Leaving Medicine for good

We are never ever ever ever ever getting back together (in my Taylor Swift singing voice). 

Yup, I was breaking up with medicine and it was about time.  This was alarming to most of the people in my life, as I had only practiced a little over a decade after finishing up my training.  But I was done and I knew it.  Unfortunately, many colleagues, family and especially non-healthcare professional friends could not comprehend why I would quit so “fast”. 

As adaptive humans, especially the high-achieving healthcare professionals that we are, we tend to use DENIAL as a mechanism to keep calm and carry on without confronting the stark reality we face.  We use denial just like any other tool in our tool box.  We are so overwhelmed for so long that we become angry and stoic. 

We all know colleagues who have ANGER issues that spill over into bad yelp reviews, getting written up or left out of key decision-making meetings.  They have bad reputations in the OR and no one wants to be around them. 

At one time or another in recent memory, we’ve contemplated or even BARGAINed with ourselves that if we could just get through the day we will  ..….. insert fun, happy or relaxing activity here. Never again will we burden ourselves with stacked call, get double-booked on the day we are scheduled to give grand-rounds, or any other unsurmountable task we have been asked to complete. 

For some of us, perhaps, most of you reading this blog post have felt totally defeated and lashed out in ways that are not becoming of a doctor or developed shameful bad habits.  But very few of us have ACCEPTed our plights and moved towards making sustainable and long-lasting change.

Wow! This eerily sounds like the 5 stages of grief.

If you are like me, you want to put things in a box, categorize it, understand new concepts through a nice bullet point presentation right? If any of this resonates with you, the 5 stages of grief may explain it.

Stage 1: Denial

Everything’s fine.  It’s ok that I just left a room where a patient almost died and 30 seconds later I have to start my next case because of course I’m late now.  Why?  Because my patient in the next room almost died. We repetitively work like this and are expected not to skip a beat.  It’s not that bad getting home 4 hours late and missing the parent-teacher conference we scheduled 3 weeks ago.  No problem that I don’t have time to make dinner, I’ll have that Cliff bar in my glove compartment and another espresso.  In fact, we are encouraged to continually deny how dangerous our lives have become. 

Life balance in my crowd was a four-letter word

I recall one evening at a medical society dinner, an older colleague of mine came in right at happy hour prior to the talk proudly announcing that he had just worked for 22 hours straight. He couldn’t understand what these residents are complaining about (insert eye roll emoji here).  Instead, the attitude was “suck it up buttercup”. 

When we are in denial about our situations or predicaments, we continue on a perilous path that we eventually become immune to the continued pressure of being a successful doctor.  We start to accept the systemic and inherent back-breaking demands put upon us. 

After all, we are super-human right?  By the time we turn around, it’s so overwhelming we just do the easiest thing possible, deny it.

Stage 2: Anger

Or as I like to call it, the enlightenment stage (insert praying Buddha emoji here).  

Over a decade of practice, I recognized the patterns and incidences where I was set up to fail and what began to unfold gave me a sense of solving a riddle.  Slowly but surely I was learning that my burn out (I had a name for it now) was not as self-induced as I was made to believe.  Money-saving downsizing and “kaizen” approaches to patient care had real-life adverse consequences.

I won’t outline the gory details here as you can fill-in the blanks yourselves.  But constantly being bombarded with “said measures” made practicing medicine an up hill/bang your head up against a concrete wall daily struggle and it didn’t have to be. 

I soon asked myself “where were the consequences for those who had made procedural changes that adversely impacted patient care”? My answer; there were none.  I was the one who could get sued or get the bad Yelp review, or worse have a bad clinical outcome due to factors I had very little-to-no control over.  I was unwilling to continuously take the blame and I couldn’t drink the Kool-Aid any more. 

But for much longer than I should have, I kept calm and carried on because at the end of the day, I and only I was responsible for my patients, therefore the burden was definitely mine (insert frustrated emoji here).

Stage 3: Bargaining

I just have to make it until the next case, the next day off, the next vacation.  There was never a sense of I NEED HELP because it would be a sign of weakness.  “Only if I switched that call I wouldn’t have been stacked.  If I only said ‘no’ to (insert random painful work act here).  If I just get through the next 72 hours, I will treat myself to…..” fill in the blank.  It was something to look forward to but not satisfying at all, a quick and fleeting fix.  All these deals I made with myself were superficial and temporary, certainly not worth what I had to give up in return. 

Stage 4: Depression

With a twist.

Very busy medical professionals don’t have time to be depressed. We all know it is borderline-impossible to take a day off impromptu.  We can’t take a mental health day to reflect on that bad case we had or how we plan to resist taking on more call, adding cases or bending for another administrator when we know it’s not in our best interest. 

Clinic, surgeries, “important meetings” can’t possibly be rescheduled.  Sadly, we power through.  On too many frustrating days at work, I felt like I had no choices and how ridiculous it all was.  Here I am, a highly educated, specialist physician with a “leadership role” who makes a generous salary with no choices?  Am I the f-ing Manchurian candidate?  It was soul-crushing. 

What I’ve come to realize is that we express our depression in a myriad of bad choices and destructive ways that boomerang back into our daily professional lives.  It becomes an inevitable vicious cycle if we let it.  This is going to be hard for most of us to admit, but some of us become alcoholics, others cheat on our spouses, or sometimes worse, get cheated on.  Some spend too much money and get into debt, and others completely check-out of their lives and become apathetic. 

By default the vice becomes our coping mechanism just to get through the next day…………since we don’t have the luxury of being depressed.  

Stage 5: Acceptance

Or as I like to say the “sorry-not-sorry” stage.   

I accepted my reality that longer vacations, giving up call and going to burn-out conferences, even taking a sabbatical were not going to fix what surrounded me, what had swallowed me up whole. 

Here I was.  Perhaps here you are too.  I did what any other card-carrying superwoman-complex-having physician would do; I cycled back through all the stages again for about two more years (insert ding-dong emoji here). 

Eventually, the life I thought I wanted was not the life I was living and I had enough. Oddly, I felt satisfied with ending my medical career now and it was liberating.  I embraced the disappointment and it was ok. 

Giving myself permission to transition not out of but into a new and bright future was delectably refreshing, like how your sore muscles feel after a massage.  I had a sense of being settled. 

Veni

Vidi

Vici

Shortly after I made this life-altering decision, I was now tasked with coming up with my “deuces date”.  It was easy, I would quit if and when I got dropped from a pending law suit.  This way, I wouldn’t feel like anything was left unresolved and I could leave my job and yes my career without reservation.  To many, it was out of left field, but to me, I was resolute in leaving and leaving soon.  “No, I am not looking for another position, no I am not moving and getting another job, and certainly NO, I am not going back to academics”. 

The parts of my career that I will remember fondly turned out just as I had dreamt.  I truly enjoyed all the camaraderie with my colleagues some of which became friends, patients I had taken care of who visited me years after I had cared for them, even late nights in the OR knee-deep in blood.  I know that I would miss the daily puzzles I solved in clinic but I could find something else to fulfill my curiosity.  I didn’t see it as a short career, I accomplished my goals and now it was time for the next adventure.

If you are here (insert pointed arrow w/ map icon) by your own choice or because something unfortunate happened like an illness in a family member or yourself, don’t feel ashamed that you want to pivot.  And please, don’t let others make you feel ashamed for considering hanging up your white coat.  Because if all of this is resonating with you, it deserves some thought. 

I want you to give yourself permission to imagine another way, to envision what life might look like if you (insert part-time, change jobs for a less busy one, totally quit, do international volunteer work, take that lucrative “industry job” here).  What if you decided to take that oh-so magical, unfathomable, borderline-ridiculous unconventional fork in the road?  It may not be today, but you are on the trajectory to something different.  It’s your choice of what “different” entails for you.  No doubt, it is a difficult decision and should not be made in haste. 

One of the main purposes of this blog is to lend a voice of affirmation and to offer a different perspective of what “should be” or what “IS”.  I don’t purport to have many answers here because we are all different and coming from many directions and circumstances in our lives.  Only you have the power to make your own reality.  Be courageous and embrace that rumbling in your belly, the adrenaline you feel in your chest right now reading this post.  

Just take a moment to stop and to think …………….what if?