In Defense of Burnout

After an overnight shift where I spent five hours of eight on the phone transferring out three patients with brain tumors to three different hospitals because I was working at NARH, I read an article entitled, “Leading Healthcare Organizations Declare Physician Burnout As ‘Public Health Crisis.’”

(Yes, mom, I know that’s a run-on sentence.)

The article referenced a report by the Harvard T.H. Chan School of Public Health, where the authors concluded that physician burnout was an epidemic. Among other recommendations that did made sense, they ruined it by suggesting that every major health organization appoint a “Chief Wellness Officer,” after which I shuddered and closed the article.

This is not the point of this post, but if my institution appoints a Chief Wellness Officer who then sends me even more emails about 5Ks and musical release yoga sessions, I am going to spontaneously combust into a nuclear fire of rage.

This has been mentioned before, but the second year of residency at my program is considered the hardest. Intern year sucks the most, sure, but second year is supposed to be the most difficult – we are expected to balance more tasks and see more patients than we ever have before.

One of the rites of passage of second year is the R2 Burnout. Every second-year resident, every year, burns out at some point. Most of us die a slow winter death when days can go by without seeing the sun on runs of night shifts. I vividly remember a stretch of NARH nights where one of my favorite senior residents, now a third-year, wore the same set of scrubs, jacket, and most-disgustingly, face mask on three consecutive night shifts. I don’t think he ever went home. Or washed his face.

The burnout is very real. While it’s happening, you’re just miserable. It’s a throwback to my intern year motto: everything is terrible and nothing matters.

I burned out somewhere around September. I spent almost all of September on night shifts, gained about 12 pounds’ worth of gummy bears, and generally hated my life. One of my succulents died. I ran out of bourbon. My bike got stolen. It was a dark time.

September is a little on the early side to burn out, but then again I do pretty much everything a little too fast. For instance, I drive a little too fast. This is due to the exceptionally morbid reason that if I crash I would much much much rather end up a windshield-shaped explosion of meat than get brought in to my hospital as a trauma.

this is what shows up if you google “meat explosion”

(Traveling over 75 mph when you crash is an excellent way to drop your survival rate to around 10%. If I wreck, I would like to minimize my risk that an ER tech I know well will be cutting off my clothes with shears, or that a resident I know personally is going to put a finger in my butt to “assess for rectal tone.” This is my single biggest nightmare.)

Anyway. The burning out sucked, but afterward I emerged a completely different resident. Even my motto changed! In a way, the burnout is protective: I no longer feel compelled to try and fix this horrifically effed up system, I don’t fight back when consultants give me a hard time, and have learned to pretty much “welp” myself out of every situation that demands a welp.

Last weekend, I miraculously had 2 days off in a row. A few friends and I drove up to a local ski resort and did normal human being things like take advantage of free time, drink wine at appropriate times of the day (aka not 8am after a night shift), go skiing, sleep soundly at night, and enjoy the company of other human beings not in a hospital. It was wonderful.

I came back to work a series of night shifts profoundly un-burned out.

IT WAS TERRIBLE. I had, in my brief return to millennial humankind, forgotten my motto of Not My Hill and instead, once again, started to fight the power.  I had energy. I had gumption. I had — I had forgotten my burnout, and spent three consecutive night shifts getting profoundly disappointed and angry.

By the end of the third night, my blood pressure had returned to normal and I was once again ensconced in my carefree bubble.

This led me to conclude that burnout, as terrible at it is to achieve, is in fact just a maladaptive (but wonderfully effective!) coping strategy.

Here’s the thing: to get in to medical school, you have to invest nearly the whole spectrum of your person – emotional, financial, physical, mental – just to get in to medical school. In order to survive medical school, you do it again, and suffer through four years of insane, poorly-structured hazing just to get to the apprenticeship for doctors.

Med school is a strange paradox: on the one hand, you are indoctrinated not just into medicine, but to the idea that physicians have an ethical obligation to improve the system they nominally sit atop.*

*This is not true; nurses exert the most control over health systems, because they are smarter than we are, but that’s a different subject.

On the other, you are systematically devalued, belittled, told you are useless to your clinical teams, and forced to measure yourselves by tests that measure nothing besides test-taking ability. For this privilege, you pay a zillion dollars and mortgage your future.

If you miraculously emerge unscathed and with your optimism intact (usually refreshed by a lengthy vacation and/or flirtation with alcoholism), you then enter the dreadcage that is residency, where a proposal to limit work hours to eighty a week and to cap 28-hour days at “a maximum of every third day” was met with derision and jeers that we Netflix-binging, Instagramming millennials are soft with no work ethic.

It may surprise you, as long as you are not a med student or resident, that the above words are not mine. Rather, they are paraphrased from a remarkable invited commentary in Academic Medicine, a prestigious medical journal, by the leaders of our beloved standardized testing service (the NBME) and the Federation of State Medical Boards:

“…if students were to devote more time to activities that make them less prepared to provide quality care, such as binge-watching the most recent Netflix series or compulsively updating their Instagram account, this could negatively impact residency performance and ultimately patient safety. ”

This is the published, peer-reviewed opinion of two men who together hold the fate of every graduating medical student and resident in their hands.

Anyway. Halfway through this depersonalizing road, I’ve concluded that it’s best to approach residency as a job. Not a career, not a profession, not a life calling – just a job. I’ll show up, work hard, and go home at the end. After all, this freedom from call and a patient census is one of the reasons I went into emergency medicine in the first place.

The dissonance, though, between treating this thing we worked so hard for like any other job, is the burnout.

The journey through the R2 Burnout is the recognition – and ultimately, acceptance – that despite all the hard work, the long hours, and the investment, we are just biding our time until it’s time to go home and binge-watch Confessions of a Dangerous Mind while scrolling through the Instagram stories of people who have a real life.

Embrace the burnout: embrace happiness!

One thought on “In Defense of Burnout

  1. i have several thoughts on reading your burnout post-

    1-that sounds terrible. come home immediately!!!!!

    2-who said you have to change the system? that is very honorable ,but apparently , not good for YOUR health so stop that right now.

    3-did you see osaka play tennis in the australian open? she was under great stress. she was in the ZONE. nothing ruffled her. nothing broke her concentration. she won. then she cried when it was over. you are a dedicated physician . i know the residency is terrible. sorry about that.

    4-im sorry your bike was stolen.TOO i love you very much and am so proud of you.

    HANG IN THERE NATHAN. LOVE,GRANDMA

    >

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