I had passion. I was driven by it. It consumed me. It pushed me forward. I had to follow it. I had no choice. Now I am ready, almost eager, to let others take over. What has happened to me?
I am tired. Years of pushing burned the candle down. I can flicker up at times but it never seems sustained. I seem to do things because I am supposed to. At times I want to but then wish I could retreat. I dream of just being able to sleep. To know what it means to really rest. For once to not feel so tired.
I feel beaten down by the repeated tasks that consume me. Rounding is not about taking care of patients or making a difference. It is about how to get through the list. How can I finish and keep up? Another note to write. Another question to answer. Keeping my inbox empty. And there is always another. And then the emails just keep piling up. And then the things that I want to do seem to keep getting undone – length of stay, readmission, survival, appropriateness – it all seems to just stay the same. I feel guilty that I have not achieved more and wait for someone to point out my flaws. Why have I not achieved the best in outcomes? Why have I not pulled it all together?
I am numb. Because I don’t know any other way. How can I keep going when the losses keep piling up? In a field where 90% one year survival is considered good, that means that we are forced to endure losing 1 out 10 of our closest patients. I am supposed to be strong, right? These patients all meant a lot to me! Chris, John, Richard, Patrick. The list goes on and on and it never seems to stop. And just when I get my confidence back it happens again. Another punch to the gut and I just take it. Don’t let it show. Don’t let anyone know. Because how can I?
I do have a bad case of FOMO (Fear Of Missing Out). I have a deep fear that I will get to the end of my life and have someone come up to me and say, “Surprise! You were tricked. You missed out on life because you were so busy living it that you never felt it – never actually experienced it.” I dream of retirement as a time when maybe I will be able to slow down enough that I can see and hear and feel again. I worry a little bit because lately people have been asking me if I am going to retire soon. I am ashamed to tell them I am only 53 years old and so I have a ways to go. I also am afraid that I will be like others who finally get to retirement and then dream of the past. They look back to the days that they had purpose and things to do. I think I am a fool.
What can I do to be able to live today? Is it possible? Can I come and play with the other kids? Or do I have to stay inside and work all day? Am I going to get to go outside while it is still summer or will I get tricked and only finish my work in time for the cold dark winter?
ADDENDUM:
I wrote this prior to my cancer diagnosis and my medical leave of absence. It is raw and honest. I never intended to post it. I wrote it for me but now am going to bravely post it. I intentionally left it with some sense of hopelessness and no real answers because that is really what burnout does to us. In all honestly at that time I did get to go outside and play, but burnout makes it so you are not able to fully enjoy it. Your brain remains inside and hard at work even when you go through the motions of going outside to play.
Now with the perspective of several weeks off I see a few answers:
- Dogged Focus on Patient Care: We have to have the strength to be doggedly insistent on focusing on patient care. The pressure of charting in the EHR (Electronic Health Record) can drag us down and distract us. We need to have the EHR be the side item and still insist that the focus of our energy is on the patients. That is where the joy is. A less complete chart is a lesser sin then an incomplete care of the patient. (The EHR is breaking us. We MUST come up with better solutions. Perhaps the answer is scribes?)[1]
- Ring-Fence Your Personal Life: We must put a fence around our clinical or work activities. We have to have time to think, breathe and exist. When you are home, without shame, be home. When you are on a walk, look at the trees and the birds and don’t feel guilty about what is not yet done at work. The undone tasks will always be there whether you spoil your walk or not. Fight to protect work from creeping into the rest of your life.
- Put Down Your Phone: Turn your phone off or put it down if you are not on call. If you cannot do this, give it to your spouse or friend when you go out. Ask them to give it to you only if there is an urgent matter that you must attend to. Get in the habit of having your brain free of work. Get free of the addiction to the phone. It is hard for me to do this but I have to. I get twitchy at first without my phone in my hand. Eventually I get over my withdrawal symptoms and start to become human again!
- Go Away: Go to the national meetings. These always are inspiring and recharging.
- Read Novels: I call these “sorbet for the brain.” Like in an expensive meal where they serve sorbet to “cleanse the palate.” It helps to restore your ability to taste before the next course. Novels can have a remarkable ability to do this for your brain!
- Sabbaticals: I still think that physicians should have sabbaticals. A 4-week period to recharge could result in a re-energized far more effective physician. If only health systems could be wise enough to invest in their physicians in such a way.
- YOU TELL ME! What else? PLEASE RESPOND TO THIS POST! I really want to hear what you think works!
There is an epidemic going on. The ICD-10 is Z73.0 and the term is “burnout”. The vaccines are not very effective. The treatments are still rudimentary and need a lot more work. Like many papers I think I will need this one to conclude, more research is needed. We desperately need it…
[1]Interestingly the EHR issue is finally getting some attention. Please read this blog post for more information: https://www.healthit.gov/buzz-blog/health-it/strategy-on-reducing-regulatory-and-administrative-burden-relating-to-the-use-of-health-it-and-ehrs-released-for-public-comment
