For what it's worth: it's never too late or, in my case, too early to be whoever you want to be. There's no time limit, stop whenever you want. You can change or stay the same, there are no rules to this thing. We can make the best or the worst of it. I hope you make the best of it. And I hope you see things that startle you. I hope you feel things you never felt before. I hope you meet people with a different point of view. I hope you live a life you're proud of. If you find that you're not, I hope you have the strength to start all over again.
Eric Roth The Curious Case of Benjamin Button
"I would like to focus on my international work."
That was the talk track, the explanation I gave when people asked why I had resigned from my job. It is a respectable explanation, one that makes people feel good. If you repeat something enough, everyone, including the speaker, starts believing it. While the statement is true, it is incomplete. The decision to leave my job was much more complicated and difficult than the talk track would imply. The fact that I left without any definite future employment shows how untenable the work situation had become.
On my last
day the orthopedic staff and physicians gathered at a local Tex-Mex restaurant for a farewell happy
hour. My mood was a bit melancholy as I reflected on the previous 2.5 years. I
had been so optimistic when I joined this practice. I hoped that this would be my
last job. I could finally do what I trained for, namely to focus on hand surgery, to be
in charge of my staff and schedule, and to make enough money so that I could work
in the developing world every couple of years. Malcolm Gladwell in his book Outliers talks about the three things
people need to be satisfied in their job: doing complex tasks, having autonomy,
and feeling properly compensated for their efforts. In my practice I lost autonomy over my schedule, my staff, my time in the OR. I was told how many patients to see, when to see them, and how I should always say “yes.” And I was starting to dip into my savings. At the end of two years, I
was 0 for 3. That’s when I realized it was time for me to go. I figured if I
was working for free, at least I could do work that was satisfying to me.
At the core of why I became a physician is a very simple desire: I want to help people. Becoming an orthopedic surgeon meant I could fix limbs, alleviate pain, restore function, and quality of life. Over the last 15 years of clinical practice, my very particular set of skills have become obscured by layers of less impressive skills. There is the charting, dictation, billing/coding, legal work, paperwork, and emails taking up several hours a day, after I am already exhausted from patient care. I need to worry about payor mix and poor reimbursements, which do not nearly compensate for the baseline level of risk and stress. There is the threat of malpractice, the surgical complications, the severely injured or unhappy patients. There is the emergency room call, with its unpredictability, and impact on schedules and sleep.
At least with call patients, I was treating real emergencies such as infections, fractures and lacerations. The vast majority of patients I was seeing in clinic did not have surgical problems. As primary care physicians are increasingly pressed for time, and often inadequately trained in orthopedic issues, they sometimes refer anyone with a musculoskeletal complaint to a sub specialist. Patient visits thus revolve around managing pain issues and expectations, instilling coping mechanisms, and minimizing catastrophizing behaviors. While I am qualified and competent to provide behavioral health counseling, it can be emotionally draining when it constitutes the majority of my practice. All these above-mentioned factors feel like death by papercuts (or mosquito bites, or any other seemingly minor insult, which when compounded, becomes quite intolerable).
Almost every physician I know is considering making a change. Whether working fewer hours, retiring early, or leaving the practice of medicine altogether, doctors are doing what they need to do to survive. There is much talk of work/life balance. There are entire courses devoted to physician wellness, or the non-clinical practice of medicine. It truly is a public health epidemic. I do not pretend to speak for all physicians, however. I can only share my experiences.
What lies ahead is still unknown. I am fortunate to have the means and opportunity to take a break. The Buddhist term "bardo" refers to the intermediate state between death and rebirth. It can also refer metaphorically to times of suspension or transition. This state of being is both frightening and exhilarating (think of standing on the precipice of a cliff). It is with gratitude for this precious time that I will proceed. I have increased my journaling and meditating. I have been reading more, which is my default coping mechanism in times of uncertainty. I have enlisted a career coach to help reassess professional and personal goals. He encouraged me to blog.
In the immediate future, I plan to teach and work overseas. I will be heading to Malawi in August, and Myanmar in October. I will work as a consultant for chart reviews and independent medical exams, on a limited basis. I may do locum tenens work when I return from my travels abroad. In what capacity I will return to clinical medical practice in the US remains unclear. I still love being a physician and a surgeon. I just need to create a life where my vocation can sustain me.
Monday, June 27, 2016
Road Trip Part 1
It’s been a long time since I’ve done an old-fashioned road
trip. Having recently resigned my job, I suddenly have a lot more time to
wander. Most of my travels in the last
decade have involved exotic vacations abroad, but this time I decided to stay closer
to home. Recent national events have left me feeling bewildered and
disheartened (I don’t want to politicize this early on, but really—Drumpf?!?),
and I thought a trip to the American heartland may restore my faith in the
American experiment. It's where the West
was won, the land of Lewis and Clark, the actualization of Manifest Destiny.
I have long wanted to visit the iconic sites of the West—Mount
Rushmore, the Badlands, the Black Hills.
From the mountains to the prairies, to where the buffalo roam, and where
the deer and the antelope play. Fortuitously,
2016 marks the centennial of the National Park Service. I chose to focus on the outdoors, the
wildlife, and the landscapes. I would by virtue of the locations and monuments,
relive elements of American history. I
chose to take the trip solo, with only the radio for company. The road trip is a classic American trope,
one that lets the protagonist (yours truly), discover some great truths about
their environment, and ultimately, about themselves. Think Blue Highways, On the Road, Travels with Charley, Fear and Loathing in Las Vegas. I decided to take this trip in
the spirit of discovery, adventure, and gratitude.
Spontaneity is great, as long as it is well thought out (“Be Prepared!”). Accordingly, I planned a rough itinerary, and picked up maps, guide books, and a Trip-Tik from the American Automobile Association (AAA). Yes, I went all hard copy, choosing not to rely entirely on my GPS, which in retrospect ended up being a wise decision. I had my car serviced, the tires rotated, and realigned. My trusty Audi Q5 was loaded up with extra oil and washer fluid. I packed a cooler with trail mix, peanut butter/Marionberry jam/bread, and coffee/tea/water. After a trip to REI, my ultra-lite pack was loaded with a CamelBak, bear spray, Swiss army knife, and clothing for inclement weather. While I planned on staying at local motels (“clean, and reasonably priced”), I did pack a sleeping bag, inflatable sleeping pad, and a Jetboil for road side emergencies. And needless to say, a camping French press for my coffee. Just the essentials.
Driving over 5000 miles gave me ample time to practice gratitude. The first thing I greatly appreciated was my Sirius radio subscription (no, I'm not a paid spokeswoman). The variety of music and comedy made driving less ponderous, and I could go for hours at a stretch without restlessness or lethargy. I thought it a good omen on my first day, when Sirius announced the limited edition “Road Trip” station. The first song I heard was Tom Petty’s “Running Down a Dream.” The station's eclectic mix varied from B52’s “Roam,” to Willie Nelson’s “On the Road Again,” to 2Pac’s “California Love.”
And I'm driving a stolen car
On a pitch black night
And I'm telling myself I'm gonna be alright
But I ride by night and I travel in fear
That in this darkness I will disappear
Bruce Springsteen "Stolen Car"
Music has played an integral role in much of my life. It has provided solace and guidance, freedom and rebellion. Over the last few years, however, as demands on my time have grown, music has become background noise. It is a luxury to be able to listen to the radio without distraction. This road trip helped me rediscover the soundtrack of my life. First Wave brought back the dance tunes I heard in my youth, and in New York City, and Edinburgh clubs. The 80s and 90s stations resurrected grunge, REM, early rap and hip hop. Particularly resonant was the Springsteen station. I was first aware of Bruce in college, late to the party, when Born in USA was released. I subsequently devoured his earlier work, particularly "Darkness on the Edge of Town," "The River," and "Nebraska." Now listening to his music over 30 (ahem) years later, his messages of disappointment, disillusionment, and perpetual hope are particularly poignant. And there is nothing finer than listening to his music while crossing the expanses of the Badlands, in all their desolation and richness. (Note: there should be a Neil Young station.)
But it wasn't all nostalgia. I got the chance to listen to new songs by artists I have long admired. The new Radiohead "Burn the Witch", Beck "WOW!", and the Strokes "Oblivius." I was introduced to bands I didn't know, such as LCD Soundsystem, Kristen Kontrol, and of course, Carseat Headrest, with their hit "Drunk Drivers/Killer Whales." And when I tired of music, I listened to Howard Stern, who has mellowed and matured with age, or the Comedy Station. What I did not listen to was the news. No BBC, CNN, or NPR stations harshed my mellow. I did not hear about the Orlando shooting until almost a day after the fact. There is no shortage of heartbreak, anger, and sadness in this world. It will keep.
We are fortunate to inhabit a country with such stunning and diverse landscapes. Glacier revealed her snow sprinkled mountains, glacial lakes, and coniferous forests. Dakotas North and South varied in their vastness, with undulating oxidized dirt, buttes and hills, sagebrush and prairie grasses. Devil's Tower (aka Bear Lodge) has inspired film extra-terrestrials. I hiked in the forests and tundras of the Rocky Mountains. And to top it off, I spent an afternoon in the volcanic aftermath of Craters of the Moon. It was the perfect culmination to the trip, with surreal moonscapes, abundant wildflowers, and 50 mph winds at the top of Inferno Cone. I took lots of pictures during my trip, but the camera failed to capture the grandeur of the spectacle, even with the Ansel Adams filter.
When I travel, and indeed in much of my life, I can be invisible. Whether by virtue of age, skin color, stature, or demeanor (resting bitch face), I can glide by without anyone paying much attention to me. Rarely do people spontaneously talk to me. (The Mormons of Salt Lake City were a notable exception, which I will discuss later.) I am the one who usually initiates conversations. This allows me to be social when I choose to be. I can say hello on the hiking trails, chat as I check into motels, or interact with staff and diners at a restaurant bar. And not surprisingly, most exchanges were lovely. People were warm, friendly, and helpful, whether with directions, suggestions, or personal anecdotes. I met adults, children, and pets, camping, hiking, caving, rafting, horse riding. I met a couple driving their RV cross country from Holden MA, and we reminisced about life in Worcester. During the Candlelight tour of the Wind Caves, I met a family from Denver, and another from Portland Oregon. The tour involved exploring the caves, illuminated with only the light from a candle held in a bucket. Not recommended for the claustrophobic, unsteady, or asthmatic. One of the families had an autistic teenage son, and I was moved by their patience and tenderness, as well as the young man's self-awareness and sense of humor.
There was the young Nigerian woman working the front desk at the hotel in Dickinson, North Dakota. This was the most depressing place I stayed (think the hotel scene in Fargo), with 70s-style carpeting, oppressive heat/humidity, and a disproportionate amount of morbid obesity. The young woman herself was quite upbeat, happy to be studying at the local university, and enjoying the perks of a small town. The hotel was nearly sold out, and when I asked about whether there was a meeting going on, the receptionist stated earnestly it was "some sort of old people convention." Indeed.
It occurs to me that this blog entry is getting excessively long.
This is why I don't tweet. I cannot limit myself to a measly 140
characters. So I will get this published, and continue my saga with
subsequent posts.
While I had originally planned to blog on the road, I ultimately kept a private journal instead. My neighborhood can be a bit sketchy, and I didn’t want any squatters taking up residence in my condo while advertised my absence for 3 weeks. So I can now share the exact itinerary, condensed stories, and significant reflections, in retrospect. Lucky you.
June 4 Missoula MT
June 5-6 Whitefish MT (Western Glacier
NP)
June 7 Browning MT (Eastern
Glacier NP)
June 8 Billings MT (Little
Bighorn NP)
June 9 Dickinson ND (Theodore
Roosevelt NP)
June 10-12 Hill City SD (Mt Rushmore NP,
Badlands NP, Wind and Jewel Caves, Crazy Horse NP)
June 13 Hulett, WY (Tower
NP)
June 14 Douglas, WY
June 15 Thornton, CO (Rocky
Mountain NP)
June 16-19 Aspen, CO (Snowmass, Pine
Creek, Food and Wine)
June 20 Salt Lake City, UT
(Big Cottonwood Canyon, Wasatch)
June 21 LeGrand, OR (Craters
of the Moon NP)
June 22 Seattle
June 22 Seattle
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