It’s time to come clean.
I have suffered from ASLS – acute self-loathing syndrome. And to be clear, it is pronounced just like you’d think. I’m lucky, as some people have the more serious ASHLS – acute self-hate/loathing syndrome. Finally, there is the metastatic form – MASHLS – where the afflicted cause everyone around them to feel ill. I’ve had a few bouts with MASHLS myself over the years, and it is horrible. You can’t stand where you are and what you do, you feel unable to bring about any positive change in your work/career, and you want no one and everyone to know about it.
The cause of MASHLS is all too often the not ironically named pesky virus massivus a$$holus. You know, the tireless, relentless, exponentially exploding army of Burberry and Prada clad healthcare administrators that has never touched a patient in their entire life but have somehow intertwined themselves into the very DNA of the doctor-patient relationship.
And absolutely no joke, the episodes of MASHLS truly are dangerous, because the support people and support systems too often want to quarantine the afflicted so as to not get caught up by the contagion of despair. They simply don’t know what to do with people who feel so trapped and lost at the same time. It leaves the victim further victimized. It can be the start – or the end – of spiraling out of control.
I’ve been lucky enough to find an effective cure for MASHLS by getting out of those increasingly hopeless situations, but it nonetheless can return, and all too often does. I’ve simply been blessed more than others to have the ability to make changes when needed. Fear of change runs deep through human nature, and that fear of change keeps too many chained to abuse. It’s like an event horizon for so many – once reached – they will never be able to escape.
Of course, none of this is real DSM-V disease. It is a ridiculously lame attempt to make this topic more approachable for those that can’t relate by experience. It would also be better described as chronic self-loathing syndrome, but CSLS just isn’t funny. An acronym that sounds like a naughty word makes me chuckle, after all, I am a kid doctor. And we desperately need moments of levity as we take the journey down this rabbit hole together.
Sadly, a change of scenery all too often does not eliminate the problems we face, and ASLS/CSLS creeps in again. Some docs are blessed with an immunity to this disease, but that comes at the price of often turning a blind eye and deaf ear to those who cannot fend off the attack of externally created self-loathing in order to preserve themselves. I get it, and begrudge them nothing.
We should be one another’s professional support systems, but that sounds like – and would be – a lot of extra work for people who are already exhausted from their own careers. Just because one appears impervious to ASLS/CSLS doesn’t mean they have the energy to help others. It’s hard enough for those folks to keep their own stuff together. So the sufferers keep on suffering. We have no wide-spread, formal systems to deal with this crisis. Just downtrodden docs fending for themselves.
My sarcastic, sardonic wit has been my most valuable survival advantage so far. Humor has been one of my only effective shields against despair. When I stop laughing at the ridiculous predicaments in which I sometimes find myself, it is time to move on. For other docs, coping can be booze, or drugs, or affairs, leaving the healthcare sector altogether, or suicide. The last being the total absence of self-love. Desperation and darkness. The event horizon for the soul.
With my childhood friend’s suicide, I’m running out of ways to find any of these heavy matters humorous, tolerable or humane. We’ve been largely abandoned by our own professional organizations except for a little lip service about physician wellness, and there is no mechanism to bite back or formalize repercussions against those who abuse us. We need help. No cavalry is coming.
Quite honestly, DSM-V doesn’t remotely come close to meeting our needs. Between anxiety, depression, fear of litigation, tolerance of abuse, dehumanization of the most human of professions, we needed a new classification anyway. So ASLS/ASHLS/MASHLS/CSLS is born. And while I won’t get a much-deserved Nobel prize for this brilliance, I’ll sure as hell going to try and help my fellow docs get better.
Sure, we are a high strung bunch of folks, with a lot of OCD and anxiety tendencies. Those are common threads through so many in our profession. They are useful traits that help us succeed in many situations and are desirable for long-term success when kept in check. And depression – more common than any of us would openly admit. But if you show me an oncologist who has never been a little depressed by their work, then you are showing me someone I would never let treat me or my family. I would fear they have a total lack of empathy.
Mild depression is probably a baseline in 30% of our profession. I don’t think we can get a survey to really answer that, because we won’t answer it honestly. Pride, fear of showing weakness and fear of punishment let the elephant sit in the room completely unnoticed. And most importantly, it isn’t typically our own psychiatric tendencies that lead to ASLS/CSLS spectrum disease, but rather external assaults on our psychiatric well-being.
Fact – a little over a year ago, I asked my former regional CEO if there were any dedicated, developed, shared programs in our massive, multi-state benevolent non-profit healthcare system focused on physician well-being. No. None. Sorry. Just keep smiling. My MASHLS immediately flared.
After my last writing that touched on suicide, one of my dearest and oldest (sorry LKF!) childhood friends asked if greed was the driving force in this quagmire of medical psychiatric assault. It is certainly contributory, but the root cause for many that suffer ASLS/CSLS is their dehumanization. Dedicated, experienced, kind, compassionate physicians feel reduced to being cogs in a machine we can’t even begin to fully comprehend. It is intentionally built to be complicated beyond our understanding. A fantastic opinion piece in the NY Times (https://www.nytimes.com/2019/06/08/opinion/sunday/hospitals-doctors-nurses-burnout.html) recently discussed how health systems fully take advantage of physician and support staff altruism. They think of it as free labor.
News flash to the MBA crowd – it is not free! It costs a little piece of your employees’ dignity and soul every time it happens. It is time they do not get to themselves, their families and their own life priorities. It is time they do not have to reenergize for the next day’s work, which makes them less happy and less efficient. And if there is anything I’ve learned by being a hospital physician – death comes. It’s inevitable. And no one looks back at the end of their life and thinks, “If I could only get one more shift…..” But to the MBA crowd, if it’s not costing actual money, it doesn’t matter. Helping the bottom line by hurting dedicated employees wrecks trust and loyalty. And those can rarely be regained once lost. As I said earlier, they are dehumanizing the most human of professions.
Fact – sometime about 6-7 years ago, my highly trained, dedicated, brilliant physician colleagues and I all had to attend a mandatory evening session to learn what kind of bird we are. Yes, you read that correctly. I said what kind of fucking bird I am. Shocker to you, dear reader, I was an eagle. Good luck doves, they will eat you for you breakfast. Dehumanizing? Damn straight it is. Literally pigeon-holing us into bird stereotypes.
Fact – same evening session, same non-clinical health system employee encourages us to always smile. In the hallway, in the elevator, in your patient’s room. Probably even in the bathroom, but my memory is fuzzy on that one. So, dear bird person, I’m supposed to smile as I tell my second patient of the day they have cancer. My ICU colleague is supposed to smile as they break ribs doing chest compressions on the terminally ill 30-year-old mother of two whose body is riddled with cancer. The critically valuable housekeepers who I should know by name, but do not, are supposed to smile as they clean the blood and feces off the walls, floor and ceiling in the trauma bay. That just doesn’t sound right, but whatever. What do I know? I’m just a doctor.
Just smile. Ok. Roger that. Check. Except…..you don’t have the foggiest idea what the hell you are talking about. But I smile and walk out, after having lost 90 minutes with my family and file it away in the overflowing folder of “time I can never get back,” because of the ever growing burden of things we are mandated to do that have nothing to do with making us better doctors. Just another little bit of soul and dignity lost to the wind.
Which brings me around to where I go from here. My most recent bout of ASLS has become manageable by speaking up in defense of myself and others. By saying something. By doing something. By trying to right wrongs that were bigger than just me. I’d known for several years I wanted to help more than one patient at a time. I needed to do something different – and looking at my profession as a diseased patient has given me ideas and a new sense of purpose. I do not think the patient is terminal, but critical care interventions seem to be appropriate.
It also appears I’ve struck a nerve with some peers, friends, and total strangers. I’m happy for that fact, and love the love that has come my way. Words of kindness and support have been appreciated, but like so many times in life, thoughts and prayers are all too often vacuous expressions. Don’t get me wrong – words of encouragement are wonderful – and I can use all the encouragement I can get. But more importantly, I am looking for ideas.
All the ideas. Brilliant ideas and stupid ideas and proven ideas and failed ideas that might work if tried in the right hands. I’m looking for contacts with people that can move this agenda forward and do more than just little ol’ me. Friends, please help. It is sometimes the friend of a friend of a friend who can move the mountain and work through the road blocks. For now, my contact is email@example.com. All correspondence will be handled in absolute confidence. Trust me, I’m a doctor.
However, any threats of harm to others will be reported to authorities, so please don’t do that. I’m also not a psychiatrist or a crisis center. But a crisis center dedicated to healthcare professionals seems like something that should already exist, doesn’t it? Idea #1.
Finally, there are a growing number of physicians who are taking on this previously taboo subject. Dr. Pamela Wible has presented lectures, TED talks and has written books on the matter. One book is entirely letters of med students, residents and physicians who have taken their own lives. You think this essay is a little dark and melodramatic? Read that book and get back to me.
The only way to make this subject less dark is to finally shine a light on it. Don’t like that I try to poke a little fun at the mountain of problems facing us? Imagine what happens when we collectively lose our ability to laugh. To find joy. To feel anything at all. Oh, and then imagine that with $200,0000 of student loan debt hanging over your head with a newborn’s mouth to feed and get back to me. The physicians of today are NOTHING like the paternalistic mold of the 1950s who were 94% men typically with stay-at-home wives. No, now we are the wives, and single parents, and medical marriages (both spouses as doctors), and everything is changed – except public perception has not.
We argue with Dr. Google and celebrity “experts” every day. We have mortgages on our homes, loans on cars, and we effectively mortgage ourselves with crushing amounts of medical school debt. The problem is we can sell a house or a car to pay off a note, but we can’t sell ourselves to pay off that loan. What used to be a carefully calculated investment on ourselves with a high probability of long term success has now turned into a high stakes game of craps. The House is winning. And the laws of diminishing returns are in full effect. More on this frightening topic later.
And Despair – my old nemesis. I still see you there waiting the shadows. You wait for one of us to stumble in school, or at work, or at home, and then you try to devour us from within. I warned you last time I wrote, but maybe I wasn’t very clear. It is not just me that is coming after you, it’s an army of doctors who have had enough. We are just now getting our stuff together, but we will reach the critical mass it will take. So, Despair- my final warning – step in to the light and run back to hell.
****This reflects my opinions only and not that of employers past or present****