The power of just letting go: Tackling burnout and coming out the other side

It’s January, and I’m remembering a brilliant, bright summer nine years ago. I had taken a month off, and we roved around the wild south with our kids: on beaches, in the bush, swimming in cool rivers. I was at the end of a tough three years, and it was a perfect holiday.

I had no idea that a month later, I would be on sick leave and selling my practice of 20 years. I thought I was all good after the break, but when I touched work again, this weird thing started to happen; it was as if the circuits of my brain started shutting down, so it became really hard to think. And thinking is mainly what GPs do: incredibly complex cognitive tasks every 15 minutes. I just couldn’t make my brain do that. I wasn’t depressed or anxious, but it was terrifying. I was worried I would make a mistake; couldn’t fathom how I could make my brain do a whole day, let alone a night on call.

I knew I needed to stop working for an extended period. Ultimately, it would be 18 months living on full or partial loss of income insurance.

Nowadays, I have “Burnout. March 2015 to October 2016” on my CV. In terms of professional development and reflective practice, it was a game changer. Of course, burnout is an awful experience but also life-changing, as illness can be, because we have to ask ourselves: who am I in the world, where am I strong and where am I fallible? What is important to me? What do I have to offer, and how can I best do that?

Not at first, of course. To start with, the trauma of burnout was horrific. The cognitive collapse was like a head injury; I couldn’t follow a complicated recipe or handle any extra stimulation. It was as if all the superstructure of self had been dismantled, and I was just skin and bone. That was scary enough. But much worse was the sense of failure, of shame. I went searching for answers to this feeling.

The Shorter Oxford English Dictionary helped as much as anything.

“Isolation: feeling alone.”

Thank goodness I had an incredibly supportive partner who believed in me. Although I needed to take time out from life, there was still a sense of being alone. I know if I had had a “real” illness, there would have been a rally cry of community, manifest in flowers and casseroles and get-well-soon cards.

To be fair, colleagues were great when they were the doctor and I the patient, but colleague-supporting-colleague seemed to be some unnavigable chasm for both sides. The ones who came towards me mostly had an experience of burnout themselves or some other professional fall from grace.

“Humiliation: to be humbled.”

I had such a strong identity as doctor, coper, carer that the idea I had toppled from my invincible grandstand was deeply humiliating.

I considered the feeling of “being humbled” and I recall the moment when I went, “That’s not such a bad thing; we doctors are pretty full of ourselves after all.” Maybe this was a beginning? Of what, I didn’t know.

“Shame: to not reach an external but internal-ised standard.”

The idea of slinking back to work without a mention of burnout seemed all wrong; I didn’t want to be controlled or silenced by shame. So, two years down the track, I spoke at the RNZCGP conference.

I knew I had to dismantle the shame if I was going to be able to stand up in front of 100 colleagues and be honest. I didn’t want to hand them the misery of it, leaving them feeling they had to rescue me; I just wanted to say, “I am human, we all are, and it’s okay.”

My colleague Hamish, who has written about shame and humiliation in medicine, asked the critical question. “So, what is the standard you have failed to meet?”

“Oh, well, I’m a doctor. I can manage everything. I can work through lunch, do a day of energy-sapping consultations, then a night on call, manage a business, race home to read stories to the kids before checking the inbox, respond to my deteriorating relationship with my partner, go through with the breakup, and then fit in buying and renovating a new house, then a new relationship and reconfigure the kids and whānau without flinching.”

Why be ashamed for not managing that? In retrospect, I should have taken three months off work.

Sometimes, life takes us beyond the limits of a self-care, resilience-training workshop.

I stood up at the conference and spoke to a fantastic group of GPs who seemed relieved someone had finally confessed; put words to it. It was a pretty visceral talk. I was doing well, but “resolved” was still in the future.

“Story: a sequence of events over time with named characters.”

I think of hope as a sense that a future story is possible. I held onto a thin thread of knowing I had the capacity to reinvent myself, even though, right then, I could barely string a sentence together.

Recently, a doctor friend asked me if I had forgiven myself for burning out. It was an interesting question. My immediate answer was “Yes!” but the more nuanced response is I don’t need to forgive myself.

Life does things to us, and all those things become subplots in our story. But books, where everyone is happy and successful, are pretty dull to read…and possibly to live in. Like all traumas, illness gets integrated into who we are and, over time, can create such richness and texture to our being that it’s hard to see what we would be like without it. I would say I accept my burnout; I learned a lot from it. There was no going back to what was before.

To my colleagues on the burnout spectrum, aroha to you, along with flowers and casseroles and cards. I love your work, your vulnerability, your strength. It will be okay. You will be okay. You are okay.

I completely trust you to work this out in your own way so you can sit comfortably with the next iteration of your story. You will have something profound to bring to medicine after this experience, so I hope you return in some new way. After a rest. (Probably a bigger, longer rest than you think you need.)

Recovery does not have to mean going back; it can mean going forwards.

Lucy O’Hagan is a medical educator and specialist GP working in the Wellington region