Burned Out

Burned Out
It’s been five months since I left my position as a psychiatrist and medical director, and like everyone, I’m wrestling with questions about how COVID-19 has changed our lives, maybe forever. As I read the news and hear from my former colleagues, who’ve had to quickly ramp up to deliver telepsychiatry, I feel a mixture of emotions: fear and concern for my former patients; guilt that I’ve left my colleagues behind to fight on without me; and uncertainty over how I can best help out in this crisis.

If helping were as simple as picking up my old job again, that would be an easy call. Unfortunately, it’s not that simple. Whenever I try to imagine going back, I’m flooded with memories of the severe burnout that forced me to retire.
In thirty years as a practicing psychiatrist, I often treated patients (including healthcare providers) who were suffering from burnout–that dreaded combination of mental, emotional and physical exhaustion, brought about by prolonged or overwhelming stress. But I never thought that I would fall prey to it myself.
Then, on January 31, 2018, out of the blue, I suffered an attack of terrible kidney pain that sent me to the ER. It turned out that malformed blood vessels in the pelvis–a congenital abnormality–were blocking my urinary tract and causing a dangerous swelling of my left kidney.
After a few days in the hospital and several failed attempts at placing a urinary stent, my doctors sent me home with a thin tube running from my kidney and out of my flank to a plastic bag, to drain my urine. It took several months of chronic pain, more procedures and another hospitalization before my doctors finally succeeded at relieving the blockage and restored my kidneys to normal functioning.
Looking back on it now, I can see the role that stress in my work life had played in bringing on my illness.
For almost eight years, I had been medical director of a psychiatric division I’d created within a large group practice–325 physicians serving more than 300,000 patients. It felt especially meaningful to make mental-health treatment an integral part of our patients’ care because, as a teenager, I had seen my own mother’s struggles to get psychotherapeutic support during her battle with breast cancer.
Directing the division brought many responsibilities, and as much as I loved my position, I found it increasingly difficult to keep up with the overwhelming demands. As the only psychiatrist for adult patients, I had a growing panel of patients whom I could only see for brief medication visits, which made it impossible to practice in a holistic way consistent with my training.
Again and again, I asked the administration to hire more psychiatrists. But because mental-health services aren’t well reimbursed, my pleas fell on deaf ears. It felt as if I would never be able to provide the care that was needed and also generate a profit.
I was in a bind. Then–seemingly out of nowhere–came my sudden, debilitating illness.
Looking back, I realize that my body had been sending me warning signals for years. I remember feeling numb a lot of the time. Despite practicing tai chi and meditation to reduce my stress, I’d grown more moody, anxious and depressed–a fact that my family had been commenting on for at least a year. My wife and friends had complained that I didn’t want to talk much and had seemed more withdrawn.
As soon as I could after the onset of my illness I returned to work and soldiered on for a while, but finally had to admit that I wasn’t up to the task. I reduced my hours while my organization and I searched for a replacement. It was eighteen months–an eternity–before I could pass the baton to a new medical director.
For me, those months were full of unexpected afflictions: fatigue, lack of stamina, post-traumatic stress symptoms and, most disturbingly, impairments in my concentration and memory that made it hard to recall the details of my hundreds of patients.
Experiencing what it was like to be “on the other side,” as a patient, I found even deeper compassion for patients who, like me, were struggling with chronic pain or severe medical conditions. I felt so grateful for the loving support of my colleagues and family; without them, the journey would have been even more harrowing.
In part, I know, my burnout stemmed from my fight to make a difference for my patients in a system where treating mental illness is undervalued–even stigmatized and discriminated against. I’ve always believed that part of my role was to advocate for my patients’ access to adequate and equitable mental-health services. Sadly, though, I’ve become disillusioned with the present practice of psychiatry and don’t have the energy left to fight these battles anymore.
It’s now been five months since I retired, and the COVID-19 pandemic has overtaken us all. I feel torn over how best to help out during this crisis. I keep flashing back to my illness and to how profoundly uncertain I felt, not knowing when it would end. Is it wrong, now, to devote myself to caring for my family, who sacrificed for me all those years, and to give them my support as they work from home amid the pandemic? Should I feel guilty about having more time to focus on my health, which includes playing music and appreciating the beauty of nature?
I do worry about how our country will address the threat of burnout faced by the doctors and nurses now on the front lines, not to mention the millions of patients affected by this virus. Given the shortage of psychiatrists, many of whom are approaching retirement age, the risk is especially concerning. I was heartened to see the New York Times recently run a front-page article on burnout, and I feel encouraged at the growing awareness and understanding of its dangers, and at the emergence of programs to keep healthcare workers from reaching the point I did.
I never expected to stop practicing psychiatry at age sixty-four. I do feel a calling to heal the sick amid this pandemic, and so I hope that someday soon I may feel restored and able to care for patients again.

 

About the author:

David Janeway is an assistant professor of psychiatry at New York Medical College, in Valhalla, NY. He has maintained a second career as a jazz pianist and composer (davidjaneway.com). “Playing jazz is like doing psychotherapy: Both involve the art of compassionate listening and responding creatively in the moment. As for writing, one silver lining of my early retirement has been finally having the time to write. From early in my career, I’ve been inspired by physician authors such as Richard Selzer, Rachel Naomi Remen, William Carlos Williams and Atul Gawande. Writing is like playing music; both are essential to keep the creative juices flowing. Without free expression, we cannot truly connect with one another at the deepest levels.”

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Comments

9 thoughts on “Burned Out”

  1. Ronna Edelstein

    Thank you for such an honest essay. I took early retirement from middle school teaching when burnout inundated me. Less than a year later, I returned to teaching on a part-time basis. You will know when you are again ready to serve—and you will always know that you dedicated decades to serving others.

  2. artie solomon

    Brilliant article with so much compassion for others and self. Burnout among doctors, nurses, and psychiatrists is something I never knew or thought about. Thank you for bringing this to our attention. Also thanks for emphasizing the desperate need for Federal and other resources for our fellow Americans mental health. Otherwise we will see anger and frustration displace and diverted as in Nazi Germany.

  3. Thank you for a honest view of mental health services in our current health care system–the disturbing lack of availability and appreciation of mental health services.
    I hope you take the time to heal yourself before you consider practicing as a psychologist again.

  4. Sara Ann Conkling

    As I’m reading this I’m hoping that you realize that music is at least as important as psychotherapy in this pandemic. It’s probably more important. And it looks like you’re still teaching. Those are both valid, important contributions. Best wishes to you. And by the way, it’s okay to rest, and to heal. I have to say that to myself as well.

  5. David, I’m so glad to hear that you’re healing and getting back to a healthier state. And that you’re still playing the piano, for your health and your audiences.

    As a career coach who only gets to meet clients when they are at their most vulnerable, right after experiencing job loss, I know how easy it is to absorb their stress and anxiety. to lose sleep wondering what else you could do and how you can help them. Thanks for the reminder to pay attention to the signals our bodies send and to remember to “put our own masks on first” as they say on airplanes.
    Ron Katz

  6. I received permission to deal with stress when I was fired at 55 from an agency for which I opened a successful expansion site. I loved the job, but I the stress exhibited in my having unrealistic expectations of the people who reported to me. Complicated by an undiagnosed thyroid disease. My forced temporary opportunity gave me the opportunity to seek both counseling and medical care. Retired the second time at 67.

  7. Pris Campbell

    I experienced burnout, too, as a psychologist, even more so as funding continued to be cut for mental health until two hospitals where I ran treatment programs for long term patients, mixed with acute are long closed and boarded up. Yes, there’s that feeling that you’re abandoning the many who need help, especially for you now as the pandemic creates even more PTSD and stress. There comes a point when we have to cry uncle, though, and take care of ourselves. It wasn’t until I left the field and started helping my husband build his business that I fully realized how knotted up I had become. I think it’s because we care so much, it’s time to take care of yourself and be with your family now. Do it guilt-free. Thanks for sharing your story.

  8. Pringl Miller MDFACS

    Dear Dr. Janeway –

    Thank you so much for sharing your heart felt and well written piece. I look forward to hearing you play the piano!

    I’m not sure who you seek permission from to put your health and your families well-being before continuing to care for patients? We have to take self care seriously and offer ourselves the same compassion we extend to patients.

    If I’ve learned anything over the last 20+ years of being in training and practice, it is that the medical profession has cultivated unhealthy and unrealistic expectations about how self sacrificing physicians & surgeons must be if they’re to be considered “dedicated” to their practice. Why must we become ill ourselves before we listen to our bodies, feelings, and our thoughts? I was deeply saddened and frankly outraged when reading “When Breath Becomes Air” because I felt Dr. Kalanithi’s death was in large part due to being indoctrinated into surgical culture which dictates putting work before anything else which tends to support ignoring one’s own needs and health.

    I truly hope that one by-product of the COVID-19 pandemic will be deeper introspection and meaningful action taken to conquer some of the barriers to physician health and work satisfaction plaguing physicians and surgeons in practice today.

    Keep writing and playing the piano!

    1. David Janeway

      Thank you Pringl for your thoughtful and supportive comments. Even though I read your words and think, of course I shouldn’t need to seek permission to take care of myself and family, it is hard not to still feel compelled to go back out there. It took the Bell commission to change 36 hour call and only after a prominent patient died, which drew attention to the issue. I guess with the growing crisis of burn out among physicians and nurses we will have to reach that breaking point where it’s seriously addressed. To address burn out at my past position I raised the possible solution of slowing down the assembly line so to speak to give doctors some breathing room but they all snickered at the very thought. Medicine sadly has become corporate and it’s a run away train. All the best to you and your family during this crisis, David

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