Burnout:

“An erosion of the soul caused by a deterioration of one’s values, dignity, spirit, and will.”
– Christine Maslach (The Truth about Burnout by Maslach and Leiter)

“Shredding of the soul.”
– Rita Nakashima Brock (Director of the Shay Moral Injury Center at Volunteers of America)

The word “soul” captures our attention by speaking in a language that bypasses the superficial, connecting directly to our deepest values and thoughts. In the context of burnout and moral injury, it is a word whose use speaks to the depth of the wound that the dysfunction in our health care system has inflicted on the innermost core of health care workers. In our technological, scientific world, the temptation to steer away from the uncomfortable magnitude of such a word, or others like it – heart, spirit, essence, life, being – is predictable, but ultimately inexcusable. Banal words create trite solutions. Only the use of a word that encapsulates the essence of our humanity can create the gravity and urgency needed for action.

Although the ultimate solutions to our current health care dysfunction are systemic, the immediate care and restoration of our “wounded, tattered souls” are personal.

In medicine, we aim for precision in our use of words to discuss the illnesses of our patients. To describe what ails physicians trying to navigate cultures of disrespect, mass productivity, and perverse incentives, we need more than those tired workhouses – resilience and well-being. We need a word that speaks to the loss of meaning; of values in conflict; of sadness and grief; of isolation and loneliness.

We need “soul talk.”

The word “soul” thwarts the whitewashing of the truth. It demands that we honestly embrace, treasure, and protect the essence of our being. Who better to challenge and encourage us to return to the driver’s seat of our lives than those masters of language and reflection – writers of prose, poetry, philosophy.

Presence

Finding space to stay centered and grounded within the relentless chaos of everyday life and work is the foundation for bringing ourselves into the moment. Out of that pause, however brief, emerges the possibility of calm, reflection, and the awareness of another way of being. The door to the memory of what lies at our core opens. That stillness offers the opportunity to create a connection with ourselves. Out of this connection comes the possibility of change and healing.

For presence

by John O’Donahue

(Excerpt)

Awaken to the mystery of being here and enter the quiet immensity of your own presence. Have joy and peace in the temple of your senses. Take time to celebrate the quiet miracles that seek no attention. Be consoled in the secret symmetry of your soul. May you experience each day as a sacred gift woven around the heart of wonder.

Self-compassion

Self-compassion allows us to get out of our way, get unstuck, and embrace the reality, beauty, and messiness of being human and imperfect. In the words of research psychologist Kristen Neff, self-compassion brings us solace and courage through self-kindness, embracing common humanity, and practicing mindfulness. It does not mean being consumed by self-pity, self-indulgence, and self-esteem. In her poem, At Blackwater Pond, Mary Oliver speaks of the wide-eyed awakening to the clarity and beauty of self-compassion.

At Blackwater Pond

by Mary Oliver

At Blackwater Pond, the tossed waters have settled after a night of rain. I dip my cupped hands. I drink a long time. It tastes like stone, leaves, fire. It falls cold into my body, waking the bones. I hear them deep inside me, whispering, oh, what is that beautiful thing that just happened.

Purpose, meaning, and vision

We enter medicine with a vision for a life that has meaning and purpose. This purpose emanates from deep inside us and sustains us through the sacrifices and hard work that are intrinsic to a career in medicine. Nothing is more crushing to the soul of a physician than to see the quality and purpose of their work compromised and put in jeopardy. Rudyard Kipling’s poem “If” comes from a different time and era, yet it eloquently speaks to the outside forces and demands that put this inner life-sustaining force at risk. It doesn’t offer a panacea for handling the vicissitudes of daily living but rather reminds us of our individual mandate to keep forging ahead with our journey, however challenging and whatever shape it may take.

If

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by Rudyard Kipling

(Excerpt)

If you can talk with crowds and keep your virtue, Or walk with kings—nor lose the common touch, If neither foes nor loving friends can hurt you, If all men count with you but none too much; If you can fill the unforgiving minute with sixty seconds’ worth of distance run, Yours is the Earth and everything that’s in it, And—which is more—you’ll be a man, my son!

Know thyself

These words are inscribed above the Temple of Apollo at Delphi. We may not ever “know ourselves,” but taking an honest, compassionate inventory of our values, strengths, challenges, and beliefs is the first step on our journey of self-knowledge. Without this process, we are, in essence, flying blind through life, allowing ourselves to be filled with the opinions, biases, and thoughts of others. When we return to living in a way that is aligned with and respectful of what is most important to us; when we appreciate our talents and inner strengths; when we honor our imagination and our capacity for change, we are no longer a stranger to ourselves.

Educator and author, Parker J. Palmer, expresses this beautifully:

I’m using the word heart as they did in ancient times when it didn’t merely mean the emotions, as it tends to mean today. It meant that center in the human self where everything comes together—where will and intellect and values and feeling and intuition and vision all converge. It meant the source of one’s integrity.

Connection

Finding and creating our own “tribe” nourishes us physically and nurtures our mental health, adding vitality, comfort, and support into our lives. Medicine has long been recognized as one of the loneliest professions. Writer and editor Julie Beck describes “The six forces that fuel friendship” – accumulation [time], attention, intention, ritual, imagination, and grace. Building a connection confronts and offsets the perfectionistic, lone ranger, ego-driven mentality so common in medicine. Creating a connection demands commitment and a wholehearted embrace of the truth that we are, in the words of the poet David Whyte, “on a journey impossible to accomplish alone.”

Friendship

by David Whyte

(Excerpt from Consolations)

But no matter the medicinal virtues of being a true friend or sustaining a long, close relationship with another, the ultimate touchstone of friendship is not improvement, neither of the other nor of the self: the ultimate touchstone is witness, the privilege of having been seen by someone and the equal privilege of being granted the sight of the essence of another, to have walked with them and to have believed in them, and sometimes just to have accompanied them for however brief a span, on a journey impossible to accomplish alone.

Creativity and growth

The practice of medicine demands an ongoing engagement with flesh and blood; joy and sorrow; hope and despair; suffering and healing. Physicians weave vital clinical knowledge and skills with the demanding, unpredictable, gut-wrenching, and heartwarming experiences that characterize the complexity of humanity. This well of compassion needs to be constantly replenished. Only by having the time and space to nurture curiosity, seek inspiration, and maintain optimism can we find the strength and courage to sustain our own humanity and fuel the fire in our souls.

Poetry

by Pablo Neruda

(Excerpt)

And I, infinitesimal being, drunk with the great starry void, likeness, image of mystery, felt myself a pure part of the abyss, I wheeled with the stars, my heart broke loose on the wind.

“Soul talk” embodies reality, lucidity, compassion, and imagination. It symbolizes a personal declaration for truth, change, and healing. It is a conversation worth having.

Jacqueline Huntly works as a career and leadership development coach. She is founder, Thrive to Lead MD, and is certified through the Physician Coaching Institute. She has extensive experience helping individual physicians navigate burnout, reinvent their clinical practice, transition into non-clinical work, and grow strong self-leadership skills that support well-being, career, and leadership. She is a retired board-certified preventive medicine physician.