Under the surface
Arriving in the wellness world
“I don’t ask how tough the work is, got a tough indestructible surface” - Encanto
I still remember the first day of medical school, looking around the lecture hall with excitement and butterflies thinking, I made it. I had always loved reading and learning, understanding how the nature of the world worked. I felt a sense of purpose in medicine, believing that I could use my intellect to do something good in the world. I had also developed an awareness and confidence for how I learned best; rather than sit through certain lectures, I would read the book, and take my own notes. Learning was a source of joy and satisfaction.
In the clinical environment, I loved piecing together the clues of a persons’ symptoms to make a diagnosis. The patterns would come together in my brain and link with the facts I had memorized from my textbooks and case studies. In residency, we worked long hours, which I didn’t love, but I got to see physiology play out before my eyes. I saw sick children get better. I learned how to talk to families, lead a team, and spot a sick kid from the doorway. I didn’t shy away from stressful urgent situations, and thrived on moments when all of my attention and energy would converge when I was called to the bedside of a kid who was worsening.
I received good grades, positive evals (mostly) and an award for The Outstanding Senior Resident. Younger residents would ask - ‘how do you do it all?’ and I would think ‘I just do it’.
photo credit: Encanto
Under the surface
Similar to others with ADHD, I’ve always had a very active brain. This often looked like worry or anxiety in my youth. But unlike the high-pressure academic culture for many teens now, I was lucky to avoid academic anxiety in high school. My worries were reserved for things like Y2K, scenes from Dateline and 60 Minutes, and later Columbine.
While in college, there was a friendly academic competition within my pre-medicine group of friends, but medical school churned that healthy competition into a battle for worthiness. Suddenly, I was in direct competition with my peers. We knew we would compete for residency spots eventually, but the competitive nature felt more extensive than the single prize of getting ‘matched’. It was a messy combination of perfectionism, wanting to look smart, stand out, prove our worth.
This accelerated my anxious streak into overdrive, mirroring the Anxiety storyline in Inside Out. In my second year of medical school, when we began to learn pathology - all the ways humans get sick and die - my anxiety had a new focus. My brain became brilliant at linking the content of the week to sensations and signs in my own body. Is that red spot the first sign of lupus? That chest pain must be a heart attack. This fits the classic trope of the hypochondriac medical student, but I can assure you the lived experience is no joke. I started waking up from a dead sleep with my heart racing and lungs gasping for air (panic attacks) and living with a certainty that something terrible was going to happen to me or someone I loved any minute. I had given my anxiety knowledge, and it was feasting.
After getting a prescription for lorazepam (though not taking it out of fear that the sedative would negatively impact my school performance), I saw a therapist. She listed off a list of questions about potential symptoms I might be having. “I’m not depressed” I said, recognizing the DSM criteria from my studies. “How are your grades?”. “All ‘A’s”, I replied. Pause, “Well anxiety NOS” (not otherwise specified) she stated while taking notes.
I wasn’t surprised to not get a formal diagnosis of anxiety, I didn’t believe I had one. I had learned in medical school that most mental health conditions are diagnosed on the predication of some impact on daily living. I was functioning just fine, so whatever I was feeling under the surface was…. well, I wasn’t sure. But I seemed ok on the outside, and that was my litmus test for well vs not.
In residency, the anxiety became somewhat subdued, or perhaps just transformed. This was likely due to a combination of the activity and fatigue of the learning environment, seeing what illness really looked like and having a more grounded sense of pathology. I developed some skills at linking feelings of worry to thoughts, and this noting would sometimes quell them. I felt pretty normal. In reality I think I had learned to turn my anxiety into an adjacent and more acceptable form: drive. I strove to be exactly what my supervisors wanted, took on extra projects both at work and home. Scanning the environment for how to talk, act, perform.
During my intern year, I had also become a mother, something I was excited and happy about. After 12 weeks of unpaid maternity leave, I went back to 50-80 hour work weeks. And my lovely first born continued to act like a baby - up every few hours until he was around age one. Waking at 5:30 AM on my days off to eat breakfast and play. And I entered a dark and difficult world of extreme sleep deprivation, on top of the tiring expectations of residency training.
I think this was the era that I developed the mindset that I could do anything (which was kind of true, at least for a limited frame of time), and that you just have to push through hard things. I didn’t ask for help, time off, or for what I needed (sleep). When I began to hear whispers of ‘physician wellness’, I scoffed. I believed you either had what it takes, or didn’t. Residency teaches you to push through physical, mental and emotional challenges. I used those skills to also ‘deal’ with my anxiety, and learned to ignore my emotions and body, thinking I couldn’t trust them. Anxiety has this terrible ability to make you doubt your own experience. Is this a true threat, or just my anxiety? Lets just shove it all down and keep going.1
The cracking shell
My second child was born the spring before my first year as a faculty member (fully fledged doctor in academic medicine). I entered my new role excited and looking forward to my career. And I kept up my same can do attitude. All while living the experiences of motherhood that only grow with a second child - endless emails and to-dos from playmates and activities, requests for snacks and treats at daycare, lack of extended family nearby, and the mental load of orchestrating it all.
“I believed you either had what it takes, or didn’t.”
Each of these elements, and many unmentioned here, became the kindling of my burnout. I became irritable, short, and reactive at work and home. I started obsessing about FIRE (financially independent retired early). One day, I walked into my house after being invited to a multi-level marketing sales party, and announced “I’m going to sell Arbonne and eventually quit my job”. Let’s just say my husband was not my cheerleader that day, as he became increasingly worried about what was going on with me. I had wanted this career my whole life, and now I was going to walk away and sell makeup? I didn’t even wear makeup.
A few months later, I was slapped in the face with the truth of what I was going through. While multitasking multiple windows on my computer, I noticed the words from a webinar I was playing in the background “Irritable, decreased compassion for patients, no longer feeling confident or good about the work”. These all described the burned out physician. I didn’t even know what that was, but it was describing me.
Walking through the door
That day on the computer was an inflection point, and when I began my walk into the world of wellness and well-being. I couldn’t continue doing things the way I had been doing them. I no longer felt indestructible. I didn’t know what I wanted, but I knew things needed to change. In truth, there was a whole list of things I didn’t know at the time: that I also needed to process the shame of not ‘having what it takes’ to be ok no matter the circumstance, that motherhood had shifted the relevance of work in my life in a way that felt confusing and destabilizing. I also didn’t realize that my years of creating a tough outer shell around my anxiety had also closed myself off from the helpful inner voices and feelings that would eventually be the key to more ease and satisfaction. So instead, I took that same can do mentality and perfectionism into the world of well-being, jumping head first into getting better.
“Under the surface, I'm pretty sure I'm worthless if I can't be of service
A flaw or a crack, the straw in the stack
That breaks the camel's back, what breaks the camel's back?” - Encanto
I know I’m not alone in this approach. The reasons people walk into a yoga studio, buy self-help books, go on retreats, join gyms - they all speak to this inner knowing that the way we are doing things no longer works. The experience of suffering, exhaustion, burnout, they are a catalyst toward finding a new way. Yet, because I didn’t have a connection with my inner sense of direction or the wisdom in my body, I only knew to look outside myself for where to go next, for healing. I was on the hunt for a recipe or map to ‘wellness’, a guru or teacher who had the answers, a medication or therapy that would help me feel better.2 Something that would take me from where I was, to where I wanted to go.
I was not alone in wanting this. To feel better. To heal. To not be burned out. But I also wonder (still)
what will actually get us there?
where is it that we want to arrive?
do we really need fixing?
I worried a lot. Will the garden grow, will the rivers
flow in the right direction, will the earth turn
as it was taught, and if not how shall
I correct it?
Was I right, was I wrong, will I be forgiven,
can I do better?
Will I ever be able to sing, even the sparrows
can do it and I am, well,
hopeless.
Is my eyesight fading or am I just imagining it,
am I going to get rheumatism,
lockjaw, dementia?
Finally, I saw that worrying had come to nothing.
And gave it up. And took my old body
and went out into the morning,
and sang.
Mary OliverThis story is not meant to medical advice. This is my experience of anxiety, and doesn’t indicate how anxiety should be treated or experienced. Please talk to your doctor, a mental health professional, or loved one if you are curious about your symptoms and what you might do about this.
Wanting to feel better and taking medication for mental and physical illness are normal and supportive choices for many people.