I took a break from clinical practice as of May of this year. I have been in practice for over 20 years (counting my 4 years in residency training) so it still feels very strange. I am so used to living with the doctor’s paranoid mantra of “I must be missing something” that it’s really hard to shake. There are a lot of other emotions too: guilt, relief, excitement, loss, and (dare I admit?) joy.
I’m having weird dreams, too. Disturbed sleep has been a normal work hazard and my constant companion over the years, so in a way that’s not surprising. Yesterday, though, I actually dreamt that I was flying for the first time in my life. It was a lucid dream and I was even able to choose which directions to travel. It was probably the best dream I’ve ever had. It’s also worth noting that I haven’t had a “falling” dream in a while (which I used to have commonly). That is really something. It doesn’t take a Freud to figure out that maybe I’m feeling freer and lighter than before.
Taking a break from clinical work has been something I’ve been thinking about and struggled with for a few years now. I’m glad that I finally had the courage to just do it. As often seems to be the case, things tend to be scarier in my imagination than when they actually come to pass. (I hope that this is some type of corollary that always holds true because this revelation has encouraged me to be braver lately.) To my surprise, the world around me did not in fact self-destruct as I worried it might, and all seems fine. In fact, maybe things are even better. Funny.
Most people don’t understand, after working so hard to become a doctor and working at it so long to finally become a half-way decent doctor, why I’d then just want to stop. Maybe I should explain.
Like many Indian kids who grew up in households that revere learning and science and believe in karmic goodness, I decided early that I wanted to be a doctor. I think I first started telling people when I was around 10. It was a no brainer: I was fascinated by science and was good at it (my favorite subjects were biology and genetics); doctors are venerated in my culture (second only to priests); my dad in fact had wanted to be a doctor but didn’t get into med school so there was also some inherited, aspirational, existential yearning there; and last but not least, taking care of people matched my soft-hearted personality.
My teenage self–an embarrassing but impressive nerd–took on this mission with zeal. I applied to a science magnet program for high school, I obsessed about getting A’s, I entered science fairs, I was a candy striper, I volunteered to be a lab assistant, and in so doing, got into a competitive undergrad and med school degree program. I tell you all this only to show just how very badly I wanted to be a doctor and how grateful I was when I finally became the very first doctor in my family. It made me proud to make my family proud.
As is my way, I followed my gut when I made the decision to be an ob/gyn. The most moving experience I had had in med school was witnessing a childbirth for the first time, born to a single, too thin, very alone, young black woman. No family member was with her at the birth, until of course, her baby was born, and then they two had each other. I’m a crier, so of course I cried. I don’t know, but in the desolate atmosphere of Newark, NJ at that time, which had too many drugs, HIV, and crime, I was touched by the beauty and hope of that moment. I took it as a sign that this was what I was supposed to do.
The analytical side of me also thought ob/gyn to be an ideal field. It offered the best of all worlds of medicine: a primary care aspect that could grant me the satisfaction of having long-term relationships with patients, a surgical side that could grant me the instant gratification of solving certain problems immediately for patients, and even an emergency medicine aspect to satisfy the adrenaline junkie in me that enjoyed the natural endorphin rush of sometimes having to save the day with quick decision making and action.
I also just admired the women role models I saw in that field. They all seemed like firebrands and lady bosses–kick-ass, bold, honest. (Yes, some would call them bitchy. And that, they would say is a compliment. 🙂 ) They were leaders among women and leaders among doctors. I wanted that to rub off on me. I don’t think I’m at the level yet of my favorites, but I did have a patient tell me last year that she thought I was “tiny but mighty” and that is now how I like to think of myself. It’s motivating to try and live up to that high compliment.
But, I’m not gonna lie: this career has been hard. Really hard. It’s been physically, mentally, emotionally, and spiritually hard. I know I’m not unique among other doctors in my specialty, or even other specialties, or for that matter, even compared to other people working in high stress fields, but I guess I’m just sharing my own personal journey and saying that I’ve struggled a lot with how to cope with the exhaustion, sleep deprivation, mental stress, heartbreak, and yes, even depression, that comes with this work. I could write a book on it, but I try to be a little Buddha about it and live with the knowledge that these are temporary states of pain and move on instead of dwell on it, so I think that this post is all I will say for now, and maybe ever.
I probably sound like a whiner. I know many other people have it much worse. Doctors in general are not a group of people that other people feel too sorry for. That is appropriate. I do know how extremely privileged I’ve been to have this amazing career, which in net has given me much, much more than it has taken from me. And even though many of my lowest lows have been at the hospital, so have many of my highest highs. In all the ways that my medical career has bruised me–physically, mentally, emotionally, and spiritually–it has also burnished me and I feel deep gratitude for that. I’m better as a result.
Medicine has helped to grow my love for humanity. I thought I had a good amount of empathy when I started as an idealistic, young med student, but I really didn’t know the depths I could achieve personally until having heard and felt some of the struggles of my patients over the years. Now, sometimes I even think I can viscerally feel people’s pain, as if it’s my own.
It’s hard to keep being a witness to everyone’s hardship and suffering and feel powerless to do very much, especially in a system that allows you only 15 minutes per patient. I’ve burnt out on that. I’ve always cried easily, but now it’s a little bit ridiculous. I’ll cry during a dumb movie, for example, not so much because I believe the fiction in the movie but because I know these types of things happen to actual people everyday, some of whom I’ve met and I’ll then remember them, and the fiction ends up feeling very real to me. I’ve learned to put myself in little escapist bubbles for short periods of time to re-charge my batteries. Maybe that’s what I’m doing now.
There’s the struggle of the individual patient but also the systemic dysfunctions that bother me, maybe now more than ever in this toxic political climate: how we practice medicine, the design of our healthcare system, and how we as doctors have little influence on socioeconomic problems that are so much at the root of public health. I don’t think it’s right that doctors spend more time with the medical record than with patients, that they are paid on incentives based on quantity of care rather than quality, that we have a structure that encourages quick fixes and overprescribing rather than the time-consuming process of actual care and healing, that patients can’t afford healthcare, that they go into debt over it, that they can’t afford healthy food, that they work too much to have time to take care of themselves, that mental health and prevention are so undervalued and underutilized, and that women seem to be the most screwed-over members in society on multiple, mind-blowing levels and hardly anyone seems to give a shit. I’m tired of all of this and more and I’m also tired of having to be a silent part of it and I guess I needed a break from my participation in it to think about what I can do with myself that will inspire me, make me feel more productive and like I’m making a bigger difference in the world, be able to be more myself and share my opinions freely about what I see without need to censor myself, and also that at the end of the day, will just feel right to me. I need to get back to following my most trusted resource: my gut.
I’m also an intellectually curious person. I’m a learner. I’ve been restless the last few years while in practice. I think it’s hard to do any one single thing for more than a decade, let alone two decades. I think it’s a kind of intellectual death to expect a person to keep being and doing only one thing for their entire lives, especially if they have a personality like this. We accept that kids keep growing and changing. Can we also expect and accept that adults do the same?
Realizing this about myself, I went back to school a few years ago to enroll in a master’s degree program in a thing called “healthcare leadership”. Honestly, I’m embarrassed by the pomposity of the name and I wasn’t even sure what I’d do with such a degree, but I liked the coursework, which was a hybrid of public health and business management courses and I thought it would help build on my background in medicine and that maybe that it would lead me down interesting, gratifying avenues. That has turned out to be true. My mind has bloomed with new ideas, and I’ve discovered a new passion for medical innovation and healthcare technology. It’s lead to some interesting new opportunities that seem to keep growing the more open I am and the more I put myself out there.
I’m excited about the future and where this will lead. It feels like an experiment. I know this could end up being a disaster. But still, I’m excited. It reminds me of what I love about science in the first place: making hypotheses, trying new experiments, discovering something previously unknown before…whether good or bad. Once in a rare while, there is even some magnificent discovery. I wonder what I’ll discover while living life using the scientific method? An experiment, even when the hypothesis is proved wrong, is a success in terms of learning and discovery. I try to remember that these are core things that I live for. (That’s why, for example, I love to travel.)
I’m now trying to think of creative ways to stay clinically engaged but in a more flexible way. I might moonlight, work part-time, in the clinic, or as a hospitalist. I’m not sure yet.
This month I’ll be back to seeing patients in a short-term position as a clinical researcher testing a women’s health device in a trial for a medtech company that is hoping to develop a better treatment for incontinence. I’m excited about that. What if it turns out to be better than surgery? What if it’s a revolution in terms of treatment of this problem? How nice if I can say I helped. Again, if it fails, it was still a worthy experiment.
I am also looking forward to continuing to work with and support startups trying to improve medicine and healthcare and I also hope to get more involved with charitable work, especially in support of women and girls. (Besides these issues, I also deeply care about animals, the environment, and the food system. It probably sounds nuts that I have so many causes!)
Once in a while I think,”What the hell am I doing? What is even my purpose here on Earth?” Am I here for others or for myself? To be the consummate doctor, to serve others? To learn and grow? To just enjoy life & have fun?
These questions used to torture me, but I’ve finally realized that it’s probably a little bit of all of these things, and maybe I should stop analyzing so much and yes…just follow my gut.
This should be an interesting experiment. There is, of course, no clear or guaranteed outcome, but I am taking joy in conducting it.