"Bugle Notes" - Despair

I know how hard healthcare providers, especially physicians, work; the challenges they face; the obstacles they must overcome; the demands and stresses they endure everyday as they do the work, the hard work of medicine. It is not getting easier; it is only getting harder; and health care providers are paying the price. We are tough, though, our training has made us this way. We think we can withstand any demand and do any job no matter how overwhelming it may feel. But in the recesses of our mind, we know it is not true and, for many reasons, we won’t admit it. For me, it was the fear of being seen as weak, not good enough, not having “what it takes”. I was taught I could do anything, endure anything through my efforts alone – or so I believed.

Have you ever felt pain? I mean real physical pain? Pain so unbearable it takes your breath away, you are afraid to move, and you can’t stop the tears from flowing. I have and the physical pain I experienced was the worst I had ever known. It gave me a better understanding and a deeper compassion for my patients who went through such pain. I could not imagine pain worse than what I had experienced. I was wrong.

There is a worse pain. Like me, others have experienced it. I know because I was at their side when they did. Too many are going through it right now and cannot endure it much longer. Like I was, they are on the precipice of a deep, dark pit called despair. Despair, with its’ brother hopelessness, is the worst pain of all. It is an emotional state that even now I find difficult to put into words. But I know it. I have felt it. I have lived it and it is bad. Despair, at its worse, must be experienced to fully understand what I am describing. I hope no one else experiences it but the reality is most will experience it at some time in their life.

Have you ever experienced pain so visceral that it was hard to breathe? Have you ever been so overwhelmed with grief or heartbreak that you cannot stop crying? Have you ever gone month after month with no joy, a complete loss of joy to the point that you have forgotten what it feels like to have it? You cannot imagine ever feeling it again. Have you ever gone night after night unable to sleep because your mind is racing, you cannot stop your thoughts, and you lay there praying for sleep but it doesn’t come? Have you ever felt completely hopeless to the point that you cannot imagine things ever getting better? Have you ever been in the bottom of a deep, dark pit and cannot climb out? Have you ever felt so alone that no matter how loud or how long you cried out no one heard you?

This is pain and too many of our colleagues are going through it right now. You can call it what you want to - depression, burnout, etc., yet these words do not do justice to the pain of despair. You cope the best you can, sometimes well, more often not so well. I know because I did the same. It was the hardest thing I’ve ever done. What saved me and brought me out of this pit of despair? First and foremost was my faith in God. A significant second, though, was when I finally opened up to a few friends, medical and non-medical, I knew I could trust, with whom I would be safe, and who would love and support me.

How wrong I was to try to do that alone because of pride, shame, embarrassment, or simply fear of being seen as weak! Trying to persevere through this alone won’t work. Eventually, your best coping skills, your strongest efforts, your best “mask” will fail and the pain of despair will overcome you. All those you love and care about will suffer with you. Fortunately, there are people who care, who will listen, whether professionally trained or simply, like me, who know what others are going through and are ready to help anyway they can. You cannot do it alone. Too much is at stake. Medicine is hard enough, life can be harder, without trying to do this alone. There is hope. Life can be good again and joy can even return! Despair does not have to overcome you. The pain can stop.

Andy Lamb, MD