Old Flame

I listened to a Planet Money podcast, Episode #740, this week. Burnout dealt with the origin and characteristics of burnout, and I would highly recommend it.

You’ve all heard the term and have a vague knowledge of what burnout is, I’m sure. You may have experienced it yourself. It affects call center employees (as in the podcast), all sorts of service workers, doctors and other healthcare providers and countess others.

Looking back on it, I have experienced various degrees of burnout several times in my career in medicine. The symptoms I have fought with, sometimes silently, have included extreme fatigue, emotional withdrawal, disinterest, lack of a sense of purpose, lack of motivation, lack of joy, and decreased participation in enjoyable activities.

I was not depressed. One does not have to be clinically depressed to be burned out. I was simply existing, performing my various tasks and duties day in and day out with little sense of accomplishment or joy. I did not take to my bed for days or weeks at a time, I did not stop eating, and I was not physically ill in the strictest sense of the word.

It was also not directly or solely related to the number of hours I was working at the time. Lord knows there were times during my residency and moonlighting days that it felt like all I did was work, but I was not burned out. Not yet.  It was not related to the difficulty of the work being done. Even now, I average from 60-65 hours of work many weeks, and yet I have never been happier than I am right now.

What are some possible causes of burnout in medicine, or in other areas of endeavor, today?

We are living in an age of marked increases in bureaucracy, regulation, paperwork, and attention to electronic detail like no previous time in the history of work.

We are engaged in mindless busy work, often related to the changes above, that keeps us maddeningly active but leading to much less focus on what is important or even expedient. I have often told my staff that I look for efficiency of process, yes, but that much more important to me is evidence of efficacy in treatment. Both are necessary. I just happen to think that the latter is more important to the wellbeing of the patient.

We are often caught not seeing the forest for the millions of trees before us. In fact, we are now forced to look at so any trees, branches of trees, groves of trees, leaves on those trees, that we have almost completely forgotten what the concept of a forest as a whole is. We have lost sight of what is truly important. We can no longer focus on one paramount outcome or goal, because there are myriad concerns and regulations and rules and reports that must be completed on time, every time, to satisfy someone’s lust for minutiae.

Then there is the firehose phenomenon. No matter how thirsty one is, it is extremely difficult to drink from a fully opened and gushing firehose. We may start out our careers thirsting for knowledge, new skills and professional fulfillment, and even joy in our work, only to be drowned by the sheer volume of information, change, and regulation in our twenty-first century world. This is akin to emotional, intellectual and professional waterboarding, and we now know just how effective that technique really is.

So, all that being said, what works for me when I feel myself sliding towards burnout? I am almost ready to start my seventh decade of life, and there is one thing that has never failed me yet.


When I get tired, overwhelmed, bored, or burned out, I have to tell myself, consciously sometimes, to go back to the basics. In medical school, I learned to solicit information by listening to stories. Stories from professors, mentors, and supervisors. Stories from patients, families, spouses, siblings, children and parents. Stories from courts, judges, attorneys and guardians ad litem. Stories from case reports, textbooks, “pot cases” in pathology (ask me about that another day), and grand rounds presentations.

My professional life, indeed most of my life in general, has been built on stories.

When I am sad, tired, fatigued, upset, feeling sorry for myself or feel that I have lost my way, I hit the reset button in my brain. I try to stop over thinking, worrying, obsessing, catastrophizing, planning, scheming, and controlling.

I listen to a good audiobook (or two). Churchill’s The History of the English Speaking Peoples and David McCullough’s The Wright Brothers are my current guiding stars. Oh, and I really listen to them. No multitasking allowed.

I go back to really listening to the stories of my patients. The happy, sad, terrible, frightening, terrifying, disgusting, off-putting, affirming, enlightening, and uplifting ones. All of them. I approach each patient encounter as an opportunity, and in fact a privilege,  to hear a new life story and do something about it. Just today, as I was writing the outline of this post, I resolved that I would start each patient visit this afternoon with the phrase, “Tell me your story.” I did just that. That little change in how I started my interview of my patients today made a world of difference in how I approached my job.

I listen to the stories of my grandchildren. What stories they can tell, long ones and short ones and one sentence ones and multi-paragraph ones about their bedrooms in their new house and their dogs, and their new baby sister, and Power Rangers. On one recent visit, it was so refreshing to accept my almost three-year-old granddaughter’s invitation to go up to her bedroom, lie down on the floor, and have her give me a running commentary on the recent activities of every Disney princess she and her siblings own.

I listen to the stories my love, who is now my wife of thirteen days, brings to our conversations. It doesn’t matter whether they are common stories we share from our teen years in Rome, Georgia, our recent travels to Europe, hiking in the mountains, or some of her trials and tribulations aboard an Airbus at thirty thousand feet over the Atlantic. They are words that connect us, that forge a strengthening bond that is one of the most cherished ones I have at this point in my life.

Life, my life, your life, is a story.

Mine began in Rome, Georgia, on October 24, 1957. I do not know when it will end.

I do know that it will continue to be a rich tapestry of work, play, disappointment, fear, exhilaration, wonder, challenge, and love. If I continue to actively write my own story, every day, being fully present in it, and listen to  the stories of others all around me,  I will continue to live life to the fullest.

Burnout is not the normal, or desirable, state of things.

Fire, as we have recently seen, can destroy and consume.

It can also light our path forward and keep us from falling headlong into the darkness of despair.


3 thoughts on “Old Flame

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