“If life has taught me one lesson repeatedly, it’s to know when I’ve been beat.” –Principal Seymour Skinner, the Simpsons
I could have used a lot of lines from The Simpsons. Somehow, “you don’t win friends with salad” doesn’t seem to fit.
I’m not bitter when I look back at my career. I’ve always enjoyed helping people. I’ve always especially enjoyed helping children. That part of me isn’t dead. Furthermore, if I said I regretted my career, I think it would be rather obscene and a slap in the face at too many people. I’ve been able to help a lot of people on the way. That’s not bad. I’ve met some wonderful people who’ve enriched my life along the way. That’s not bad. And if I hadn’t gone down this road, those two things may not happen. So I certainly won’t begrudge that. Rather I’m grateful.
I went in to Medicine with the best of intentions, to work tirelessly to do good for people, and hopefully all would turn out well. To put it another way: do no harm and maximize the good. However, doctors and nurses are subject to the same stressors as other professions. Even the most altruistic, idealistic, kind-hearted people can lose faith if they lose energy and hope, just the same as anyone else when things go wrong. And I believe a common thread is that it’s always a variety of factors that cause a person to go off the rails. It’s never one thing.
Such was the case for me. If I had one or two issues, I could justify sticking through the situation and fighting to make it work. But when the list grows, to me, it means that the preponderance of the evidence is suggesting that I need to take an alternate route. If there are multiple problems that need to be addressed, maybe the problems can’t be fixed. Maybe it’s just time to walk away and let someone else take a whack at it.
If I’m going to be honest, I’m a factor as well. You can take five different people, throw them into the same work environment, and you may very well wind up with five different opinions on what the job is like. Individual personality and hard-wiring plays a role. From that standpoint, I’m a tireless worker. Sometimes, I don’t know when to quit. For example, about three years ago I had entered a 30 km trail race. With 5 km to go, I stopped sweating. I had a terrific headache, and had trouble focusing on the trail. When I got to the finish line, I collapsed in a heap. I wasn’t too bad off, but if the race it been 31 km, it might be a different story. Incidentally, I was so salty encrusted, that when I got home, our parakeet at the time, Gonzo, licked me for about an hour because I was such a good Salt Lick. I could rub my own skin, and you could see salt flakes cascade to the floor.
I’m also a people pleaser. Sometimes, that’s a good thing. My instinct is to kill people with kindness. I’m not the type of person to demand to get things my way. I have seen grown adults argue, get upset, talking loud voices/shouting, and stamp their feet literally to make their point. That’s just not me. I will try to bend and be as flexible as I can to make things work. I don’t even mind having a discussion with people. But if I can’t get through to you with rational thought, on an even keel, with facts, and in a polite tone, it’s just not worth it to me. There’s a line in the movie The Usual Suspects where Kevin Spacey’s character describes the supposed criminal mastermind Dean Keaton as being able to “wrangle the wills of men.” That definitely isn’t me. I fall into the “lead by example” faction.
The other thing, and it isn’t easy to come clean with now, is that I have a problem with anxiety. And for most of my life, I’ve been able to avoid addressing it directly. I think in large part, I coped with it in my running. There’s probably a metaphor in there, which would and should be the basis for yet another blog. I guess in retrospect, I have been able to operate at just under the red line for quite some time. I have a relatively high threshold for discomfort. So I was able to push, and push, and push, until that wasn’t an option anymore.
Anybody expecting any salacious details about my job can skip the rest of the blog. And as I alluded to, I’m not really angry at anyone at this point. Frustrated? Absolutely. But anger doesn’t lead anywhere, and maybe if I had been a little more outspoken, a better self advocate, or addressed my own anxiety earlier, maybe I’m at a different endpoint. That’s not regret. It’s just me being honest. I’m quite happy with where I am now. So is my family.
While I could include other smaller reasons why I decided to walk away, it boils down to five big topics. And it’s not like they are entirely separate entities; each area truly could influence the other ones. But for the sake of this exercise, I will treat them like a distinct entity.
- Clinically, I just got busier. Whether this is selective recall or complete truth, I’m not sure, but right after I got back from meningitis, patient care seemed to explode. My days in the office became busier. I started seeing more patients on a daily basis, and the medical complexity seemed to go up disproportionately as well. My call group became smaller and smaller. The number of days that I had free in between times where I had to be available for 24+ hours dropped. Furthermore, I spent more and more time helping out with resuscitations for newborns and preemies at the hospital. In short, there was just more clinical work to be done, more complex things to be done, and less time off in between to recover. I will state here publicly that I worked with some of the most phenomenal nurses that I could ask for. Had it not been for them, I’ve been worse off even earlier. But I just couldn’t get past the fact that I felt like I was always failing at something from a clinical standpoint, but still barely able to keep my head above water.
- I started to have a drastic increase in administrative responsibility. Between running a pediatrics department, at different times both for my organization and the hospital, they were more things that took my attention away from direct patient care. There was not a mentoring process to help along the way. I just had to figure it out on my own. I had to have my fingers in recruiting, policy development, and conflict resolution. If I would’ve had more protected time to do these jobs (which happens in many organizations), it might have been doable. But I was doing this on top of the full clinical schedule. I was, in essence, trying to do two jobs – one clinical, one administrative.
- While I cannot go into detail fully on this topic, personal safety had become a real issue. It was a big enough issue to me that it definitely carried over into my family life. It would be a fair assessment to say that concerns about safety assuredly “got in my head.”
- My job entailed a fair amount of work that could be classified as “social work”. Not only did I have a large portion of medically complex patients, but I was trying to help children and families in complex social situations. I found in my job that many of the stereotypes about “the poor” are wrong. At the time of my writing this, I really miss the families that I served. By far, the vast majority are good people. But there are a number of things that I just couldn’t fix. Either I couldn’t get help to families that really wanted and deserved help, or I couldn’t get enough kids out of bad situations. I began to feel like my situation on a philosophical level was lose-lose.
- It was also clear that I lacked appropriate administrative support. I wonder if most upper level administrators see communication as a two-way street or as a one-way alley. I’ve worked for some great administrators, and I’ve worked for some that are “less than stellar”. From my experience, people that like to “tell you how it is,” really aren’t interested in ever hearing anything back. I had plenty of administrators tell me that I needed to do X, Y, and Z for them instantly. But if I ever needed anything back, different story. I felt like I was everybody’s “guy”, but that I didn’t have anyone that I could rely upon if I needed help or support administratively or clinically. The best administrators and the best leaders understand that communication is a dual relationship. In all honesty, I don’t know how many people comprehend that.
It’s not like I got back from meningitis and I was underwater on day one. It built slowly like a pressure cooker. I was told frequently that I “just needed a vacation”. But I would come back from vacation, and the good mojo would start wearing off faster and faster each time. I frequently did not want to take vacation, because I would be even more buried after I returned. I honestly tried to look at the situation and first change what I could. When I realized there wasn’t much that I could change, I tried my best to change my reaction to things. But that could only get me so far.
It’s funny, because I’ve been told by several nurses that “you don’t act like a doctor”, “you’re too polite”, or “you say ‘thank you’ an awful lot.” I always tried to treat nurses and other non-medical staff at the office and in the hospital like coworkers. Not like I was a superior. I always tried to be unfailingly polite. What I always appreciated from coworkers, other staff, or administrators was a simple and heartfelt “thank you”. This rarely, if ever, came from administrators. As stated earlier, I really enjoyed working with the nurses at the hospital. They are an intelligent, compassionate, and loyal bunch. When they would do neonatal resuscitation teaching, the nurses that taught the class would frequently asked me to stay and give some extra pointers to the new nursing staff. This was not part of my job, nor was I compensated for it. But I figured that anything that I could do that helped with quality or communication couldn’t be a bad thing. I was only too happy to help out. And a big reason was that they would say thank you at the end of the class. I’m a cheap date.
Two things kept me from coming apart at the seams earlier: My family and running. It’s just that simple. Had it not been for Sonia, Andrew, and Allison being so adaptable and supportive, I never would’ve made a decade. It became clear the last two or three years that I was missing too much of their lives, and soon it would be unforgivable. I missed parent-teacher conferences, music concerts, soccer games (and Andrew’s City championship this year), let alone dinner. Furthermore, given my schedule, I could only run so much. At some point due to fatigue it just became counterproductive. Running became less for enjoyment and fitness, and more of a mental health need. I run best when I have a relative peace of mind. During my workouts, especially my long weekend runs, the first 30 to 40 minutes were what I would term “blackout rage.” It wasn’t a good mental state of mind to be in for an activity that I really enjoy.
So, how does stress manifest itself? At first, it was just the migraines. And they were somewhat infrequent. But over the course of the last five or six years, I went from having migraines perhaps once a month, to once a week. And it’s not like I could take off work and sleep off a migraine. I just had to work through it. But then my blood pressure started going up. Then came the stomach pain. By the end of 2014, I couldn’t get through any meal without my stomach hurting. That bought me an upper endoscopy. Thankfully, it was normal. The GI doctor said “it’s just stress.”
Then came the recurrent illnesses. Even if I wasn’t really sick, nagging illnesses just wouldn’t go away. I would cough for months. There was a period of time when Sonia didn’t even remember what the house sounded like without me coughing. She also couldn’t remember a year where I didn’t wind up on steroids due to the coughing. In fact, when our parakeet escaped the house, he responded the following morning to hearing me cough.
But by far the worst was the anxiety. Mental health in the medical and nursing professions is still an under-addressed topic, and I should probably dedicate a whole blog to this in the future as well. To expect otherwise is preposterous. Currently, we put people in charge of taking care of the physical and mental health needs of the population, work them hard (contrary to advice we give about stress mitigation in our jobs), yet expect them to be bullet-proof. It’s like Tony LaRussa talking about his baseball teams when they hit a rough patch: “Men, not machines.” Inside the medical profession, from my experience, you’d damn well better be bullet-proof, or close to it.
It would be fair to label me as a bit of a worrier. Letting go of things it’s not my strong suit. I’ve got a strong analytical mind, but sometimes I can spin a situation forward to much. Even when things are going well, I’m not a good sleeper. Most of my dreams fall into the nightmare category. For example, during one very busy and stressful stretch during 2015, Sonia woke up in the middle the night and found me wandering about the house in my sleep. I was crouched down by a window in our bedroom. She asked me what I was doing. I said, “Snipers! Get away from the window.” She had a “fun” time talking me down from that situation. I thoroughly enjoy one of Mike Birbiglia’s comedic pieces entitled “Sleepwalk with Me”. Although, I must admit, that hits a little too close to home.
I would go through stretches where it would be difficult to get more than three or four hours of sleep a night. I just accepted this as normal. I could lay in bed for hours, with patient care scenarios racing through my head. But due to work constraints, I didn’t really have an opportunity to address this head-on. Of course, to address it, one has to acknowledge it’s actually a problem.
In early June 2015, I got back to work after taking a vacation with my family. We had just completed what we called “the great southwestern road trip.” It was the trip of a lifetime. All four of us got along, and we got to see the beautiful part of the country that three of us have never seen before. Dare I say life-changing.
I sat at my desk on the following Monday. I had just finished nursery rounds much earlier than usual because I anticipated a pile of work on my desk. It was there, and then some. My partner would be out on vacation, and another colleague was now going to be out for months due to injury. As I sat at my desk, I wondered to myself, “How the hell am I going to get through this?” At that moment, the room started to get warm. I started sweating from my brow, and then I started sweating profusely. My chest felt like I had a two ton boulder sitting on it. I started feeling dizzy, and the room started spinning…
Fortunately for me, I was sitting down, and I recognized what was going on. This was my second panic attack. My first one hit in January 2008 when I was driving home from work. The first one was much more distressing in one sense, because I thought, “Wow! I’ve never had a heart attack and wrecked my car at the same time before!” Not that I want people to have a panic attack, but on some level it would be good for everyone to experience one. You’ll know symptoms for a heart attack for the future (they are very similar), and you’ll understand just how distressing they actually are. It had been a long time between events, but at least I remembered how I felt. So this time around, I sat my chair for about 15 minutes until I could get my body back under control. But I felt drained for the rest of the day.
After that, I started having panic attacks on a more regular basis. None were as severe as this episode. But Sonia was none too pleased to hear about any of this. Sometimes it would hit once or twice a day for days on end. Other times, much like migraines, I would go weeks without having one. Regardless, they always came back. This was past being a problem. This was the final straw. I made up my mind, and decided it was time to make a change. I had to take a break. What Sonia had asked me to do in 2010, I had come around to seeing her way. I put in my resignation.
This didn’t offer me a lot of immediate comfort. I won’t say how much advance notice I gave my office, but suffice it to say I gave them plenty of time to prepare for me leaving. But in healthcare, you can’t just mail it in. People still deserve the best outcomes. There was no taking it easier. In fact, if possible, I worked harder my final stretch to make sure things turned out well for my patients and so I could stay above reproach.
In the late winter or early spring of 2016, after a particularly stressful week, I kind of fell off the apple cart. I’ve asked my sister since then if there’s an official DSM categorization for what I went through. Descriptions to the lay-person would be “nervous breakdown.” “Subacute, prolonged panic attack” would also fit. Preceding this weekend, I was so nervous about going into work that I would vomit while driving there in the morning. This went on for weeks. I went in to see my doctor. Amongst other pieces of advice, my doctor recommended that I start an SSRI for anxiety. Seeing as how I wasn’t in the position to argue at this point, I agreed. However, the one I started on made me feel even more anxious in a matter of days. By the time the weekend hit, I couldn’t sleep at night. I would get up and feel exhausted, yet wired and jittery all at the same time. I would lie down, and try to watch college basketball, but my mind was racing more than a miIe a minute. I wouId pace our house. I was sweaty. I slept maybe three or four hours in a 60 hour window. Some of the nurses at the hospital noticed I didn’t look good, so I told them that I had a bad reaction to some migraine medication.
I called my doctor early the next week. I stopped the first SSRI and started taking a different one. Fortunately, this worked. Over the course of several weeks, I slowly got better. I was able to fall asleep in a reasonable amount of time at night. I was able to sleep most of the night without terrible, recurring dreams. I was able to eat breakfast again without throwing up on my way to work. You know, I was able to be semi-normal.
I’ve never discussed any of this outside my family until now. Who the hell was I supposed to go to? If I missed office time, children went without care, let alone addressing who would fill in during any prolonged absence. My schedule didn’t allow for any time to see a therapist. It’s not like there was someone I could go and speak to with complete honesty without multiple people at work knowing my private business. During my residency, I would have felt comfortable going to any number of people (chief residents, program director, advisor, or just respected attending) if I was having this kind of trouble. There ought to be options for healthcare professionals, but even looking back, I don’t see where I had much of a choice. The healthcare system just expects that as a physician (or nurse) that you won’t bend, nor break. The assumption is that our “healers” don’t ever need healing. I just had to put my head down and make it to the end, and even looking back, I fail to see other viable options.
I can’t remember a time in the past several years where I actually felt “normal” for a prolonged period of time. Even after I started to get on top of the anxiety issue, I wound up with pneumonia in the spring (and it lasted quite a while). I coughed so hard that I pulled rib cage muscles. In order to function, because I was having pain with every single breath that I took, Sonia would put “icy hot” patches on my rib cage so I could get through the day. She would even come up to work and change them out for me if needed. I had one stretch where I was up for a day and a half working, and between sweat, hot patches, and not enough deodorant, I probably smelled terrible. One of the nurses (Diedra), God bless her, took a sniff near my armpit. She looked at me and told me without a hint of irony and a smile, “don’t worry, Doc. You don’t smell that bad at all.” By any measure, that’s one hell of a friend.
I never took any measure of relief in telling people that I was leaving. As it got closer to my final day, I got a lot of hugs from nurses, coworkers, and even families that I have worked with. I still feel badly for them, because after a decade, changing relationships isn’t an easy thing to do. It’s not like I was happy to leave. This was never my goal. It wasn’t a want; it wasn’t a play for more money or power. It was a NEED. I firmly believe that if I hadn’t left when I did, something else much more alarming would have eventually gone wrong with my health. Maybe not in 2017, but soon. And the consequences would probably be more long-term.
My last night on call, I got called in for a resuscitation. The nurse (Jenny) that called me in was so apologetic, as though it were her fault that there was work to be done. It was rather comical, to have someone apologize for needing me to do my job. I thoroughly enjoyed working with that crew. The nursing staff, the following day, threw a wonderful going away party for me that I will never forget. They were overly generous; I certainly was not deserving of that kind of fuss before I left.
My last day in the office was even funnier. Either a case of food poisoning or a G.I. virus had started ripping through the office. The last day or two that I was there, there were numerous people having to call off of work. My last day was a half-day, and people felt so terrible physically from the illness that I got to leave without that much of a fuss. Most of the office staff told me to leave, “before you get this.” I literally was able to slip out the back door almost unnoticed.
That brings us up to current time. Sometimes, I’ll try to play the “what if” game. Could I have changed something sooner? Could I have done something differently? Sonia will remind me that I can’t go down that road, and that it’s pointless anyway. As I said before, too much good came from that decade of work to have any regret now. I think I had to take each and every lump in order to learn my lesson. As I started the Christmas holiday 2016, I was literally free. People have asked what I felt like before I left. Sometimes, it seemed like I was jumping out of an airplane without a parachute. One kind person told me, “it’s called a leap of faith, and it’s OK.” Other times, I stole a line from David Letterman. He was asked before he retired what he felt like. I can’t remember his response verbatim, but he did say something to the effect that he felt “naked and afraid.” He also stated that he felt this way every single time after making a hard decision that turned out to be the right one. I have that same feeling as well.
My family is happier. I hope that this process has taught my children a few things. Like any parent, I want my children to learn the value of hard work. As Sonia has pointed out, it is also important that they have a willingness to change as well, even if they are afraid. Most importantly, I learned that second lesson before I lost them. For this, I am eternally thankful. Enough of looking at the past. No more paralysis by analysis. It’s time to think and present and future tense. Goals, hopes, and dreams. I could walk into another job almost at the snap of my fingers. But that’s not what needs to happen. I’ll be more than happy to explain what I want to happen in the next 12 to 18 months. It’s refreshing to look forward with a clean slate, on what I would like the immediate future (2017) to look like.
The fact that I’ve started writing, this blog in particular, is out of honor and respect to the Yoakum and Fricks families. “Smell the flowers, while you can.” –David Wojnarowicz