No Wonder I’m Burned Out!

Once again, I ask my friends:  How are you? 

I am not great!!  Neck, back and head pain, insomnia, low mood, and the worst case of stress eating in a couple years—GRRRRRRRR!  *deep breath*  …So, like a good primary care doctor (she says with tongue in cheek), I evaluate and treat myself.

I ask patients to rate the stress and meaning of their work and then compare:  Is work overall more stressful than meaningful, or the other way around?  It helps me assess the sustainability of their work life, and gives me insight into their values and priorities.  In recent years when I’ve asked myself, the answer is consistent: moderate stress, HIGH meaning.  Today it’s high stress, less high meaning.  For the first time in a long while, work is not necessarily more meaningful than stressful.  Yikes.

Stress:  It’s COVID. 

Meaning:  I ask patients how they derive personal fulfillment and meaning from work.   I recently asked myself again.  It’s twofold:   Relationships and Efficacy.

Relationships: I am your primary care doctor. Sometimes I’m your therapist, your cheerleader, your drill sergeant, and your accountability buddy. I have always loved this, even on the hardest days. But this year, I am also a resolute public health advocate. Sometimes that rubs you the wrong way, because I tell you things you don’t like. I recommend against flying. Don’t eat at restaurants. Don’t gather with your family for the holidays. Don’t go to church. Stay home for 14 days after an exposure. I interrogate your COVID precaution practices. Then I dissect and judge them (not you), thank you on behalf of humanity, and admonish you to persist, longer and longer, for all our sakes. It kinda puts a damper on our relationship.

Efficacy:  I. Help. People.  It’s my calling!  Hemorrhoids?  No problem.  Back pain?  I’ got this (yer back, that is).  Viral gastro?  Migraine? Core instability, palpitations, paresthesia, GERD, thyroid nodule—even  depression and anxiety—I can make a good plan for all of these things.  I can walk you through it, reassure you, and help you feel better, even when I can’t fix the problem. 

Not so with COVID.  How did you get it, when you were so careful?  If the test is negative there’s still a 20-30% chance you’re infected if the scenario is high risk, but I can’t say for sure.  If you’re sick, how long will it last?  Will it get worse before it gets better?  How much worse?  Will you have lasting symptoms or long term health problems?  How long does immunity from illness or vaccine last?  I cannot lie:  I. Don’t. Know.  I will stay with you through it, but I can’t even satisfy your most basic questions, while you sit alone at home coughing, short of breath, unable to see or touch your loved ones, sipping ginger ale because you throw up anything else.  I can’t help.  And it kills me.

On top of that, I’m not doing any good as a public health champion, either!  Have I changed any of your behaviors?  Have I made even an iota of difference in my community to stop the spread?  All signs say NO.  I’m failing left and right.  No wonder I’m eating so much.


Burnout is widely understood to have three key components: 1. Emotional Exhaustion, 2. Cynicism/Depersonalization, and 3. Reduced Personal Efficacy. Studies of physicians generally show that while we often score high on the first two, we do better with the third. I think not anymore. Burnout affected about half of all physicians in all specialties a few years ago, but had improved due to widespread research, awareness, and advocacy for systemic change led by professional societies such as the American College of Physicians and the American Academy of Family Practice. But think about 2020: Whatever emotional exhaustion my emergency medicine and critical care colleagues felt before, caring for the sickest of the sick, likely pales in comparison to the horrors of this pandemic. When their health systems ignored their pleas for PPE and then laid them off, making remaining docs work that much harder, and when they saw people partying and spreading virus all over the place, could you blame them for getting cynical? And though we’ve learned so much and fatality rates are lower now than in March, imagine going to work every day to watch patient after patient suffer and die alone, despite your and your team’s best efforts. We can no longer count on efficacy to save our morale.


So how do we hold it together? Well DUH, it’s about connection! I had not felt this bad in a long time, but I’m better now, thanks to my peeps. They’re everywhere, and we hold each other up. Texting a meme here, venting (a lot) over there, and generally being present for one another, sharing, even embracing, the deep suck of the morass. Because this too shall pass… Like a kidney stone, as they say.

The only way out is through.  The best way through is together. 

I haven’t thought, said, or written that in a while.  It’s not that I forgot.  I got overwhelmed.  Happens to the best of us. 

Walking the Talk

NaBloPoMo 2020 – Today’s Lesson

Where do you fall into dogma traps?

Back in March I told friends not to wear masks in public.  I was angry at people for hoarding PPE for personal use when hospital workers did not have enough.  My classmates sewed cloth masks for nurses while people perused grocery stores wearing N95s around their chins.  I stated my opinions strongly and ate those words later.

This week I find myself softening previously strong opinions about in person school and personal gatherings.  I have successfully sought varying perspectives on these issues, and not always so successfully incorporated contrary information into my perspective.  At the end of summer I could not imagine how hordes of kids could be brought back to school safely.  Now I have seen multiple accounts of schools and universities that did it safely.  The keys:  Cogent plans based on local conditions; heavy investment of myriad resources; and constant, clear communication.  While I worry increasingly about family gatherings for the holidays, it looks like restaurants, bars, and churches may still be the chief culprits of the current COVID surge.

I still get a little palpitative hearing some patients’ plans for Thanksgiving, and picturing college students coming home this week.  It could be bad. But thinking in broad, overgeneralized terms, and especially making skeptical assumptions about people and their motives, doesn’t help anything.  I just get grumpy, and my neck hurts.  We messaged our patients about how to do the holidays safely.  Though not quarantining, many have tried earnestly to minimize exposures in advance of gathering.  It could be okay, maybe.

We are all doing our best.  I speak and write about withholding judgment and being present with generosity.  Now is a good time to hold myself accountable to that standard.

Death Comes Closer

NaBloPoMo 2020 – Today’s Lesson

How many more before it’s over?

This weekend I felt the Reaper’s cold breath over my shoulder again.  It came last 20 years ago, when I left residency for a week and flew to Taiwan, where my grandmother was dying.  The ICU at the teaching hospital in her city was positively rudimentary compared to where I was training.  She was intubated but fully awake, and rolled over before the doctor even had to ask, so he could listen to her failing lungs.  That was Po-Po, always making life easier for others, even at the end of her own. 

Imminent death agitates and disorients like nothing else.  In training I learned to detach just enough to be objective.  My elders modeled the compassion and empathy required to shepherd both patients and families through the passage.  In the emergency department and ICU, and on the cancer floor, we observed a calm, professional reverence for the end of life.  But only a few patients might die on any given month-long rotation.  Today my friends in these specialties witness death, sometimes multiple, often gruesome, on a daily basis.  They risk their own lives, and serve also as intimate messengers and chaplains, in service of helping soul after soul ascend in peace, if that’s even possible. 

When it was my Po-Po, I was beside myself.  I cried non-stop the whole 15 hour flight stateside.  And then I went back to work. 

Tonight I pray for all of us, especially our healthcare heroes.  Death will likely claim someone in each of our circles before this pandemic is over, if it hasn’t already.  I wish I could do more to halt the unyielding march.  But how many times can I say mask and distance?  It’s futile.