Breaking from Chronic Stress of Doctoring

Taking much needed time away from the often unrelenting stress of caring for critically ill kids

A few weeks ago, I was on call, up until the wee hours of the morning caring for an exceptionally sick child. I got them safely back to pediatric ICU and dragged my tired ass home to bed to pass out.¹ I was on call the next day as well meaning any call from the hospital would likely mean I would need to leap out of bed and rush back. There’s always a risk the sick child from last night will need care the next day as well

So when my work phone made it’s special tone (I have unique tones set up for the various apps and pagers that all run through my work mobile phone) this is what my heart rate did:

My resting heart rate of 53, jumped almost immediately to 100. Even after the call was over and clear I didn’t need to rush to the hospital, it was basically impossible after that to go back to sleep

I’m generally not into bio wearable devices, but got one about a year ago when I was worried my resting heart rate was getting high. As soon as I wake up, my heart often feels it’s racing. Turns out my resting heart rate is fine. My waking heart rate is another story.

I love being good at my job. I love caring for the tiniest, most fragile patients for surgeries - from simple to complex. I love being a trusted resource for ethics concerns and having the skills and expertise to help clinicians navigate moral distress.

But the chronic stress of this role is a serious downside.

The National Institute for Occupational Safety and Health (NIOSH) calls out some of the following as risk factors for HCW experiencing chronic stress and burnout²:

• Intensely stressful and emotional situations in caring for those who are sick.

• Exposure to human suffering and death.

• Unique pressures from relationships with the patient, family members, and employers.

• Working conditions with ongoing risk for hazardous exposures.

• Demanding physical work and risk of injuries such as from patient handling.

• Long and often unpredictably scheduled hours of work related to:

  • As-needed scheduling.

  • Unexpected double shifts.

  • Unpredictable intensity of on-call work.

  • For many health workers, unstable and unpredictable work lives, and financial strain.

  • High administrative burdens and little control over schedules.

The most obvious solution is to stop practicing medicine. To give up. To quit. A growing number of my friends are doing that. I know I could leave medicine and take up consulting or coaching or whatever. But I still like being a physician, and after investing so much time and energy to become a doctor with a very unique and valuable set of skills, quitting feels wrong. It feels like abandoning the patients I’m uniquely trained to care for. Is part of this a sunk-cost issue? Maybe, but I find so much meaning in this work, that I don’t think that quite covers it.

Fortunately, I have the immense privilege through my academic job to take an extended, paid break from my clinical responsibilities.

After ten years in practice, I’m taking my first sabbatical (AKA professional development leave).

Before working in my current job, I had never heard of sabbatical. Where I live in the Silicon Valley, similar leave is offered at certain tech companies like Google. The idea seems to be a recognition that we can’t do our deepest, most interest work without time away from the day-to-day admin and other tasks of our regular work.

It says something that so many people at work have congratulated me on taking a sabbatical and immediately followed it with some version of “please come back” when it’s over and “don’t quit.” I wish folks saying this sounded like they’re joking, but I get the impression folks worry this is a real possibility.

So for the next 8 weeks, I get to disconnect from my pager and my email. I left my most boundary-setting automatic away message yet and programmed all emails to be sent to a special folder rather than the inbox. I considered routing them all to the trash, but there are some conferences and journal emails that I know I’ll need to search for when I get back.

I see my job over these next eight weeks is to rest my brain and my body, paying special attention to my stress response. I need to rebuild habits I’ve allowed to slip in favor of more work. Mainly I know need to recreate the habit of exercising, which for me has always been the first habit to let go. I’m also working on letting go of a bunch of commitments that maybe - just maybe - I don’t actually need to do.

So hello and happy holidays from my first prolonged vacation since before medical school! I’m traveling with my family for the next few weeks. I’m writing this poolside from my phone, having left my laptop behind. When my partner and kids all go back to work and school, I have plans to write - both for you all and on my other projects.

I hope you’re all doing well and also getting some time to rest.

1. Driving home while sleep deprived is another major problem in medicine. Studies indicate that sleep deprived driving is pretty darn similar to drunk driving.

2. https://www.cdc.gov/niosh/healthcare/risk-factors/stress-burnout.html