"Bugle Notes" - You Are Not An Island

The years 2000 - 2002 were a very difficult time for me. I was in a busy Internal Medicine private practice as well as its President. My outpatient clinic was full to the point that I could no longer see new patients. Hospital call was the “old way” before the time of Hospitalists - 24-hour call for both assigned and unassigned patients and then working the following day. I stayed in the hospital call nights. There was no use going home because invariably you would be called back for an admission. Then there were the countless phone calls from the answering service or from the floor nurses. Call was hard and becoming harder. I was also very actively involved in church, doing medical missions, coaching my sons in baseball and basketball, and trying to be the best husband and father I could be. I was not doing a very good job as a father.

Any of these would be enough to raise one’s stress level. However, the final straw came when my mother was diagnosed with a rapidly progressive form of myelofibrosis of the bone marrow in early 2001. She was only 66 years of age and completely healthy up to that time. 2002 was the most difficult time of all. My father, three brothers, and sister were not handling her illness or the reality that she was dying well at all. My mother’s Hematologist/Oncologists did a terrible job communicating with them. By default, I became “her doctor” in the eyes of my family while all I wanted to be was her son.

Starting in January 2002 until she died that May, nearly every weekend I would leave from my office as soon as I could in the early afternoon on Fridays and drive 7 ½ hours to my parent’s home in Alabama. I did this to see my mother, calm my family, and insure things were being done for her care. I would return each Sunday only to repeat the same thing week after week, month after month. The only time I did not go was if I was on call. Needless to say, this was emotionally and physically exhausting.

 I began to notice a change in me that at first I could not understand. I became very irritable, impatient, and withdrawn to the point that as soon as I went into an exam room to see a patient I immediately had a nearly overwhelming need to leave. It was all I could to make myself stay in a room and listen to the patient’s complaints especially since all that was happening in my life made their complaints seem inconsequential. I began to question whether I had made a mistake going into medicine and this was why I was feeling as I was. I was definitely “burned out” among other things but had yet to fully recognize this.

One night, while driving to Alabama, I was trying to find a radio station outside of Atlanta. I happened to come across a talk station and the topic was depression and in particular depression in men. For some reason, I continued to listen and as I heard the manifestations of depression in men and how they can differ from women, I realize that nearly everything they were saying I was experiencing! I suddenly realized I was depressed. I wasn’t simply “burned out”, or had made a wrong career decision, I was truly clinically depressed. The thought of depression had never crossed my mind. After all, I could handle stress as well as anyone. My years at West Point, my time in the Army to include in a war zone, the arduous years of medical school and residency training more than proved I could handle anything, or so I thought.

When I returned from Alabama, I immediately sought help. More importantly, I also began opening up to close friends. Until that time, I had not talked to anyone. I simply tried to bear this alone. I thought I could handle it on my own, after all, I had always done so in the past. I quickly began to improve and the irritability, impatience, frustration, etc. all resolved and I was back to my usual self. 

From this, I learned that no one is immune to significant life stressors and all that can happen as a consequence - burnout, disruptive behavior toward others, maladaptive responses, and even depression. I had failed to recognize this could happen to me. I only thought of it as happening to others or my patients but not me. But it did and the same can happen to each of you.

 There is a saying “No man is an island” and it is very true. People need others to encourage, support, and help them during difficult times. It is not a sign of weakness to acknowledge that, it is a sign of being wise. Not doing so can have significant consequences on you emotionally and physically as well as those you love. There is help whether by opening up to a trusted friend or seeking professional help. I know the work you do. It is hard and getting harder.  Take care of yourselves so you  can do the same for those entrusting themselves to you. Thank you for all you do every day in the care of others.

Andy Lamb, MD