This article was written in spring March 2021 during another lockdown. Here I share seven days of my diary as a physician struggling with burnout, wherein I move from resistance and numbness to connection and finding myself. I hope that readers resonate with my physician burnout diary
I went in to work yesterday. I felt guilty for being there when I was supposed to be on leave. I felt guilty for having cancelled several patients. I felt guilty for not cancelling other patients to ensure that their paperwork was ready. I was stuck between the desire to uphold the high expectations I have of myself as a physician versus my great aversion to harming. There was no solution to the guilt, and I already felt heavy; so what would a few more bricks of guilt change?
At the end of the day, I took a breath of courage and humility and spoke to the secretary, and afterwards, the Medical Director. I don’t think I used the words “burnout prevention” but explained instead that my family doctor recommended that I take time off. Every clinic was to be cancelled, no exception.
“No problem”, I was told, and asked to prioritize the list of cancelled patients for eventual rescheduling. I faced no resistance and especially, no judgment. That is exactly what I needed to prevent my guilt from swelling further. In that moment, it struck me that I must be doing the right thing.
But soon, I forgot that thought.
Once I had finished the day at the office, I crossed the threshold into the real leave. It was the beginning, like the first moment I sit on a bean bag. At first, I’m fine. Then I just sink deeper and deeper into discomfort.
As if accepting “burnout prevention” isn’t bad enough, I find myself repeatedly resisting the fact that I am on leave.
I remember reading a parable about two arrows. The first arrow is the insult or the illness that directly wounds us. The second arrow is our perception of the wound or the illness, adding insult to injury. Right now, I am deeply wounded by both arrows (burnout and resistance to leave) as I try to disown them.
I started listening to an audiobook today and the author said something so poignant, it stopped me in my tracks. He described the sensation of “working against every fiber of your being” just to do ordinary, daily things, and how a “feather” can push you over the edge.
That is exactly how I feel now, and have been feeling for the past months. Like I am “working against every fiber” of my being. In fact, every fiber of my body is pulling me, with intense gravity, to the ground. I feel tethered to an inertia that is greater than my being.
And yet I get up, get the school uniforms on the kids, start the car, drive. The kids’ bickering doesn’t even reach me anymore. Is this what it means to be numb?
Earlier today, all it took was a feather to tip me over. My husband looked at me with what I assumed was disappointment. Immediately, I had intense negative thoughts that triggered a feeling of derealization. I felt dizzy; I felt like someone had unplugged my mind from me and I wasn’t sure I would get it back. I was questioning everything: reality per se, my ability to perceive reality, and every belief I have ever had. When I spoke, I did not recognize my voice. And I could not fathom how I sounded so normal when I felt anything but.
Again and again the relentless, recurrent thoughts: “I am too sick, I am not improving, I am letting everyone down.” Even as I write this, thoughts of failure enter my mind and I cannot turn a corner. I’ve failed in the big and in the small. I feel like my body is gone and my heart is thumping in a painful void.
How do I get out of here? Somewhere in me, I know that I have not failed everything. I know that there are blurred memories of kindness, gratitude, belonging and humor that I have contributed to. Even though they are there, I am having trouble seeing their light.
Last night, after I put the kids to bed, I went to my husband and asked him for help. It was the first time since all of this started that I was asking for help. I had hit rock bottom and I couldn’t bear it alone. He listened attentively and was sincere and supportive. He understood that I needed him to listen, not to problem-solve.
I realized a few things from this conversation. First, that there is a difference between being in a relationship and being in relation. Being in a relationship means sharing responsibilities; but being in relation means sharing yourself, including your deep vulnerability. The latter is what heals, when the other person receives you with grace and love. And there I was, all along thinking that I could heal myself, in self-isolation. I realized how deeply I underestimated not only my need for support, but also my husband’s and friends’ love and ability to support me.
I also realized that I need to find a practice that restores my connection with something larger than myself. I need to connect with a purpose and meaning that are bigger than just surviving. I need to return to the roots of me as a person, not just me as a doctor.
Last night, I had a dream that shook me. I dreamt that I was watching a sunset and thinking: “I can’t go back to work.”
I was destabilized by the recurrent idea of not being able to return to work because – well, because it is a destabilizing thought and because I had begun to feel better. Thankfully, by chance, a good friend called this afternoon. When I told her about my dream she said: “It doesn’t mean that you can’t go back to work. It means that you cannot return with the same work conditions.”
Wow. Such power, clarity and hope in those two words. Work conditions –what are my work conditions, which conditions are under my control and which ones are not? What do I need to do to have work conditions that sustain me instead of draining me? These are really complex questions, because I need to discern where I have been failing myself versus where the system is failing.
Yesterday, even though I was not supposed to work, I called a patient in response to a task that was sent in the EMR. When I asked her what she needed, she started by saying: “Well, our appointment was supposed to be today and since it was cancelled…” I didn’t understand what was happening, but I couldn’t focus anymore and felt a great malaise. Afterwards, I realized that I had felt extremely guilty and ashamed because I had put my needs before her needs. By taking time off for my mental health, I had put my needs first. My shame had led me to believe that no doctor should do that.
So this morning, as I walked in nature, I reckoned that if I want to get out of this, I need to start valuing my needs another way. I also need to respond to my needs differently. The voice of my own needs cannot continue to be lower than the voices of others’ needs. The voice of my needs must be louder, so that I do not end up in a series of burnouts. A sense of balance needs to finds its way into the way I view myself as a physician. A balance of the needs: my own, those of my family, those of work.
This morning, I tried to meditate or pray. The quiet thinking made me realize how strongly and inconspicuously we are pulled away from our true selves by the machinations of daily life.
I have learned this lesson before, many times. But slowly, little bits of me are taken hostage by routine and responsibilities. Soon,I no longer realize that the whole of me is held hostage by my “life” – that is, the demands of others on me. Therefore, I will need to recall who I am, recall my purpose and meaning, daily. That is how I will reclaim the parts of me that are taken hostage.
I spoke with my family doctor today. I explained how I had reflected on my schedule and work habits. I told her about my “Work-Family-Self Balance List”, which included changes to my children’s care plan as well as “mandatory” self-care. She encouraged me to reflect further on my work schedule and make sure I devoted time to charting and other administrative tasks. I’m so grateful for her input.
I’m feeling better and I’ll be going back to work in a few days. This morning, I sat down and wrote out a work schedule following my family doctor’s advice that includes time for charting, time for reviewing results, time for CME and time for my needs. I no longer assume that these things will magically happen in the time in-between scheduled events. I finally understand that I am responsible for keeping my boundaries firm, otherwise, medical life will consume me once again.
At the bottom of the schedule, I wrote: “To be reviewed in 1 month to ensure that I am meeting my needs.” It’s funny to say, but putting this down on paper feels like I’ve just made a contract with myself for a better life. This better life comes with sacrifices – sacrificing my perfect devotion to work, sacrificing my perfectionism (still a long way to go!), and sacrificing my finances. But I feel empowered as a person, as a living being!
I am feeling hopeful that I will be OK, and I am feeling hopeful that I can listen to my needs. Ironically though, the most important change for me has been a deeper, more radical one. I have noticed that the ground I now stand on is different, because it is connected to those I love and to my greater meaning and purpose.
This article shares seven days of growth from rock bottom to feeling better recorded in my physician burnout diary from 2021. I needed to take time off, to heal, and to discover self-care. I needed to reconnect with nature and prioritize my own needs in order to be of service to my self, my relationships, my family, and my vocation.
I hope that this resonates with readers and that it is of support to someone in the same place. Know this: you are not alone, and it will get better.
Thank you for reading my story.