What do you do when you love your job, but it’s killing you?

That’s an easy question if it’s asked by someone else.  It’s a hard question when you’re asking it of yourself.  As a physician, I give advice to people all the time — other people.  If you have diabetes, control your diet.  If you are obese, then lose weight and exercise.  If you have COPD, then you better not continue smoking.  Common problems.  Obvious solutions.

What if burnout is your problem?  When your cell phone rings, you get tachycardia wondering what catastrophe awaits you.  You work 80 hour weeks and have no time to recuperate between catastrophes.  When you’re not working, your mind is still there, wondering what you could have done differently; feeling responsible for any bad outcome; feeling thankful and lucky (more relieved than proud) of any good ones.  Even when you’re not at work, your mind is.

What about your own health? Preventative and health maintenance factors including diet, exercise, and stress reduction are put low in our own priorities.  There’s just not enough time for these.  And, there’s a stigma attached to looking after ourselves.  We work sick and injured.  We go for long periods without eating and then binge on unhealthy foods.  We barely stop to chew.  Does running from one catastrophe to the next constitute exercise?  Those physicians that do exercise often become intense and competitive about it.  What happened to the moderation we recommend to our patients?

What about being human?  There is a crucial human need for connectivity and relationships.  Are these being fostered when social engagements are canceled because of work priorities; or, when we are not truly mentally or emotionally engaged because of fatigue or work related stress.  When do we stop being “Dr. X” and just be ourselves?  What about our relationships in the workplace?  Do we have time to stop and see the people we’re working with?  More often, we spend our time judging them and ourselves harshly.  The work environment is conflictual, not supportive.  If we can’t see ourselves and our colleagues as human, then we don’t foster teamwork, and we and our patients suffer.  If we don’t see ourselves as human, then we don’t give ourselves or our colleagues a chance to recover when we struggle personally or professionally.

The result of burnout is depression.  Mine was a deep, dark hole that sucked all the life out of me.  I wanted, more than anything, to feel again — joy, sadness, anger, anything.  I couldn’t look after myself.  And, I certainly couldn’t look after patients.  But, that was what I was forced to do.  I told my chief of staff I was struggling and needed time off.  They told me they would try to find a locum to cover my on-call responsibilities.

But, in the meantime, I was to carry on.  Despite medications, my depression continued and worsened.  It was exacerbated by work.  I clearly wasn’t performing to the best of my abilities, and my patient complications and complaints were increasing.  A patient died from a post-operative bleed.  Would I have managed it better if I wasn’t suffering myself?  (When I spoke to the patient’s wife, as he lay dying 20 feet away, she asked me if I was OK.)   After struggling at work for two months, there was still no time off/locum coverage.  So, I told the chief of staff I was taking time off anyways.   I was worried that my leave of absence would cost me my job.   I called the physician health program to find out what my options were.  They offered a referral to a psychiatrist.  I was already getting treatment; I just needed to know I would have a job when I recovered.   They couldn’t help.

I spent the first month of my leave of absence sleeping in my car.  I would put on a “happy face” for my kids, drop them off at school, and then try to find the motivation to do something.  No amount of caffeine or walks in the fresh air worked.  I would end up in a public parking lot, sleeping in the front seat.  I would wake to pick up the kids from school and spend the evening feigning interest in them.  It took three months for my numbness to clear.  Being away from the stress and mental and emotional trauma at work, gave me a chance to heal.

I returned to work after three months.  Shortly after I left, a locum had been found.  The job was still there when I returned.  But, so was a deep resentment towards me from some of my colleagues.

It took two years to fully recover.  I am more resilient.  But, the stress and trauma at work haven’t changed.  I’m a surgeon.  I work 1 in 5 call at a busy community hospital.  We are the default physicians for many emergencies.  We don’t cross cover on weekdays, and it’s not unusual to be in the hospital or woken in the middle of the night when not on call.
In the summer, we often do 1 in 3 or 1 in 2.  It was during one of these extreme stints this summer that I was called upon to perform an emergency tracheotomy on a 2 year old who was brought in for an exam under anesthesia to rule out epiglottitis.  I had been up most of the night, most of the month.

The previous week, I had self-administered a saline IV bolus between surgeries to combat the gastroenteritis I contracted from a patient.   I’ve never seen a pediatric tracheotomy, and this would usually fall to our ENT surgeons, who both happened to be out of town.  I had never seen the equipment.  And, the nurses working that night weren’t any more familiar.  It was only by sheer luck, at the last minute, someone noticed I was given the adult kit — one that I would have never been able to fit in a 2 year old.  Just before I began, the parents were brought in for a heart-wrenching last goodbye.  They were told that the procedure I was about to do could save their child, but that I had never done one before, and that if I failed, their son would die.  I knew that if I failed, I would die too — not a physical death, but a mental and emotional one.  (Worse so, I knew that my children would suffer.  They already lost their father, also a surgeon, to depression and suicide.)

The tracheotomy was successful.  The 2 year old lived and so did I.  The relief was overwhelming.  But, it was on to the next emergency case and the next on call.  There was no time to recover.  Two weeks later, when my on call stint ended, I broke down.  Then, I quit.

I am pleased to see the increasing awareness of physician burnout and availability of resiliency training.  But, it’s not enough.  It’s time to change physician work hours, so we have time to recover from the stress and emotional trauma.  It’s time to trust our colleagues to look after our patients evenings and weekends when we’re not on call.  And, it’s time to applaud physicians that don’t go to work when they are sick and build a system with enough human resources to fill in the gaps.  Greater manpower makes it easier to fill in the gaps when those left behind aren’t already exhausted themselves.  Working exhausted and stressed to a breaking point is unacceptable.  It’s not just us that suffer.  It’s our families, our friends, and our patients.

In a day when there are physicians graduating that can’t find jobs, being overworked is unacceptable. Why are we still doing this? Money?  What are you willing to sell your health and happiness for?   Why do we test our own resiliency by continuing to ignore the stress that our work and long hours put on us?  We are instructed on airplanes to put our own oxygen mask on before helping someone else.   We need to look after ourselves individually and as a group.   It’s time to admit we are human.

The author is an anonymous surgeon.

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