“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 switch things up. Just under two years ago, I embarked on a project with the intention of compiling stories by physician authors in a physician wellness anthology. Although the intention of a book length anthology remains, for now, I thought I would start 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 first submission from Dr. Larry Kramer.
It has become appallingly clear that our technology has surpassed our humanity. ~ Albert Einstein
Medicine has always been more than a job. Often it becomes a way of life, an all-pervasive reason for being. How far down this road we go in defining ourselves frequently becomes a problem. Too easily physicians become entirely and always physicians. This makes for some awfully good clinicians and some awfully poor human beings.
To be a physician is hard enough. It takes so much time and effort that there just isn’t energy for very much else. There seems to be a selection bias for those willing to sacrifice everything on the altar of medicine. To survive residency this becomes almost a necessity. Can it be surprising that the individual becomes psychologically welded to his career?
But we need to see beyond that. We need to see medicine as a means of understanding and appreciating a far greater picture. Through medical knowledge we address only a piece of the puzzle of what it is to be human. Medical knowledge without a compassionate understanding is like the proverbial one hand clapping. We must see ourselves in our patients. This might make me not only a better physician, but also a more complete human being.
In the pre-tech era of medicine, the art was the only thing. The laying on of hands, the listening, the understanding, were all we had to offer. Now science has superceded and threatens to eclipse any remaining vestiges of art. The pendulum has swung away from humane interactive medicine towards a colder impersonal science. I am more apt to treat laboratory or X-ray results than I am to treat a broken heart, or the defeated spirit these results have produced. And if I am to treat that depression I am more likely to define it in neurochemical terms than in the intangibles of human loss and despair.
Yet both art and science are essential to good medicine. We have perhaps worshipped the science and neglected the art. The perfect doctor is a combination: the scientist who understands the anatomy, physiology, and pathology and the artist who appreciates the poetry, the history, the feelings, the personality, the motivations that make each of us unique. The healer considers both and offers help that is scientific, and compassionately human.
Art and science. Apollo and Dionysius. Balance is the key.
Backstory – Dr. Larry Kramer
I was a family physician in rural Ontario for the larger part of my career. After graduating from U.W.O. Meds ’73, I did a 12 month rotating internship (The College of Family Practice was a dream when I began medical school) and a 6 month Family Practice Anesthesia diploma. This paltry preparation allowed me to inflict myself on the general public.
After a few months of locums, ER work and travel, I settled into a general practice in a small Ontario town not far from where I was born. I did what most docs did then – too much and everything. Anesthesia, Obstetrics, ER coverage (there were no ER docs), in-patient care, and a full family practice were expected and I was happy to comply. Being on-call for one or more of these became the norm as did being at home less and less. I recall never thinking much about it then. I had been well conditioned by the professional expectations that were ingrained in medical school, internship, and residency. These were both subtle (Q: what’s wrong with taking call one night in two? A: You miss half the good cases.) and obvious (the surgeon whom I never saw out of OR greens in 4 years). How could I behave otherwise.
So for 25 years I managed, trying to be all things to all people. As a partner, father, physician, colleague, confessor, non-complainer and on-call masochist I both succeeded and failed. At first life was good. I was doing what I loved and getting paid way more than I ever imagined possible. We (my partner and I) were young, prosperous, respected even pedastalled (if that is a word). My family grew to three kids and we seemed to be living the dream. But the carousel spun ever faster. It became difficult to hold on. There wasn’t enough of me for all the bits of life that were demanding a piece. Children grew up quickly. I didn’t notice. Parents age. I was too busy. Material things now seem a poor replacement for all the things I never had time to do. Gradually I learned that obsession demands a price. Eventually I realized I had to get out.
My coping strategies, short of leaving never seemed to help for long. Holidays were yearned for and dreaded. The preparation (arranging calls and coverage of patients with colleagues who were already overloaded) and returning to work piled up was daunting. It was easier not to go. Locums at a slightly different type of work – as a GP in a large psych facility, ironically, brought a temporary measure of sanity to my world. But the comfort was always short lived. By year twenty-six the stress, depression and anxiety never really left. Medicine was always on my mind. There was little room for anything else.
After much soul searching and dealing with feelings of inadequacy and guilt, I left my practice in 2002 after 27 years. I became a hospitalist in a larger nearby city. This move saved my life or at least my sanity. Suddenly I had the luxury of time. My patient load was manageable and I didn’t have to worry about money or business. I could know, understand, and care for each person I saw and had time left over to care for myself and my family. Interestingly the burnout symptoms, anxiety, insomnia, and obsessive worrying and behaviour regarding patient care reappeared near the end of my 9 years as a hospitalist. By then FP’s were leaving the hospital in large numbers and the work load, time commitment, and “acuity creep” (sicker and sicker patients) were increasing exponentially. Or was it just me? I didn’t want to go through that again. I couldn’t. So I took the easiest job in the world. Being a locum is like being a grandparent; all the joys but few of the headaches (“your regular doctor knows you so much better than I do and will be able to deal with this way better than I can”).
And after 40 years I have now retired but still struggle with ramifications of that decision. I feel like I should still be working, that I have let down the side. This is fading with time but I suspect will persist like an instinct dulled by conscious effort.
I had thought that I was alone and that my inadequacies led to burnout. I now take comfort in the realization that I have not been a solitary traveller on this road. The feelings I experienced were probably closer to the norm than the exception.
You can read more of Dr. Kramer’s works on his blog – Just a G.P.
If you are a physician, resident or medical student, and you are interested in contributing to this project, please feel free to contact me.