalist. At times, the route is crystal clear. Other times, the only path apparent to me is the return route back to the comfort of what I know.
But changing my path doesn’t mean I can no longer practice medicine the way I had intended.
I will still be able to be fully present with each encounter, to see my patients for their humanity rather than just their medical problem lists, to still practice compassion and empathy at the crossroads of someone’s life when these are needed the most.
No longer being a primary care physician doesn’t make me any less of a healer or doctor, but if I were to stay in my current situation, the tide of cynicism and bitterness that has consumed me in my burnout struggle over the last year would absolutely undermine everything I stand for.
Do I regret my journey?
No.
The relationships I’ve developed with my patients and knowledge I’ve gathered as a primary care physician will continue to define who I am as a person and a doctor into perpetuity.
My burnout struggle forced me to take a hard look at some strongly held beliefs. It forced me to come to terms with the fact that we all, even myself, need a little help from time to time. I no longer need to be marooned on my own little island because someone once led me to believe in doctors’ omnipotence – a fallacy from the very start that no longer permits us to see our own frail humanity.
Most importantly, it brought me to this moment and this space – to you, my readers. I write for you. If any of what I’ve written has resonated, know you’re not alone. Please reach out by email, Instagram, Twitter or Facebook if you just need someone to commiserate with.
Connection matters.
You matter.
The struggle is real and still something I contend with daily – but we can do it.
I want to empower you to find your strength and courage to pivot to something that will make you happier, because as we all intimately know, life is too short to live your life in misery.
The first step is to reclaim your story.
Come join me and take yours back.
***
Sign up for the email newsletter:
Photo taken of M stumbling along the rocks along the Columbia River Gorge, WA side, via J’s new drone! For more aerial photography, follow me on Instagram!
L nailed it: “Can you believe this woman? She doesn’t even know how great she is.”
If there are a few patients for which you have a personal attachment, there is nothing wrong with a friendly check-in or an occasional coffee. You can still be a friend, even though the professional relationship will end. People connect and want to stay connected. It’s up to you. (I agree with L, BTW).
The three part series was well delivered and wrapped up nicely. Happy holidays to you, J, and the dogs!
RK
Thanks for being along for the ride, as always.
I didn’t really think about the possibility of continuing to stay connected until I read your and Crispy Doc’s comments – thank you for that!
I hope you and your family have a wonderful holiday as well 🙂
I’m hesitant to congratulate you because of how hard this decision was and because you had to give up on something you held dear.But I am still happy for you that maybe your next job will rekindle some of the passion you had for medicine. It took courage to change your career and hopefully it will be a fun adventure!
The moments with people are fleeting as a hospitalist but they can be profound.
We all tend to think that what we are doing now we have to do forever. I feel that way about being a hospitalist. If I was so inclined, there is nothing stopping me from being a general pediatrician other than my own fear of doing it. If being a hospitalist doesn’t work out then there is something else waiting for you to find.
I often wonder how many times in one’s lifetime can he/she reinvent themselves.
Then I remember we were constantly doing that in med school and residency – adaptation was the name of the game.
It’s so easy to fall into routine and habit now as an attending that it’s harder to re-imagine my life being in upheaval again, but I suppose q3 yrs is a cakewalk vs qmonth!
Thanks for the shoutout of the series in your Sunday Selections! I’ve been on somewhat of a self-imposed technology hiatus, but I’ll try to be better with the commenting!
M, I’ve been where you are – almost 19years ago. And I still remember (and miss) some of my outpatients. But for me, the hospitalist path was the right one, as I hope it will be for you. If not, know that parting from the hospitalist position will be easier (though you will likely miss your colleagues a lot). The beauty of medicine is it allows us so much freedom; so many options. Don’t stop looking until you are truly happy. As you say, life is, indeed, way too short. Cheers!
Thank you for your comment Dr. X. I’m hoping with a few more years under my belt, this will be but a little bump in my path. Once I allowed myself to look beyond my current job, I was almost paralyzed by the multitude of options available to me – it was so overwhelming. But there is a certain freedom in knowing that I always have a choice, and I’m so appreciative of that part of medicine.
Thanks for stopping by!
My favorite moment this week came when my sister-in-law in Canada sent me the first installment of this series. A friend had sent her the link, and she thought it might resonate with me.
I’m so proud of you, my famous invisible friend. You are a multinational success!
“I want to empower you to find your strength and courage to pivot to something that will make you happier, because as we all intimately know, life is too short to live your life in misery.”
Remember Law #8 from The House of God:They can always hurt you more. You need to find a way to practice medicine where that type of cynicism is kept at bay, and where the hurt is manageable and comes from a place of empathy.
It hurts to make that pivot away from the difference you made for L and the others who made it worthwhile until now. Ultimately, like L, those folks you connected with will celebrate your victories.
And Vagabond is absolutely right – a friendship I valued during residency was the guy my age I saw in the ED with recurrent lymphoma who I ended up inviting out to coffee the following week. He became a close friend, and to this day I keep in touch with his widow.
If your patients are going to break your heart, let it be in the way that leads you to enlarge it.
Your parting statement is brilliant – thank you for wishing my heart to be broken by a dilated cardiomyopathy 🙂
It has been amazing the reach Act One, in particular, has achieved. It’s humbling and terrifying at the same time, to know my mishmash of words have resonated across borders. It’s proves to me it is a universal experience to watch your youthful idealism die as you enter into adulthood.
At any rate, thank you for telling me about your residency friendship. It wasn’t something I had considered doing, but there are definitely a few patients I would like to continue to keep connections with. You’re right – the people who I have connected with have been genuinely happy for me, which has taken some of the heartache away. Thanks again for your thoughtful comment!
Wonderful post yet again M. You have made quite an impact on your patients.
It is a shame that the medical system is causing burnout in docs like you. I do think you will always be able to make an impact and wish you the best in your new transition to a hospitalist. Hopefully that will douse the flames of burnout once and for all
I hope so as well! But, I am not so naive to believe I won’t find another set of pain points once I transition to hospitalist medicine.. this time though, I was much more intentional about making sure I create some space in order to schedule some life things in there. We shall see how this goes!
I think it is incredible that L is your cheerleader encouraging you to take care of yourself.
After all, if you don’t take care of yourself – who will there be to take care of other people?
I was visiting with some close friends of ours for the past several years last night, and one of them was an ED doc who is burnt to a crisp. He and his wife are both in a really bad place. I thought of all the great examples of people successfully battling their burnout (you, crispy doc, vagabond, etc)…. and yet I could see how trapped he felt. I mentioned cutting back or changing jobs, and anything I mentioned he felt was not an option for him.
So, thank you for being open and honest about your reality and the fight against burnout which is very real.
TPP
Thank you for continuing to read!
I was exactly where your friend was a year ago. In that stage of burnout, I felt so trapped but constantly shot down any suggestions to help improve my life. Because admitting I needed to make a change meant I would actually have to follow through. Instead, I was content with living the dog fire meme (http://gunshowcomic.com/648) –> “This is fine”.
I remember friends and family futilely banging their heads against my brick wall – it was easier to shoot down their suggestions than to come up with my own. If you’ve ever read Games People Play by Eric Berne, he describes a game called “Why don’t you – Yes but”, and this is a common social interaction that reinforces both parties’ positions of rescuer/victim. The only way to move past the game is to have the person come up with their own solution.
Eventually your friend and his wife will come to terms with the idea of choosing their poison – either continue living in their current state of misery or pivot to a new state of misery that may hopefully improve their lives. The first step is to create space for themselves to think it through, and that is something they will have to do for themselves, as frustrating as that may be for you as someone who obviously wants to help.
If all else fails, I find asking invasive questions until they break down and start giving real answers works wonders!
You are awesome. But get over yourself and your humblebrag self-importance. Love your blog but just do it and stop overanalyzing.
You know, when I was writing this I thought to myself, “But how can I brag about myself more? It needs more brag. But humbly, of course.”
Hah.. I did think it was a bit overly gratuitous, but I swear L said all those things!
Why did I include it though?
I did this very intentionally – anyone who has dealt with burnout and depression intimately knows how much negative self-talk there is. There is nothing you can ever do right. You’re an imposter – who do you think you are? You aren’t worthy of being loved and no one really cares about you anyway, so why do you even bother?
To hear someone like L say good things about you is hard to take. It’s even harder when it comes from a genuine place, because you know in your heart that somehow you’ve tricked that person.
This is what makes burnout and depression so dangerous – existing in states of disconnection. And sometimes to heal from that, one needs to start accepting love from other people.
That’s why I included my humble brag, one that I still struggle to believe…
I hope it make sense now.
Gosh, this made my eyes water. It’s been incredible to follow your journey and to be able to relate to it so much.
Thank you for being along for the ride, and I’m glad to hear it continues to resonate with you!
M,
It is a tough moment and we can always make it tougher on ourselves. Having the grace to accept kindness and care from our patients takes a great deal of strength.
The patients we connect with know we are human, because no one connects with a medical automaton. It is against our medical programming to accept that fact, but it is part of the owning our humanity which will make us better doctors.
You and L were both right. In that moment, you made something possible that she may have been unable to do on her own, but healing, true healing, means you also helped her see her own strength and no longer “need” you, but rather appreciate you.
Those who resent us for leaving didn’t have a connection, but a dependency – which is no good for anyone.
I really like how you delineate connection from dependency – brilliant, yet again 🙂
It is a strange moment to be in when you switch from the person from providing care to the person on the receiving end, and it’s not one that I typically allow to happen, especially in a clinic setting. But, it was healing nonetheless.
I think a lot of us struggle to doctor while human, as if we can delineate those two aspects of ourselves entirely. It is a fallacy that has been ingrained in us since the start of our medical training.
Medicine is something you do, not something you be. A physician is something you be. Not in the sense of being God like but in the sense you have the skill set trained into you of being able to stand at the head of the bed and make correct decisions while everyone else has the luxury to lose their minds. You were chosen for one reason, not because you’re smart or talented or did good on the MCAT but because you would take the beating and show up the next day for rounds at 5 frickin 30. That’s what all that hazing we all suffered was all about. Now however you are dangerous. You are a gladiator, a Paladin. Hell on wheels. You have the license, the credentials the knowledge and the ability to make a difference. You have a choice to make, are you a Physician or a Provider. Physicians run their lives and care for patients, Providers are run by MBA’s and care about nothing but leaving. That may sound a bit snotty, but it is in fact the choice we all face. All of the burned out docs who respond to you and care about your success and well being have chosen Physician. It is why they are successful. I had a pain practice and I had a patient, a survivor of domestic abuse. She needed thoracic epidurals to be able to work. She had survived being stabbed in the back by her abuser. This meant in order to treat her, I, a man, had to literally stab her in the back. Imagine the courage it took for her to come see me. Over the course I made her better. She could work, but more than that she could be touched by a male and she could precisely trust in my intent and I never betrayed her. You are the captain of your ship not some MBA. Do not lose heart or feel guilt but understand the quality of your power. One bad practice experience does not a career make. It’s barely a weigh station on the road. It wasn’t what you thought it would be, but in fact it can be much more. All time travel is forward moving and as it becomes present, is something you can touch. The past is an illusion you can no longer touch.