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About More Voices

Every month More Voices invites readers to contribute short nonfiction prose pieces of 40 to 400 words on a healthcare theme.

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Stress and Burnout

Destinies

 
I know how to care for my seriously mentally ill patients, while shielding myself from the pain of this work--how to let the ache go and not bring it home. But I've been away for a while, my guard has dropped, and there is no Star-Trek–like force field to keep my heart safe today.
 
My job as a psychiatrist in a large county jail provides some protections; cell doors and corrections officers guard my body. And unlike the young man I'm meeting with today, I started life in relative safety. I was not born with a congenital brain malformation giving me a speech impediment, an awkward gait, and a lowered IQ. I was not born with a predilection for schizophrenia, not adopted into a family overwhelmed by too many adoptees to be able to provide for a child with special needs.   

Secrets and Suicides

I must disguise the truth.

Because of HIPAA.

I must hold these heavy truths within my small-framed body. Because of HIPAA, I can't tell you the real reasons I'm so upset--the death tolls, the suicides, the real-life people who are my patients and the real tragedies that they suffer. I have to change the identifying facts about this person or these people to the point that they are unrecognizable. They are my secret, my deep, dark secret that can fester inside of me and cause me to feel terrible. Incapable of saving. Inadequate at what I do, because what I am expected to do is everything.

25 Minutes


Pager rings. Just 5 minutes to get to the ED. Calling down as I rush to the trauma elevators, they tell me over the phone "Shots fired at a hotel in downtown Los Angeles." I know that place...

At least 3 people arriving. The ED is bustling, preparing for their arrival. Blade and Prolene stitch in my scrub pocket, I am ready. We are ready.

For a moment the ED almost seems silent.

Timeline

 
It's 8:00 pm. You check your work inbox and prepare for the following day: reply to emails, fill prescriptions, prep your notes.

You wake at 5:00 am. You exercise, eat, rush your daughter to school. You arrive to work at 7:30 and review the schedule with your team. You see a man with shortness of breath and a new arrhythmia, a walk-in patient with a severe headache, a teenager there for a sports physical who admits she’s binging and purging. You're already running behind.

Sertraline for Diabetes

 
She was here for her diabetes.  Her blood pressure was high, she said, because she expected me to scold her.  She hadn’t brought her log, but her sugars were in the 200s overall.  Not good.  She hadn’t been exercising, but she had been taking all her medications.

Again we talked about options: cut out carbohydrates, increase exercise, add medicines.  She admitted a predilection for bread, and I talked about mood eating: how stress can drive us to eat.  She smiled back at me, shaking her head.  I mentioned our counselors and the option of coming just to talk.  She shook her head again, but her smile broke and her eyes closed.

Her one son, whom she brought here as a six-year old, had been deported back to a country he doesn’t know, where he has no one, where life is dangerous.

Inner Turmoil

 
As a third-year medical student, I know I have a beautiful purpose in life. I care deeply about my patients. But the one person I am having difficulty treating is myself.

Expectations

 
Before the start of every school year, from the time I was nine up through middle school, I would make the same school-year resolution: to become shy.

I have always been too enthusiastic. Out of all my classmates, I sang the loudest at birthdays, I laughed the longest at jokes and I asked more questions than anyone else. In fifth grade, a firefighter visited my class; after I'd asked my third question about how fire suits actually work, I remember hearing some classmates groan and seeing my friend Thom lift his arms up and, in mock agony, flop down on his desk. I tried to be shy, really. I would go for a few days sitting on my hands during lessons, but, inevitably exhausted by my inauthenticity, I would soon find my excitement uncontainable once more.

Choices

 
My current life as a locum tenens--a doctor who travels around to fill in for vacationing or ill physicians--is lonely. I spend endless days in hotel rooms, away from my family. But I chose this existence as an antidote to the professional exhaustion that threatened to end my surgical career. Regular panic attacks, maladaptive coping behaviors and compassion fatigue had turned me into a person I did not like or recognize.

Reverse Burnout

 
I have a long commute to the hospital where I work. I've been doing this for a long time and have thought about retirement. So when I'm stuck on the turnpike in morning rush-hour traffic, when it takes me 60 to 90 minutes to get in to work, I often say to myslf, "Why am I doing this? Why not just quit, retire and enjoy life at home? I don't need this aggravation."
 

My Puzzled Self


“It is no measure of health to be well-adjusted to a profoundly sick society.” -Jiddu Krishnamurti

How many times have I tried to begin writing about my experience of stress and burnout?

I’ve lost count.

Each time I begin to write, detachment renders me into pieces like a jigsaw puzzle. Where are the straight edges? Where is the frame? What is supposed to be where all of these empty spaces are? Where is the box lid with a picture to guide me?

A few years ago the medical library where I had worked for six years relocated from a building outside the hospital to a space inside the busiest area of a busy hospital. Prior to the relocation, I rarely entered the hospital or did so only when my energy felt sufficient to handle whatever I might see, hear or smell. It helped that I worked an evening schedule. After 5:00 p.m. the hospital was almost unpopulated.

Confessions of a Recovering Insurance Addict

 
When I hear other physicians talk about burnout, I often feel a little guilty. Sometimes I sit in meetings of physician associations where they are discussing ways to help physicians deal with the stress of the job and the increasingly complicated demands for documentation and billing. I think to myself, "Don't physicians always talk about prevention being better than treatment?" Yet most of what I hear about are measures to deal with the aftermath of burnout.

Seventeen years ago, I was in an environment seeing thirty patients per day, spending more time on documentation than patient care, and longing to focus on just spending time with my patients. I hated the rushed appointments, the endless coding and the administrative burdens. I interviewed practice managers, read a lot of practice managment magazines, and interviewed a lot of physicians. One thing was clear: 99% of the frustrations came from filing insurance.

Weary and Wishful

 
I was living just two blocks away from my parents, but I spent more time at their condo than I did at my apartment. I shopped for them and cooked, cleaned, and did laundry for them. I took them to appointments. I tried to help them lead lives of quality. Every night I went home feeling tired--after all, I was in my sixties--but also feeling glad that I could support them after all the years they had supported me.

Encounters

mainencounterspicWe are proud to announce Encounters, our latest feature. Patients talk about their healthcare experiences, share stories about their lives outside the doctor's office and reflect on how these two worlds affect one other.