I’ve had enough and ….. I have enough

I had the answer to my burn-out and didn’t even know it. It was a hard choice. Sell the house and be done.

“Meditate more – it will fix things, go exercise – you will increase your endorphins, burn lavender or some other random essential oil, it’s guaranteed to relax you, get more sleep – it will solve everything”. We’ve all heard these “solutions” before. The problem with this is that you continue to circumvent the actual issue of burn-out by not directly addressing the etiology. No doubt, doing all these things may have an impact, but at least for me it was fleeting. Yeah, I meditated on my days off, I got 7 hours of sleep on average if I wasn’t on call and I love burning eucalyptus oil. But in the long run, I never felt like anything had changed. I continued to feel like I was on the 24th mile of my marathon barely keeping the time I had set for myself.

The burn-out was insidious and gradual.

It did not happen overnight or even over a year. At the beginning of finishing up my last fellowship, I was eager to see my own patients and finally getting to see cases and doing procedures I had trained for, for so long, to have a nice house in the suburbs, go on nice vacations with my husband and occasionally dancing to good Disco. In addition to saving 15%, at the time I was happy with just snowballing my student loans and living comfortably.

After a few years had passed, I gained more and more patients, volunteered (and sometimes was made to volunteer) on more committees and taught students and residents which I enjoyed. Enough became making it home for dinner at a reasonable hour and not spending 2 days in the hospital with a very sick patient. Inexpensive vacations or vacations “sponsored” by my work were top on my list. Since my student loans were paid off by then, our goal was to save up for another rental property or maybe pay off the mortgage early.

I didn’t know at the time, but as more and more people in my organization bottom – to – top started to rely upon me, I was at the beginning of burn-out. I just remember having a sense of continuously being on “go-mode”; my I/O binary button was always in the “I” position. I looked at my partners 20 years older than me, doing as much work as I was, “no rest for the weary” they would exclaim, and so I prodded on. Less time for family, less time for friends, even less time for my husband and what I enjoyed, definitely no time for me. Was this what I signed up for?

Damn – still living like a resident, but with sprinkles on top of practice meetings, RVU quotas and dealing with all the ugly crap of running a small business. Lazy employees, patient complaints, inner fighting amongst staff, people-pleasing the referring docs, the escalating hoops to jump through for maintenance of certification, hospital privileges, and new insurance rules, etc. The only time I felt like I was actually doing what I had trained for so long was about 35% of my time! I’m a huge percentage partitioner. My brain always puts stuff into percentages. 35% was NOT a percentage I was happy with.

This is NOT enough for me.

So I started to pay off that big-fat mortgage in hopes of working less eventually. I finagled a few more vacations/conferences on my work’s dime and I started to hyper-save. Never did it occur to me to look for another job as I felt in my heart that administration, demanding/needy patients, crescendoing encroachment on my time especially with EMR and various hospital responsibilities would be no different any where else. Enough became just getting through the next couple of weeks before an overdue vacation. This period lasted the longest.

As the years went by, I slowly realized in bits and pieces that I needed to make some hard choices, really hard choices if I wanted to “fix” this. It was a hard pill to swallow as a doc. I am used to picking up a book, going to a course, or reading an article, implementing what I learned and solving “the problem”.

Not so – for burn out

Just like any other pending issue in my life, I wanted a tangible and obtainable solution. # goal (in my high school cheerleader voice at the championship). But as my burn out got worse; I felt defeated. This was not going away as easily as I assumed it would. I could not deny that I had enough of the gut-wrenching conversations with patients conveying bad news. I was done with the futile discussions about yet another way we could lower our standards, see more patients and save more money for “corporate medicine”. I had enough of feeling pulled in 8 different directions all at once and expected NOT to skip a beat, not miss a meeting and for everyone around me to continue to NOT value my time or my well being.

To make things worse, then I got sued. I was warned for many years, that if and when I got sued, it would make me depressed and maybe even paranoid. I could anticipate second guessing every clinical decision I made for the foreseeable future, etc. My reaction was one of anger. I was so angry. I had global resentment towards the chronology of events, other colleagues involved in the case, the patient dynamics, the system that made me vulnerable, and especially myself.

I traded in my youth for good grades so that I could be the best physician I could be, I sacrificed having children because I knew my patients would come first, and just having a daily life – culminated into getting sued? Really? It was just too much for me.

Then it became crystal clear. Enough for me was – I WANT OUT and right now! It was like a meteor had blown up my entire notion of what I thought my life would be. I had taken off rose-colored glasses and the world was now in crisp “portrait mode” on the new iPhone. I discovered F.I.R.E. (financially independent, retire early) shortly after this revelation. I dove deep (in my James Earl Jones voice).

Almost immediately, I re-configured my budget in Y.N.A.B. and increased the amount funneled to my taxable account; my F.U. money. I was laser-focused on getting my savings percentage up. IT WAS ON (insert muscle emoji here). My new revelation had a serendipitous pebble effect too. The next thing to go were 90% of the committees I was on. I only participated or sometimes ran committees I felt were meaningful for my patients or for me.

I no longer participated in frivolous nonsense.

Finally, I went natural, YES, after 40+ years of straitening my hair, I came into the office with my natural hair. It was long overdue. I didn’t care anymore what patients thought, I had long not cared about what staff or my partners thought. I was a caterpillar who metamorphosed the night before into a butterfly! It was uncomfortable, oh yes, and quite awkward for me and the people around me, but liberating none-the-less.

Ironically and somewhat to my surprise, I found myself fantasizing about what my life would be like if I were a “civilian” meandering in the world of endless time on my hands.

Even after studying for as long as I did, seeing cases that were so rare most docs would never see in a lifetime of practice, I felt really blessed that I had enough of that too. Contributions to my field through collaboration and teaching, most importantly, the help I provided my patients who needed me the most was satisfaction for me.

It was enough

Revelation

Each and everyday I was getting more brave, more comfortable with the reality of not practicing medicine. But, how were we going to pull this off financially? Sure, I was a good saver, and we had some rental property but we live in one of the most expensive cities in all of America. How could I possibly retire now? And then it dawned on me………………………….

Holy Crap! I am already F.I. (insert surprise emoji here)! I have enough equity in my home to retire! It was like a ton of bricks came tumbling down, but not onto me, on the construct of what I used to value, what I used to hold in high regard; I was F.I. and didn’t even know it.

Whoot whoot, I was going to put that equity to use baby (insert sunglasses emoji here)!

Yes, to the contrary, a HCOL area put me over the hump.

I was F.I. , in fact Fat F.I. because of the equity in my home and I HAVE ENOUGH!

I made the decision to leave medicine but when? Just like that it came to me, if I get dropped from the case, I would quit shortly after. Luckily for me I did get dropped from the case and I was so relieved.

If you are reading this and you are contemplating the decision to quit medicine you know exactly what I am talking about. I didn’t have to do a Pros & Cons list. I didn’t have to speak to my mentor about it, I didn’t have to doubt that THIS was enough.

Enough

Enough was not drinking so much, being with friends and family that I really cared about, having the time to mentor others like I know I wanted to and they needed. To have meaningful conversations with people instead of always feeling pressed for time and “getting it in”.

Enough was spending countless and maybe wasted hours on “how can I do this craft I’ve been wanting to do” for literally decades and watching a Hallmark movie with my husband on the sofa we made together. It meant swimming without already thinking about when I’m going to get out of the water. It meant working on my physical health and finally getting around to going cold turkey off the proton pump inhibitors for good. It especially included more Disco dancing.

Without hesitation, my definition of enough did not include practicing medicine in a high cost of living (HCOL) area for 11 more years. It didn’t include missing yet another funeral or destination birthday party, fancy vacations or even hitting “my number” for traditional retirement.

Hyper-saving and using the equity in my HCOL home is how I got to …………………….enough.

Ahhh, now I want you to take a deep breath. What is enough for you?