Burnout and "The Good Ones"

I’ve been thinking a lot lately about the kind of burnout that happens in people that come into medicine with eyes wide open, thoughtful and informed and generally pretty intolerant of the kinds of cognitive dissonance that help most people get through.

I’ve heard too many stories of “the good ones” quitting – the ones renowned for empathy, advocacy, patience – the people that still get mad about the ugly way things are, and try to be better. There’s even a Scrubs episode about it (or several).

We’re all starting our intern year in just a few months. Residency (along with the third year of medical school) is notorious for making jaded cynics out of the most doe-eyed baby docs. It’s daunting.

There’s a classmate I’ve been getting to know much better the last couple weeks (dissection makes fast friends) and I feel we have a lot in common – he goes on some of the same rants that I do, for example. During one of his particularly snarky rants something really struck me. I realized I’m so worried about this friend losing his hope. I’m so worried about him feeling overwhelmed by the isolation of being the one that cares all the time. I’m so worried about him quitting.

What struck me, I guess, was that with all of his rants I’ve been seeing myself in him. I’ve really related, really connected, to his anger. So, this really begs the question: am I worried about myself?

I worked very hard for my hope early on, and that hard-won optimism is something I see as essential to my identity. Cynicism is so unattractive to me now. It dresses up truths in dissonance and distractions until what looks logical is excuses and rationalization. I see the familiar hipster misogynist nihilists that pride themselves on loving Fight Club as children more than I see them as edgy or smart – they haven’t yet developed into real humans with sophisticated understandings of the world and real-life experiences with humanity.

So, to me, there's some honor in quitting, if it comes before or in the face of cynicism. In fact, I always had given myself permission to quit. The decision to give myself that permission was conceived under the angst over whether I would go to medical school – I had met too many bad doctors that hurt patients. I didn’t want to become a cog in that machine. I knew that doctors that hated what they were doing were bad at it – they hurt patients – and so I gave myself permission to quit as soon as I hated it, and I’ve checked in with myself frequently in that regard. If I’m not doing my job better than another premed/med student/resident/physician would in my place – if I’ve become another cog in the machine – I might as well leave and let someone else do it. I’d rather quit than be adding more to the balance of harm.

But what that decision (to give myself permission to quit) looks like has evolved interestingly in these four years. What was once a judgement-free opportunity for reflection is now a scary window to a distinct, and unsavory, possibility. I know what quitting would look like for me now. I know what things might happen in my experience with medicine and what kind of person I would be, and I also know, deep down in my gut, that I don’t want that to happen. I want something out of medicine, and it’s not quitting.

It’s really hard when you feel like you’re the only one around to care about something. My third year of medical school, for this reason, was extremely, soul-crushingly isolating. And on top of that isolation, I felt this intense pressure to get really really mad about everything terrible I saw because nobody else was doing it. Somebody had to, at the very very least, notice. And when I looked around there was nobody but me to do it. Somebody had to care. So I felt the weight of thousands of witnessed traumas – I bore a lot of anger on my shoulders.

I remember coming home one day ready to go on yet another rant about something that had happened at the hospital, and Lumberjack saying to me, “Monica, you don’t have to get mad about everything. How can you do that to yourself? That’s unsustainable.”

And it was. But who else was there to notice? If I didn’t, it felt like letting a multitude of bad things slide. It felt like condoning them.

Isolation is so dangerous. I can’t muster the rage that’s called for in medicine by myself – I have a lot of feelings, but not that many. There’s strength in numbers.

And this, I guess, is what I need from my peers and colleagues. I need someone to co-rant with me. I need someone else’s gaze to meet when something terrible happens. I need to feel like at least one other person would back me up if I spoke up about something.

We really have to support each other. Resilience is relational.

Giving a shit is a 24/7 job. It requires constant vigilance to defray participation in a corrupt system that mediates daily oppression and institutionalized damage. The easiest way to get through medicine is the one where we fall into a state of cognitive dissonance that allows us to tell ourselves things aren’t so bad, it’s not our problem, hope is impractical. Avoiding that is really hard. And when you do avoid that, the unending effort required to maintain your humanity and your hope requires a lot of social support.

This is why I’m so grateful for my co-ranters within medicine.

I don’t like thinking about the possibility of quitting, but I also think it’s important, because it allows me to start building now a network that will allow me to spread some of this rage around. Supporting each other is a vital part of maintaining our humanity, of cultivating our hope, and of therefore effecting meaningful change. I’m really grateful to all the people that have helped me in those ways. Please stick around. Let’s have each others’ backs, as fellow humans facing a monolith together. Stay loud. Stay mad. Stay hopeful. Fight on.