healthcare and unwellness.

Lately, I can’t help but dwell on my state of unwellness. I feel like I’m drowning in a pool of my own self-pity.. Hoping to find a little release and catharsis in writing out my feelings and thoughts here.. 

Imagine this: you are required to work 24 hour shifts every 3rd night or so during which you do not sleep. You do not drink enough water because you do not have time to urinate. You eat whatever you can get your hands on quickly. The cafeteria only serves expensive, frankly unhealthy food. When you sleep for undefined periods of downtime, it is severely interrupted and poor quality. The next day you are in a state of fatigue but are somehow “wound-up.” Probably because you are so addicted to coffee that if you don’t drink it you get a severe headache and can’t sleep, but if you do drink it you are caffeinated and can’t sleep. Probably also because it’s hard to wind down when you’ve been telling your body that it’s not OK to wind down for such prolonged periods of time. When you do sleep it is a either a deep and disorienting sleep in which you wake up in panic, or a fitful tossing of poor quality rest. Either way, you wake up and eat something and try to go back to sleep because it’s night time, but you can’t sleep well because you “slept” during the day. When your alarm clock goes off at 4:30am the next morning for a full day, you feel slightly nauseated and more than slightly suicidal. Now repeat this for weeks or months. Years. 

The damage is real. 

Try adding on a pregnancy. A first child. Now say that first child needs surgery at 12 weeks old. You use all of your paid and unpaid time off caring for a colicky child who barely sleeps while trying to heal from childbirth. Your sleep deprivation worsens. You are forced to go into a “survival mode” of life that has become all too familiar… 

You feel guilty because you should be grateful. You should be happy. You "should".....  

*Almost* every July since the summer of 2005 has been a time of pretty intense stress, work, and general unwellness. I say *almost* because there was that one summer.. The summer after I finished my first residency in 2011.. I guess it had it’s own set of stressors given that I had to move, get a real job, and had pretty significant student loan and credit card debt as leftover carnage from med school and residency, but I was able to kind of start to let that go.. 

I distinctly remember something happening during that time that indicated to me that I was starting to heal as a human. Most importantly, I slept every single night. Sleep. Glorious, essential, imperative sleep. I restored my circadian rhythm. Gradually, I started becoming curious about things again and retaining information again. I started listening to other people during conversations. I started to become interested in things again. I had fun. I went on a rafting trip in the Grand Canyon with some friends, acquaintances, and strangers. 3 of those strangers turned out to be pretty fascinating and introspective conversationalists. I guess it’s not surprising that they were awesome people: some combination of being the type of people to sign up for such a trip and also they were friends with a great friend. We spent some time every single day for almost 3 weeks talking, relaxing, and playing poker.

Side note, but I’m convinced that Poker, by the way, is one of the most quintessential human games. 

I remember realizing what a deep fog of depression I had been in for years, and I remember it starting to lift… I am looking forward to feeling that again sometime soon. I can almost taste it. 

I’m not saying that everything bad in my life is med school or residency’s “fault,” or that I would have been much happier doing something “else.” I am clearly a person who is prone to depression. I was pretty existentially lost in high school trying to decide where to go to college and same when I was an engineering student in college. I have never particularly found “my place” and I strongly suspect that I am a member of the eternal “lost boys club.” I have lived in self-doubt and self-pity more than a decade now… BUT, that is actually a separate issue from this topic which is WELLNESS. 

I am a person who truly enjoys wellness. I love to exercise; I love healthy food; I love yoga and meditation; I love a good massage. I believe that the way to health is via good habits and behaviors… I admire those beacons of health that I see teaching me during yoga or crossfit. I admire those people I meet who have taken time to nurture and care for their minds and bodies. I love that they appear to be so healthy and happy by simply internalizing what we all know is “good for us.” And I sincerely try to achieve those goals. Guess how many of those role models are in medicine.... Zero. It is completely impossible. Some are better than others, but none are "well." I would say, given my past 10 years of experience, that working within healthcare does almost everything it can to impede that process. 

Why is that? Why can't we encourage or allow a life of wellness within healthcare? Why can't we encourage basic tenets of health? Enough sleep, healthy eating, and physical activity is not such an outlandish goal.... It is basic wellness. How can we expect to be successful at our endeavors if we are such poor role models? How can we teach and recommend something that we have so little experience with? 

I’m not saying that mine is the worst life possible. Probably one of our strongest messages in medicine is that nothing in our own lives is “as bad as” what we see day in and day out. I mean, it’s not like I’m being shot in the chest. I’m not getting beaten by my ex-boyfriend with a bat. I’m not a child who’s been sexually molested by her parents or a baby put into a washing machine with glass, it’s not like I’m a preterm fetus being born with narcotics, benzos, and marijuana in my blood. I'm not a homeless schizophrenic.…. Yes, it could be much much worse. And the reason I know that is because these are actual examples of scenarios I have witnessed repeatedly over and over during the normal course of doing my job. 

But the thing is, I didn’t have to do this. I could have done anything else. I came from resources. I was “smart.” I could have done something else. I could have easily stayed in engineering and never had to come to terms with this level of unwellness or witness these horrors of human suffering over and over. I could have maybe done something that brings happiness and wellness. Maybe personal training, maybe teaching.. Nutritionist? I don’t know. Sometimes, I feel like I would give almost anything to take back the past 10 years of my life. Turn back time and heal. I would almost sell my soul to erase my debt and buy back my freedom... 

Or maybe I’m wrong. Maybe most of what I’m feeling is that sadness that comes from being an idealistic child who grows up one day to adulthood and looks around them with eyes open… Maybe it has nothing to do with my career and everything to do with the loss of innocence. And maybe that would have happened no matter what I chose to do with my life.. 

Either way, though, I am fairly convinced that our current model of western medicine does not offer happiness or wellness to anyone, although there are those urban legends you hear about of “that patient that quit smoking” or “that patient who lost weight.” Rarely a friend in medicine will get a card or something thanking her for taking care of them and everyone rejoices with glee at this small victory. I mean, sure, there are some people who can be helped or even cured with procedures or treatments, but it is not the norm. It is not the majority. We save some lives on the trauma service, but it is often a life of suffering. I don’t know, I just don’t really buy into it anymore. I am damaged. I see what I do primarily as prolonging suffering and death. Blame it on my depression, or my sense of fatalism, or my coming to terms with the reality of the situation. Some people clearly can deal with the sadness and realities of modern medicine better than I can. Some people can rejoice in small victories. The whole thing weighs heavily on me. 

At least anesthesia is a world better for me than family medicine was. Family medicine was a firehose of pain and suffering blasting into my face all the time… There was dissatisfaction all around. The patients hated waiting, they hated the short appointment times, most times they hated the "treatment" options offered, the administration hated the lack of productivity, the MA’s hated being spread too thin, the docs hated the endless barrage of busy-work (charting, prior auths, labs, phone calls, requests, billing), hated the pressure of the numbers, hated never having time to do your job well, hated being a drug dealer constantly forced to bargain and argue with drug addicts, hated hated hated everything. Or at least I did. There was only so much you could ever do anyway. It was such a difficult job. 

Anesthesia has a certain level of disconnect that is therapeutic for me. There are some clear goals. You should keep this patient alive for “x” amount of time. At some relished point during your delivery of anesthesia, it is you and a piece of machinery with mechanical beep beep beep. The patient is far far away, and anyway you don’t really know the patient all that well, and transition of care is pretty smooth. It’s so. much. easier. 

I can survive again this time. I’ve done it before. I always tell myself two things that help get me through rough times.

1. It could be worse. 

2. I just finished one more day of residency, which is also one less day that sucks.  

See, this is what happens to me when I can’t get to the gym enough. 

Thanks for the vent. 

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We cannot lead someone else to the light while we are standing in the dark.

-anonymous

In three words I can sum up everything I’ve learned about life. It goes on.

-Robert Frost

And now here is my secret, a very simple secret; it is only with the heart that one can see rightly; what is essential is invisible to the eye.

-Antoine de Saint-Exupery

The nice thing about meditation is that it makes doing nothing quite respectable. 

-Paul Dean

Although the world is full of suffering, it is also full of the overcoming of it.

-Helen Keller