Why? I am sure if you were to ask my parents, they would tell you that this is the first word that I ever said. It is certainly the most common word that comes to mind, and out of my mouth on any given day. It has been this way for as long as I can remember and it continues to fuel my searching to understand the world in which I live. Simon Sinek has become famous for looking at this, and lately I have found myself delving ever deeper into this fundamental question of ‘Why?’
There have been times in my life as a doctor when I find myself hosting that most unpleasant feeling of burnout. I have danced with that feeling enough to recognize it when it begins to peak around the corner. For me, it telegraphs its arrival through the rise of smouldering resentment at the work. The moments when I find myself no longer feeling empathy for the people in my office. When that voice in my head says…’well there are people far worse off than you are’… When I start to notice the tone in my internal conversation, when I hear myself blaming the person in the office with me for their current predicament. When I start to long for a job that does not involve lots of decisions throughout the day. These are the signs in my life that burnout is planning a visit. If I am paying attention, and noticing these ‘subtle’ signs, then I have the opportunity to make a change and modify what I am doing, how I am feeling, to perform some self-care that was lacking and allow my life to self-correct without the need for burnout to come for a full-fledged visit.
In his work, Simon Sinek looks at the ‘Why’ that fuels the work that we do, the passion that drives what we do, and encourages us to find out own burning ‘Why’ in life. I have noticed that in my own life, the feelings of burnout seem to arrive when I have lost sight of my ‘Why’, and in losing sight of this passion, then I lose sight of my work, my purpose, and my love. Going into medicine is not a small task, there must be great passion to pursue this to its end. You must work diligently to make good grades in high school so that you can get into a university that has a high rate of acceptance into medical school. Then you must do well in university, do well on the medical college admissions test, and don’t forget those extracurricular activities that help you stand out from the crowd of other smart people. Once in medical school, you must work hard so that you can get into the residency of your choice, in the specialty of your choice. It is a grueling process through which you go if this is indeed your dream, your passion. And to this I will add, that the two most stressful times in the life of a young doctor are the acceptance to medical school and the graduation from medical school. Throughout this process you are tested, and tested and tested again, and it seems like each test can potentially destroy your chances. The sheer volume of information that gets dumped into the heads of young medical students is fantastic, and then you head to the wards and clinics and try to put all that information to good use in the real world. In order to sustain such a journey the ‘Why’ behind the effort has to be substantial. And for some, as they move through this process they realize, that the ‘Why’ that has driven them to this point in their lives is, in fact, not enough to continue with the process. Some leave prior to the conclusion of medical school, some leave during residency, and some progress into practice only to see themselves burn out because their ‘Why’ is not in alignment with the work they are doing, and for others, they lose faith with the ‘Why’ that brought them here in the first place.
Medical school for me took place in Dallas at the University of Southwestern Medical School. My prime clinical locations were the Dallas Veterans Administration Hospital and Parkland Hospital (the county hospital for Dallas). My clinical years began in 1993 around the same time that HIV and Crack Cocaine really took off in Dallas. Working the Internal Medicine wards during that time was hard, it seemed like the hospital was filled with young men who were dying, and often dying alone. These were young men my own age, and the deaths that came from HIV were horrible during that time, they were marked by substantial suffering. In that time, there was not a strong hospice movement, and so our efforts were at sustaining life as long as possible regardless of the cost in terms of suffering, and we performed that task well. It was during this time that I learned to shut off my feelings for the people in those wards. It was a moment of self-defense, to protect myself from the daily grind of watching my age bracket suffer and die. Life in other parts of the hospital was little better as the cries of the babies withdrawing from crack are etched into my mind. Even now, I can hear the desperate plea these little voices carried in the air for someone to ease their pain. Some of us would earn extra money as students by performing newborn examinations on these babies (there were more than could be managed by the students and residents on the service). Many times, at the end of the examination, I would just sit and hold one of these infants and rock them for a bit hoping that it might ease the misery they were clearly enduring. Rarely did the crying stop, at times it would slow, and in exhaustion they would sleep. And again, I found myself moving my feelings deeper inside so that my own suffering was reduced. So it went, most days, my walls grew taller and my heart more distant.
Trouble is, you cannot wall off part of your heart. If you begin to build those walls, then they impact everything in your life. As I built walls to insulate myself on the wards, those same walls insulated me throughout the world. My grandfather died during my time in medical school, and while a spilled a few tears during the funeral, the grandson who interacted with him, the grandson who attended the funeral, was the same one who was insulated from the suffering on the wards. My grief would not come until later in my life, during that time, I did not grieve, I simply turned from this death to the next person to be seen, the next diagnosis to be made, the next night on call. My humour developed a morbid edge, and I found myself laughing out loud at things that previously would have stunned me. Just a few short years later, on call at Dugway Proving Ground in Utah, at the post movie theatre with the on call ambulance crew and soldiers, the distance between these insulated medical types and normal humans became very clear as we laughed out loud at scenes in Bring out the Dead, the other patrons seemed shocked at our laughter.
Today, from the vantage point of 18 years, I can see how my life began changing from that moment in the theatre, and while I did not see it at that time, I can see know how I began to change the way I worked with people in the office, how I worked with people in the Emergency Room, and how I began to work with people in my life. It seems so much more difficult to take down this wall, this insulation than it was to erect it in the first place. Maybe it is my age, and maybe there is some fear, but removing the bricks has taken so many years, and they seemed to go up with such ease. These days, I look at the disassembly of these walls as the return of my humanity, and it has prompted me to once again consider my ‘Why’.
Beneath the desire to help people, there is a deeper desire, the ‘Why’ that fuels my engines comes from my passion to live my life a fully as possible, to ‘live to my maximum potential’, and it is the ‘Why’ behind the work that I do with others. It is the passion that brought me into medicine in the first place, to help people live their lives as much as they could, and it was the crushing of this passion by a system that was overwhelmed, and far too clinical (and cynical) that lead to building the walls of protection. As I take those walls down, I do so looking at each brick and hearing the story of how it was placed, and the role it served. My practice has begun to change, I find myself looking for the walls that others have built to protect themselves from pain and suffering, and I ask if they are ready to take that step toward disassembling their walls. It has become the fullest manifestation of the ‘Why’ that drives my work, and it has become the most satisfying part of my day. For as I walk beside those brave souls who are ready to disassemble their walls, I see more clearly than ever, myself, through their lives, and I step a little closer to realizing my humanity fully.
If any of resonates for you, and you happen to be curious, and wish to study it more, do not hesitate to drop me a line. If you would like to know more about my work, or to work with me, feel free to contact me. I post regularly to Instagram (@gilgrimes), Twitter (gilgrimes) and Facebook (gilgrimes) about whatever arises from my meditation each day. And if you would like to stay in touch sign up for my newsletter (probably once or twice a month at most).