“There is no greater agony than bearing an untold story inside you.” ~ Maya Angelou, I Know Why the Caged Bird Sings
This week, I am excited to present another story from a fellow physician as part of the physician wellness anthology. Although the intention of a book length anthology remains, for now, I will continue sharing some of these stories individually for all to enjoy.
I am truly honoured that these physician authors have entrusted me to share their stories. Some have multiple stories to share that touch on a variety of topics including experience with addictions, burnout, and stress-related conditions.
All submissions remain unedited in the author’s original words. So, without further ado, I am pleased to present our third submission from Dr. Andy Thomas.
“Physician (heal thyself) let others heal you”
October 14th, 2014. It has been 117 days since I last worked, last drank and last ran on the “hamster wheel” known as primary care. I have completed (or rather graduated from) the full 35 days at the Homewood Health Centre, sharing a room with 2 different roommates. Room 265 B – my lucky numbers (better rely on more than luck). The experience was very positive and took me back to my old boarding school days. It’s the first time I have really breathed in years. It is regimented – I know what is expected. There is a feeling of certainty. Many of the staff have been treated and are in recovery. I am not alone. “You have a week to go Andy, you better start opening up.” I realize how many defenses I have surrounded myself with, but at least the journey has begun.
Up to this point I had a well paying job as a Family Physician, a supportive spouse, two great kids, a home that was paid for and the usual collection of big boy toys. I lived and practiced medicine in a small tight knit community in semi-rural Eastern Ontario. I had worked for 16 years in a group practice serving 6 smaller communities and had been involved in a wide range of professional and volunteer activities. I feel quite tired just thinking about the range of activities, but I felt that it was expected of me. The burnout probably started quite early, but my grumblings seemed justified and the promise of Primary Health Care Reform made my concerns seem valid. My spouse had asked that we move to a bigger community so that she could pursue more of her interests. She thrived in the new community. I was initially almost euphoric with the promise of joining a Community Sponsored Family Health Team (the answer to all my problems). I was a full-time Physician with the Family Health Team, provided Palliative Care and a Coroner service, did hospital inpatient care, served on 2 volunteer boards, taught medical students, and was involved in leadership activities with our LIHN etc. etc. In addition I participated in numerous strategies for wellness and self- improvement. I have run 5/10/21.5 km races, cycled long distances, can pronounce namaste like I belong in a yoga studio and have a burgeoning collection of self help books. I have a lot of great friends, get along with my colleagues, have a good working relationship with most of my patient roster, play well with other non-physician providers and love teaching students. Granted I complain about the system like many of my co-workers. “Stick it to the man!” Why am I so discontent? Why does everything around me need to be different? Why am I always thinking of my next binge to get relief? Some of my patients have a right to be stressed out by their lives. I really haven’t earned that right. Homewood helped me to practice acceptance. I accept that I am an Alcoholic. I accept that I need help. I am angry at myself for drifting from recovery. I was working hard, doing good works and living a clean lifestyle. What went wrong? I come to understand that trying to recover in isolation doesn’t work. Ok I’m ready for the next steps.
I feel good. I am recovering. “This wasn’t my first rodeo”. I had spent a month in the Donwood Treatment Centre in late 1996 and had returned to work 5 days or so after getting back from treatment. I have an awesome AA sponsor who has supported me since 1994. The AA groups in our area have a lot of good sobriety and I had benefitted from 2-3 meetings per week. I picked up a 10-year medallion in 2008. I did however always feel somewhat unique and AA members asking me medical questions at meetings reinforced this. I allowed this to continue because I liked feeling important and didn’t know how to set those boundaries. The arrogance ultimately ended in relapse. In retrospect I kept myself isolated from all the good things that the AA fellowship, a supportive spouse, great colleagues and good friends had to offer. This time around my mantra is “Never Alone”. On the day that I had had enough I called a friend and respected colleague to tell him what was going on. He strongly encouraged me to call the Ontario Medical Association‘s Physician Health Program. I have decided to put my care into the hands of this robust and supportive program. I have doctors, counselors, am more actively involved in an Alcoholics Anonymous and belong to a Caduceus group. The random urine tests give me a strange security. I need to be sure that I will not use again. As a high achieving people pleaser I have followed all the suggestions. It’s paying off. “You are recommending 6 more months away from work?” Is that really necessary? After all I was back at work 4 days after my last residential care program. I feel guilty that my colleagues are covering for me. The fact that I have covered for others in sickness, death and the joy of new children enters my conscious mind briefly. For some reason I rapidly discount this. Strangely I do not feel any sense that I am abandoning my patients this time. I am concerned about what will happen to some of the vulnerable individuals I care for, but I have admitted that I have already given way too much of myself. Some of my “Homewood alumni” friends are back at work. Why not me?
I attend a compassion fatigue workshop at our local hospital. I know and admire the colleagues from the spiritual department that are giving the workshop. They present the risk factors for burnout. Almost a “perfect” score. So I work too hard, care too much and cannot say no. It’s been noted before. However no patient or colleague has ever reported me to our College for these practices so they must be good qualities right? Now the burnout and compassion fatigue scores. This is a bit like my golf game – high score is not good! (Oh that’s right I haven’t been playing much golf). I make a mental admission to myself and again surrender to the need for care and healing. It is paradoxically a big relief. I’m not just making this up. After listening to myself and other co-workers on the treadmill bemoan the numerous forms and letters for “unworthy” insurance applicants I had counted myself among them. “You are worthy of care little grasshopper”.
AA has helped me get over the “poor me’s” and the “pour me’s “(their play on words to warn against the dangers of sitting in self pity for too long playing my mini violin). Now the “why me’s”. I do a life review and examination of my strengths and vulnerabilities. For interest I do the 16 personality test (based on Myers-Briggs). The outcome is the same as when I did it 10 years ago. The rare and mystical INFJ. It makes sense. It tells me what I have known since my earliest awareness. The strengths and weaknesses fit. Too sensitive, tends to isolation, perfectionist, always needing a cause and can burn out easily. Creative, insightful, inspiring/convincing, determined/passionate, altruistic and decisive. I move to a different level of acceptance. I realize that this wiring/neurobiology makes finding a new way to live, work and love essential. Does primary care in its current form allow this personality to exist and flourish? I do not have a definite answer. Was everything that I felt and thought wrong? I know that the traditional medical model works for some things. It doesn’t work for most of my primary care encounters. I may never have the answers to these riddles. I do know that I cannot work in isolation and need to take care of me. “You can’t give away what you don’t have ”! I understand why I need to heal more before returning to any kind of work in health care. As my sponsor says “more will be revealed”.
I share this part of my story in gratitude to my spouse, my children, my AA sponsor, my buddies in recovery, my healers, my friends, my co-workers, my patients and most of all to that positive force in the universe – a power greater than myself. May that force grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.
Backstory – Dr. Andy Thomas
Dr. Thomas (1962) was born in Kitwe, Northern Rhodesia (now Zambia). His Father was a physician and his Mother a high school english teacher. He spent his early childhood in Bulawayo, Rhodesia. Life was simple and he enjoyed the middle class existance of most european settlers. His great, great grandfather had emigrated as a missionary from Wales to Central Africa.
Most of his forebears had worked in the civil service or in agriculture. As a sensitive youngster he was easily slighted by his peers and was fearful of many things. As an adolescent he excelled academically and in sports. Emotionally he was detached and confused by a war that took place to maintain the dominance of one people over another. Like many others his family experienced loss of loved ones, family break up, loss of societal position and a sense of no longer belonging in Africa.
He attended the same University as his grandfather, both his parents and siblings in Cape Town, South Africa. His father had inspired a love of medicine in him and both his parents a love of learning. He enjoyed success in Medical School, but socially he had already begun a spiral of alcoholism and all that goes with it. The inequities he saw in Southern Africa have left him feeling helpless. He left Africa with his spouse in 1989 and moved to Canada, a country that seemed to be more fair and caring to all its citizens.
Canada has been very good to Andy and his wife. They have 2 sons who are currently completing university degrees. Dr. Thomas took a Residency in Family Practice at the University of Saskatchewan.
If you are a physician, resident or medical student, and you are interested in contributing to this project, please feel free to contact me.