For an audio version of this post, please click on the speaker icon (top left).
This post is a follow up to last week’s post, “The Flames Of Burnout Have Risen Again. FI Makes It Worse.”
I thought it would be beneficial to share with my readers some of the emotions and personality changes I noticed as I once again fell into the grips of physician burnout at the end of the last year and beginning of this one.
If you are beginning to notice similar feelings and personality changes you may find yourself getting burnt out as well.
Much like a charred piece of wood cannot return to its original form, it is hard to magically transform yourself back to your pre-burnt out self.
Therefore it is vital to try and nip this insidious process in the bud as early as possible before irrevocable damage is done.
In Dante’s epic poem, The Divine Comedy, Dante introduces his audience to the 9 circles of hell.
Because work begins to feel like a living hell when you are in the midst of burn out, it is quite fitting to take a similar approach when I try and convey my burnout journey.
My circles of burnout hell differ from Dante’s in that there does not have to be a chronological divide between the circles.
You can find yourself in multiple circles at the same time.
It was also a judgement call on which circles I thought were worse than others and some I felt were on equal footing.
Burnout Circle 1: Resistance is Futile.
As referenced in the “The Flames Of Burnout Have Risen Again. FI Makes It Worse” post, the end of the year typically has a marked uptick in imaging studies, particularly mammograms.
In that same post, I also revealed why the end of 2020 was particularly awful because of the influx of extra studies that were previously displaced due to the COVID lockdown.
It was probably in my 2nd week of straight mammography that I started feeling like keeping up with the onslaught of studies was futile.
It truly was a demoralizing realization.
Despite my best efforts, the list never seemed to decrease.
It truly felt like I was fighting the mythical hydra, where I chopped off one head and 2 would take its place.
[Perhaps the tale of Prometheus is more apropos given the natural link between fire and being burnt].
In order to keep up with this I ended up employing a technique that caused me to enter the next circle of burnout:
Burnout Circle 2: Self-harm.
Now I do not want you to jump to conclusions and assume that I was entertaining any suicidal thoughts/actions as a potential course of action.
Nothing could be further from the truth.
Unfortunately, however, there are many physicians that have indeed committed suicide because of burnout.
No, my form of self-harm was far less drastic but nonetheless still damaging.
Because I was constantly reading study after study, I barely had time to step away from my chair.
Although the effects of being sedentary are insidious, there can be long lasting implications.
I had to consciously remind myself to flex my calves every now and then (similar to what is recommended to do on long-haul international flights) to help ward of potential for developing a deep vein thrombus.
Every day I go to work, I bring a 64 oz container of water that is the goal I set to drink during the work day.
Whether it was a conscious decision or not, I found myself drinking less water (I really do think I just did not drink much water because I was constantly dictating studies) which provided the “benefit” of not having to go the bathroom and thus take away valuable time which I could be interpreting and dictating instead.
I know I must have done a number on my kidneys during this time as it was not unusual for me to go a whole work day without taking one bathroom break or if I do take a , usually one maximum, bathroom break, the urine would be a darkened color.
During lunch I would wolf my food down while still looking at studies.
Certainly not an enjoyable way to eat food but it was it was.
Another phenomenon I became aware of during this hectic time was that I was no longer sleeping well through the night, most notably Sunday night.
I found myself tossing and turning in bed and waking up in the early morning hours (often multiple times from 1-4 am).
Sometimes I was able to go back to sleep.
Other times I was not so fortunate.
My mind was often racing in my semi-awoke state.
It did not take a genius to know that the culprit to this was that I was anticipating what laid in store for me in the upcoming work week.
Which leads us into the next circle….
Burnout Circle 3: Feelings of Dread.
This truly was a new feeling for me.
As bad as some periods of work could be in the past, I never dreaded going into work regardless of whatever modality I had to read that day.
But this was different because again it felt like no end was in sight.
I finally realized the beauty of our previous arrangement of alternating modality coverage schedules.
Anything is tolerable for a week.
Much like having a palate cleanser between courses in a fine dining establishment, this former schedule allowed me to wash away any bad taste of the previous week.
Without variety, which is indeed the spice of life, I was stuck in the doldrums of the reading room constantly having mammogram after mammogram populate my screen (I do tend to pick on mammogram reading a lot because it is the study that taxes my visual acuity the most).
My morning commute was filled with dread as I anticipated what laid in store for me that day and I couldn’t wait for the evening commute which I did often mentally exhausted.
Burnout Circle 4: Changes in Personality.
It should come to no one’s surprise but sleep disruption, neglecting basic body needs, and higher levels of stress from working full tilt is bound to have some mental/emotional repercussions.
I became less and less tolerant to minor issues that routinely crop up in an average workday.
I was definitely more irritable throughout the day.
I had to check myself after snapping at a tech if something was not quite right or keeping communications with staff to an extremely terse statement via our work instant messaging system.
I’m afraid to say that sometimes my office manager took some of the heat when she was tasked to notify me of last minute coverage changes that were not in my favor during this month plus of hell.
The worst of this was the two times I had the day I was supposed to be off taken away from me at the last possible moment.
One time I got a text early in the morning on my “day off” saying I had to come in that day as the coverage guy was unable to.
Another time I was notified the afternoon prior to my day off which was particularly problematic as I had planned several phone call meetings etc that ended up getting compromised.
She started off by saying, “Don’t kill the messenger,” but it was really hard not to.
I am quite fortunate that I am relatively isolated in my office with my door closed because often a tirade of cussing would emanate from me as I continued to see the worklist grow despite reading at my limits.
It truly was reminiscent of how my personality changed during my surgery residency before I switched to radiology.
It was an incredibly difficult situation at the time but ended up being the best career move for me.
It would be a lie if I said the thought of quitting and finding a slower paced opportunity or one that may provide a better lifestyle, such as teleradiology, never crossed my mind.
Burnout Circle 5: Spreading wildfire.
Much like a natural wildfire, what started out in one area can spread quickly into adjacent areas.
Unfortunately my bout with burnout did not just relegate itself to the workplace.
How can I enjoy activities at home when I crossed the threshold still mentally taxed from the day’s events?
One of the things I was quick to notice was that my desire to write posts for this blog vanished.
There was a time when I could not wait to put thoughts to paper and share with the world.
I had built up such a huge reserve of posts that at one point I could have stopped writing new material for months and still have 3 new posts a week published.
That buffer quickly evaporated during the end of 2020 and beginning of 2021.
Last week’s Flames of Burnout post and this one were written just days before the posting deadline.
Blogging, unfortunately, no longer moved me.
I soon began rationalizing ending this blog altogether:
- Low pageviews on a published post? Why are you putting yourself through this. Just quit and save yourself the headache..
- Lack of interaction with audience/no comments? Just quit and save yourself the headache.
You get the picture.
It is a constant struggle right now with both the devil on one shoulder and angel on the other chirping in my ear (I will let you decide which of the two is the one encouraging me to continue blogging.)
For the first time I shared these thoughts with someone else (my fiancee) who was saddened by the thought of me ending my blogging journey.
Obviously right now pressing on with blogging is winning, as evidenced by this post.
Just don’t know how long I can stave off the alternative choice.
It is definitely mind games being played courtesy of my burnt out state.
Burnout from work just sucked the joy out of life at work and at home.
If left unchecked it could easily progress to the next circle….
Burnout Circle 6: Friendly Fire.
I consider myself incredibly fortunate that I was able to not let burnout impact my duties as a father and interactions with my daughter.
I know that this is not often the case with others who may unleash their anger on innocent bystanders after having an awful day at work.
I reminded myself to listen to and address problems my daughter had while not dismissing them as trivial compared to the problems/inner demons I was experiencing.
One saving grace was that I found myself rapidly decompressing whenever I interacted with my daughter, be it playing video games with her, cycling, or even watching her learn to drive (she just got her learner’s permit in December).
Burnout Circle 7: You Can’t Unburn Toast.
Like I predicted in my previous post, once the new year was upon us, volumes did trend downward from the record highs of winter.
The strangest thing happened though.
I just so happened to start out the new year wrapping up my 3 week stint with mammography/X-ray/Ultrasound.
Each day I felt no difference from what I was feeling in December.
I was still miserable and mentally taxed with all the personality changes described above in full effect.
At the end of one particular grueling day I just happened to do a tally of the amount of studies I had read.
Lo and behold, it came to a number that would have been considered a slightly slow/normal day in the past.
But here I was still feeling burnt out.
Much like the healing process, recovery from burnout is not as simple as flipping an on off switch for the inciting factor.
This is indeed the residual effects of burnout, almost like mental scar tissue.
As part of “making it up to me” for the previous schedule from hell, it was arranged so that I could be on the CT/MRI schedule (which I enjoy) for 2 weeks straight.
It took until the beginning of the 2nd week before I started feeling a semblance of normalcy return.
COVID-19 has impacted many lives including those of healthcare workers.
It has gotten to the point where some of the psychological effects healthcare workers experience are akin to individuals suffering from PTSD (post traumatic stress disorder).
I won’t go as far to say that is what happened to me, as I am truly not a front line healthcare worker who has seen unspeakable atrocities from COVID firsthand.
But I definitely know what I feel would be classified as burnout in any sense of the word.
If you feel like you are currently in any of the above circles, there is absolutely no dishonor seeking help.
As mentioned in my previous post, I have notified the president of the board who is acutely aware of my situation and trying everything to make it right.
I am keeping my fingers crossed how this hopefully gets resolved in 2021.
At the time this post goes live, I will once again be immersed in a week of mammography, so wish me luck.
Have any other circles of burnout I may have missed? Are you experiencing burnout that was exacerbated by COVID? Please share in the comments below.
If you are in search of financial help, please consider enlisting the service of any of the sponsors of this blog who I feel are part of the “good guys and gals of finance.”
Even a steadfast DIY’er can sometimes gain benefit from the occasional professional input.
NOTE: The website XRAYVSN contains affiliate links and thus receives compensation whenever a purchase through these links is made (at no further cost to you). As an Amazon Associate I earn from qualifying purchases. Although these proceeds help keep this site going they do not have any bearing on the reviews of any products I endorse which are from my own honest experiences. Thank you- XRAYVSN
“You can’t unburn toast” Love that, I’m gonna steal that one.
This burnout stuff is pretty dark, but I guess if I’m honest I was probably near that state at times in my career. Hunker down Doc, you’ll get there.
Appreciate it Dave. Yeah that toast line is an original (at least I haven’t come across it) and originated when I used it on a comment to someone else and thought that is a great line, need to incorporate it into a post.
Yeah burnout has many forms and can really depend on where you are in life as how severe it feels. This particular one is the worst I have ever experienced. There may be some promising changes at work so keeping fingers crossed and hopefully can update if it happens
My son is a third year med student trying to figure out what area of medicine he will pursue- he scored extremely well on his boards so he has choices- he considered radiology at one point but decided it wasn’t for him. I think all areas of medicine cause burnout- my husband is a retired anesthesiologist ( retired when covid hit) worked 32 years and had had enough- he did night calls at hospital once a week which is tough in your 60s. He now works very part time at an ambulatory center. Can you practice radiology part time? Just… Read more »
Congratulations first off having a budding doctor in the works. You are correct that no matter what the specialty there is possibility for burnout. The best prevention for that is going into a field you truly enjoy rather than one for name recognition or money. I would say radiology was at one point truly a great lifestyle choice with great pay. My partner and I feel that the golden age of radiology has passed though and it has changed quite a bit. The biggest issue is that imaging studies have been under the microscope for cost cutting maneuvers and it… Read more »
Love the “you can’t unburn toast”… similar line was delivered to us in a Thai restaurant, “you can’t unring the spice bell”… Yes… lots of Info Tech WFH folks are experiencing burnout. We don’t want to complain because… hey… we still have jobs (good jobs) AND we’re working from home. No fighting traffic. Car is lightly used. Etc. But, the number of hours worked has gone up significantly because you can’t unplug. It takes real discipline to walk away and stay disconnected. I’ll just check my email turns into “why am I hungry… because it’s already 2:30” Our HR team… Read more »
Really really appreciate the comment Kevin, thanks for taking the time to write it. I think you hit another nail on the head about vacation which I didn’t really address in the post as a cause of burnout. I previously had a Cancun vacation plan that was for my daughter’s spring break that was canceled week prior because of the Covid outbreak. That was depressing as we both were looking forward to it. Then because of COVID never took a true vacation getaway for the rest of the year. Days off were spent at home and of course at home… Read more »
I work in healthcare (not a doctor)…in my early 50s now and a few years back I stepped down from a pretty high position looking for a change. I was anxious, depressed a little. And now I’m just at this point where I want this work thing to just be over. It doesn’t matter if you are a doctor, scientist, teacher…this burnout thing is REAL. And yet I feel guilty at the same time because I have a job, good salary, but everyday I’m off to work and it doesn’t feel right. I review my investments, networth, etc almost daily.… Read more »
I really feel for you because I go through the same motions (review investment, net worth) and keep mental debate alive about how much is enough. I know I heavily suffer from one more year syndrome, but these past few months really made me feel like I can’t last another year like that. Fortunately things are tapering down some finally and some good news on the horizon (have a post this Tuesday about it) that may help me put this behind me. Best of luck for your situation. I agree, burnout can hit any profession. I do hope you can… Read more »
Tough spot to be in, brother. Burnout is unfortunately quite powerful. Particularly when we don’t feel like there is anything we can do about it.
Keep your head up! You aren’t alone.
Thanks TPP. Yeah I experienced burnout a long time ago but had it under control when decided to take a day off each week (best decision ever). 2020 though took it to another level. I discussed it in my reply to Kevin but the lack of a true vacation getaway for an entire year also had a psychological impact. Never had a get away from it all moment for 12 months and had a great spring break vacation in Cancun canceled last minute because of COVID.
I appreciate all you do. Hopefully 2021 makes 2020 a distant memory.
Hey Xrayvsn… thanks for the reminder on drinking water. Us guys (and I guess gals?) of a certain vintage, if you’ve had a kidney stone, you certainly don’t want a repeat. I know it’s more trips to the bathroom, but the alternative is not pleasant. Yep, had a trip to Boston cancelled this summer. Had a debate with our HR department that not all vacation days were created equal. There was some idea that we could make up some days after the first of the year if we pushed hard on a project due end of December. My argument is that taking vacation days in… Read more »
Never had a kidney stone (knock on wood) but my colleague had and he was in excruciating pain.
I hear you on not all times of the year being equal for vacation. I’m a spring/fall person myself. I’m not an outdoorsy person myself. Prefer to be pampered on vacations. 🙂 Have a great one and thanks again for commenting.
I know how you feel and the ” you can’t unburn toast” comment is genius. I enjoy your posts immensely and would encourage you to continue posting as you, eloquently, voice what many of us are feeling. I use your posts as my escape from burnout. Live, laugh, love, and breathe deeply!
Really appreciate the kind words. Really does motivate me to try and continue blogging. It is hard to get out of this funk but the pressure is on because I no longer have a safety valve of already written posts as a buffer like I had in the past. It really does move me knowing my words can help someone else in a similar situation. I truly hope you can manage escape velocity from burnout. I have a small glimmer of hope right now that something amazing at workplace might actually come to fruition. I don’t want to jinx it… Read more »
I have also found that truly unwinding and staving burnout takes more than just time off. You need to also make time for hobbies, passion projects, and reconnecting with people important to you. If you are so burnt out that even your hobbies seem like a chore, where your emotional energy is used up and find it hard to connect with others, then you definitely need a hard look at changing your situation. Having the ability and fortitude to reject additional work “opportunities” that take you away from what matters most to you, is key. As physicians, we are used… Read more »
Thank you for the enlightening comment. Love the quote by Lao Tzu, never came across it before but it is very profound. I think you hit the nail on the head that time off does not necessarily mean it is a cure for burnout. That’s another thing that 2020 took away from me was the ability to get away from it all as vacation/travel plans were taken away or put on hold indefinitely. Any time off was me staying at home where I could always find chores to do. Appreciate you stopping by and dropping some great inspiration for me.… Read more »
I hope you are holding up during your mammogram week. Hang in there! I am not a big fan of promoting physician resiliency when the real problem is the job. But, if the people higher up know about the situation, and are working on it, some self-care habits may help you get through to the other side of this problem. If you will excuse a bossy PCP who gives unsolicited advice for a living: Leave your desk for work, and even go outside for fresh air, if you can. Eat your snacks and your lunch, drink water, AND go to… Read more »
Thank you so much for the encouragement and advice. I would love to say that things have gone down in volume for mammo week but it has not (I actually was curious so I tallied everything read today which was 176 studies (68 were mammo, the rest split between xray and ultrasound). But tomorrow I actually get a day off! So I am thrilled after not having my weekday off since Christmas. I do have a post in mind so I am actually going to try and get it done tomorrow so the blog survives for another week. Lol ?… Read more »
Thank you for sharing your story. I hope you can get through this tough part. The whipsaw nature of this pandemic has been really hard on the medical community. Change is hard, and I’ve struggled with the crazy changes from week to week. One day we’re operating on Saturday to catch up with our surgical backlog, and the next we’re cancelling all our elective cases because all the OR staff got redeployed to the inpatient floors. It’s maddening for both physicians and the patients. I’m not sure why this change increases burnout, but it clearly does. All my colleagues are… Read more »
Great point about how the change from a normal routine is tough on everyone and only adds fuel to burnout. I wonder if people who were on the brink of calling it quits were pushed over the edge by this.
You need a vacation. I was burned out at my old job and went through a similar experience. You need to step away for a bit to reset. Can you get someone to cover you for a week or two? Good luck Doc.
Thanks Joe. Yeah a vacation sounds great and I think that is the main problem because all of last year all our vacation plans got canceled. Any time off was spent at home which really wasn’t a vacation.
I do have a week requested off for spring break with my daughter again coming up. Not sure if I feel like it is all clear to travel somewhere though
I’m sorry the year end has been such a bastard to you. I can relate to your 5th and 6th circles. I tend to experience inspiration for posts as quanta, with 4 or 5 coming all at once. The dry spells between inspiration were longer these past few months. I’ve also been playing strategy games with my son, and that combined with the occasional family game of dominoes is the hard reset on my good mood that makes all the difference.
You are close to done, so hang in there, my friend.
It’s funny how a dry spell can hit in both blogging and in real life.
Hard resets are vital and quality family time is one of the best ways to do it
Hope things are well with you and the dark starts to fade away for all