Updated: Apr 25, 2019
For National Women's Health & Fitness Day...
“Just one more rep!” chants the voice bellowing in your head and transmitting from the television as you push yourself to do just that. The human body is impressive in that only when you think that you are at your physical limit, the potential for more is there. The limitation that our brain puts on us is the element that holds us from reaching our maximum potential. Despite the rapid cadence of your heartbeat, discomfort in your muscles, and overall sense from your body that you should stop, you do one more rep. Then another. Then another. You complete the program, and you collapse on the floor in a flurry of joy, pain, and relief. You did it! You got in your workout.
Not so long ago I was at a point in my life and career when I was unable to tap into the energy renewal necessary to avoid the abyss of physician burnout.
Realizing that the path into and out of burnout is different for each of us, let me tell you my story. The progress in the negative downward direction was slow and tedious. Post-residency training, I was a fresh, wide-eyed, excited young attending looking for a niche in EM to call my own. This journey led to the exploration of many areas from medical education to palliative care in the Emergency Department. If there was a mini-fellowship or a conference to attend, I was there. If there was a committee that needed someone to be on it, I volunteered. Concomitantly, I was working full-time nights in the ED and serving as the Site Director for the Medical Students in EM.
Personally, our family grew from my husband and me to include three cherubs all born in a four-year time span. Then, after the birth of our third child, I attempted to stay as active as I had been during the pregnancy. I started to run 5K races on a monthly basis during the running season as soon as I was cleared to do so. Much to my chagrin, I sustained a cryptic knee injury that would go undiagnosed (not for lack of trying) for a full year. Thus, the energetic, physically active, engaged young attending was slowing losing steam and falling into an abyss. The proverbial hammer or anvil dropped when I was about to give a talk and realized that none of the suits in my closet fit and I was almost a year postpartum. Not only had the muscle mass in my right quadricep atrophied to be visibly less than the mass of my left but also, my clothing size had increased 2 sizes up. As you can imagine, even the most confident among us would have a moment of pause and self-image issues given this situation.
As my body held on the solution to my knee problem, my love for Emergency Medicine was fading, and I was oblivious. After all, my journey into this profession and specialty had no scarcity of sacrifice and struggle. How could I not be joyful about doing something that I have wanted since the age of eight? We had left our homeland, Jamaica, for the United States because of my declaration at age eight that I was going to be a doctor. I had worked hard in school to ensure that I would get into a good college and be able to get into Medical School. There were setbacks, struggles, failure, recovery, and lots of hard work that led to the completion of Medical School. Emergency Medicine residency was a time of significant personal growth and skill acquisition that was welcomed with open arms. My twenties, like so many of us, were a blur, spent working toward a singular goal - becoming a physician. So, it just did not occur to me that my joy for the one thing that I felt called, destined, and desired to do for the majority of my life would ever fade or for that matter was in danger of being extinguished.
I was oblivious to the signs, though now that I reflect, they were blatant. Somehow, I did not think it was abnormal that I would dread the sound of my alarm clock that bellowed to wake me from my pre-night shift anchor nap. Nor did I believe that forcibly willing my body to move from the recumbent to the sitting to the standing positions was abnormal. Nor did I think it odd that I would get to the hospital parking lot and grip the steering so hard that my knuckles were white and blanched. Again, it became normal for me to have to forcibly will myself to let go of the steering wheel, open the car door, step outside and walk into the hospital. What is now apparent was reasonable to me then.
Clearly, I did not recognize the signs of my burnout.
It is hard to say which of these elements contributed the most to my stint with physician burnout. It may have been a single element, or it may have been a culmination of all of them. It is tough to say even in retrospect. What I do know is that for me it turned out that a focus on my self-care in the form of nutrition and exercise was my lifeline out of the abyss of burnout. This discovery was purely accidental. It came in the form of an invitation to a group fitness accountability group from a fellow homeschool mom. First I should mention that my knee injury was diagnosed in the operating room and the operation was both diagnostic and curative. For some reason, my meniscal tear, joint erosion, and debris contaminated knee were not evident on MRI. Okay, so my knee was fixed, but I was still two dress sizes up from my baseline and had visible muscle atrophy with a marked range of motion limitation.
I needed something to change. Joining the group, I had a tribe to keep me accountable and to encourage in return. It was during this time that I rediscovered my love for fitness. My physical transformation happened in a matter of months, and my emotional change shortly followed. It is still remarkable to me that I carved out just 30 minutes a day, six days a week to exercise and that totally transformed not only my body but also my life. I was getting stronger and fitter. I was also getting happier. The benefits of self-care were real for me, and I decided to pay it forward. My fitness journey was a public one, as I posted my workouts, sweaty selfies and what I was eating. From this, I learned that my story inspired others and started to pay it forward by coaching others to reclaim their fitness mojos. So, I mentioned before that I am a nocturnist; therefore, you may be wondering when I work out. My workouts would generally happen after my shifts when I was working and first thing in the morning when I was not.
After a few months, I realized that I was no longer dreading the chime of my alarm before shifts or having difficulty getting out of bed to get ready to go to work. Turns out that I jumped out of the car too when I got the hospital and smiled liberally while at work. My mindset about work also changed. I no longer viewed going into the ED as a chore but instead as a privilege and an opportunity to serve patients. It is clear to me now that I have become dependent on the endorphins that are released when I work out. When I carve out my time in the “fit lab” (my basement gym) things in my life run a lot smoother. It did not take a lot of time to see the difference. For me, I did 30 minutes of work each day, six days a week.
When my physical form became stronger and fitter, my confidence grew, and my joy was replenished.
Today I love to talk about wellness, burnout, resilience and incorporating self-care in the form of exercise. Fitness and exercise saved me in many ways. So when I hit my wall, and that voice in my head and on the television calls for “one more rep,” I remember where I am coming from and push myself. That extra rep renewed my love for medicine, instilled a confidence in me that was not present before, and resurrected a drive that led to the realization of a childhood dream. That extra rep pulled me out of a bottomless, dark, hidden pit and transformed my life, family, and career. For you, your narrative may be different. Exercise is a huge part of my wellness. If exercise is not your forte, find another outlet to dedicate your 30 minutes of carved out self-care time. Just make sure that you take time to care for you and your psyche. You are too precious to go through the throes of burnout. Recognize the signs, ask for support, ask for solutions and thrive!