These last 11 months, I’ve been telling my story of burnout, but I suppose I should rename it Death of a Primary Care Physician's Career. I’m letting go of the person, the doctor, I wanted to be. Ironically, she is the person who dug this 6 foot hole for me, and now I’m laying her in it after 3 long years.
"Give it to me! I got it first!!!" "NO YOU DID NOT! I grabbed it off the shelf first!" "This Elmo is mine!!!!!! Bob, tell her I got to this first!" Bob looked like a man who wanted to disappear into his turtleneck. "Come on, Nancy.. it's a toy." "DON'T TELL ME IT'S JUST A TOY! THIS IS A TICKLE ME ELMO!! AND IT'S MINE!!!!" Shaking my head as I walked away, I assessed the chaos that had descended on this Black Friday. What was this alternate reality I had entered into?
Last week, the prolific Xrayvsn reached out to me on Twitter and asked if I would be willing to represent the Millennial generation in a 4 way cross-platform collaboration, looking at medicine through the eyes of different generations: Baby Boomer, Generation X, Millennial and Resident Physician. My first reaction was ,“This is an awesome idea!”, immediately followed by an Oh sh*t moment. Who am I to speak for an entire generation? And isn’t our Resident Physician also a millennial?? But, my enthusiasm got the best of me and I couldn’t back out, not when I have the word Millennial in my own name. These days, I no longer identify myself solely as a doctor but as a storyteller and as such, I’d like to couch my response to Xrayvsn’s request in: A tale of 4 frogs
"Doc, I'm tired of this." I looked at V's wan face. The vibrance that I adored had been sucked out of her over the last 9 months by chemotherapy and radiation. I remembered the moment she cried in my office, angry I hadn't been the one to tell her that her breast cancer had returned everywhere. Now she couldn't muster up any emotion - no tears, no anger, no frustration. Just tired.
As a millennial physician, I grew up in the world of team-based care, evidenced based medicine, and "To Err is Human." I graduated a rigorous, work-hour rule bending residency program that still managed to provide a supportive environment filled with camaraderie. We celebrated success and newfound skills together. We also suffered, grieved loss and failures - together. The togetherness gave it meaning. I was eager to join the community of practicing physicians. On the other side of board certification, I found no such community. Rather, I found merely a group physicians in close proximity doing similar tasks, but in pursuit of individual and often disparate goals. In my search for community, I found myself alone.
"You know your job is killing you, right?" Startled, P's back stiffened, gaining him another 2 inches of height as he sat up straighter on the exam room table. Gah!! What is WRONG with you!? You don't have time for this pandora's box today. You're not Dr. Now from TLC's My 600 lbs life! Ugh.. fine. You're in too deep now.
"How do you keep doing this every day, patient after patient and still keep saying the right thing?" A thousand thoughts raced through my mind. Do I demure and say what I'm supposed to say? "Oh, this is all just part of being a doctor! It's such a privilege to be allowed to enter into someone's fears and emotions. Everything is awesome. Just living the dream." Or do I say, "I'm fine. You're fine. We're all fine. Please stop asking questions for which you're not prepared to hear the answer to." Or perhaps the truth, "I'm actually not fine. Thanks for asking. The only thing that's allowing me to make it through the day is that I've formulated an exit strategy, because I can't take this anymore."
Mom nodded, eyes glazed over from the bombshell I just threw her way. Taking and squeezing her clammy hand in mine, her attention returned back to the room from reeling into the land of "What if's?". "Mom... it's going to be ok. O's going to be ok. I just need you to get him to the hospital. Can you do that, or do you want me to call 911?" "No... I can do it. It's only 5 minutes away. It'll be faster if I take him now," the determination grew in her voice.
Turning to T, I said, "I'm going to examine you, but did you have any questions you wanted to write out for me?" Reaching out for my lapel to presumably find my name embroidered on my white coat, his hand landed, palm open over my left breast. He was just a squeeze away from a full on grope. "Is this really happening right now??"
"I love my doctor! She's the best." "Aww.. thank you! You're going to set some unrealistic expectations for him from the get-go... see you next time!" Turning to A, my new scribe, I pondered out loud after exiting the room, "I don't know what it is about having you here, but all of a sudden people are coming out of the woodwork saying nice things. It's to fill the awkward silence of having someone new in the room, I think. This is not typical. AT ALL. You can't ever let this stuff get to your head, because it just makes the bad days worse." Watching A nod his head, probably in an effort to patronize me, I couldn't silence the inner monologue. You're just teaching him foreboding joy*, M. Don't pass on your maladaptive coping skills way before his time.