Needing to be helpful.....

Sometimes Medicine wants more than you can give, and there are many times in the past when I’ve given Medicine everything I had and a little bit more. These days, I give medicine what it deserves and nothing more. I don’t spend myself into debt for Medicine, I don’t empty my emotional banks to make sure that Medicine is full, I do what I can and when I get to the end of what I have to give Medicine, I stop.

It has been a very strange road to get to this place where I can see Medicine for what it is and for what it is not. Like so many others, I find that Medicine fills my need to be useful.  It has been this understanding of my ‘need’ to be useful that has allowed me to take a liberating step away from Medicine, to see what it was in Medicine that seduced me into making it number one on my to do list, above myself, above my relationships with others, above everything else.  Medicine was there to fill a need, and like anyone else who has a need that must be filled, you know we will find any means possible to fill that need.

I needed to be helpful.  That was what I knew.  I have always had this need, for as long as I can remember I have needed to be helpful.  I want to help those around me, even when it is not really in my best interest, or the best use of my time.  I would help without being asked, I would help even when it was not really needed, I would help, or more accurately, I had to help.  I was driven by an internal compulsion to help, and if I did not, then feelings of unworthiness would begin to creep up into my head.  I would hear those familiar voices that were all too often just below the surface coming up to tell me what they thought about my ‘selfish’ withholding of help.  They would be there, just out of my field of vision, murmuring in the background, just loud enough for self-doubt to emerge, for self-criticism to find footing, and then the self-reproach would awaken.  So, I helped, it was the way to keep these feelings quiet, it was the way to make things better.  It was the natural complement to never needing help from anyone and so there I was, helping all I could, never asking for assistance in return, and slowly burning myself out again and again, as I worked valiantly to try to fill the bucket of need that is bottomless, that bucket of need that is Medicine. 

Medicine is never finished, there is never a finish line, the job is never done.  There has never been a day when I could look back upon my work and see that it was complete.  It is like building a house for someone who changes the plans at the last minute to add one more room.  Nowhere is this seen more clearly than in the emergency rooms or the hospitals.  They are never empty, there is always a chart in the rack indicating someone is out there waiting to be seen.  There is always an admission to be seen, a discharge to do, a question to answer.  In the clinic, there are always folks who want to be seen today, just worked in if you could.  There are faxes and phone calls, requests for refills, or just a quick question over the phone.  There are lab reports, specialist letters, and insurance forms, all of which require some small action on your part to complete.  In this way, the ‘bucket of need’ is never filled, no matter how much of yourself you pour into it. 

Take this bottomless bucket and hand it to someone who has an unquenchable desire to be helpful, and you have a perfect combination for burnout.  I have been that perfect person, that one who simply said yes to being helpful because I could not find a way to say no without feeling disgusted with myself.  Yes, I will cover the hospital; yes, I will be the palliative care doctor; yes, I will be the house doctor for the nursing home; yes, I can take on your kids and grandkids who need a doctor; yes, go ahead and just add them to the end of the day…. These are the stories of the last decade, the stories that arose after moving my practice to start again; after leaving academic medicine because I could not say no; after leaving the country to find a new health system that would be different.  Everything changed except me, and there I was again recreating the whole catastrophe once more, feeling that old familiar singe of burnout starting to creep in to my being.  Those feelings of being unappreciated for the work I was doing, the desire to escape, the dip in compassion that seemed to happen all too often.  But something different happened this time, I began to recognize the common thread through all these narratives, and that thread was me.

Working on myself has been the most important work I have done in my life.  It has been the golden thread that I followed to pull myself out of the threatened burnout that was beginning to simmer up.  It has been the change that has allowed for a different outcome, it is the solution to the problem of having to be helpful.  In this last year, I have had the golden opportunity to sit with people who accept me as I am, without judging me, and who help me look with brave curiosity at the way I organize my life.  It is in my Hakomi training, that I am having the chance to look inside myself and discover the headwaters of this river of helpfulness that has always flowed through my life.  In those mindful moments, together with support, I turn toward this behavior, I begin to feel that edge arise.  I sense the danger in looking at the ‘why’ behind the helpfulness too closely, it feels like looking will destroy who I am, it will damage me beyond repair.  It is in this moment, when the observer inside me notices this fear, that I know I am close to understanding.  Like a flash the memory arises, my younger brother, he had medical needs when he was little, it took all of my parents’ attention, suddenly I did not seem to exist in their world anymore.  My response to this overwhelming pain was to find a fix, and that fix arose in being helpful.  Being a helpful older brother meant I got noticed again by my parents, it meant I was included again in the family, and it reduced the pain of being ignored.  And in those moments, the Helpful one was born, and that pattern, that behavior continued to reap rewards over the next 49 years.  He was soon joined by the Smart one who did so very well with every intellectual endeavor he tried, those good grades earning him more praise from parents who had busy lives of their own.  Together, Helpful and Smart, worked their way through life until they met Medicine, and then they knew they were home.  Here was a place that welcomed Helpful and Smart with open arms, and feed their desire to be needed until they could barely move from such a banquet. I could see all of this in a flash as I realized how this one choice, this one pattern had dictated so much of my life, and in that flash, my therapist asked… ‘what decisions did you make in that moment?’ and I knew how I had chosen and never looked back.

There is a great deal of energy that arises when you begin to notice a pattern of behavior.  At first you are amazed at how often you do that thing you do, then you get angry at yourself, and at some point, you simply start laughing at the absurdity of this repetitious action.  This is what began to unfold.  I noticed how often I found myself helping in every situation.  I saw in real time all the many small ways I simply said yes to whatever was being asked.  I saw this again and again until one day I decided to say no.  That first time, that very moment I considered doing something different, it felt as if I was looking over the edge of a tall building into the street below, it was a feeling of groundlessness, or vertigo.  In that moment, I said no and then waited for the world to end, but to my surprise it did not, it simply kept on rolling.  It was liberating in the moment, to begin to say no, to set a boundary, to take a step back from the seduction of Medicine.  As I did, many things came into sharper focus.  My compassion for others began to awaken again, I truly felt for them, in their situation, and my heart was able to break for what was happening in their lives.  I could do this without the urge to fix it for them, I could sit with them, in their pain, supporting them, holding space, and I did not have to fix it, to make it better, or ‘do something’.  I started seeing my relationship with Medicine change, there were times when it took a backseat to self-care, when it took a backseat to my marriage, and the world did not quit spinning, my life did not end, everyone did not hate me.  I noticed that as I began to take better care of myself, I began to take better care of others.  I became a better doctor as I became a better human, and these days, I can see how each new understanding of who I am, of how I am organized, ripples out into my work.

Here I am, today, taking care of myself.  I am learning to see the organizing principles of my life, of how they came to be, and I am learning to love the one what made those decisions.  They were made with the best of intentions, they were the very best that he could do in those moments, and if he had been able to do any better he would have.  I see all of this and more as my life starts to rebalance in a way that leaves me free to do the work I love without the compulsion to give more than I have to offer.  I am no longer spending myself into emotional debt, I am no longer stealing from my other relationships for Medicine, and in doing this, my relationships are returning to a life they have never been allowed to really have, with a depth of emotion I would never thought possible.  There are surely other lessons that are still to be learned, but the lesson of taking care of myself has been the best so far.

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).