Life beyond Burnout

Chapter One: In the Beginning “In the middle of the road of my life I awoke in the dark wood where the true way was wholly lost” Dante, The Divine Comedy. “I hate my job,” I said. Sitting in the doctor’s lounge, across from my friend, I could hardly face him. “I just can’t do it any more. I can’t go back.” “Isn’t there anything you like about your job?” I shook my head. “No,” I replied, my voice breaking. “Nothing at all.” I couldn’t find the right words to tell him how bad things had gotten, how hopeless I felt. I no longer had the energy for my work. Cynicism had taken over my thinking. Admitting it out loud showed me just how far I’d fallen into the dark crevasse of professional burnout. Though I had served the Puyallup Tribal Health Authority for nearly twenty years, first as a physician, and more recently as Medical Director, I felt completely lost. I’d even begun to consider leaving medicine, giving up on the profession I loved. Could I ever escape the unending disappointment and frustration of my work? It seemed I’d been swallowed up by hopelessness. But I hadn’t always felt like that. Twenty years before this surprising confession, I’d taken my first post-residency job as a Family Practice Physician serving Native Americans in Puyallup, Washington. I’d begun that work full of passion, determined to make a significant difference for this underserved population. In my youthful exuberance I expected to heal every patient and to be loved and appreciated by everyone. Instead, I encountered a population struggling with all the disadvantages of poverty and marginalization. Many suffered from the physical, social and emotional sequella of addictive disease. Making matters worse the staff at our medical clinic seemed to arrive and depart via some invisible merry-go-round. In my first ten years at the clinic, I had 17 different partners. Early on, I discovered that a Tribal Medical Clinic is a bit like a small town. Tribal politics frequently influenced clinic decisions without regard to the recommendations or preferences of the professionals providing health care. Supervising the medical staff required that I correct or dismiss nonperforming employees—something outside of my training and comfort zone. The work in our clinic was both emotionally and physically demanding. During those difficult years, I remember one month where I delivered 18 babies. Early mornings, late nights and frequent all-nighters left me chronically exhausted. But what I felt was more than physical exhaustion. This combination of political and staff upheaval, combined with demanding and difficult patients left me feeling fed up and frustrated. At the same time I was exhausted, used up, empty and hollow. I’d lost all sense of joy in my work. I had no resiliency, and was no longer able cope with unexpected challenges or difficulty. I had become so cynical that I no longer approached most problems in a productive way. And then, quite suddenly, I realized that I’d begun resenting my own patients. Though I didn’t feel this way about all of them, whenever a particularly difficult patient appeared on my appointment schedule, I dreaded the encounter, feeling resentful of my patient’s chronic complaints, dissatisfaction and manipulative behavior. I just didn’t want to take care of those people any more. Recognizing my own begrudging emotion somehow shook me awake. It was as if, by resenting my own patients, I’d crossed some invisible and unforgivable moral line. After all, I’d studied medicine in the hope that I might help suffering people. How could I have sunk so far? Overwhelmed with guilt about my attitude, my frustration mounted. At the end of the day, I had no sense of accomplishment, no job satisfaction. After a day of watching the clock it was everything I could do to crawl back to my car and drive home. Desperate, I tried to reverse the situation myself. Believing I suffered from fatigue, I took time off. I planned longer vacations. On weekends, I played hard—as if by wild activity I might recover my lost sense of joy and purpose. I used my time off as a way of recovering lost opportunity, lost exuberance. I coached basketball, went skiing, and spent time with my kids. I kayaked, hiked and went camping. Those efforts, frantic as they were, made no real difference. Every Monday, I returned to work in the same condition I’d left—dreading every minute of the day ahead. One afternoon, while sitting at my desk in a common work area, a pre-med student came in to interview our medical staff. He approached my colleague’s desk first, asking a simple question. “If you had to do it over again, would you choose to become a doctor?” Without hesitation, the other physician replied, “No. I’d become a high school teacher and coach basketball.” Eavesdropping, I wondered how I would answer the same question? If I could go back and do it all again, would I choose medicine? What other career appealed to me? In an instant I knew I would choose medicine—regardless of how deeply disillusioned I’d become. When I am at my best, there is nothing quite like the work I do. When I connect with my patients, solve problems, and make a difference in outcomes, my profession provides enormous joy. Even at my lowest point, I recognized that no other work would ever satisfy me in quite the same way. At one time I’d loved my vocation, though somewhere I’d lost that sense of fulfillment. Listening to the student interview my colleague, I realized I had find some way to turn myself around. In the many years since that low point, my life has radically changed. I have recovered my youthful enthusiasm for the practice of medicine.