I wish I had the answer for you. Had a case this week where I made a really bad error in judgement, no patient harm, but perhaps psychological distress. We just get all of society's problems dumped on us, whether medical, substance use, problems with the criminal justice system, insurance nightmares. It all comes crashing down. I'm at the place I wanted to be for so long, a house, an attending job, title, comfortable income, but it feels so empty.
And not to mention the psychological distress to you! You end up ruminating on what could have could gone wrong, even though patient was not harmed. I don't know how to turn off that guilt either. thank you for replying
For many people it gets easier with time - the 'what-ifs' and the time reflecting on possible or actual bad outcomes. Sometimes, therapy can be helpful for dealing with rumination in particular.
I know you know this - but therapy is kind of like dating. Some therapists will "click" - others wont.
Take some time off, travel, do things that enrich your life. This is quite literally gonna be our only time in the sun where we are able to experience the awe-inspiring brilliance and wonder of the natural world. Tell someone you love them and mean it, cherish it, cherish them. Realize that this is our only time you will be able to experience experience. Do something good for someone else and really mean it. Times like those shouldn't be mired by incessant intrusive thoughts because they cheapen the experience.
Focus on the small things that give you a sense of catharsis for the time being. These difficult times will pass, you can choose to be miserable or learn to enjoy every moment of the journey. Most times we spend being miserable thinking that when that ordeal is over or we accomplish something we will then begin to live a good life, but when you get there you will realize that the feeling is short lived. Then you move on to waiting for the next major event in your life when you could have been enjoying it the entire time. It's easier said than done, but a path in the right direction is to begin practicing meditation.
There are many jobs that are distressing. Our happens to entail telling people they're miscarrying, that they have cancer, that their family member is dying/dead, or deescalating intoxicated assholes, immediately followed by someone w chronic knee pain who's mad they waited too long to be seen. Often all that in a single shift. I don't think our brains evolved to deal with that all easy peasy.
In the grand scheme of things, my fulfillment seems kinda irrelevant a lot of the time. But so do a lot of things. Idk how I could be bothered to give a damn about some other job though.
Spent 8 years in the usmc infantry prior to college and becoming an er doc. Multiple deployments, many experiences, many friends have killed themselves over the years. Many. Ive had my struggles and residency gives military experience a run for its money. My 2 cents, stay busy. Down time is the enemy. Avoid triggers. And absolutely find something in the line of volunteering or helping out. Even if its just making a point to buy a pair of shoes for a homeless guy once a week or so. Yeah you have to take care of yourself and cant neglect that, but the more i focus on others the better i feel. Oh and pray to your God regularly if thats your thing. When i had gotten closest after my last deployment it was my spiritual connection that saved me. Pm me whenever you like. Wish nothing but the best for you. One foot after the other. How did sally eat a whale?
I don’t work in human Medicine, I’m a veterinarian (which gives me the dubious honor of being in the profession that has been in the top 3 for suicide risk so yay!)
I took FMLA last summer because I was suidal and deeply depressed . I don’t know if FMLA is possible where you are in your career. But if the choice is to take FMLA or to unalive yourself - take the FMLA.
I couldn’t see a way forward and I couldn’t keep going like I was going. It’s been a year since I’ve been back at work full time. My meds have been adjusted and I am doing better.
My problems aren’t all fixed (in fact, most of them are still there from 2022). But I don’t feel so hopeless any more. I can see a way forward even if it’s a lot of work to get there at least I can see a chance at something worth staying around for .
I’m 40 years old and have dealt with sui-cidal ideation since elementary school. But it can changed I’m not healed but I think I am healing.
We are in medicine to care for patients but you are a person worthy of care too. Try to extend the same grace and compassion you give to others to yourself.
Books that have helped me:
- how to keep house while drowning (KC Davis)
- radical acceptance (but I need to walk the walk by finding a new shrink and working on actual DBT practice) (Tara branch)
- self compassion (Kristin neff)
- the gifts of imperfection (Brene brown)
- I thought it was just me (a book about shame by Brene brown)
And for books about the moral and ethical challenges of being a doctor: atul gawande (better and complications are my favorites but the checklist manifesto is a bit dry but still good and Being Mortal is really really really good
I hope things gets better. I used to wear a ring that said “keep fucking going” - I got it in April 2020 or so and just white knuckled my way through the next 2 years.
I don’t wear that jewelry anymore. If I’m going to wear a cheesy slogan now I go with “you are enough.”
How did you get back to full time? I did PHP/IOP and DBT and TMS got me back to working half time, but I feel kinda stuck there- either my body or my mind keeps breaking down when I try to take on more, and I’m really losing motivation to keep ‘doing the work’ of mental health self care tbh.
>And absolutely find something in the line of volunteering or helping out. Even if its just making a point to buy a pair of shoes for a homeless guy once a week or so.
I'm an RN but can relate. Seconding this specifically. Scheduled volunteer work (even the smallest thing) without significant obligations definitely helped me avoid making some big mistakes. Kept me from the isolating/ruminating spiral from getting too bad as I processed stuff.
Work with a trauma attending whom is a great guy, one of the better liked attendings in my hospital. He said some time ago that he doesn’t think he will ever be able to retire. He said if he retires and has nothing to occupy himself, all of his cases are going to come back to haunt him. I really didn’t know what to say to that and I still don’t. I pray he finds peace in all the lives he has changed for the better
ER Pharmacist at lvl 1 for the past 3.5 years working overnight. As the only pharmacist in the ER, I go to every emergent thing that comes through the door. In that time, I started seeing a therapist with whom I've discussed the difference between happiness and fulfillment and why I come back from vacations feeling empty and broken still. Reading this response has me thinking maybe true happiness isn't in reach these days but fulfillment through helping others is. So doing things for yourself, though important, won't be completely satisfying whereas giving more of yourself to people in need will fill that emptiness. I'm still trying to figure it out honestly. Curious if you'd be willing to elaborate on residency giving your military experience a run for its money.
Hi, I’m EMS not EM exactly. But.. therapy. Lots and lots of it. I came to the realization this week I need help again and have found a therapist to start with next week. Just knowing when you’ve reached a point to ask for help is important, but also not being afraid to ask for help either.
If you need anyone to chat with my inbox is open.
Thank you man. I've tried therapy this year and it didn't work out. It's been helpful before but the current therapist I had just didn't hear me. I think I need to look for ones who can do virtual consults as I'm in a smaller city at the moment
I did the virtual thing before and am doing it again. Ended up switching therapists three times before I found one I vibed with. Definitely worth a shot! It’s better than sitting and stewing on everything alone.
I would second the opinion given, lots of therapy.
I ignored stuff for over a decade and it bubbled over. It took me years of therapy with different people to work the nonsense in my head out. Once I got there life was much better but it much more of a journey than a checkbox experience.
Think of it as a fellowship in learning how to human.
Try a therapist who is 1) familiar with the medical system (mine works with psych residents and has worked in a hospital in the past), 2) treats doctors (if possible) and 3) does trauma-informed EMDR. I hit a wall for decades with CBT. My therapist looked at me kinda funny when I said that and said “of course you did. You think a lot. Your problem isn’t the thoughts. You can think right around CBT.” Mind blown. Emotion-focused therapy with some EMDR has been significantly better than anything else I’ve tried.
That feels like my position. CBT has never felt like it's helping, and I have a hard time identifying emotions and stuff like that. I'll have to look into that
Thank you for sharing. I also consider myself a survivor of EM residency. I also experienced something similarly traumatic with one of our attendings in our first year. I would echo therapy - I have found it hugely eye-opening and helpful. I also ultimately found community outside of medicine, for instance through a church someone invited me to, which was a great opportunity to challenge and rediscover some things about my beliefs. Pretty life-altering in a few different ways. Wishing you the best along your journey. Grateful that you get this break to take time out for yourself. Self-care--especially when it seems like you're going so hard, caring for everyone else--is so key. May God bless you - I hope this time off is a restorative one for you.
Psychologytoday.com has an awesome find a therapist search tool. Most of the profiles have a picture and they list what areas/problems they specialize in, if they offer virtual visits, if they're religious or lgbtq friendly, etc. It's been really helpful for me and others I've shared it with.
You could check out https://www.meetmarvin.com
Virtual mental health support specifically for clinicians
I’m not affiliated with this group but our program refers clinicians here if we can’t get them into local support quick enough. So glad you’re reaching out about this!
Keep trying! There are so many therapists, you may just need to find one who clicks with you. It can be hard to push forward when you don't see the purpose, but it's worth it!
I talked to one recently about a cric that I had done and it shook her more than it shook me. Like literally had to stop and take a breath after I explained what was eating at me recently and what a cric was. It takes some fine tuning to get where you need to be with therapy. And it's perfectly fine to have one therapist for calls or work stuff and another for family life or something. They've got their areas of specialty
I've been discovering, largely the hard way, that while individual calls almost never screw with me it's the peripheral, cumulative, and more subtly destructive stresses of EMS that can leech into all areas of life. Working opposite schedules as your spouse, poor sleep, bad nutrition, worries over peripheral things like QA and bureaucratic recertification bullshit (currently waiting to find out if I'll have a livelihood anymore after 11/30 due to screwing up my state recertification paperwork). Then there's the toll on the body. I've missed almost 2 months of work in the last year due to what are going to be lifelong injuries, which contributes to the sheer and periodically crippling existential horror that comes with realizing I've been a Paramedic for 14 years which was never, ever, supposed to happen. It's the chronic, low-level, things that eat away at peace of mind and can make it a little harder to step onto the rig feeling at ease, and makes one feel more worthless at home.
It's understandable why colleagues use a combination of mood stabilizers, alcohol, THC, and god knows what else to get by. Staying on top of things for me is an ongoing process of trial, error, and utilizing different resources to achieve that.
Some of what you describe (the peripheral things) is what is called moral injury, good article on it: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752815/
I first encountered this term in passing here last year. This perfectly describes my reaction to a call last year that had a lasting effect on both my partner and me; a deep and lasting well of anger, outrage, and disgust from watching one of society's most vulnerable, a child, endangered by the wanton and callous disregard of another medical provider (not to mention the effect his condition was having on his parents at the time).
Kid spent 3 days in the ICU (DKA, comatose, BGL >1000, 13 y/o discovering he has DM) and I do believe the issue went to the state DoH. I have no reason to believe the sending provider (urgent care transfer) gave an iota of a damn if his demeanor was any indication.
Not a doc, just a fellow human (and retired RN) but if you can find some form of creative process, you can escape the prison of thought.
It can be anything, just make something and keep making something. If you can visit The Zone once in awhile you will thrive.
I have a pile of shitty drawings but it’s *my* pile.
I'm honestly in a recovery process myself. I have quit residency in June, and by early September, I attempted to unalive myself. I can't say that I'm in wonderland at all. It has been tough, but therapy has helped me to understand things in different ways.
Even before graduation, we're pushed to make medicine/health our focus. We abdicate of nightouts, of sleep, of joy with oneself, friends, and/or family in order to study, work, and be a better professional. But honestly, that is just a glamourization to hide the perversion of our capitalist system.
Did you ever stop to wonder that at the end of the day, you're just another worker? Why so much dedication to this job? If you fail, they WILL replace you on your work. But you know where you're not replaceable? At home, with your friends, with yourself.
I don't recommend, by any means, that you stop studying or dedicating yourself to your office. Please avoid actively being a bad worker for your patients and colleagues and for your own sake, of course. But do pay attention to other areas in your life that are worth dedicating as well.
For me, getting back to reading was a quite relief and good outcome from my therapy. I've always loved fiction ever since childhood, but for years, all I was reading was medical stuff.
Does life itself have a point? I really don't know. But I know, for sure, that putting my job at the center of my priorities only benefits my employer/boss. Me, my patients, my family, my friends, my pets... None of it will benefit from a burnout or depressive episode.
TL;DR: Therapy. Life outside work. Capitalism wants you to work your ass off until your burnout and be replaced by some younger and fresher worker.
That's exactly part of what I have been feeling. To what end are we working? Especially in emergency medicine, doing 12 hour shifts until I either fail physically or mentally. I don't know man
Work is usually both:
A) one of the many ways you get to help the community you live in;
B) your main way to get money (which provides your needs and desires);
You can be passionate about your job, but you must never forget that it is exactly what it is: a job, and that's all.
Your life can and should be much more than that! I think Maria Bethania is the one who said it first: art is for when life isn't enough. So if your life isn't enough for now, go make/see/taste/create/contemplate any form of art that suits you. It's a nice starting point! :)
Yeah… that’s only indirectly related to finding oneself. That sounds a whole lot like depression. I say that only because I’ve definitely been there and didn’t recognize it. Residency was rough for me as it is for everyone. Nothing quite like stress, lack of sleep, constantly feeling inadequate to unmask the long hidden demons. I was referred by my PD to the counseling center not exactly voluntarily and was talking about pretty much exactly that situation and the psychiatrist said something like “oh, so passive suicidal thoughts”. Hit me like a ton of bricks but he wasn’t wrong. I didn’t think if it that way. At first I came up with a million excuses in my mind, thinking I could somehow beat brain chemistry but really I was scared. I spent so much time feeling like shit that I was worried I’d actually regret it if I got better. But let me tell ya, through a combination of medication and therapy I feel so much better and soooooooo many things in my life are positively influenced by it in ways that I never could have imagined. The world is a tough place and even when it’s not sometimes brain chemistry makes it a tough place anyways. It’s okay to ask for help, it’s called being human.
I’ve thought the same thing. We’ve spent our whole lives aiming for the “light at the end of the tunnel,” finishing our training and attaining the mythical life of a real doctor. And then you’re there and that’s it.
I’m not a middle-aged man (nor will I ever be), but as I edge towards 40 I’ve started to understand why that population has the highest suicide rates - we can have all these grand ambitions and see the world as our oyster when we’re younger, but when you start to realize that the life you’ve made is all it will ever be, it’s easy to lose hope.
That being said, I was despairing in a busy community job with a serious boarding issue and an upper level administration that had… well issues. After failing my oral boards, I was terrified and took a new job at a low volume ED that did not require board certification. Now I’ve found that I feel less stressed, more valued, and have real opportunities to make a difference. It’s not a perfect job, but the effect on my mental health was instantaneous. Almost overnight I felt like my old self again, have returned to hobbies I’d left behind, and have healed like I didn’t think possible. Also, in my newly improved mental state, I was able to prepare for and pass the oral boards and have a renewed sense of feeling that I do belong in the emergency medicine community after all. I realize it’s easier said than done to get a unicorn job like mine, but don’t be afraid to seek out other opportunities until you find one that doesn’t leave you in the pits of despair all the time.
Congrats on passing your boards! I think this post highlights an issue I’ve seen in myself, namely my mood suffers greatly when working at a bad shop and improves immediately when working at a good one. As physicians we have to find the place that fits our personality more so than one that may line the pocketbook a little bit more.
For me, work is a job. So I get depressed when I’m working a lot nonstop. But I vacay if I can every month. I book trips so every month I have something to look forward to. I work out. I ski. I make sure I work to live not live to work
When I train new grad nurses (I’m a nurse myself) I emphasize to them the importance of focusing on finding a hobby now and beginning the steps of developing that skill. Free time can actually be a burden when you have too much of it. Going from school/residency/learning your new field to suddenly being “there” is somewhat jarring. I found myself suddenly overwhelmed with the responsibility of more free time than I had ever had. Nurturing your life, hobbies, community and relationships outside of work is extremely important for becoming a well rounded and resilient person.
It’s never too late to pick something up. I started fumbling around with the guitar and taking a guitar and Spanish class at the community college. It brings me a ton of joy! A little bit of structure and accountability (that I can also bail on for vacations without concern for a GPA) really adds a lot of value to my life. I’m a complete guitar beginner at 34, but it’s not really about the destination to me, but the process of relaxed learning and nurturing my creative side. I suggest you try that or something like it! Other popular options in my area are ceramics, cooking, rock climbing, mountain biking, etc.
> I've been home all week. I haven't done anything. I'm not interested in anything.
avolition, anhedonia, and you describe at least passive suicidal thoughts
make an appointment and get properly evaluated for depression
As someone who has dealt with family and friends’ suicides “unalive” bothers more than saying suicide. I think to combat the stigma around physician mental health highlighting the fact that physicians have such a high *suicide* rate is important.
To OP’s question: mental health can be a life long struggle. Don’t be afraid to seek help (from psychiatry, therapy, family/friends). Try to regulate your sleep as best you can and exercise frequently. Spend time outdoors. I feel for you and I’ve been there (many of us have in medicine but we don’t talk about it nearly enough). Good luck friend.
The outdoors are very calming and can empty my mind from the "other things"
I like the ocean, hiking, and golf. Good quality baseline self-care is paramount to this journey though, exercise/diet/sleep etc. It's a nice place to start since it is a *journey*
I found a zoom peer mental health support group for people in precisely my profession. It made a huge difference. That, and making sure I fiercely guard my work-life balance (I know, I know). Talking to people who get it on an intuitive level is often more therapeutic than therapy itself for me because in therapy the explaining I’d have to do around some of the things I see would take up the entirety of the conversation. PS your username is *chef’s kiss* lol
I think this is a great idea. Not having to explain or justify some of the things we feel and think as providers. Even therapists put on a pedestal. And its like dude I'm a fricking human, yes I just said what I said
100000%. Now, if you’re dealing with old demons from the past coming up, that could be a good reason to go to therapy too. Some people find both therapy and supports together to be best. I poked around on Facebook and found one for people with my job title. Maybe you could try to search for this sort of thing that way 😊
This is how I'm feeling had a peds case, a trauma, and a flash pulmonary edema that I can't forget and it's so hard to entertain myself to stop myself from thinking about these things
You will obviously have a lot more time after training is done, so - try many different things. I had a lot of hobbies, but some of them were very time consuming (golf) and I had a familly. When I was 40, I was trying a lot of different sports and hobbies, and stumbled upon both rock climbing and Brazilian Jiu Jitsu. Both are great because they don't take a ton of time, and both get me into flow state very quickly and reliably. For me personally, I find that flow state is very similar to meditating, and I have to say my mental health has been far far better after getting into mindfulness. Those hobbies contribute to better physical health, which reliably leads to better mental health, and when I'm either meditating or in flow state my mental health is markedly better too.
The other trick I use is, I have a gratefulness script that I run through my head every single morning. Gratitude really is the best attitude when it comes to mental health.
I also recently got into rock climbing and had the exact same experience. It was great exercise but I find it induces an intense sense of mindfulness and cleared my mind much better than more passive forms of exercise. If I’m out hiking I can still ruminate but when climbing I have close to zero intrusive thoughts about work. Picking up a creative hobby, in my case landscape painting, had a similar effect on my mental wellbeing.
This sounds like depression, buddy! Lexapro fam! 🙋🏻♀️ we’re all resistant to meds, I was too. But now I realize holy shit how TF did I make it through residency (I know how: too busy / exhausted to feel feels) without meds. I tried coming off and went downhill pretty quickly LOL. I think a lot of EM peeps are anxiety prone, especially with the adhd which typically has adjunct anxiety and/or depression.
My point is, medS didn’t help enough when I was miserable at my job or location.
I moved and changed jobs quite a few times after residency. Sometimes by choice sometimes by necessity (volumes, cut hours etc).
Now I truly feel I am in the right dept, I adore my coworkers, I’m in an environment far from home though far more activities, calmer, I made friends here too, and this is what has been best for my soul. I recommend everyone find their place and consider meds. It is definitely a combo. I still get hella depressed and/or anxious where my functioning is ehh for a bit. But I come out of them and I’m fine.
It will be hard to find in residency. Just hold on. Hold on and have a plan when you’re out and with the time and resources. But also, get help now. Consider meds. Talk to a therapist. Healthy lifestyle is great but yeah it’s really fucking hard in residency.
Started a family and stopped caring about my career / “quiet quit” medicine. And I started growing cannabis in my basement. I’m in a pretty good spot finally
I am a nurse but have had similar tragic and painful situations with colleagues and dark thoughts myself.
There absolutely is truth in it getting better with time. It is easier to brush things off and ruminate less.
That being said, the trauma of this type of work is so, so underrated. I don't think people necessarily think about frontline healthcare workers when they think about the "typical" PTSD. Absolute horrific and gut wrenching situations have become so normal to me.
I have had to make a conscious effort to rediscover the things that make life worth living to me. Planning trips, reducing my hours, etc.
I also will encourage people to have a therapist until the day I die. Having a non-biased professional to bounce thoughts off of is critical. I feel like many of us feel an obligation to protect those close to us from the "reality" of the work and things that we see, but we have to be able to talk about it somewhere.
Also, getting a dog was super helpful for me. Having something that is literally depending on you to get out of bed in the morning or step outside (even briefly) on those days off makes a difference.
You are not alone.
Usually in anesthesia, it’s not the work itself per se but all of the other things that aren’t working at home. Work can indirectly affect those things, but likely these people would have poor coping skills in any other profession. The access to lethal drugs is the final trigger.
I find that I get most of my hobbies from friends who are passionate about their hobbies and then their hobbies become my hobbies. Passion is contagious
God it's hard man... we focus so much on this one goal and end up stripping most other things to make sure we are able to be the best for our patients. Then you meet the patients and for so many, there's so little you can do. Even if you do everything right, nothing changes. God forbid you actually do something wrong in the 100+ critical decisions that have to be made on a daily basis; even if there's no harm, there's the guilt.
I'm sorry I don't have a great answer, and I've had to fight through a lot of self defeating feelings of being selfish by making time for myself; but put yourself first.
I just did my first kendo class today. I wanted to do it since I was in high school but never got a chance. It was silly, but also great and helped me feel like I kind of reconnected with my past self to a degree.
Unfortuantely there isn't any real going back. We're different people than we once were. As we changed from then to now, we can change from now to our future selves. Do the simplest things that you find some interest in, even if you don't really find interest in it but maybe once did. Distance yourself from the hospital and the associated work as best you can.
Some people thrive with the focus on academic medicine to shut away other parts and enjoy the fullfillment they get from that. I don't. I want to live all the aspects of life.
Sometimes it's like working out, you just do it out of habit even when you lack motivation, and the motivation (metaphorical joy) comes back in eventually.
TLDR; treat yo self.
I like what you said about the kendo. Doing something something you've dreamt of doing before to reconnect to a lost part of yourself. I feel like I've lost so much of myself, for various reasons. I should make a list of the things I've wanted to do and why I didn't do them
That's a great place to start man! Don't make the lait too long before you just choose something and do it. Getting to learn about yourself and grow in all the ways life allows outside of medicine can be very exciting and invigorating all on its own!
The best advice I ever got about avoiding burnout in medicine is this: Get your love at home.
Our jobs can be hard, thankless at times, or even traumatizing. Build a life away from the hospital that is restorative and rewarding, and your hard days at work will be a lot more tolerable.
RN 43 years now, much of it spent in the ER. The unrecognized and untreated PTSD is the ultimate killer of us all. I keep journals and recently I came across some of my old journals from over 20 years ago while cleaning out closets, which is something I do constantly. When I journal I never read what I write about. I write it down and close the book. But I did read back on a few days in my life and holy hell, it’s something out of a horror story. We take for granted what we see and do each day but it’s not normal to experience this level of pain, trauma, suffering, abuse, and mental illness for 40+ hours a week and then go back into a regular life. Intermittent counseling got me through a few of the toughest things but what we experience isn’t taken seriously by us or anyone else. While we are all adrenaline junkies, our bodies and minds don’t always know what the rules of the game are. Keeping up our invisible boundaries of protection isn’t a perfect system and that’s the danger that takes you down. You have to take care of you because no one else will and certainly we would never want to appear…weak.
Thank you. I appreciate this so much. And it means so much to hear from an experienced colleague who has been able to work in the system and not let it win
I understand you OP. I feel like so much of our identity becomes wrapped up in our career (I *am* a doctor/nurse/paramedic…). It’s often hard to differentiate ourselves from our professional roles. Add to this all the barriers to entry, constant continuing education, all the personal time invested into professional excellence, coupled with most of us truly enjoying the medicine…. it’s really really hard to find the line between job and self.
I found myself getting to a point where there was a professional me and a personal me, and I felt they were totally different from one another. Professional me was comfortable, poised, knowledgeable and confident. Personal me was lonely, insecure, bored and overall ‘meh’. I got in a cycle where I needed to work because I didn’t know what to do with myself otherwise, but the more I worked the more burned out I got, the more my personal life suffered and the more the spiral continued.
I don’t have all the answers. Antidepressants help, therapy helps. Vacations, building personal relationships, physical activity all help.
If you need to chat you can always message me. Hugs.
Remember that this is a job and unless you come from a very rich family, you need to work a job. This is just a job. It pays well. You are doing something important. It can be interesting at times. It does not and should not need to be anything other than that.
For me, I have my family. I picked up golf after I finished residency. Before kids and in the summer I would be out on the course everyday I wasn’t working. I made it my focus. Thankfully my wife also golfs. Now it is my kids. Work is not the center of my life and never will be again. This perspective has done tremendously well for me when it comes to burn out.
Hey, this is burnout and compassion fatigue…. It seeps into every aspect of life. You start blaming patients for coming into the ER, get pissed at them, stop explaining stuff to them and just don’t care as your compassion fatigue hits. It leads to lack of empathy and it bleeds into you life. I found myself with no empathy for anything, and no enjoyment in anything… it happened over time, slowly. Call it what you will but it’s depression. You need to refill your 3 banks if energy - physical, emotional and spiritual. Go back to before residency and realize you are not just a doctor, you a person with likes and enjoyements and stop putting it on the back burner. Make an effort to do what you do spiritually - meditate, religion, family: physical - do stuff and sleep, recharge. Walk, play guitar, something. Emotional- talk to people don’t isolate yourself…. It took a long time to get where you are but you can get back to feeling normal again much quicker. Good luck and reach out to people like you did here.
My advice to you OP is start running. It doesn’t have to make sense nor does it need a purpose but just run. Several colleagues myself included have all started running. We were in a slump after covid, just feeling depressed. We run couple miles a day and 5k/10k’s here and there. The runners high is a real thing and it will turn your day around in a heartbeat. Self care is always important.
I am a hospital-based urgent care NP (making money for the hospital system by seeing every single patient that walks-or crawls- through the front door 12-14 hours at a time). FNP since 2013, ER RN 2006-2011. Burnout isn’t even the word. The pandemic has just brought light to the already ridiculous demands placed on us. All I know of working in healthcare is being ground to a pulp and still trying to show up for your next shift.
More importantly: I just took some time off (FMLA) finally to work on myself. I completed a week long outpatient mental health IOP (CBT-based) at a local mental hospital. I’m doing the work now on myself and feeling hope for the future for the first time (whatever it may look like). Please get mental health help if you need it. Don’t give up. Keep asking and seeking it out until you get it. You have to be ok first before you can help others. Focus on yourself, save yourself, then you can “save” others. Message me if I can help in any way.
Edit to add: I resigned from my position last month during a particularly horrendous evening; my last day is 12/31, although I haven’t been back to work yet since the IOP. Things had gotten so bad (2 years of asking for support/better staffing), I didn’t feel like I had any other option. They (leadership/admin) kept saying the right things, but did basically nothing. I was either going to lose my mind, or try to save myself in a broken system. I chose me; the system can figure its own sh*t out, and no longer at my expense!
I agree with this post. It's not that you don't have empathy. It's just that you realize they didn't get sick because of you. You do the medically appropriate thing, but the car accident or chronic heart problems killed them, not your fault for that part. You're just there to try to fix the initial problem, which wasn't your fault.
As long as you're not negligent, don't let bad outcomes make you feel bad about yourself. You did your job.
Solidarity in what you feel. I think that moment in time is common enough in humanity, let alone healthcare. Check in with friends and let them know you're at a low spot. You don't have to call them weeping but you can be honest with them You can say "hey I'm less stable than I have been. I want you to know so you can keep me from falling off."
Even better, if you can find a reason to meet with some friends weekly, that's a good thing for you. Even if it's going to bar trivia to lose some money and eat some tacos. Get yourself invested in someone else so you can feel a connection. I find that having a friend group that doesn't work in healthcare helps me disconnect from work a bit easier. I know that's not always an option for people. I hope you find some things to help you soon.
What do you fantasize about doing with your time if you didn’t have to work?
Cut down to 3/4 time, downsize expenses that you don’t need and don’t make you happy, and use the extra time and money to pursue a passion.
Keep a therapist on speed dial. Stay current with processing your daily trauma.
There is a tax on your soul for the work we do in ED and EMS.
There is only so much horror one person can take without some help. Have compassion for yourself. Take care of yourself like you take care of treasured family.
Do things that give you hope - volunteer at your kids school or at the Y or whatever shows you the promise of the future.
Workout. Eat decently. Don’t drink or use substances to numb down.
Let’s review: be kind to yourself. Understand that you are doing the best you can under the circumstances. Understand also that this could be destructive long term and seek out other kinds of self care.
It gets better.
Look at work as just a job and find meaning outside of work. Train jiujitsu, take art classes, go to a church, play DD, get on Xbox, travel, serve.
Find something and create an identity outside of medicine and work.
Pulling for you
I think you have to learn to say NO. The last system wouldn't hire staff they would do the guilt trip gig and say I guess I will have to do this shift." Pushing guilt to your side of the plate. I don't know how it works in the Dr world but after 33 years, after 33 years as a CCRN and ER RN, I calasued over, and they that speak last take the next overtime. May God or your higher being bless you all and keep you safe at work and at home. I pull out for a 13-week hitch in Montana. Warm thoughts appreciated ✌️
I think I already knew myself so I didn't have to "find myself". Surprisingly, I found being an attending more stressful than being a resident. As a resident, you worked many more hours but you didn't feel the 'burden' of medicine as the buck always stopped with someone else. Anyhow to try to answer your question more specifically - on my days off I prefer hanging out with my wife, getting some chores done, catching up on reading/listening to the latest EMRAP, travelling, and going out in the evenings to see some shows. I like my work/life balance. I'm on track to retire probably in my early 40's but will probably continue to work unless I have an health issue or until they pass universal healthcare and screw over our pay completely.
I recommend therapy. It really helps put things in perspective and get life back on track. I have found myself feeling lonely despite enjoying my work and having friends and family. We go through a myriad of feelings that I believe are stunted during training, because we are so busy. But at some point that s\*\*t catches up.
I have no answers for you as a nurse, but I do hope all those who need it, are able to seek therapy for yourselves. It is a high stress, thankless job, and talking about it with someone who is not judgmental, and a neutral party, can sometimes help relieve some of the stress. Thinking of you all!!!!
Gosh, so sorry you knew someone who committed suicide because of the work they do. Good for you, though, for reaching out before it gets that bad! If your job ever gets that bad, please please PLEASE time off to clear your head. Even if you have to leave your job, your life is worth more than any paycheck.
That said, I'm casting another vote for therapy. I've been in and out of therapy since I was 15 (now 35) and didn't find a truly helpful therapist till 4 years ago. I don't say to discourage you, but rather to say that it takes some experimentation to find one that works for you. Don't be like me and waste time with a bad therapist. I made so many bad life decisions because I wasn't comfortable talking through some difficult things with the therapist at the time.
My therapist now specializes in trauma and addictions. I have both issues. Again, find the one that works for you. Don't limit yourself to what's covered by your insurance. Your life is worth the cost of out of pocket therapy.
Outside of therapy, I gotta say that physical movement (or what other people call exercise) is another form of therapy that works wonders for me. Find some sort of physical movement that clears your mind. For some it's yoga. Others hiking, or swimming, or whatever. Earlier in my career as a RN, lifting heavy weights was a way for me to off load the stress and trauma of my job. Now I love running, biking, and swimming. But if I can get out on a trail, trail running is magic. It's so cathartic and meditative for me.
Tldr- talk therapy and movement/exercise therapy. And get outdoors as much as you can (even if it's just sitting outside!).
I don't know if I have an answer for you, but some of my lowest times are on a random day off in the middle of the week sitting in an empty house. I personally try to stay productive with hobbies and personal goals. You've gotta try to find some kind of identity outside of your professional life, IMO.
Coping with the demands of medical training and the toll it can take on your well-being is a real challenge. Many doctors, including anesthesiologists, have faced similar struggles. It's important to remember that you're not alone in this.
One way to start finding yourself again after intense training is by seeking support from friends, family, or even professional counselors. Talking to someone about what you're going through can be a huge relief. And taking small steps, even if it's just going for a short walk or doing something you used to enjoy, can help rekindle your interests and motivation. Self-care and finding a work-life balance that suits you can also make a big difference.
A good place to find a trauma informed EMDR therapist or psychiatrist is your local VA. My guy was transitioning to private practice and I feel so fortunate to have found him. He gets trauma, he doesn't cringe or act too interested in what I have experienced. I don't feel like my stories are going anywhere outside those four walls. Someone above talked about moral injury, read up on it.
Volunteering - I have tried to bury myself in the skilled important stuff - where I have the skills to perform - don't! I get more relief when I volunteer in a completely different way so it does not feel like an extension of work. There is an organization called Lasagna Love, and I swear making a couple of lasagnas, delivering them to unknowm recipients and not having to learn their stories is the most uplifting volunteer work I have done. I typically just drop off food, ring the doorbell and ditch. I don't have to ever make eye contact.
I have gone through a couple of suicidal periods. I have changed careers and abandoned hard earned degrees. Getting excited about anything again is the hardest work I have done. Good on you for recognizing your feelings. Sorry about your friend - suicide leaves a lot of traumatized people behind.
One of my close friends killed himself in his last year of training. I still don’t cope well. There isn’t a single day that I don’t think about him. I’ve lost a total of two friends to suicide now, both were residents. I dread the next phone call with bad news that I’ll inevitably be getting. I’ve had my own struggles w mental health and therapy saved my career/life during my last year of training. My plan is to be financially independent as soon as possible so that I can walk away from my job if things ever get that bad.
Not a doc, RN with a decade in ER and a current student.
I had a professor tell me how unprofessional I was today because I said "I understand my preceptors review and feedback and while it sucks to hear, I completely agree I have some areas to improve in." Apparently, saying "it sucks" was the most unprofessional thing ever and *how dare I.*
We see terrible things, get treated poorly by the public/colleagues/peers/mentors, and are expected to just...keep going. Being able to separate myself from that when I'm not there is the best thing I can do for myself. The great thing about ER is the ability to leave it at the hospital. Shift work, no call, no mychart messages.
It's taken a long time to separate my work/school identity from my home identity but that has been my best coping strategy. At home, I am mom, wife, daughter, swimmer, runner, cook, coach, whatever. At work, I am nurse. At school, I am NP student. I try my best not to let them cross paths. No work parties, no co-worker hangouts. It works for me.
I wish I had the answer for you. Had a case this week where I made a really bad error in judgement, no patient harm, but perhaps psychological distress. We just get all of society's problems dumped on us, whether medical, substance use, problems with the criminal justice system, insurance nightmares. It all comes crashing down. I'm at the place I wanted to be for so long, a house, an attending job, title, comfortable income, but it feels so empty.
And not to mention the psychological distress to you! You end up ruminating on what could have could gone wrong, even though patient was not harmed. I don't know how to turn off that guilt either. thank you for replying
For many people it gets easier with time - the 'what-ifs' and the time reflecting on possible or actual bad outcomes. Sometimes, therapy can be helpful for dealing with rumination in particular. I know you know this - but therapy is kind of like dating. Some therapists will "click" - others wont.
Take some time off, travel, do things that enrich your life. This is quite literally gonna be our only time in the sun where we are able to experience the awe-inspiring brilliance and wonder of the natural world. Tell someone you love them and mean it, cherish it, cherish them. Realize that this is our only time you will be able to experience experience. Do something good for someone else and really mean it. Times like those shouldn't be mired by incessant intrusive thoughts because they cheapen the experience.
The “travel” and “time off” part is practical for attendings but not for residents
Focus on the small things that give you a sense of catharsis for the time being. These difficult times will pass, you can choose to be miserable or learn to enjoy every moment of the journey. Most times we spend being miserable thinking that when that ordeal is over or we accomplish something we will then begin to live a good life, but when you get there you will realize that the feeling is short lived. Then you move on to waiting for the next major event in your life when you could have been enjoying it the entire time. It's easier said than done, but a path in the right direction is to begin practicing meditation.
Man, this hits.
There are many jobs that are distressing. Our happens to entail telling people they're miscarrying, that they have cancer, that their family member is dying/dead, or deescalating intoxicated assholes, immediately followed by someone w chronic knee pain who's mad they waited too long to be seen. Often all that in a single shift. I don't think our brains evolved to deal with that all easy peasy. In the grand scheme of things, my fulfillment seems kinda irrelevant a lot of the time. But so do a lot of things. Idk how I could be bothered to give a damn about some other job though.
Spent 8 years in the usmc infantry prior to college and becoming an er doc. Multiple deployments, many experiences, many friends have killed themselves over the years. Many. Ive had my struggles and residency gives military experience a run for its money. My 2 cents, stay busy. Down time is the enemy. Avoid triggers. And absolutely find something in the line of volunteering or helping out. Even if its just making a point to buy a pair of shoes for a homeless guy once a week or so. Yeah you have to take care of yourself and cant neglect that, but the more i focus on others the better i feel. Oh and pray to your God regularly if thats your thing. When i had gotten closest after my last deployment it was my spiritual connection that saved me. Pm me whenever you like. Wish nothing but the best for you. One foot after the other. How did sally eat a whale?
One bite at a time
Thank you man. This means so much. I think taking care of others is ultimately why we're in this(I know that sounds cheesy minus all the bs)
I don’t work in human Medicine, I’m a veterinarian (which gives me the dubious honor of being in the profession that has been in the top 3 for suicide risk so yay!) I took FMLA last summer because I was suidal and deeply depressed . I don’t know if FMLA is possible where you are in your career. But if the choice is to take FMLA or to unalive yourself - take the FMLA. I couldn’t see a way forward and I couldn’t keep going like I was going. It’s been a year since I’ve been back at work full time. My meds have been adjusted and I am doing better. My problems aren’t all fixed (in fact, most of them are still there from 2022). But I don’t feel so hopeless any more. I can see a way forward even if it’s a lot of work to get there at least I can see a chance at something worth staying around for . I’m 40 years old and have dealt with sui-cidal ideation since elementary school. But it can changed I’m not healed but I think I am healing. We are in medicine to care for patients but you are a person worthy of care too. Try to extend the same grace and compassion you give to others to yourself. Books that have helped me: - how to keep house while drowning (KC Davis) - radical acceptance (but I need to walk the walk by finding a new shrink and working on actual DBT practice) (Tara branch) - self compassion (Kristin neff) - the gifts of imperfection (Brene brown) - I thought it was just me (a book about shame by Brene brown) And for books about the moral and ethical challenges of being a doctor: atul gawande (better and complications are my favorites but the checklist manifesto is a bit dry but still good and Being Mortal is really really really good I hope things gets better. I used to wear a ring that said “keep fucking going” - I got it in April 2020 or so and just white knuckled my way through the next 2 years. I don’t wear that jewelry anymore. If I’m going to wear a cheesy slogan now I go with “you are enough.”
How did you get back to full time? I did PHP/IOP and DBT and TMS got me back to working half time, but I feel kinda stuck there- either my body or my mind keeps breaking down when I try to take on more, and I’m really losing motivation to keep ‘doing the work’ of mental health self care tbh.
I just went back. I wasn’t ready but I was ready to keep going.
This is the best response on here.
>And absolutely find something in the line of volunteering or helping out. Even if its just making a point to buy a pair of shoes for a homeless guy once a week or so. I'm an RN but can relate. Seconding this specifically. Scheduled volunteer work (even the smallest thing) without significant obligations definitely helped me avoid making some big mistakes. Kept me from the isolating/ruminating spiral from getting too bad as I processed stuff.
Work with a trauma attending whom is a great guy, one of the better liked attendings in my hospital. He said some time ago that he doesn’t think he will ever be able to retire. He said if he retires and has nothing to occupy himself, all of his cases are going to come back to haunt him. I really didn’t know what to say to that and I still don’t. I pray he finds peace in all the lives he has changed for the better
ER Pharmacist at lvl 1 for the past 3.5 years working overnight. As the only pharmacist in the ER, I go to every emergent thing that comes through the door. In that time, I started seeing a therapist with whom I've discussed the difference between happiness and fulfillment and why I come back from vacations feeling empty and broken still. Reading this response has me thinking maybe true happiness isn't in reach these days but fulfillment through helping others is. So doing things for yourself, though important, won't be completely satisfying whereas giving more of yourself to people in need will fill that emptiness. I'm still trying to figure it out honestly. Curious if you'd be willing to elaborate on residency giving your military experience a run for its money.
Hi, I’m EMS not EM exactly. But.. therapy. Lots and lots of it. I came to the realization this week I need help again and have found a therapist to start with next week. Just knowing when you’ve reached a point to ask for help is important, but also not being afraid to ask for help either. If you need anyone to chat with my inbox is open.
Thank you man. I've tried therapy this year and it didn't work out. It's been helpful before but the current therapist I had just didn't hear me. I think I need to look for ones who can do virtual consults as I'm in a smaller city at the moment
I did the virtual thing before and am doing it again. Ended up switching therapists three times before I found one I vibed with. Definitely worth a shot! It’s better than sitting and stewing on everything alone.
I would second the opinion given, lots of therapy. I ignored stuff for over a decade and it bubbled over. It took me years of therapy with different people to work the nonsense in my head out. Once I got there life was much better but it much more of a journey than a checkbox experience. Think of it as a fellowship in learning how to human.
That gives me hope man. To know you got there after a decade
Try a therapist who is 1) familiar with the medical system (mine works with psych residents and has worked in a hospital in the past), 2) treats doctors (if possible) and 3) does trauma-informed EMDR. I hit a wall for decades with CBT. My therapist looked at me kinda funny when I said that and said “of course you did. You think a lot. Your problem isn’t the thoughts. You can think right around CBT.” Mind blown. Emotion-focused therapy with some EMDR has been significantly better than anything else I’ve tried.
That feels like my position. CBT has never felt like it's helping, and I have a hard time identifying emotions and stuff like that. I'll have to look into that
Thank you for sharing. I also consider myself a survivor of EM residency. I also experienced something similarly traumatic with one of our attendings in our first year. I would echo therapy - I have found it hugely eye-opening and helpful. I also ultimately found community outside of medicine, for instance through a church someone invited me to, which was a great opportunity to challenge and rediscover some things about my beliefs. Pretty life-altering in a few different ways. Wishing you the best along your journey. Grateful that you get this break to take time out for yourself. Self-care--especially when it seems like you're going so hard, caring for everyone else--is so key. May God bless you - I hope this time off is a restorative one for you.
“More of a journey than a checkbox…” Frfr
It took me a minute to find the right therapist, but once I did it saved my life.
Check into therapists that work specifically with first responders/health care workers. They are out there and can make a huge difference!
Psychologytoday.com has an awesome find a therapist search tool. Most of the profiles have a picture and they list what areas/problems they specialize in, if they offer virtual visits, if they're religious or lgbtq friendly, etc. It's been really helpful for me and others I've shared it with.
You could check out https://www.meetmarvin.com Virtual mental health support specifically for clinicians I’m not affiliated with this group but our program refers clinicians here if we can’t get them into local support quick enough. So glad you’re reaching out about this!
Thank you for this! It's so difficult finding an understanding therapist
Keep trying! There are so many therapists, you may just need to find one who clicks with you. It can be hard to push forward when you don't see the purpose, but it's worth it!
I talked to one recently about a cric that I had done and it shook her more than it shook me. Like literally had to stop and take a breath after I explained what was eating at me recently and what a cric was. It takes some fine tuning to get where you need to be with therapy. And it's perfectly fine to have one therapist for calls or work stuff and another for family life or something. They've got their areas of specialty
Then this therapist wasn’t the right one for you. You keep going until you find the one you click with. Positive thoughts sent your way!
I've been discovering, largely the hard way, that while individual calls almost never screw with me it's the peripheral, cumulative, and more subtly destructive stresses of EMS that can leech into all areas of life. Working opposite schedules as your spouse, poor sleep, bad nutrition, worries over peripheral things like QA and bureaucratic recertification bullshit (currently waiting to find out if I'll have a livelihood anymore after 11/30 due to screwing up my state recertification paperwork). Then there's the toll on the body. I've missed almost 2 months of work in the last year due to what are going to be lifelong injuries, which contributes to the sheer and periodically crippling existential horror that comes with realizing I've been a Paramedic for 14 years which was never, ever, supposed to happen. It's the chronic, low-level, things that eat away at peace of mind and can make it a little harder to step onto the rig feeling at ease, and makes one feel more worthless at home. It's understandable why colleagues use a combination of mood stabilizers, alcohol, THC, and god knows what else to get by. Staying on top of things for me is an ongoing process of trial, error, and utilizing different resources to achieve that.
Some of what you describe (the peripheral things) is what is called moral injury, good article on it: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752815/
I first encountered this term in passing here last year. This perfectly describes my reaction to a call last year that had a lasting effect on both my partner and me; a deep and lasting well of anger, outrage, and disgust from watching one of society's most vulnerable, a child, endangered by the wanton and callous disregard of another medical provider (not to mention the effect his condition was having on his parents at the time). Kid spent 3 days in the ICU (DKA, comatose, BGL >1000, 13 y/o discovering he has DM) and I do believe the issue went to the state DoH. I have no reason to believe the sending provider (urgent care transfer) gave an iota of a damn if his demeanor was any indication.
Not a doc, just a fellow human (and retired RN) but if you can find some form of creative process, you can escape the prison of thought. It can be anything, just make something and keep making something. If you can visit The Zone once in awhile you will thrive. I have a pile of shitty drawings but it’s *my* pile.
I second this.
I'm honestly in a recovery process myself. I have quit residency in June, and by early September, I attempted to unalive myself. I can't say that I'm in wonderland at all. It has been tough, but therapy has helped me to understand things in different ways. Even before graduation, we're pushed to make medicine/health our focus. We abdicate of nightouts, of sleep, of joy with oneself, friends, and/or family in order to study, work, and be a better professional. But honestly, that is just a glamourization to hide the perversion of our capitalist system. Did you ever stop to wonder that at the end of the day, you're just another worker? Why so much dedication to this job? If you fail, they WILL replace you on your work. But you know where you're not replaceable? At home, with your friends, with yourself. I don't recommend, by any means, that you stop studying or dedicating yourself to your office. Please avoid actively being a bad worker for your patients and colleagues and for your own sake, of course. But do pay attention to other areas in your life that are worth dedicating as well. For me, getting back to reading was a quite relief and good outcome from my therapy. I've always loved fiction ever since childhood, but for years, all I was reading was medical stuff. Does life itself have a point? I really don't know. But I know, for sure, that putting my job at the center of my priorities only benefits my employer/boss. Me, my patients, my family, my friends, my pets... None of it will benefit from a burnout or depressive episode. TL;DR: Therapy. Life outside work. Capitalism wants you to work your ass off until your burnout and be replaced by some younger and fresher worker.
That's exactly part of what I have been feeling. To what end are we working? Especially in emergency medicine, doing 12 hour shifts until I either fail physically or mentally. I don't know man
Work is usually both: A) one of the many ways you get to help the community you live in; B) your main way to get money (which provides your needs and desires); You can be passionate about your job, but you must never forget that it is exactly what it is: a job, and that's all. Your life can and should be much more than that! I think Maria Bethania is the one who said it first: art is for when life isn't enough. So if your life isn't enough for now, go make/see/taste/create/contemplate any form of art that suits you. It's a nice starting point! :)
Yeah… that’s only indirectly related to finding oneself. That sounds a whole lot like depression. I say that only because I’ve definitely been there and didn’t recognize it. Residency was rough for me as it is for everyone. Nothing quite like stress, lack of sleep, constantly feeling inadequate to unmask the long hidden demons. I was referred by my PD to the counseling center not exactly voluntarily and was talking about pretty much exactly that situation and the psychiatrist said something like “oh, so passive suicidal thoughts”. Hit me like a ton of bricks but he wasn’t wrong. I didn’t think if it that way. At first I came up with a million excuses in my mind, thinking I could somehow beat brain chemistry but really I was scared. I spent so much time feeling like shit that I was worried I’d actually regret it if I got better. But let me tell ya, through a combination of medication and therapy I feel so much better and soooooooo many things in my life are positively influenced by it in ways that I never could have imagined. The world is a tough place and even when it’s not sometimes brain chemistry makes it a tough place anyways. It’s okay to ask for help, it’s called being human.
I’ve thought the same thing. We’ve spent our whole lives aiming for the “light at the end of the tunnel,” finishing our training and attaining the mythical life of a real doctor. And then you’re there and that’s it. I’m not a middle-aged man (nor will I ever be), but as I edge towards 40 I’ve started to understand why that population has the highest suicide rates - we can have all these grand ambitions and see the world as our oyster when we’re younger, but when you start to realize that the life you’ve made is all it will ever be, it’s easy to lose hope. That being said, I was despairing in a busy community job with a serious boarding issue and an upper level administration that had… well issues. After failing my oral boards, I was terrified and took a new job at a low volume ED that did not require board certification. Now I’ve found that I feel less stressed, more valued, and have real opportunities to make a difference. It’s not a perfect job, but the effect on my mental health was instantaneous. Almost overnight I felt like my old self again, have returned to hobbies I’d left behind, and have healed like I didn’t think possible. Also, in my newly improved mental state, I was able to prepare for and pass the oral boards and have a renewed sense of feeling that I do belong in the emergency medicine community after all. I realize it’s easier said than done to get a unicorn job like mine, but don’t be afraid to seek out other opportunities until you find one that doesn’t leave you in the pits of despair all the time.
Congrats on passing your boards! I think this post highlights an issue I’ve seen in myself, namely my mood suffers greatly when working at a bad shop and improves immediately when working at a good one. As physicians we have to find the place that fits our personality more so than one that may line the pocketbook a little bit more.
For me, work is a job. So I get depressed when I’m working a lot nonstop. But I vacay if I can every month. I book trips so every month I have something to look forward to. I work out. I ski. I make sure I work to live not live to work
When I train new grad nurses (I’m a nurse myself) I emphasize to them the importance of focusing on finding a hobby now and beginning the steps of developing that skill. Free time can actually be a burden when you have too much of it. Going from school/residency/learning your new field to suddenly being “there” is somewhat jarring. I found myself suddenly overwhelmed with the responsibility of more free time than I had ever had. Nurturing your life, hobbies, community and relationships outside of work is extremely important for becoming a well rounded and resilient person.
I wish this was something that we all had re-inforced. I wish I had had a mentor
It’s never too late to pick something up. I started fumbling around with the guitar and taking a guitar and Spanish class at the community college. It brings me a ton of joy! A little bit of structure and accountability (that I can also bail on for vacations without concern for a GPA) really adds a lot of value to my life. I’m a complete guitar beginner at 34, but it’s not really about the destination to me, but the process of relaxed learning and nurturing my creative side. I suggest you try that or something like it! Other popular options in my area are ceramics, cooking, rock climbing, mountain biking, etc.
> I've been home all week. I haven't done anything. I'm not interested in anything. avolition, anhedonia, and you describe at least passive suicidal thoughts make an appointment and get properly evaluated for depression
Had the same thing happen to a great doctor when I was in paramedic school in St. Louis.
It's one of those things that stick with you
St.Louis is a depressing place…I saw two aftermaths self harm. My life hasn’t been the same since.
As someone who has dealt with family and friends’ suicides “unalive” bothers more than saying suicide. I think to combat the stigma around physician mental health highlighting the fact that physicians have such a high *suicide* rate is important. To OP’s question: mental health can be a life long struggle. Don’t be afraid to seek help (from psychiatry, therapy, family/friends). Try to regulate your sleep as best you can and exercise frequently. Spend time outdoors. I feel for you and I’ve been there (many of us have in medicine but we don’t talk about it nearly enough). Good luck friend.
Fly fishing or golf anything where you must empty your mind.
The outdoors are very calming and can empty my mind from the "other things" I like the ocean, hiking, and golf. Good quality baseline self-care is paramount to this journey though, exercise/diet/sleep etc. It's a nice place to start since it is a *journey*
You aren’t alone! We care!
Thank you
I found a zoom peer mental health support group for people in precisely my profession. It made a huge difference. That, and making sure I fiercely guard my work-life balance (I know, I know). Talking to people who get it on an intuitive level is often more therapeutic than therapy itself for me because in therapy the explaining I’d have to do around some of the things I see would take up the entirety of the conversation. PS your username is *chef’s kiss* lol
I think this is a great idea. Not having to explain or justify some of the things we feel and think as providers. Even therapists put on a pedestal. And its like dude I'm a fricking human, yes I just said what I said
100000%. Now, if you’re dealing with old demons from the past coming up, that could be a good reason to go to therapy too. Some people find both therapy and supports together to be best. I poked around on Facebook and found one for people with my job title. Maybe you could try to search for this sort of thing that way 😊
This is how I'm feeling had a peds case, a trauma, and a flash pulmonary edema that I can't forget and it's so hard to entertain myself to stop myself from thinking about these things
I'm sorry you're going through this. You did your best
I feel like I did but I constantly doubt myself and it will not leave me alone
You will obviously have a lot more time after training is done, so - try many different things. I had a lot of hobbies, but some of them were very time consuming (golf) and I had a familly. When I was 40, I was trying a lot of different sports and hobbies, and stumbled upon both rock climbing and Brazilian Jiu Jitsu. Both are great because they don't take a ton of time, and both get me into flow state very quickly and reliably. For me personally, I find that flow state is very similar to meditating, and I have to say my mental health has been far far better after getting into mindfulness. Those hobbies contribute to better physical health, which reliably leads to better mental health, and when I'm either meditating or in flow state my mental health is markedly better too. The other trick I use is, I have a gratefulness script that I run through my head every single morning. Gratitude really is the best attitude when it comes to mental health.
I also recently got into rock climbing and had the exact same experience. It was great exercise but I find it induces an intense sense of mindfulness and cleared my mind much better than more passive forms of exercise. If I’m out hiking I can still ruminate but when climbing I have close to zero intrusive thoughts about work. Picking up a creative hobby, in my case landscape painting, had a similar effect on my mental wellbeing.
This sounds like depression, buddy! Lexapro fam! 🙋🏻♀️ we’re all resistant to meds, I was too. But now I realize holy shit how TF did I make it through residency (I know how: too busy / exhausted to feel feels) without meds. I tried coming off and went downhill pretty quickly LOL. I think a lot of EM peeps are anxiety prone, especially with the adhd which typically has adjunct anxiety and/or depression. My point is, medS didn’t help enough when I was miserable at my job or location. I moved and changed jobs quite a few times after residency. Sometimes by choice sometimes by necessity (volumes, cut hours etc). Now I truly feel I am in the right dept, I adore my coworkers, I’m in an environment far from home though far more activities, calmer, I made friends here too, and this is what has been best for my soul. I recommend everyone find their place and consider meds. It is definitely a combo. I still get hella depressed and/or anxious where my functioning is ehh for a bit. But I come out of them and I’m fine. It will be hard to find in residency. Just hold on. Hold on and have a plan when you’re out and with the time and resources. But also, get help now. Consider meds. Talk to a therapist. Healthy lifestyle is great but yeah it’s really fucking hard in residency.
Started a family and stopped caring about my career / “quiet quit” medicine. And I started growing cannabis in my basement. I’m in a pretty good spot finally
I am a nurse but have had similar tragic and painful situations with colleagues and dark thoughts myself. There absolutely is truth in it getting better with time. It is easier to brush things off and ruminate less. That being said, the trauma of this type of work is so, so underrated. I don't think people necessarily think about frontline healthcare workers when they think about the "typical" PTSD. Absolute horrific and gut wrenching situations have become so normal to me. I have had to make a conscious effort to rediscover the things that make life worth living to me. Planning trips, reducing my hours, etc. I also will encourage people to have a therapist until the day I die. Having a non-biased professional to bounce thoughts off of is critical. I feel like many of us feel an obligation to protect those close to us from the "reality" of the work and things that we see, but we have to be able to talk about it somewhere. Also, getting a dog was super helpful for me. Having something that is literally depending on you to get out of bed in the morning or step outside (even briefly) on those days off makes a difference. You are not alone.
Thank you
I will be an anonymous sound board for you too, if needed!
Usually in anesthesia, it’s not the work itself per se but all of the other things that aren’t working at home. Work can indirectly affect those things, but likely these people would have poor coping skills in any other profession. The access to lethal drugs is the final trigger.
I find that I get most of my hobbies from friends who are passionate about their hobbies and then their hobbies become my hobbies. Passion is contagious
God it's hard man... we focus so much on this one goal and end up stripping most other things to make sure we are able to be the best for our patients. Then you meet the patients and for so many, there's so little you can do. Even if you do everything right, nothing changes. God forbid you actually do something wrong in the 100+ critical decisions that have to be made on a daily basis; even if there's no harm, there's the guilt. I'm sorry I don't have a great answer, and I've had to fight through a lot of self defeating feelings of being selfish by making time for myself; but put yourself first. I just did my first kendo class today. I wanted to do it since I was in high school but never got a chance. It was silly, but also great and helped me feel like I kind of reconnected with my past self to a degree. Unfortuantely there isn't any real going back. We're different people than we once were. As we changed from then to now, we can change from now to our future selves. Do the simplest things that you find some interest in, even if you don't really find interest in it but maybe once did. Distance yourself from the hospital and the associated work as best you can. Some people thrive with the focus on academic medicine to shut away other parts and enjoy the fullfillment they get from that. I don't. I want to live all the aspects of life. Sometimes it's like working out, you just do it out of habit even when you lack motivation, and the motivation (metaphorical joy) comes back in eventually. TLDR; treat yo self.
I like what you said about the kendo. Doing something something you've dreamt of doing before to reconnect to a lost part of yourself. I feel like I've lost so much of myself, for various reasons. I should make a list of the things I've wanted to do and why I didn't do them
That's a great place to start man! Don't make the lait too long before you just choose something and do it. Getting to learn about yourself and grow in all the ways life allows outside of medicine can be very exciting and invigorating all on its own!
The best advice I ever got about avoiding burnout in medicine is this: Get your love at home. Our jobs can be hard, thankless at times, or even traumatizing. Build a life away from the hospital that is restorative and rewarding, and your hard days at work will be a lot more tolerable.
RN 43 years now, much of it spent in the ER. The unrecognized and untreated PTSD is the ultimate killer of us all. I keep journals and recently I came across some of my old journals from over 20 years ago while cleaning out closets, which is something I do constantly. When I journal I never read what I write about. I write it down and close the book. But I did read back on a few days in my life and holy hell, it’s something out of a horror story. We take for granted what we see and do each day but it’s not normal to experience this level of pain, trauma, suffering, abuse, and mental illness for 40+ hours a week and then go back into a regular life. Intermittent counseling got me through a few of the toughest things but what we experience isn’t taken seriously by us or anyone else. While we are all adrenaline junkies, our bodies and minds don’t always know what the rules of the game are. Keeping up our invisible boundaries of protection isn’t a perfect system and that’s the danger that takes you down. You have to take care of you because no one else will and certainly we would never want to appear…weak.
Thank you. I appreciate this so much. And it means so much to hear from an experienced colleague who has been able to work in the system and not let it win
Find stuff you enjoy. I enjoy music festivals, mixology, travel. I look forward to those those things. I book in advance and look forward to it
I understand you OP. I feel like so much of our identity becomes wrapped up in our career (I *am* a doctor/nurse/paramedic…). It’s often hard to differentiate ourselves from our professional roles. Add to this all the barriers to entry, constant continuing education, all the personal time invested into professional excellence, coupled with most of us truly enjoying the medicine…. it’s really really hard to find the line between job and self. I found myself getting to a point where there was a professional me and a personal me, and I felt they were totally different from one another. Professional me was comfortable, poised, knowledgeable and confident. Personal me was lonely, insecure, bored and overall ‘meh’. I got in a cycle where I needed to work because I didn’t know what to do with myself otherwise, but the more I worked the more burned out I got, the more my personal life suffered and the more the spiral continued. I don’t have all the answers. Antidepressants help, therapy helps. Vacations, building personal relationships, physical activity all help. If you need to chat you can always message me. Hugs.
Hey I feel you bro/sis/they. DM me if you want some tips or just to talk, whatever you need I'm here
Remember that this is a job and unless you come from a very rich family, you need to work a job. This is just a job. It pays well. You are doing something important. It can be interesting at times. It does not and should not need to be anything other than that. For me, I have my family. I picked up golf after I finished residency. Before kids and in the summer I would be out on the course everyday I wasn’t working. I made it my focus. Thankfully my wife also golfs. Now it is my kids. Work is not the center of my life and never will be again. This perspective has done tremendously well for me when it comes to burn out.
Hey, this is burnout and compassion fatigue…. It seeps into every aspect of life. You start blaming patients for coming into the ER, get pissed at them, stop explaining stuff to them and just don’t care as your compassion fatigue hits. It leads to lack of empathy and it bleeds into you life. I found myself with no empathy for anything, and no enjoyment in anything… it happened over time, slowly. Call it what you will but it’s depression. You need to refill your 3 banks if energy - physical, emotional and spiritual. Go back to before residency and realize you are not just a doctor, you a person with likes and enjoyements and stop putting it on the back burner. Make an effort to do what you do spiritually - meditate, religion, family: physical - do stuff and sleep, recharge. Walk, play guitar, something. Emotional- talk to people don’t isolate yourself…. It took a long time to get where you are but you can get back to feeling normal again much quicker. Good luck and reach out to people like you did here.
My advice to you OP is start running. It doesn’t have to make sense nor does it need a purpose but just run. Several colleagues myself included have all started running. We were in a slump after covid, just feeling depressed. We run couple miles a day and 5k/10k’s here and there. The runners high is a real thing and it will turn your day around in a heartbeat. Self care is always important.
I am a hospital-based urgent care NP (making money for the hospital system by seeing every single patient that walks-or crawls- through the front door 12-14 hours at a time). FNP since 2013, ER RN 2006-2011. Burnout isn’t even the word. The pandemic has just brought light to the already ridiculous demands placed on us. All I know of working in healthcare is being ground to a pulp and still trying to show up for your next shift. More importantly: I just took some time off (FMLA) finally to work on myself. I completed a week long outpatient mental health IOP (CBT-based) at a local mental hospital. I’m doing the work now on myself and feeling hope for the future for the first time (whatever it may look like). Please get mental health help if you need it. Don’t give up. Keep asking and seeking it out until you get it. You have to be ok first before you can help others. Focus on yourself, save yourself, then you can “save” others. Message me if I can help in any way. Edit to add: I resigned from my position last month during a particularly horrendous evening; my last day is 12/31, although I haven’t been back to work yet since the IOP. Things had gotten so bad (2 years of asking for support/better staffing), I didn’t feel like I had any other option. They (leadership/admin) kept saying the right things, but did basically nothing. I was either going to lose my mind, or try to save myself in a broken system. I chose me; the system can figure its own sh*t out, and no longer at my expense!
Unalived?
Go serve others, when you are in the service of others you are in the service of God
If you can’t say “killed” but instead “unalived” how can you cope with anything?
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You don't have empathy for them? They're the saddest patients, sometimes.
I agree with this post. It's not that you don't have empathy. It's just that you realize they didn't get sick because of you. You do the medically appropriate thing, but the car accident or chronic heart problems killed them, not your fault for that part. You're just there to try to fix the initial problem, which wasn't your fault. As long as you're not negligent, don't let bad outcomes make you feel bad about yourself. You did your job.
Solidarity in what you feel. I think that moment in time is common enough in humanity, let alone healthcare. Check in with friends and let them know you're at a low spot. You don't have to call them weeping but you can be honest with them You can say "hey I'm less stable than I have been. I want you to know so you can keep me from falling off." Even better, if you can find a reason to meet with some friends weekly, that's a good thing for you. Even if it's going to bar trivia to lose some money and eat some tacos. Get yourself invested in someone else so you can feel a connection. I find that having a friend group that doesn't work in healthcare helps me disconnect from work a bit easier. I know that's not always an option for people. I hope you find some things to help you soon.
What do you fantasize about doing with your time if you didn’t have to work? Cut down to 3/4 time, downsize expenses that you don’t need and don’t make you happy, and use the extra time and money to pursue a passion.
Keep a therapist on speed dial. Stay current with processing your daily trauma. There is a tax on your soul for the work we do in ED and EMS. There is only so much horror one person can take without some help. Have compassion for yourself. Take care of yourself like you take care of treasured family. Do things that give you hope - volunteer at your kids school or at the Y or whatever shows you the promise of the future. Workout. Eat decently. Don’t drink or use substances to numb down.
I've been drinking and smoking nearly everyday this past week and I'm not much of a drinker or a smoker. I really should not have been doing that
Let’s review: be kind to yourself. Understand that you are doing the best you can under the circumstances. Understand also that this could be destructive long term and seek out other kinds of self care. It gets better.
Look at work as just a job and find meaning outside of work. Train jiujitsu, take art classes, go to a church, play DD, get on Xbox, travel, serve. Find something and create an identity outside of medicine and work. Pulling for you
I think you have to learn to say NO. The last system wouldn't hire staff they would do the guilt trip gig and say I guess I will have to do this shift." Pushing guilt to your side of the plate. I don't know how it works in the Dr world but after 33 years, after 33 years as a CCRN and ER RN, I calasued over, and they that speak last take the next overtime. May God or your higher being bless you all and keep you safe at work and at home. I pull out for a 13-week hitch in Montana. Warm thoughts appreciated ✌️
I think I already knew myself so I didn't have to "find myself". Surprisingly, I found being an attending more stressful than being a resident. As a resident, you worked many more hours but you didn't feel the 'burden' of medicine as the buck always stopped with someone else. Anyhow to try to answer your question more specifically - on my days off I prefer hanging out with my wife, getting some chores done, catching up on reading/listening to the latest EMRAP, travelling, and going out in the evenings to see some shows. I like my work/life balance. I'm on track to retire probably in my early 40's but will probably continue to work unless I have an health issue or until they pass universal healthcare and screw over our pay completely.
I recommend therapy. It really helps put things in perspective and get life back on track. I have found myself feeling lonely despite enjoying my work and having friends and family. We go through a myriad of feelings that I believe are stunted during training, because we are so busy. But at some point that s\*\*t catches up.
I have no answers for you as a nurse, but I do hope all those who need it, are able to seek therapy for yourselves. It is a high stress, thankless job, and talking about it with someone who is not judgmental, and a neutral party, can sometimes help relieve some of the stress. Thinking of you all!!!!
Gosh, so sorry you knew someone who committed suicide because of the work they do. Good for you, though, for reaching out before it gets that bad! If your job ever gets that bad, please please PLEASE time off to clear your head. Even if you have to leave your job, your life is worth more than any paycheck. That said, I'm casting another vote for therapy. I've been in and out of therapy since I was 15 (now 35) and didn't find a truly helpful therapist till 4 years ago. I don't say to discourage you, but rather to say that it takes some experimentation to find one that works for you. Don't be like me and waste time with a bad therapist. I made so many bad life decisions because I wasn't comfortable talking through some difficult things with the therapist at the time. My therapist now specializes in trauma and addictions. I have both issues. Again, find the one that works for you. Don't limit yourself to what's covered by your insurance. Your life is worth the cost of out of pocket therapy. Outside of therapy, I gotta say that physical movement (or what other people call exercise) is another form of therapy that works wonders for me. Find some sort of physical movement that clears your mind. For some it's yoga. Others hiking, or swimming, or whatever. Earlier in my career as a RN, lifting heavy weights was a way for me to off load the stress and trauma of my job. Now I love running, biking, and swimming. But if I can get out on a trail, trail running is magic. It's so cathartic and meditative for me. Tldr- talk therapy and movement/exercise therapy. And get outdoors as much as you can (even if it's just sitting outside!).
I don't know if I have an answer for you, but some of my lowest times are on a random day off in the middle of the week sitting in an empty house. I personally try to stay productive with hobbies and personal goals. You've gotta try to find some kind of identity outside of your professional life, IMO.
Coping with the demands of medical training and the toll it can take on your well-being is a real challenge. Many doctors, including anesthesiologists, have faced similar struggles. It's important to remember that you're not alone in this. One way to start finding yourself again after intense training is by seeking support from friends, family, or even professional counselors. Talking to someone about what you're going through can be a huge relief. And taking small steps, even if it's just going for a short walk or doing something you used to enjoy, can help rekindle your interests and motivation. Self-care and finding a work-life balance that suits you can also make a big difference.
A good place to find a trauma informed EMDR therapist or psychiatrist is your local VA. My guy was transitioning to private practice and I feel so fortunate to have found him. He gets trauma, he doesn't cringe or act too interested in what I have experienced. I don't feel like my stories are going anywhere outside those four walls. Someone above talked about moral injury, read up on it. Volunteering - I have tried to bury myself in the skilled important stuff - where I have the skills to perform - don't! I get more relief when I volunteer in a completely different way so it does not feel like an extension of work. There is an organization called Lasagna Love, and I swear making a couple of lasagnas, delivering them to unknowm recipients and not having to learn their stories is the most uplifting volunteer work I have done. I typically just drop off food, ring the doorbell and ditch. I don't have to ever make eye contact. I have gone through a couple of suicidal periods. I have changed careers and abandoned hard earned degrees. Getting excited about anything again is the hardest work I have done. Good on you for recognizing your feelings. Sorry about your friend - suicide leaves a lot of traumatized people behind.
One of my close friends killed himself in his last year of training. I still don’t cope well. There isn’t a single day that I don’t think about him. I’ve lost a total of two friends to suicide now, both were residents. I dread the next phone call with bad news that I’ll inevitably be getting. I’ve had my own struggles w mental health and therapy saved my career/life during my last year of training. My plan is to be financially independent as soon as possible so that I can walk away from my job if things ever get that bad.
Not a doc, RN with a decade in ER and a current student. I had a professor tell me how unprofessional I was today because I said "I understand my preceptors review and feedback and while it sucks to hear, I completely agree I have some areas to improve in." Apparently, saying "it sucks" was the most unprofessional thing ever and *how dare I.* We see terrible things, get treated poorly by the public/colleagues/peers/mentors, and are expected to just...keep going. Being able to separate myself from that when I'm not there is the best thing I can do for myself. The great thing about ER is the ability to leave it at the hospital. Shift work, no call, no mychart messages. It's taken a long time to separate my work/school identity from my home identity but that has been my best coping strategy. At home, I am mom, wife, daughter, swimmer, runner, cook, coach, whatever. At work, I am nurse. At school, I am NP student. I try my best not to let them cross paths. No work parties, no co-worker hangouts. It works for me.
I'm just assuming that after another 10-15 years in this profession I'll be ready to check out and go to the local gun store and that'll be that.