On my final day of work before beginning my self-imposed burnout sabbatical, a colleague asked, “Why don’t you just get on medication?” I remember thinking, “What am I medicating? I feel nothing.” I was in the vice grip of burnout, overwhelmed, and physically and emotionally exhausted. But mostly, I was numb. But in reality, I have always self-medicated – with work. As a professional ballet dancer turned doctor, my life has been defined by immersion in learning and achieving, being the best, perfection. I left home at thirteen for Russia to pursue a life and career in dance. This move was exhilarating, lonely, and the studio became my safe space. I could just move, turn off my brain, and not feel anything. When I later endured the rigors of medical training, my 80+ hour work weeks could similarly block out any thoughts or emotions of my life outside of work – an unhappy marriage, stresses of raising small children, and personal conflict. A physician friend jokingly asked me recently, “At what stage in your training did you learn to give up feeling anything?” I remember very clearly. It was my second year of residency in the ICU. I lost two patients who were my age as well as a member of my ICU team. Instead of processing these losses, our team kept rounding. I carried my grief for years. I internalized the belief that when a patient died, it was my own personal failure. If I were smarter, worked harder, read more, learned more, or researched more, I could somehow cheat death. I worked obsessively to mute grief, fear, inadequacy, and rage. This made me a highly-skilled resident and an emotionally muted human being. With a new baby and tenuous marriage, I began therapy within a month of completing residency. Appropriately, the therapist would ask how I was feeling, and I would guess, “Um, anxious? Is that right?” I literally could not name what I was experiencing. I was numb after decades of avoiding the reality of my life. I was emotionally comatose. By disallowing the pain, I had cut myself off from all emotions – even the ones that make us feel alive. I can point to specific examples of how my emotional muting developed and sustained me through many grueling years. When imposter syndrome crept into my medical training, I worked harder and longer. When I ran my first code on a very young patient, to avoid the terror, I learned everything I could about septic shock. When the nanny of our small children was murdered, I avoided my grief by jumping into the pragmatics of arranging new childcare and logging on to EMR until well after midnight. The inherent problem is this: There is no RVU compensation for bereavement, for seeking help in dealing with the emotional toll of practicing medicine, for modeling self-care for colleagues and trainees. In a culture where productivity is rewarded, and self-sacrifice is praised, we as individuals, groups, and organizations must recognize and give margin for the emotional work required not only provide excellent care for our patients, but for ourselves. In medicine, I can work 24 hours a day, seven days a week, and still have more to do. This false comfort and escape can be likened to an alcoholic with access to a 24-hour liquor store. Always there, welcoming me. Always masking the pain or fear. And, for me, giving me a feeling of redemption and value because what I do, what we do, is worthy, important, noble work. What I did not realize until I was nearly 40, is that I cannot selectively mute my feelings. My joy, humor, love, kindness, and compassion were also reduced, numbed. My emotional bandwidth was so narrow that I could no longer experience any intense feelings. There were no highs or lows. In fact, love and joy felt just as scary and unmanageable as fear and grief. My friends and family were the collateral damage of this coping mechanism. Not surprisingly, nearing mid-career, I found myself burned out and in need of a reset. I needed time to find out who I was – as a physician, a wife, a mother, a human being. I was finally ready to feel again. By giving myself permission to step away from my work, I was also admitting I would no longer be defined by that work. There was more that I wanted, needed. It didn’t happen overnight. It was a solid two years before I felt the sun. It was terrifying, grueling work in therapy, requiring me to be vulnerable and exposed. I asked for and received help both from within my medical community and from friends who had watched me hit bottom and wanted to help lift me back up. In the end, I surprised myself by choosing to return to my patients and clinical practice. The life I live now, I could never have imagined ten, even five years ago. It’s like watching a technicolor movie for the first time. Everything is more vibrant, more vivid. I know I can experience self-compassion, forgiveness, mercy, love, and grace in a way that I never have. I know that I can withstand anger, fear, loss, and disappointment, not by suppressing and avoiding these emotions, but by embracing them. I can love myself and others in a way that was previously impossible. I am a better wife, mother, friend, and doctor because of this. Kara Pepper is an internal medicine physician and can be reached at her self-titled site, Physician Life Coach: Kara Pepper, MD. Source
