I have recently undergone (yet another) transition and am now back to living at home with my family full time instead of in an apartment half of the time. So wonderful most of the time … I think.

It is amazing and a very big wake-up call that I missed many of my children’s lives. And that those two years I will never get back, but it’s also just so hard to be “on” all of the time. I am not complaining, but these thoughts and feelings are real.

Mom, mom, mom, Mommy!

OK, so you will think this is a piece about being a working physician mother, but it’s really not. It’s more about how we can feel multiple ways about something, and it does not always have to be so black and white, or either, or.

Medicine included.

I continue to be amazed at how we all have convinced ourselves that leaving clinical medicine, changing jobs, and profiting from a side gig is the key. I understand why we feel that way. I have done all the above and likely will continue to do so in the future, but I think we are vastly underserving those who are watching us when we pretend it’s “so much better” out here than inside the arena of clinical medicine. This is an all-or-nothing approach to a complicated, complex, personal issue.

This is not to say these moves or thoughts are not necessary or warranted. People in medicine have been destroyed physically, mentally, and emotionally by various aspects of being a physician or clinician in the modern world, especially over the last decade.

In fact, I watched part of what tears people apart happen to a trainee this weekend on call. Profanities and cruelty were thrown at them while doing a procedure. Many laypeople don’t understand or have never experienced that part of it.

It would be easy for me to state that this is uncalled for and yell at or be dismissive to the patient, but the reality is I knew this patient and their story intimately and understood why they acted in such a way. It wasn’t an either/or situation; it was truly a both/and situation.

I recognized the pain and abuse spewed at the trainee while also knowing that this patient had endured similar. Does this excuse it? No, it doesn’t, but it does give me pause when I consider walking away from medicine. Sometimes we are bearing the results of prior abuse at the hands of others, including other clinicians or physicians.

It can be true that physicians gaslight their patients, while physicians/clinicians are also abused at an unacceptable rate and compound an already overwhelming career choice. Pretending that these two experiences are not intimately connected is where we lose the forest for the trees.

I see it the same way that we as physicians become enraged and indignant about prior authorizations or peer-to-peer consultations from insurance companies. As someone with friends and colleagues who have done or are doing these jobs, I would ask why we think these things are necessary.

Though physicians may want to bemoan that it is the insurance companies’ way of controlling us or making money off of us, I would also ask us to consider why they became necessary in the first place. It can be true that these requirements result in delays in care or even morbidity/mortality while also being true that physicians were allowed to dictate care for decades/centuries with minimum to no oversight. It’s both.

This brings me to the ongoing disaster of a relationship physicians seem to have with other clinicians and/or nurses and how it plays out on social media.

There really are situations where it’s just different being a physician — when it’s your name, your license, your career on the line. If you bottom line a patient’s care, it’s absolutely crucial for us to have opinions and be a part of the care provided to a patient. But this doesn’t mean we, as physicians, are immune from bad or unnecessary care or interventions.

It doesn’t mean care provided by all “other providers” is inferior or that all physicians are arrogant power-hungry people who want to be called “doctor.” It can be both that we work together as a care team and that there are strengths and weaknesses that we all bring to the table.

It can also mean I want to quit medicine, run far away, and never want to stop practicing, as I do derive a large part of my identity from my practice of medicine. Anymore it’s seen as a weakness or a fault to derive your self-worth from anything outside of yourself. Which I find incredibly misleading when we also teach our children to be kind to others and to help other people so that they know they are special and not alone.

So is it both/and or either/or?

How would it make sense to teach children that their community and sense of belonging is essential to their happiness and success but then expect adults to find everything inside themselves? Can we work on finding the core part of our identity while also deriving fulfillment from caring for others? I sure hope so.

I am the first to admit that I have ignored and shoved my burnout down underneath a layer of hard work and recognize that I must face it now while also maintaining my practice of medicine. The culture of medicine has taken advantage of this resiliency. And I have a responsibility to work on it for the sake of myself, my family, my patients, and my colleagues. It’s both. For some of us, this work has or will require leaving clinical medicine — but I don’t think it has to be either or for all of us.

Nicole M. King is an anesthesiologist and intensivist.

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