“M… I gotta tell ya, this has been the hardest week of my attending life.”
Sitting in the hospitalist work room, I watched the adonis before me shrink into the back of his ergonomic work chair, as if it were the only thing keeping him upright.
Dr. T
A young attending in his first year of full-fledged doctoring after residency with the frame of one of those towering Greek gods from Xena, my beloved childhood show my parents probably should’ve never allowed me to watch. In the 3 months we had crossed paths, he left nothing in his wake but songs of praise for his kindness and heart of gold. Today, I saw him in action as he came back to help me with a goals of care discussion for an unfortunate quadraplegic man, suffering his 2nd stroke in 3 months.
I could see the weight of the last week crushing him, avalanching down on me as I took over his patients. Now he was reaching out through the cracks in his armour, as if I was a place of safe refuge.
It must be your face, M. Something about your face just makes people want to spill all the things to you unprompted.
Even with us sitting side by side, T towered over me by at least a foot, his presence filling the entire cubicle while my legs swung like a child’s over the edge, barely touching the ground.
Who else did he have to talk to about this? How isolated had he been this last year as a locums physician just biding his time until his palliative care fellowship in a few months? Maybe it wasn’t really me he was reaching out for… maybe it was just anyone who would listen.
Still, the irony of this situation struck me as he looked down on me to be a mentor in this moment.
“I can see why. This is a really intense list you handed over.”
The sense of relief washing over him was palpable. Validation. Understanding. Just another successful variation of the NURSE acronym at work.
But there was something else… something he was holding back. I could feel it calling to me to pull it out into existence. Something he couldn’t or wouldn’t name.
“T, you’ve been doing this for almost a year now and you seem worn down. I may be overstepping my bounds here, but do you really see yourself doing this for the rest of your life? Working like this for the rest of your life?”
As he contemplated the last 21 days in a row of 12+ hour work days in an effort to squirrel away money before he headed back into training, I could see him mentally count down the number of goals of care discussions that sucked his compassion dry. The days that started at 7 am and didn’t end until 9:30 pm because he didn’t know how not to go the extra mile. The nights spent crashing in an empty hotel room, only to restart the next iteration of groundhog day the following morning.
Again and again and again.
I heard his logical self’s reassurances,
“But it’s still better than residency, right? Because I’m actually getting paid for this. Besides, it’s only temporary.”
But his emotional self had opened the door to this conversation against his better judgment.
Was he going to step through?
“… No. No, I don’t think I can do this.”
His hand flew up to cup his chin, almost as an attempt to shove his hushed answer back in. But it was too late. As he squeezed his lips tight, I could see the regret at his exposure threatening to shut this conversation down.
“Then don’t.”
His brow furrowed as his logical self scoffed.
“It can’t be that simple, can it? I have student loans. I have bills to pay, an engagement ring I’m saving for! And this is what doctors sign up for! This is what we do.”
Watching his internal struggle play out in front of me, I couldn’t help but imagine his responses in my head. Because they were the very ones I clashed with last week. Right before I decided I was done over-complicating the hell out of everything.
“T, think about the things you regret missing out on the last 3 weeks. 3 weeks you haven’t had a single moment to yourself. Missed conversations with your girlfriend. Going back home for Memorial Day weekend. Spending time with family you haven’t seen in a while before you move on to fellowship.
You’re never getting those chances back again. And at the end of the day, these are the things you’ll regret. Not working for 21 days without a day off. Not paying your student loans off a few months earlier. Yes, you do great work here and you’re an amazing doctor. But you’re also a person who needs rest and a life outside of the hospital.
It’s ok for you to want and have these things.“
End-capping my monologue with silence, I waited for my words to settle in.
Would he take it or not? Some people derive a lot of their self identity in the harriedness of life, in the struggle.
Was he one of them?
“Is that why you switched from outpatient to inpatient? How do you do it?”
Searching his face to determine how earnest his question was, my eyes settled on the dirty blonde curl tumbling down his forehead while I contemplated my answer. Again, I was faced with the decision to deflect or tell the truth.
Talk about the blind leading the blind. How do you keep finding yourself in these situations?
“Yes, it’s part of why I made the switch. Look… I’ll be the first one to say I don’t have all my shit together. But what I do have going for me is that I’m crystal clear on what I want, what’s important to me.
That first year out of training is hard because you’ve always had this path to guide you to the next step, and now you’re faced with making decisions on what you want the rest of your life to look like. And there are a lot of us who never really took the time to think about what that looks like, so we fall back on what we’re comfortable with – work.
Even though you’re going back for fellowship, think about the life you want to build. And figure out how to make it happen. You don’t have to work like this for the rest of your life. Making money is an important step to building the life you want, but it’s not the only one.
You don’t have to live like this.”
As I wrote out the list of essential blogs for wrapping his mind around finances as a young physician: White Coat Investor, The Physician Philosopher, Physician on FIRE and The Happy Philosopher, I left him with some final instructions.
“So your homework for today – I want you to be specific about you want. None of this vague crap… none of the ‘I just want to be happy’ BS that says absolutely nothing. Write down the actual things that always bring a smile to your face and rearrange your life to get more of that.
Cooking new Vietnamese recipes with your girlfriend? Write that down. Traveling to museums and reading every plaque in the place? That goes on the list too.
It’s your time now. You get to decide, T.”
Driving home that day, I thought back to an old blog post I had written in October last year that never made it to the light of day. Scrolling back through my drafts later, I wondered if my list of wants still held true:
You know what I want?
I want to wake up in the morning on my days off and stay in bed for as long as I want, listening to my dogs rhythmically snore in chorus to the birds randomly chirping outside.
I want to lazily drink coffee while listening to my husband geek out about how you can really tell the cherry undertones with this new Ethiopian coffee bean, unlike the more nutty, chocolate undertones with the Costa Rican blend.
I want to spend uninterrupted time with friends and catch up on how turning into cat parents has brought joy into their lives, or going over pics of recent honeymoons and trips, or even listening to them complain about how much they too, hate their job. I want to send random texts to old friends halfway across the country just to check in, or Facetime them so I can see their growing children and get into long winded email chains where we spend half the time insulting the other person, out of love, of course.
I want to hike to the top of a mountain and get too close to the edge, jump into the base of a waterfall or sit back in my hammock and drink a beer while I watch the trees sway back and forth in the wind.
Last week, this addition made it to the list:
I want to be present with my patients and care for the whole person, not just their problem list. To provide healing sometimes through medicine and always through listening, because often times that’s the only thing I can offer and the only thing they need.
What do you do for a living?
When I first started this journey, I thought medicine would be everything. And for a long time, it was.
Over the last 16 years I geared my entire life around it – the classes I took, volunteering opportunities, people I networked with, places I’ve lived. I’d squeeze in “life” during allowed breaks – sleep, exercise, celebrations, time with my husband, friends and family – all the while patting myself on the back for finding such a great “balance”.
But as the scales tipped more and more toward medicine the longer I headed down this path, the realization hit me:
I’m no longer working to earn a living, I’m living to work.
I watch so many of us continuing down the road we were set on, unsure if we can take another step but pushing forward because that’s the only way we know.
What if we stop?
What if instead we chose a values-driven life?
A life in which we determine what our lives will look like, not mimicking what other people say our lives should look like?
What if we ignored the rules that say it’s unreasonable for doctors to work “only” 40 hours a week? The ones that glorify self-sacrifice in service of others, otherwise you’re a “bad” doctor? The expectations that we need to get that doctor-approved house, car and engagement ring which only serve as anchors chaining us to a downward spiral?
What would happen if we all started to do this boldly, without apology?
Would the system shift to accommodate this new generation of doctors who “don’t even want to work anymore” and transform the language to be accepting of the humanity of our physicians?
I, for one, am not going to hold my breath. I’m going to channel my inner Xena and make my own rules because ultimately, it comes down to me.
And you.
What are you doing to make a living?
***
This post was inspired by Crispy Doc and his kind assessment of my “unapologetic desire for work-life balance“. Turns out we were both on the same inspiration train today as he unexpectedly sent a shout out my way on his latest post about being a proud member of a defensive nudity colony… ? Check it out HERE!
***
Photo taken of the path I want to follow with my husband – mountains, boardwalk and glacier water on The Hooker Valley Track, New Zealand.
M, this post was everything. Thank you for sharing.
Zoe,
Thank you for reading ❤️
Ok I definitely felt this post deeply. Thanks for vocalizing what I have buried deep inside of me for so long. It’s great that you have the insight early into your career. Make it a great ride and enjoy it- the honor of holding a patient’s trust as they put their health and lives in your hands is like no other privilege or responsibility on earth. It is an intense experience that doctors get the privilege of knowing, so make it so that you are 100% present in the now when you have the gear on, then (as you have so early in your career discovered) enjoy the disconnect while allowing yourself the privilege of being a free agent to enjoy the simpler things in life. What a fine line we walk with the burdens of this responsibility squarely on our shoulders while tending to our basic humanity and to the simpler things in life that peel away the burdens of our status. Thank you for allowing me the platform to express.
Dr. Hernandez,
I’m so glad this one resonated with you, though it saddens me that you haven’t been able to voice it for yourself for a long time. I’ve come to realize and accept that despite all the complaining I do about medicine, I still love being able to take care of patients. I’m just unwilling to compromise the things that are important to me in order to do that, and it feels like the corporate machine that medicine has become will never be accepting of anyone’s boundaries unless we force the issue. I’ll enjoy this experience for as long as I can, and when the time comes for me to step away, I’ll be grateful for the privilege of having done this.
When I read that first paragraph after the quote I was thinking, wait, have M and I met before? Then quickly realized it was not me 🙂 LOL
Another great recollection of a powerful situation. I think your advice was spot on and something he needed to hear. Whether he takes heed of it is up to him of course, but at least you gave your insight.
I remember in the beginning it was all about making money and sacrificing time and sleep to achieve it so you can pay of the debt you have accrued. But you are correct, killing yourself to shave just a few months, or even a few years, is not worth it if you are already getting burnt out.
Medicine should not define you. It should only be a part of you.
🤣 Well, I will probably just refer to you as Dr. Adonis from now on if that’s alright with you.
I think we’re just used to going so hard for so long that we’ve forgotten how to get our feet off the accelerator. I truly believe busy-ness is an affliction – no one really knows how to slow down anymore.
The most important part of any struggle is feeling like you are not alone. Kudos on taking the time to reach out and let someone else feel they are not alone. Like you said, being “present” is only thing we do that matters 100% of the time. It is more useful to our patient’s, colleagues, friends, family for us to be 100% present 50% of the time than to be 50% present 100% of the time.
The suck of Medicine would be so much easier to bear if real collegiality weren’t limited to the odd handoff.
I agree… we’re all too consumed by our checklists and other paperwork to really be able to sit down with one another and really check in. When I’ve attempted to do that, there’s always another page or call that interrupts. Your comment about being present 100% of the time really speaks to me.
It’s one of life’s greatest luxuries to find others cut from the same cloth, something I’m reminded of when I read posts like this (even without regard to the kind words that followed it).
It’s another of life’s great luxuries to take a risk with another person, reveal a doubt or failing, and hold a personal imperfection up to the light.
Your locums colleague was fortunate he had you to validate the depletion of the job and to show him where to begin seeking a path leading to an alternative future.
Before I was a doc I was a high school hospital volunteer in our local ED, which taught me that often the highest impact intervention at my disposal was a warm blanket. It was caring made sensory.
Helping a colleague envision not being stuck – that’s a warm blanket you brought someone on their coldest day.
Keep making those differences, M.
Fondly,
CD
I love that imagery – caring made sensory. It’s true… the little things are what make the difference, even if we don’t have the time to see it in that moment. Maybe it’s the collection of those little moments that allow people to feel comfortable undertaking the bigger risk to actually be seen.
I remember when I interviewed for med school the guy asked me, why do you want to be a Dr. I told him because I think I can do the job, and I think there is a group of patients I can take care of. That interview to me kind of limited the scope of my responsibility. After I was attending for maybe 10 years a OB/Gyn came on board fresh out of residency. She was a local but trained in Detroit and came home to practice. The OB’s would dump on her like mad and I would catch her in the medical records spot with 6 dozen delinquent charts, not her own. I would just spend a few minutes with her and encourage her. I would do her epidurals and C-Sections and make it clear I favored her. It was enough to help get her through. She now has the biggest OB practice in town and people don’t mess with her because she could eat their lunch. That’s what I did for a living, took care of my peeps. It’s all you got to do.
Why do we eat our young? It’s something I’ve seen perpetuated in medicine, but definitely not isolated to just this profession.
How do people not take a step back and see that if we support the next generation of docs/workers/etc, we all do better? Ah, perhaps that’s a little too naive on my part, but there needs to be a better way. Thank you for sticking up for your colleague, and I’m sure she appreciates your acts of kindness even now.
She’s the gyn of my wife and children. We eat our young because that is the script we follow. You can either stick with the script or write your own. The advantage of writing your own is you get to pen the ending. Nobody feels slighted if you are kind to them. The definition of kindness is using one’s power for the benefit of another. It is not NICE, which is subjugating someone to submit to your conception of reality. Kindness is a virtue niceness is a kind of violence
I’m not sure this is “the blind leading the blind”. Sounds to me you’re seeing things quite well (and better all the time?), which is why you have smart, thoughtful people from various backgrounds and stages of life reading and commenting.
I don’t know you, but feel a kinship – that we find ourselves in this strange unpleasant landscape of medicine; we can see it, but we don’t like much of what we see, and it’s it’s confusing too, so we suspect we’re not seeing clearly. But I think your vision is 20/20 and that day, when you saw you weren’t alone, you did the right thing.
I’m 42, with a wife and four kids; just finishing a year off. I thought I was done with medicine, but I’ve decided to give it another chance (very part time). One of the things that gives me hope is that now I know I’m not walking this path alone. Thanks for making yourself visible.
You are living my dream of escaping medicine and traveling. I see you last visited New Zealand which is where I went to lick my wounds in February between my clinic and hospitalist job! I was very tempted to sell every last thing I owned when I returned and just continue traveling, but alas, my student loans won out.
I find it fascinating you’re now returning to medicine after having been off traveling the world for so long and will definitely be scouring your blog to read about your journey. One of the greatest things about starting this blog has been hearing and learning from like minded people with so many different backgrounds and stages of life, as you put it. The path can be long and winding, but we definitely don’t need to do this alone.
Thank you for commenting!
It’s funny how we find each other. Your post was inspired by CrispyDoc who found our blog months ago and we’ve been email pals ever since. I’m very happy to have found your blog – I love the way you write – and even happier if you are getting something out of ours. Looking forward to future posts and comments 🙂