Coauthored by Linda Davidson Meyskens
Although the concept of professional burnout has been with us for a long time, its occurrence in medical students and physicians has become much more common in the last decade, with a particularly high rate both early and late in one’s career. The reasons are multiple, and details have been presented and discussed widely in ASCO and the American Medical Association (AMA) forums and conferences.1
But how can we do better? Three years ago, much to the amazement of this ‘60s rebel, I joined the AMA and its Orange County and California counterparts. And, indeed, they are doing their best to protect physicians against the adverse effects of organizational and corporate-driven “health care” in which money reigns supreme. But what more can we do? Recognition of the existential world in which we are embodied is absolutely necessary and all physicians and their teams need to understand this dynamic in order to survive effectively.
But what is this “existential space”? Broadly speaking, our thoughts and actions are driven by the tripartite realms of our biological, emotional, and social/cultural actions. The existential dimension is not a separate or parallel activity, but an embedded and unifying force of human existence. For those individuals with a religious underpinning, the existential world is “spiritual” and devotional with a God as the caretaker, and they find solace and strength in their faith to survive the difficult encounters of existence. But what about the large and increasing number of people who do not have such a foundation or who have abandoned their religious beliefs? What role does the existential arena play for these individuals, including yours truly, an ex-altar boy?
First let us identify some of the more prominent elements that give value to life: beauty, love, trust, truth, and hope. Specific (dis)stressors erode these values and produce feelings of emptiness, absurdity, irrelevance, false self, radical autonomy, and many more. In essence, existential (dis)stress is self-contradiction and leads to fear, alienation from others, grief, guilt, shame, denial, and feelings of being deceived, trapped and angry, and hopelessness. What more can we do to cope with the onslaughts that “break the camel’s back” and lead to burnout in the rapidly changing and evolving world in which we live?
To rescue someone on the precipice takes courage, with strong doses of love, acceptance, and supported choices and, above all, trust and hopefulness. With physicians leading, each caregiver needs to adopt a personal and selfless system of executive self-control that deals with life as a pathfinder of one’s own existential world and those of one’s team. I call this property “spiritual humanism,” and I believe its driving dynamic is an entity which knows no bounds: kindness.
One might call it the “p53” of your soul.
Offered here are two of many poems I have written that encompass my personal journey towards spiritual humanism.2,3
Today was the day that you told me
The diagnosis and changed my life forever…
Pushed, plummeting from an airplane.
My chest bursting, lungs gasping,
Skin seeping cold sweat
From the words that you have spoken.
Hit and run by a Hummer
My body flying, muscles frozen,
Skin crusting over with ice
From the sounds that I have heard.
Squeezed by the vise of not knowing
My heart stopped, life ending,
Skin prickled and graying
From the roar in my head.
Your words, a sucker punch,
Brain stupified and paralyzed,
Now at military attention
Awaiting your command.
My silence is not acquiescence
For I am not a screamer
These white walls are not
A harbinger of death.
For you are my savior…
whether you wanted to be or not.
ODYSSEY OF A PHYSICIAN SCIENTIST
From a very early age
released from the fatality
of a mysterious childhood illness.
Unexpectedly diagnosed in medical school
and told that my life would be short.
Working in a liquor store at age twelve.
Learning judo to avenge a wrong at age thirteen.
Hitchhiking at midnight, surviving a mortal encounter
with an evil man along the way.
Unsolicited and caring guidance in high school,
a blue collar kid now private college bound
traveling between worlds on a daily bus.
Boxing in the Fillmore to contain
the anger of my roots
To become a physician in training
and a scientist in the wee hours,
probing the most basic secrets of cellular life.
Hundred-hour work weeks since.
Not tiring in the quest to understand
what life is saying
and more often than not,
hearing deafening sounds of silence
when the road taken leads to darkness.
A street lamp in a darkened city.
The stars shining brightly.
Hard realities seen for what they are
the bête noire of life detoured.
But on occasion… illumination
Revelation, expectations, dreams
The wolves become as tame as lambs.
Then translating to humankind to
men and women with hearts and souls,
goodness and evil, ambition, greed and generosity
that challenges the interpretations of our testing.
But when discovery and healing gets it right,
… we doctors can seem like gods.
A poignant glance back to 1977.
My first month as an attending, my third patient
a teenage girl from Snowflake, Arizona
who has lost her unborn baby
to the ravages of melanoma exploding.
She will never know that I think of her often.
She pierced my bulletproof vest
and led me on to roads not taken
and the existential loneliness of that journey.
- “In continued effort to address physicians’ burnout, AMA adopts policy to improve physician access to mental healthcare”, The ASCO Post, 6/26/2018.
- Meyskens F. “Savior”. In Aching for Tomorrow (Fithian Press, 2007, with permission), p 17.
- Meyskens F. “Odyssey of a Physician Scientist”. Written for and read on June 2, 2016, when receiving the Clinical Translational Scientist Career Achievement Award from the Institute of Clinical Translational Science, UC Irvine.
Acknowledgement: Special thanks to Joseph Sun Nguyen, Chaplain Emeritus, UC Irvine for his many insights.