By Paula A. Sinclair, MD

If you hadn’t smoked your whole goddam life, I would be asleep right now. This thought floated through my brain as I stood waiting for the elevator to take me to where an old man with emphysema was gasping for breath. It was 4 a.m. I was a second-year resident on call. I had been working almost 24 hours with barely time to pee, let alone sleep. And here I was called to yet another emergency. The thought that floated through my brain was less than honorable, less than compassionate, and I was not proud of it. But, there it was.

I had gone into medicine with all my heart, believing it to be my destiny to put whatever talents I had into helping others. High-minded. Passionate. Inspired. And it all went out the window in that moment. All I could think about was myself. A certain paranoia lurked in that thought, as if the patients were conspiring against me, just to see how far I could be beaten down before I broke. I would have stood in proud judgment of any physician who confessed such thoughts, until I stood in that elevator bay and found my breaking point.

Of course I handled the emergency. A single idle thought was not enough to derail my clinical skills. Thank God. But it gave me pause. As a physician I was supposed to be perfect. Perfect in my diagnostic acumen, perfect in my clinical judgment, perfect in my professionalism. And here I had had an uncharitable thought of someone who was suffering, someone who needed my help. The last thing I was supposed to think came to mind, and I was both chagrined and defensive. The fact of the matter was that the patient had smoked his lungs into a pair of useless bags, and that his struggle prevented me from getting sleep. These were true. But was I now a bad physician because I had needs of my own?

Our profession is one of self denial. We are told that if we work hard, deny ourselves sleep, rest, recreation, meals, even our bodily functions, in the name of our training, we will be awarded with a rewarding and prestigious career helping others. Then a doctor jumps off the roof of the ambulatory care center to his death. There’s a disconnect. We adroitly distance ourselves, tell ourselves we are different, that that person had mental health problems, depression, and should have gotten help. We even say they should get out of medicine if they cannot take the stress. But perhaps their suffering is a matter of degree, a final edge of the continuum that starts with an uncharitable elevator thought.

Fast forward twenty years. An anxious patient with a multitude of psychosomatic symptoms I can’t do anything to fix comes at me with yet one more complaint, and something inside my head screams at him, “Will you shut up!” Again, I am taken aback. I pride myself on my patience, my compassion, my empathy. But here I am exhausted, thinking uncharitable thoughts, and inwardly chiding myself for not being able to be those things in this moment. I end the patient visit graciously and move on to the next.

When I went into medicine it didn’t occur to me that I would ever tire of it, that I would ever want to walk away from it. That the day would come when patients would seem like parasites, each taking a little piece of me as the day goes on. There’s a disconnect, a chasm between my grand aspirations and the reality of what I have become: a burned-out doctor.

What next? Certainly not jumping off the roof of the ambulatory care center. And certainly not continuing as I am. The answer lies somewhere in between, but what that place is remains to be seen. There’s no medical textbook I can open that tells me how to manage burn out. Nothing in the seven-year curriculum that was medical training prepared me to face the biggest occupational hazard of my profession. We don’t talk about it. Everything in our training teaches us to be like titanium: untouchable, indefatigable, adamant. Not human. Superhuman. Until we burn out and feel subhuman. The disconnect again.

I am leaving medicine. To do what, I don’t know. Surely the skills and experience accrued over the years have value to someone. The practice of medicine has been lucrative, to be sure, but the administrative burden, the endless needs of patients, and the hours spent at home charting are sucking the life out of me. When did the money stop being a temptation? Money comes and goes, but time just goes. And my final deathbed words won’t be: I wish I had spent more time at the clinic.

Paula A. Sinclair is a family physician.