The Way Forward by Amita Dayal 

Having been through it once before I could recognize the signs, albeit only the late signs, oblivious to the subtle ones I’d missed along the way. Avoiding work, ironically, as looming piles of work was part of the stress I was ignoring. Avoiding work and instead googling; alone in bed at night. Into that white bubble of hope, my cursor blinking; ‘non-clinical jobs for doctors in Canada’. This had been a late sign of significant burnout for me several years ago. That someone who worked their entire young life, giving up much of their twenties, amassing enormous debt to have their dream job would, in a dark place, be searching for any way out.

I was rescued from my first episode of burnout by a fire. A fire of the roof of our community hospital that, as it melted into the electrical room, became my salvation. We had to close for a year and luxuriously I slept in my bed every night for that year; something I had not done in close to 20 years. It afforded me an opportunity to re-group, to catch my breathe. It was an unfortunate and unexpected gift. What it did not do was show me how to prevent the cycle from happening again.

And so, it began again – the saying yes, the being everything to everyone, the pushing of my already poorly defined boundaries. These unconscious acts resulting in long hours and endless meetings. Impossible to fulfill commitments and the chest squeezing physical stress that accompanies that feeling of drowning. Drowning under a situation you yourself created and can’t see a way out of.

Burnout is an insidious thing, sneaking into the days and weeks; initially affecting the ‘off hours’, those times with family and friends, what should be recharging time. Instead of connecting, becoming distracted, irritable, withdrawn. Just plain exhausted. A vicious cycle.

From above, hovering near the corner of the ceiling, I see myself, scrolling, checking, texting, and avoiding. Avoiding sleep or avoiding something more? Something buried deep. Maybe many things. Maybe the anxiety, the losses, the anticipated disasters. Things that are part of the life of a doctor but made exponentially worse by the slap of a global pandemic.

It is only after the online exploration of jobs in medical writing, teaching, and medical administrative work that the bundle of frayed wires I call my brain thinks to google, ‘burnout’. Burnout is characterized, as per the internet definition, by three dimensions. One is the feeling of energy depletion or exhaustion – check. I can’t find the energy to take a lunch to work, adopting an ‘I’ll figure it out’ attitude (which means I’ll eat random office chocolate) let alone exercise. Increased mental distance from one’s job- check. Although I would never let on when face to face with a patient most weeks I am counting down the hours until I get a break, even when that break is 7 or 8 days away. The final dimension is a feeling of negativism related to one’s job – check. The google search. My late sign.

I tried adding monthly massages and weekly workouts with a trainer to my schedule; hoping some self-care would cure me. I joined a writing group; to nurture my childhood love of writing and allow for venting of my stress and life pressures. I met with a social worker online who empathized with my situation and gave me a safe space to share. I felt blessed that I was able to do such nice things for myself. Ironically, my calendar became fuller, and I felt even emptier. Everything felt like a chore, even my burnout strategies.

I imagined myself as an old water jug, crockery from a deceased relative; no longer able to hold water. Leaking like a sieve; broken handle, lip chipped. I was trying to fill it up but was left tapped out, feeling broken with not much left to give.

There becomes a point of despair; when you feel that you can no longer help yourself but also that there is no one who can help you. I considered acceptance. Maybe this is the price of being a doctor? For the life I chose, for my big house and safe lifestyle. I considered my options, but nothing seemed reasonable or possible. Not without letting everyone down or imploding my life. I am not an imploder, I am a live by the status quo, do what you know kind of person. Not a risk taker.

I sat in the parking lot, between work and home and cried, and crying does not come easy. Emotions must be compartmentalized to get through the day and with opening that box comes the fear that the lid may never fit back on. Emotions take time and I was short on time. Crying is messy. Eventually, I made a phone call. I explained where I was, the hole I was in, the need for a person at the top, throwing a rope and holding it while I climbed.

Help came. In the form of a woman who had previously worked as a rural family doctor but now spent her workdays coaching physicians. Physician like myself who were burnt out and needed to find the way forward. She asked me difficult questions, making me take stock of my values, my strengths and those weaknesses that made me vulnerable. I made hard decisions, about my work-life balance and I had the strength to carry them through. I understood why they were necessary. I let people down but, in the process, found a way to stop letting myself down.

I am moving forward. After 17 years of acute, fast paced care, I am moving towards some more creative aspects of medicine, such as writing and humanities. Slowing down. I try to view my practice through a physician wellness lens and hope to lead my colleagues and students by exploring burnout avoidance strategies that go deeper than so called self-care. A spa day or a cup of tea are good. Better still to ask yourself, who am I? What do I need to succeed in my version of success?

I want to have the energy to do my clinical work with some left for exercise. I want to be present with my patients and colleagues and cherish the role I am blessed to play in their lives and health. I want to feel good about the choice I made to follow my dream of being a physician. I want to never do that google search again.

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