Out of Isolation

{Calistoga, California}

I noticed that my latest posts convey far less emotion than usual.  My reserve for tolerating stress had reached maximum capacity, which I realized upon my first day back at work from vacation three weeks ago as exhaustion immediately erased any sense of relaxation from my trip.  Perhaps I should have requested two weeks off instead of one?  Either way, I’ve felt numb in the past (as I wrote in previous posts), but my current state of numbness also included fatigue and the need for multiple naps throughout the day.  At first, I blamed my tiredness on multiple potential causes (overexerting myself during workouts, not eating enough, lack of sleep).  I returned to clinic with a massive inbox full of emails, prescription refill requests, and patient messages, but the one message that impacted me the most was a note documenting that one of my patients (whom I least expected to have a suicide attempt) was in the psychiatric hospital due to an attempted suicide by overdose. Normally, I’d breathe a sigh of relief knowing that my patient was alive, safe, and receiving care in a secure environment, however, something triggered me at that moment to feel even more anxious than usual, which led to a massive headache.  Did I develop a headache because my mind can’t tolerate the thought of experiencing even more patient loss and grief?

Fatigue continued to hit me on a daily basis.  And how ironic that I recently wrote a blog post on tiredness and neither of the reasons I listed seemed to fit my case.  However, I neglected two important, plausible causes (one that I even listed in my post) — Burnout & Depression.  One of my closest friends asked if I might be depressed and I quickly replied, “no, I just need to eat better.”

I thought to myself, “How can I be depressed?  I make a good living, I chose to enter this field, people respect me and tell me I’m a great doctor, I have amazing family and friends…”

Yet, after fighting the idea that I may in fact be burned out and depressed, I became more accepting and relieved at finally pinpointing the cause — yes, I was burned out and depressed.  I was experiencing loss of interest, fatigue, poor concentration, lack of motivation, and increased naps during the day.  How dumb of me not recognize the signs, especially since I’m a psychiatrist???  (Depression obviously impacts cognitive abilities as well)

Later that day, I randomly thought of one of my patients whom I haven’t seen in clinic for quite some time.  He missed his last two appointments with me and never returned follow-up calls.  I quickly searched for his name and confirmed my biggest fear once I saw the word “obituary” next to his name.  Tears filled my eyes, which led to uncontrollable sobbing.  I seriously wanted to quit my job that very moment.

My attempt at self-care and setting healthy boundaries:

Whereas in the past, I would’ve dealt with the news by isolating, throwing myself into work as a form of distraction, or having several glasses of wine once I came home, I knew that I’d eventually hit rock bottom unless I sought help from others.  I reached out to my close friends, sought support from my clinic manager, opened up about my issues in my therapy group, and talked to other staff members who knew my deceased patient.  I allowed myself to cry rather than holding in the tears.

Feelings of detachment had also replaced my propensity to engage with others, which made practicing psychiatry and being fully present for my patients much harder.  I scheduled a trip to visit my family in northern California for Father’s Day because I knew that visiting home would alleviate my detachment and make me feel like myself again.  Also, in further effort to prioritize self-care, I requested a two-week long vacation in the following month because I knew that more time off was necessary to fully recover my emotions, energy, and drive.

Why am I sharing my experience?  We may read research, statistics, and articles about physician burnout, yet the majority of people in the medical field still do not feel open nor comfortable enough to share due to fear of stigma, criticism, and feelings of guilt and shame.  A part of me even feels somewhat embarrassed posting this, but if someone out there can identify with my experience, then why not share?  Physician burnout is more common among physicians than other workers in the United States and has been linked with the following: negative impact on patient care, more likely medical errors, depression, and increased risk of suicide among physicians and medical students.

Staying silent about our struggles and trying to cope on our own does not solve the problem, especially since the rate of physician burnout is on the rise.  If we can’t advocate and stand up for ourselves, then who will?