Posts Tagged With: physician burnout

Neil Young, Papal Yogaphobia, and the Power of Prayer

As I intimated in my last couple of post, I’ve been going through a down patch, experiencing some discouragement and burnout.  In our pre-deployment training, we had lectures and sessions on this, and they were helpful, but when you’re in the middle of it, it’s a little tough to see an obvious escape route.

One belief in Christianity is that we often get in the way of our own relationship with God.  The image is one of a door, with you on one side and Christ on the other.  He’s knocking to come in, but the door only has a handle on your side: God’s side of the door is blank.  We often shut the door, and then complain bitterly that God is absent, or doesn’t exist, or doesn’t care.  God is always present, waiting for us to open the door, but it doesn’t work if we close the door, close off the relationship.

Slightly cheesy Bible picture

Reaching for that handle, opening the door, re-establishing relationship with our creator, can be difficult.  Difficult not because it requires knowledge of a certain denomination, or sacrificial practice of an esoteric spiritual discipline.  Difficult not because the key to that door belongs to a certain sect, and not because one needs a mantra or wisdom from a gnome-like guru sitting cross legged in his mountain cave, or in his palace in Rome.

The opening of that door is difficult, because to grasp the handle, we must let go of what we’re holding on to.

From the Gospel of Mark:

As Jesus started on his way, a man ran up to him and fell on his knees before him. “Good teacher,” he asked, “what must I do to inherit eternal life?”…

 Jesus looked at him and loved him. “One thing you lack,” he said. “Go, sell everything you have and give to the poor, and you will have treasure in heaven. Then come, follow me.”

 At this the man’s face fell. He went away sad, because he had great wealth.”

I don’t think this passage was meant to say that everyone is supposed to go out and sell everything and give it to the poor.  If you look carefully, an unusual sentence is inserted into the passage:  “Jesus looked at him, and loved him.”  In his day, Jesus was a hugely popular and controversial figure.  He attracted crowds of thousands wherever he went.  But over and over again in the Gospels, we see Jesus as very “one on one.”  On only a few occasions does he address large groups of people.  Rather, he spent three years wandering around from town to town, engaging individuals deeply.  Touching lepers, dining with people we might despise, confronting the possessed, really “hands on”.

And in this particular circumstance, he stops, looks at this rich young man, looks into his soul,and sees what is preventing this particular person from experiencing God.  In this particular instance, this man cannot reach up and open the latch on the door because he is clinging tightly to his wealth.

The current Roman Catholic Pope Francis is a rock star.  The press loves him, mainly because he embraces humility, poverty, and authenticity, over the trappings of his office.  There was a recent flurry of concern over his comments on yoga!  Is the Pope yogaphobic?  Is he prohibiting Christians from using yoga for core strength or to get those six pack abs? If you take the time to look at what he said, you’ll find this non-controversial statement: “You can take a million catechetical courses, a million courses in spirituality, a million courses in yoga, Zen and all these things. But all of this will never be able to give you freedom”.  The Pope tells us that only the Holy Spirit can “move the heart” and make it “docile to the Lord, docile to the freedom of love”. If we are seeking a zen-like peace from yoga meditation, or wealth, or security, then we are seeking peace from the wrong source.

So the supposed papal statement on yogaphobia also includes a warning that Catholic theology classes (catechetical courses) aren’t the way to go!  It turns out that the path to peace in your heart is just letting that door open, and experiencing God directly.  But again, to do that, you have to put down what you’re grasping.

One of the great poet-sages of our time, Neil Young, captures this pretty well:

Workin’ hard every day
Never notice how
the time slips away
People come, seasons go
We got something
that’ll never grow old.

I don’t care
if the sun don’t shine
And the rain keeps pouring
down on me and mine
‘Cause our kind of love
never seems to get old
It’s better than silver and gold.

I used to have a treasure chest
Got so heavy that I had to rest
I let it slip away from me
Didn’t need it anyway
so I let it slip away.

I don’t know what Neil Young’s spiritual beliefs are, but his song “Silver and Gold” captures exactly the same point.  Holding on to wealth, pride, security, pain, whatever is in our “treasure chest”, gets very tiring.  It’s okay to rest, put down whatever you’re holding on to so tightly, and reach up for the handle on the door.

So I think the Pope and Neil Young would agree:  if what you seek is peace, no amount of striving can get you there.  If you’re burned out and discouraged, trying harder, working harder, wishing people would just see your vision and fall in line, just isn’t going to put you on your zen mountaintop.

One of the advantages of living in a village in Africa is that you can get away from people pretty quickly.  Yesterday afternoon, I was in such a black hole that I couldn’t stand myself.  I put on my running shoes, and within five minutes of old man shuffle, was on a muddy twisty mountain road with dense bush on all sides.

This is a great place to talk with God without looking like a crazy person.  No one to judge you but baboons.  I shouted, I pleaded, I got angry, I let Him know exactly what I thought about my current situation.  But the door was firmly shut.  He was nowhere to be found.  Great.

Just when I need Him, He’s either not paying attention, doesn’t care, or doesn’t exist.

The only thing listening were the baboons, and they had nothing helpful to contribute.

I expected to come back from that run rejuvenated and energized.  After all, I had done my part, I had “gone to the mountaintop”, spent some quality time with God.  It was time for him to do his part.  So why did I still feel so black?

Last evening, we had a dinner engagement at our house with some of my favorite people in Kijabe.  Chege is one of our senior trainees, and his wife Evalyn is a nurse in the operating theatres.  They have a beautiful four year old boy named Nimwell.  They are gentle, loving, kind, amazing people.  Chege is in the middle of a spine surgery fellowship in Egypt, and so hasn’t seen his family in a couple of months.  He’s spending a short break back here in Kijabe, and they were good enough to agree to have dinner with us.

We had a great dinner of Irish stew and mashed potatoes, which, it turns out, is very similar to Kikuyu cooking.  No surprise that mashed potatoes and beef with gravy are everyone’s comfort food.  Great conversation, hilarious stories, just one of those nights of fun and relaxing relationship.  As we stood up to say our good-byes, Chege asked if he could pray briefly.

I’ve heard Chege pray and preach before, and he is a gifted speaker.  But he was moved at this moment to pray for me, to encourage me, to lift me up, to allow me to let go of my treasure chest of pride and insult.

As he prayed, I could feel the anger, resentment, burnout, begin to melt.  I went to bed, and woke up this morning, with the blackness gone, and the enthusiasm and energy returning.

I don’t pretend to understand how prayer works.  I don’t know how Chege knew that I needed prayer to help me let go of my treasure chest.  Theologians could debate paradoxes and mysteries for lifetimes.  But like this laptop, I don’t need to know how it works.  I’m just glad that it does.

I’m heading off on an outreach trip tomorrow, and I wasn’t sure how that was going to work.  The travel, cross-cultural setting, and security measures are all exhausting.  To head into that week depleted looked like a recipe for disaster, and I had contemplated a last-minute cancellation, knowing how disruptive that would be.

But I think that all had to do with what I was holding on to.  And I think my friend Chege saw how firmly I was holding that door closed.  His prayer helped me to just let go of what was bothering me, quit taking myself so seriously, and see the beauty around me.  We hold on so tightly to the chains that bind us, hold on so tightly to what we treasure.  Too often, the peace we seek is right in front of us, but we refuse to accept it.  If you think that might be true in your current setting, I encourage you to pray, find someone to pray for you, let go of your treasure chest, and see what happens when that door opens.

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” … an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”

After my annual evaluation last night, I went back over some of the things I had been discussing with Ann and our team leader Bethany.  Some of the things I was saying really didn’t sound like me:  tired, purposeless, sometimes hard to remember why I came here in the first place.  I do get fatigued here, as much from the cross-cultural differences as from the work itself.  But why was I sounding so negative?  The cross cultural stress inventory didn’t paint a pretty picture.Screen Shot 2015-05-20 at 10.53.50 PM

I got to thinking about burn out.  In the US, physicians experience real burnout at some point in their careers at close to 100% incidence.  Cross cultural living and working also has a pretty high burn out rate.  Hmm, so if I’m a physician in a cross-cultural setting, any chance at all that I might be experiencing a little burn out?

There’s a website call happymd.com which discusses the topic at length.  If any physicians reading this want to learn more about what to look for, I’d recommend you visit.  I can’t speak for other professions, but as a physician, you either have been, are, or will be burned out at some point in your career.

The website defines burnout as being depleted to the point where you don’t bounce back from normal stresses after a day or weekend away from work.  There’s a double edged sword here when in medical work that is also a ministry:  there is no end to the need, no obvious point at which you should go home, say no to another responsibility, or go on vacation.  Serge, our sending agency, is quite intentional about avoiding burnout.  I guess you have to actually listen and take the leadership’s advice for it to work.  But it kind of feels like you’re letting down yourself, the hospital, your patients, your agency, and of course, God.

A researcher named Maslach investigated physician burnout, and describes its effects in terms of physical, emotional, and spiritual depletion.  Burnout leads to fatigue, depersonalization, cynicism, and lack of efficacy.  It has effects on work, marriage, and relationships with family and friends.  She described its effects as ” … an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”

Maslach created an inventory, or questionnaire, to look for and determine the severity of physician burnout.  Just for a laugh, I though I would take the test.  I kind of wish I hadn’t.Screen Shot 2015-05-20 at 10.55.23 PM

On all scales, of physical, emotional, and spiritual burnout, I fell into the “severe burnout” category.  Not good.  Really, quite a wake up call.  I feel like I’m tired, not at my best, but this really tells me I may not be functioning at a very high level.

Thankfully, there is a lot of good work done on what to do with burnout.  Less time at work isn’t necessarily the answer, but looking at what parts of work are depleting, and what parts are energizing, is vital.  The key is to structure the day, week, month, and year, to find ways to engage with those parts of the work which are invigorating, knowing that other parts of the day will be “soul eroding.”

How to reconcile this workaholic, all-responsible, soul-eroding lifestyle with a life of following Christ?  You really can’t.

The message of the Gospels never promises an easy life, or lack of suffering, when following Christ.  But they do offer hope:

I came so that everyone would have life, and have it in its fullest. “(From the Gospel of John).  Or, from the Gospel of Matthew, ““Come to me, all you who are weary and burdened, and I will give you rest.  Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls.  For my yoke is easy and my burden is light.”

I have to admit, right now I’m not feeling I’m having life to the fullest, or finding the yoke easy or the burden light.  I can identify pretty strongly with the weary and burdened part, however.

So my plan is to take some steps to get back to the enthusiasm and energy that brought me here in the first place.  I’m very thankful that taking care of patients has always energized me.  Being part of a team that comes alongside the sick or injured in the healing process, talking with families, working with residents and other trainees, will always remind me of why God put me here on this Earth.

I’m heading off on an outreach trip beginning Sunday, so I will be gone for a week with some Kijabe colleagues.  I’ve been to this hospital before, and find it extremely challenging and energizing.  This small hospital, outside of a small town, in the middle of a large desert, is really striving to provide excellent and compassionate care.  I will have the privilege of doing surgeries with the resident surgeon, as well as teaching a one day seminar on the treatment of orthopaedic surgical emergencies.  I’m excited and grateful to be part of such a trip, and this is definitely part of the work which invigorates and fills the soul.

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