“Because, as it turns out, you have to start somewhere.”
–Mike Birbiglia (“Sleepwalk with Me”)
My name is Jason Kesselring. I’m a pediatrician. And I recently did something that most people in the medical world would consider career suicide. In fact, many people that I talk to don’t really seem to understand the idea. I decided to take a sabbatical. Which is really a fancy way of saying that after 10 years of feeling like I was failing at my job, and not giving sufficient attention to my family life, that it was time to take a really, really long vacation. And probably not come back to clinical medicine. I know that I would like to still “be a helper” whenever I come back, but just doing something a little different.
I’ve been asked “when” and “how” this happened repeatedly by people who care. And it’s gonna take a little while to explain. What may get split over several blog posts, however, really comes down to a few simple factors. Natural personality. Lack of support from administrators. Job stress. These things are not unique to medicine. These are universal themes across modern life. What I’m describing is burn out. Mentally, emotionally, and physically, I’m toast.
I even know the first day when everything got set into motion. Something about stones, ponds, and ripples could be inserted here.
June 19, 2010.
It was Father’s Day weekend. I was not on call, so we had a fair amount of activity planned. I had recently gotten back into really good running shape. I will explain my two decades long love of the sport some other entry. What’s relevant here is that I was in killer shape, and I had hoped to set a new personal best at 10K in a local road race that Saturday morning. But it was brutally hot, projected to be well over 100. I decided that running a 10K at 8 AM was probably not in the cards. What I did decide to do was cut down the ornamental plum tree in our front yard. In my mind I would be shaded for the morning, and I would have plenty of access to fluids. You could accuse me of being a stubborn cuss, much as my wife correctly pointed out that morning. But down the tree came, and I stopped before it got to unbearably hot. I pounded water like it was going out of style. To paraphrase Lewis Black, the only way I could have been better hydrated would have been to take a garden hose, shove it down my esophagus, and turn the spigot on full blast for 5 minutes. To this day, I’m sure that I was well hydrated.
After taking it easy for a bulk of the afternoon, I started cleaning up scraps of wood, before we went to a good friend’s house for birthday parties for his two daughters. I was beginning to feel a little headachy, so I drank some more water, and didn’t think too much of it. We ate some killer chicken tacos, and had a good time kibitzing with our friends. Around 8 PM, my head started really bothering me. To those of you out in cyberspace, go throw your man cold jokes away. I do have a relatively high threshold for pain. If I can get through a hospital shift with gastroenteritis and require 3 L of fluid hydration after being up for 24 hours, and not eating or drinking a thing, but not missing any work, leave your man cold jokes at home. Back to the story… we left the birthday party and went home.
My head kept hurting worse and worse. Worst headache of my life. In medical school, before you start any neurology rotation, you learn that the worst headache of your life is an aneurysm that’s about to blow until proven otherwise. Everything about my head and neck hurt. That second part should’ve been my tip off. But I was just so focused on my head. I asked Sonia (for those of you who don’t know she’s my wife and the smartest and most compassionate person you’ll ever meet) to smash my head through a wall to make it feel better (she refused). Around 11 PM, she called my mother to come over and watch the kids while she took me to the emergency room. I don’t remember much about driving to the ER. My head hurt like hell, I was wearing sunglasses, and I could feel every little bump on the highway on the way there. All I know is that Sonia stayed with me the entire night, and I’m forever grateful for her.
As we waited in the waiting room, I was convinced I had an aneurysm that was about to blow. That’s the danger about being in medicine, or nursing. You have some knowledge of what’s going on. I didn’t have any diagnostic tools at my disposal, but I knew things weren’t great. I was doing my best not to think about the countdown of how many hours I had left to live. That only made matters worse.
When I got back to the ER exam room, they got the attending back there right away. I swear to this day, the dude looked like Buddy Holly. Definitely taller than Buddy Holly, but it was Buddy Holly, MD, all the way. I was half expecting the CT tech to look like the Big Bopper, and Richie Valens to come in to verify my insurance. Dr. Holly was a nice guy, very kind, and worked swiftly. He saw my sunglasses, asked me a few questions, and did a quick exam. He told me he needed to obtain a CT scan of my head right away. If the scan didn’t show any blood or mass effect, he was going to spinal tap me. The nurses put in an IV, and gave me some pain medication called Dilaudid. The nurse told me that some people come in drug seeking enough that they ask for the stuff by name. I don’t ever want to have a life experience were Dilaudid becomes a reasonable option for me. In fact, if you reach the point of saying “Hey, I could use some Dilaudid today,” you need to re-evaluate your life choices. The pain was blunted, but I felt really loopy.
The CT results seemed to come back quickly. Don’t ask me to be a real judge of time because I was so out of it that it could’ve been 20 minutes, or it could’ve been three hours, I don’t really know. But I do remember is that Buddy Holly came back and said that my scan was clean. He started setting me up for a spinal tap. I rolled over to my side; he exposed by lumbar spine, and begins prepping me. I began to wonder how this was going to feel. As a pediatrician, especially during my training, I had performed the same procedure on countless babies and small children. It’s akin to getting an epidural, except you don’t get any medication. They’re just taking off a sample fluid. I kept wondering how this was going to feel, how long this was going to take, when this would be over…
It was done in two minutes. Buddy Holly explained that for adults, if you’re skinny and have “good landmarks”, it won’t take that long. I was grateful, and according to my wife I fell asleep for the first time that night.
Dr. Holly came back, which seemed like another quick turnaround to me. I have always liked this guy for the subsequent conversation:
Buddy Holly: “Dude, you have meningitis.”
Buddy Holly: “Yeah.”
Me: “F bomb.” – I said the word; I’m just not retyping it here.
Buddy Holly: “It’s probably viral given that it is summertime.” (For those who don’t know, Enterovius is a common cause of non-bacterial meningitis in the summer.)
Me: “Do I get to go home then?”
Buddy Holy: (somewhat incredulously): “No. You need dexamethasone. And vancomycin. And Rocephin. And we need to make sure your cultures come back negative. We’ll get you a bed in the hospital very quickly.”
Buddy Holly: “Absolutely.”
Me: “F bomb.”
I got up to my room at perhaps 3:30 in the morning. Sonia was finally able to go home and get some sleep. I was by far the youngest patient on the floor by perhaps 25 to 30 years. The nursing staff was very kind, and when they found out I was a physician, everyone seem to be on even more eggshells. I made sure to be exceptionally polite, and made it a point to tell them that I don’t try to micromanage my own medical care or diagnose myself. Once I got checked in, the nurse told me to try to get some rest.
She left the room, and turned out the lights. From my room, I think I was on the seventh floor, I had a great view. Of the industrial sized, heating and cooling system for the hospital. The thought occurred to me that if I had bacterial meningitis, and if I close my eyes, this might be the last view I ever see.
This was somehow fitting. And if I was funnier, I’d write a joke about it. But it was not reassuring at the time. One thing we should all realize is that most of us die in nondescript ways. Morgan Freeman isn’t going to narrate your death. We’ll be lucky to have a little family by our side. And time for a bucket list? Forget about it. The view of pipes and chillers and coolant was fitting. Between the dexamethasone coursing through my system, and the fear that I might die, I wouldn’t sleep that night. Nor the rest of the time I was in the hospital.
It was kind of an eye-opening experience. I had an almost 5-year-old son, two-year-old daughter, and a wife. I didn’t want to leave my young family without a husband and a father. Much like any young professional, my early career has been a steady march to do more, more, more. It was eye-opening. Sobering. A moment of clarity. That’s really a terrific experience to have. I highly recommend everyone to go through it, and really begin to prioritize what is important in life. My advice, however, is to avoid the life-threatening illness to ignite such a thought. I don’t know if that’s possible. That might fall under the category of “mutually exclusive.” Regardless, I felt that whenever this was over, I had to do something different with my life in order to get that sense of balance back.
I don’t remember much else about those days I was in the hospital. I remember one of the patient care techs being very kind. She was Bosnian, she loved soccer, and she really loved Ronaldo. She made an oversized cup of Bosnian coffee for me, and came in to check on me frequently. I think she really just wanted to come in and watch a little World Cup and Ronaldo while he was playing. I remember Sonia coming up and helping me pass the time. I remember the Reverend Ed Zumwinkel coming to visit me on a Monday, and taking off his mask to talk to me. That small act made me feel a lot less like a leper. I would be discharged later that day due to my bacterial cultures coming back negative.
The infectious disease doctor that was on my case in the hospital suggested that I take a minimum of two weeks off of work. But the reality of being in medicine began to sink in. I was in a busy call schedule, there were reports on my desk at work, and I worked in a largely underserved community. I was the only pediatrician in my office at that time. Every day that I’m out is a day that the child and family went without help and care that they needed. Since I hadn’t kicked the bucket, I felt the urge to push and get back as quickly as I could. I went home from the hospital on Monday afternoon. I was working on reports for a half day on Wednesday. I saw patients on Thursday. On Friday, I was doing physicals for a preschool program in a non-air conditioned church.
But I was far from well. I never had migraines before meningitis. OK, I had one. Driving was the worst. Visual stimuli would trigger hours of headaches. I would leave home even earlier to get done with my work in the nursery, so I could sit at my desk in the dark before seeing patients. I would repeat this when I got home. I felt stupid and stunned. Concussed… I don’t know if it’s an actual feeling, like a sensation, but it’s the best way I can describe it. I felt like Keanu Reeves looks if that makes things clearer. My thought processes were slow.
Sonia told of one instance, when I was rummaging through the kitchen on a Saturday morning. I was standing in the kitchen with just about every cabinet door open. She asked me what I was doing. I told her I was looking for something. She asked me what I was looking for. I told her I was looking for U2… bad joke; I told her that I wasn’t sure. Very kindly, she pointed out that it was morning and asked if I was hungry. I was very eager and polite and said “Oh yes, some food would be great!” She pointed out that there were some Cheerios just in front of me. I thanked her profusely, and set about pouring myself a bowl. That’s kind of how I wandered through the next two months. I tried explaining this to some of my friends. A good friend of mine, Dave Custis, told me with a grin, “Quit bitching. It’s just a brain infection.” I like having loyal friends that aren’t overly effusive with sympathy. My sister bought me a “Life is Crap” hat after the illness; it’s still one of my favorites.
Work became exponentially busier. I started seeing a lot more patients. I was in a very busy call schedule and that drained a lot of my energy. My organization approached me about being department chair. I was always told in residency that when you were relatively new to your first job, jump in with both feet. I was assured, by my organization that I would have the administrative support I needed. Furthermore, the organization needed me to collaborate with a nurse practitioner in rural Illinois. So I said “yes” to both. I didn’t want to disappoint, and I trusted that I had the support in place that I would need going forward. Sadly, my personality as a people-pleaser doesn’t always suit me well, at least when it comes to self-preservation. I jumped out of the personal health crisis fire, and into a whole new set of infernos.
But the headaches… To this day I still get the migraines. I’ll never be able to prove that it was a sequela of the meningitis. I don’t know if this is something that was going to happen anyway, or if this was an effect of the illness. It’s probably moot point now. I do know that after having been off of work for almost 2 months, I still get them with similar frequency.
Sonia was very concerned. She wanted me to quit at the end of 2010. She was concerned for my health. She “put her foot down.” I assured her that I was fine, and I had everything under control. She wasn’t so sure. So I promised that I wouldn’t keep at my current career forever. In my mind I thought it was going to be another 20 years down the road before I needed to change. In her mind, it was one or two. What’s amazing to me in retrospect is that it was so clear to me on Father’s Day weekend 2010 that I needed to do something different. And in the subsequent months, I was able to gloss over, mentally speaking, all of the shortcomings and push them to the back of my mind. For me, the instinct to just keep going was able to take over so quickly. I had seen the truth, and then ignored it in rapid fashion.
In the book Bowerman and the Men of Oregon by Kenny Moore, there’s a significant passage at the very beginning where coach Bowerman tried to explain on a yearly basis to his track team how he would try to get through to them. What follows here can be found in the book and are not my original thoughts, but the words of Mr. Moore:
“But I regret to inform you,” he (Bowerman) added, his tone not the least regretful, “you cannot just tell somebody what’s good for him. He won’t listen. He will not listen. First… first you have to get his attention.”
…Bowerman didn’t have a central organizing principle. He had this, a central organizing parable.
“Farmer can’t get his mule to plow,” he said. “Can’t even get him to eat or drink. Finally calls in a mule skinner. Guy comes out, doesn’t even look at the mule. Goes in the barn, gets a two-by-four and hits the mule as hard as he can between the ears. Mule goes to his knees. Mule skinner hits him again, between the eyes.”
Farmer drags him off. “That’s supposed to get him to plow? That’s supposed to get him to drink?”
“I can see you don’t know a damn thing about mules,” says the skinner. “First you have to get their attention.”
Apparently, meningitis was my first 2 x 4. I suspect, like most people, one trial learning is not my forte. So what happened between the summer of 2010 and the end of 2016? A series of 2 x 4’s. Don’t worry, it has a happy ending. The lesson would just take 6 years, and multiple 2 x 4’s, to be comprehended.