Despair has been trying to find me again. That fickle fucking bitch is breathing down my neck once more. I know her all too well – she has nipped at my heels most of my career, and has kept me running for the past 20 years. Running from friendships, running from family, running from loss, running from debt, running from jobs, running from guilt – running as hard as I can, just to run another day.
Now I consider many of you who will read this my friends, and the words I’m about to put forth might just blow your mind. My apologies in advance. For as much as I sometimes blather on in friendly and benign conversation, it is too often a mask to hide the sweat and tears streaming down my face from running nonstop. These next few paragraphs are going to unload some things you may not want to know. Fair warning.
For you see, I can’t run another day. Today is the day I stop running. I’ve truly had it with the role of being prey. It’s time to turn around, square my shoulders, and tell despair she’s in for a fight. It will be her or me – and it sure as hell isn’t going to be me. She will growl and snarl and bite and claw. And all I can do is laugh in her face. For me, the pen is my sword and it is now Game On.
So why take the fight against despair public? Because I am not the only one running. Depending on which survey you read, upwards of 60 to 70% of physicians may be running their own race with despair. And the dirty little secret is we largely have our own profession to blame, as select winners from the past few generations of physicians have become the very teeth of modern-day despair. Those old docs gave up the race and made deals to buy themselves a little more time before they would let the wheels of modern American medicine start grinding us to bone. Medical heroes turned villains, willfully.
And it is hard, if not damn near impossible, to get anyone outside of medicine to understand the assault on physicians. Too many folks still think we all get paid vacations to play golf in the Caribbean, and that our Porsches and BMWs are outward trappings of immeasurable, luxurious success. It’s hard to find a sympathetic ear when those are the preconceived notions we have to overcome. I do not golf, have never had a free vacation, drive a Ford, and can’t get a free pen these days. Hell, I couldn’t even get my last hospital to buy a bag of decent coffee beans for my team. Hospital coffee is a cruelty in and of itself. Seriously. And as for the fancy cars, and boats and houses – all too often it is just docs trying to cover their own sense of loss, emptiness and void with material stuff. I would hardly consider that a measure of true success.
Over the past two years, I’ve worked with more physicians than I can count who have been victimized by our own profession. Our boards create more and more expensive hoops to jump through and fill the coffers for a select few – leaving us no choice but to comply if we want the illustrious “board certified” title behind our name. Payors pay less while electronic medical records decrease efficiency and cause overhead to skyrocket, forcing tired and overworked doctors to see more and more patients just to not lose more money. And the public is then complicit in the attacks. Nameless Google reviews rail against doctors who then can’t answer the complaints for fear of legal repercussions. The wild west of the internet is all too often the bane of our professional existence.
Reflecting on my own journey, I realize I have no choice but to fight to restore dignity to our profession. I’m bound and destined for this fight, and each day I ignore the bell and settle for just hiding from despair, I’m at odds with my purpose. I’ve written before about the loss of my Mom when I was a child and the impact it had on my life. It was immeasurably painful, but the experience strengthened me and forged a resolve that matches anything this pitiful monster of despair can throw at me.
I’ve been given the undesirable, yet invaluable, gift of “despair context” that so many of my peers do not have. They feel the crush of growing and unrelenting despair, and its overwhelming nature puts them in harm’s way. And for far too many – medicine kills them. The profession of love, mercy, compassion and healing destroys them, and inflicts collateral damage on their friends, family, and colleagues beyond any measure.
Taking care of patients was just the start of my calling. Helping my peers is now an equal part of that calling. I will freely admit I cry on occasion, but not only for myself. I shed tears for my brothers and sisters who don’t know how strong and resolute they truly are. Too many are trapped by debt and circumstances in jobs that intentionally keep them down. It’s almost as if there is a business class that teaches it is easier to control and manipulate a demoralized work force – except a depressed work force performs worse in every metric you can imagine. Placing value and dignity on physicians could reap unimaginable rewards if CEOs had even just a little imagination.
And finally, there is Peg. We were childhood friends and went to church together as kids. Her family was a pillar in my hometown. She was a beautiful woman, inside and out – and she took her own life earlier this summer. In fact, I’m weeping as I type these hollow, empty words. Equal parts sorrow and equal parts rage. Medicine – promises of cure and a disease at the same time. So much conflict in one little word.
Peg called me before going to med school, as I’d already been there and done that. I desperately wish I could remember what we had talked about when she called me those many years ago. But the years have washed that conversation from my memory, and sadly we never spoke again. Now she is gone. It is inexcusable, immoral and senseless that healers are dying by suicide at higher rates than any other profession in this country. Roughly one doctor dies each day at their own hand, and countless others will live shorter lives because of the self-neglect this career continues to breed.
You can search this subject on the internet and find stale, cold, and dispassionate talking points. We treat the disease in our own profession as if we are watching a surgery in the old school surgical theaters. The academicians ponder and study and talk and talk and talk, while the corporations consider risk analysis and liability exposures. State medical boards still consider psychiatric stressors as character flaws. The human cost in all of this is an inconvenient variable that cannot be openly discussed. As for me, I will rage and write. Emotion is precisely what is missing from the conversation, when it should be center stage.
The absence of consistent, safe, structured, and non-career threatening mental health care in our profession hearkens back to days before antibiotics. It’s what the generations before settled for, and we now reap what they have sown. Peg cannot die in vain. The thousands of other medical students, residents and physicians cannot simply die in vain. Medicine must stop eating its own.
It means you care.
So today I stop running. And despair, you might want to get a move on. For it is now my turn to come after you.
**These comments are strictly my own and in no way reflect the opinion of employers past or present. Yes, they make me say this, but it seems pretty obvious**
August 22, 2019 at 7:55 pm
Wow, powerful and we’ll spoken thoughts! There is a great deal of truth in that. I look forward to more of your musings.
August 25, 2019 at 11:45 pm
Brian, This Peg’s husband, Larry. Thank you so much for writing this. It needs to be said loudly and clearly. I helplessly watched all this happen. It was so out of her control to fix what had to be fixed and there was so much internal pressure to not show weakness that she folded. It’s something that will haunt many of us forever. Keep up the fight please.
August 26, 2019 at 12:09 am
I’m just getting started. You are in my prayers every day. We have to take back our profession. I hope to visit with you soon. There is work to be done.
September 4, 2019 at 4:01 pm
BOOM!!! Thank you for writing this!! . We are currently an unsustainable profession. We are in the middle of a slow bleed Dr-exit,. Physicians working fewer hours, retiring early, leaving medicine for non clinical careers, telling youth NOT to go to med school and the most horrific of all exits, the high suicide rate you mention. Meanwhile voices are being stifled by those who blame physicians that patients across America are paying more and getting less. ( Physicians account for 8cents on the healthcare dollar). Enough! That hippocratic oath… we must see it as a calling to advocate for the soul of medicine! Unless we band together, the public will discover Dr-exit when it’s too late and there is nearly no access to one trained well enough to remove an appendix, deliver a baby, resuscitate a baby, place a trach, manage a complicated illness, etc. If even 10% of us stood up, we could right the ship!