Medicine / Psychiatry

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) — BurnoutDepression.  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?

26 thoughts on “Out of Isolation

  1. I have burn out for seven years now, since my last mania. Since I came up with this diagnosis myself, I am better aware of what is going on in me.

    I don’t mean to worry you though, though I think, given observing myself, burn-out is not something to approach litely.

    Keep strong! 🙂

  2. You rock. I just came home for lunch and was thinking about a young woman we reached out to a year ago. I was thinking about how when she was doing great (emotionally) she would engage other people, and create the “illusion” she never faltered, second guessed herself, etc.) and then when she did encounter some choppy waters (emotionally) she would drop off the map/ withdraw/ sometimes for several weeks and months….It bothered me because I knew it wasn’t real…so sitting here reading your candid/ vulnerable post, encouraged me, it even gives you more credibility in my eyes.. Thank you for writing and posting even when you don’t have it all quite figured out.. 🙂 DM

    • Hi DM – that young woman sounds exactly like me (particularly just a few years ago, I’d drop off for a long time, but now i’ve improved to take shorter hiatus)! It’s people that I’ve connected with, esp through blogging, like yourself, who inspire me and make me feel supported enough that I can share. I really appreciate you DM!

      • The best mental health counselors I have had the privilege of interacting with have been the ones who knew first hand some of the same struggles we were coming to them for. Grace and peace. DM

  3. Reading this post, I am quite concerned for you. Forgive me for being blunt. It seems to me that your depression has been evident for a while now. Your delay in recognizing this is cause for concern. Your empathy for your patients is admirable, but do you not think that your behavior as described here is obsessive? I hope you would include in your two weeks off some time for considering your depression and your work. Do you know oncologists? How do they deal with the high mortality of their patients?
    If you feel that I’m full of shit, feel free to delete. My concern is genuine, though.

    • Hi Tom – I’m always appreciative of your genuine concern, yet trust that I’m truly doing okay, and blogging (as you’ve pointed out before) has been therapeutic for me and posting this is a sign that i’m feeling better 🙂 Dyane (who pointed out in her comment below) mentioned the word “vulnerable” instead of “obsessive” and I agree with her observation — my empathy is a part of who i am and as a physician we are taught to save lives, not how to cope when you lose them. I know a few oncologists, though i believe there is more guilt and shame associated with loss related to suicide, esp due to the stigma surrounding mental illness. Even clinicians in the mental health field feel uncomfortable talking about…i brought up the topic at a recent meeting and the subject was changed. the depression has subsided –now to deal with the burnout…get ready for more beach/scenic cali pictures 😉

  4. Oh, Dr. V, my heart went out to you as I read your post. You are truly amazing to share this update with your readers and I’m so glad you did. That took major guts. Many people wouldn’t do it because of….wait for it…. 😉 you already stated it…it’s the STIGMA that’s slammed at mental health professionals who actually admit they’re human and have the same struggles many other people suffer with.

    The fact that you’ve recognized your depression and burnout is what matters. There’s no point in berating yourself over the time it took you to realize this despite your profession; I’ve read about this situation happening to many other psychiatrists. As you know, what matters is how you move forward and that you take as good care of yourself as you do for so many others. It sounds like you’re doing just that.

    I read Tom’s comment and I believe he’s sincere and not full of dog doo. However, I disagree with him about one point. I don’t feel you’ve been “obsessive” in the behavior you depicted…it sounded completely reasonable to me. Another word such as “vulnerable” would be more fitting.

    I’m very glad & relieved to hear you requested 2 weeks off to practice self-care. I’ll be thinking of you and sending you positive juju from Santa Cruz! 🙂 Please let us know how you’re doing when you feel like it, but absolutely no pressure as far as that goes either. :))) XO

    Dyane

    • Hi Dyane — thanks so much for your compassion and understanding! I hate the word “stigma,” yet it’s always so applicable when it comes to mental health. I felt a lot better once I posted this…I only hope others will realize how therapeutic self-disclosure can be (clinicians and consumers).
      Thanks for the positive juju! By the way…i went in search of the comment you wrote for my “exercise impact on mental health” post and couldn’t find it! sad face 😦 I wish i could read it, i’m sure it was very thoughtful as always.
      Will keep you posted on my adventures!

  5. Just want to offer you virtual hugs!

    I feel there’s unspoken pressure on mental health professionals to not have clinical struggles of their own, which probably compounds the “I can’t be depressed!” feelings.

    But caring takes its toll, definitely. One can get overwhelmed, overworked, sick, vicarious trauma etc.

    • Virtual hug back! 🙂
      I definitely relate more to my patients by acknowledging my own struggles, but it’s always interesting to see how shocked they are when i tell them i have bad days. it’s hard for caregivers to put themselves first, yet so necessary to do and set healthy boundaries in order to best care for others 🙂

      • As a patient myself, sometimes it’s hard to remember that our doctors are human. Some of us think “she / he looks so put together, is always so calm and non flustered, probably has a great life with close friends and family…what struggles do they have?” and forget that exhaustion, burnout and depression can plague any of us without needing much reason!

  6. I don’t know much about depression, though I believe grief is very close. It sounds that Dr.’s are exposed to the sharp edge of grief every day or almost every day, without getting a relief or at least de-compression from the exposure. I would venture to offer these two tidbits, first always take 2 weeks of vacation, the first week is to decompress from the work, and the second is to relax and “recharge” (and that includes not having media of any sort), second get out and press the flesh, get to know new people all the time, just talking to people who you don’t know is just good for the soul, it maybe in the store, or in line for a event, it maybe at a restaurant. If I can’t meet new people I read “Humans of New York” or a good book and it has helped me, maybe it will help you.

    • Hi Bob — thanks always for your tidbits! i think med school and residency conditioned me to be grateful for even ONE day off, so it has been quite an adjustment to accept that one week isn’t even enough these days! as for tidbit #2 — a definite must, esp since i’m an extrovert, so meeting and being around people always energizes me

  7. I’m a life coach and I work with doctors too, wish more of them could express like you. Many times people distract or bury themselves in work (and family) and ignore some warning signs that they always preach about to their patients but ignore their own. No one can be all sunshine 24/7 (even my laptop starts getting cranky after a while) so kudos on being expressive with your thoughts.

    • Hi Mich — thanks so much for your comment! And how wonderful that you help docs become more self-aware! Self-awareness is seriously key (it has taken me A LOT of work on myself to get to this point and still a long way to go)…and practicing what we preach is sooo important! I agree with you about the “no one can be sunshine 24/7” comment — i sometimes tell my patients that i think it’s pathological to be super cheery and happy ALL the time 😉

  8. Hi “Doctor F&F”. Thank you for your visit. (My apologies for being such an ireegular blogger) 😉
    Thank you for sharing your experiences. We all know that letting it out is Therapy 101.
    I also know how doctors can easily be affected by what happens to their patients. Good doctors that is. 😦 Bad doctors don’t give a damn. Now, in your particular case, ask yourself: Aren’t you too hard on yourself? Too eager to pressure yourself to other summits? 🙂
    I think I told you once: take a walk on the beach. A wonderful therapy. And give yourself breaks. 🙂
    Be good
    Brian

    • no apologies needed 🙂 and yes it has been therapeutic to write about it! my struggle has also been maintaining compassion, empathy and my standard of care in this field where doctors are overworked to the point of becoming numb and lose empathy. Walking on the beach has become a regular occurrence for me 🙂

      • I’m glad. (I wish I had a beach to walk on. Need to work on that) And yes, you are right, the workload (or lack of sensitivity) may push some doctors into indifference. So, walks on the beach, tick. Add a cold beer with friends from time to time, and you will be fine. 🙂 Hope the rest of the week will be smooth. Au revoir

  9. Pingback: Say ‘No’ To Burnout: A Renewed Physician’s Goal for 2016 | Freud & Fashion

  10. Wow! I just found your blog and I think I’m addicted! I think it’s so great that you are writing about topics that generally have “stigma”, even in the medical field!
    I’m a second year medical student and have GAD + Situational Anxiety + Panic Disorder and let’s just say it did not add up to good last year! I actually had to remediate 2 classes over the course of an extra year, however I did realize that it gave me a bit extra time to find myself and happiness and to simply push further.
    Anyways, looking forward to future posts!

    Cherish

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