As anyone who has ever done a job that involves interacting with another human being will tell you, it's often the human factor that ruins most things. In fact it can ruin it so much you can start to lose your will to live. Let me describe one scenario that is all too familiar for anyone who’s ever worked a junior doctor job in a hospital:
Say the procedure is: patient is 1 year old and has a tumour, patient needs pre-op MRI, patient needs surgery, patient then needs post-op MRI. The actual procedure becomes: need to talk to the patient’s parents about the surgery, risks, etc. You then have to organise the pre-op MRI, which is absolutely necessary for surgical planning – and everyone knows this – but either way someone will have a go at you about because you’re requesting it be done today or tomorrow because the surgery is to be done tomorrow and the boss only told you about it today and the patient did not ask for their tumour to be diagnosed only yesterday. Then you have to discuss the case with the anaesthetist who tells you that you need to put an IV cannula in this child before he gets to theatre, although you tell him that the only accessible vein in this child is in his neck and it took another consultant anaesthetist 2 hours to get a cannula in him last time. Somehow, he tells you, the patient’s poor venous access is your fault and you’re incompetent for not being able to cannulate the child. Eventually the kid gets the surgery (after the 2 hours it took the anaesthetist to find a vein in the child) and you have to talk to the parents again because they're worried something went wrong, they think someone somewhere stuffed up and it's someone's fault, and they get all unpleasant towards you even though you're trying to explain to them that their child is just post-op and they'll improve or that it was a risk you had discussed with them previously, etc. Then you try to organise a post-op MRI and the radiologist decides to pick this occasion to tell you how surgical teams do too many scans, that they don't plan them right, that they order unnecessary investigations, that you personally are a crap clinician, that you don't understand how the MRI machine works, that you are wrong and your patient doesn't need the scan... but they'll do it anyway. So by this stage everything that needs getting done IS getting done BUT all these people have in the meantime made you feel so negative about yourself that you start to wonder if it was all worth it. Like, really, why must it be you that cops the abuse? Your role could easily be filled by someone else who knows how to fill in the forms and talk to people (aka the majority of the tasks the junior doctor job actually involves). So why must it be you? Why? Seriously. Hopefully the kid gets better, and maybe you had something to do with it, but you'll never think of it that way, and the family or the patient will never thank you, so all you remember from the interaction is the abuse everyone laid on you and how small you felt afterwards. Was it worth it? Was removing that child's tumour worth you self-esteem? Was it worth losing your self-worth? Was it worth losing your passion for your job, the big picture? And maybe, just in some, the question becomes ‘was it worth losing your will to live’?
Okay, so maybe the final statement was a bit of an exaggeration but it is not describing a new phenomenon. I always remember that story from ‘House of God’ about the medical intern that suicides and how every year a certain percentage of doctors do. But the phenomenon, of course, isn’t limited to health professionals. Cliff Baxter, one of the executives of Enron Corporation (the U.S. energy company that went bust in 2001), suicided after he was indicted to court for his role in the Enron bankruptcy case. In his suicide letter he wrote, “where there was once great pride, now it’s gone”. As an executive of a corporation like Enron was, Cliff Baxter wasn’t a weak or stupid man, but to me at least, his story warns about the risk of defining yourself by your job. I find it sad to think that having a wife and children, he saw his life as not worth living because he could no longer live with pride for his work. What about living for his wife or his child? What about living because there are other things in life besides work? I can’t help but feel that if you have to rely on your job to make you feel satisfied, to make your life feel like it is worth living, to make you happy, then you’re probably lacking something very important and beautiful in your life.
They say that doctors are especially prone to what is commonly called “burnout”, in general, for the same reasons that they have chosen to become doctors: they are often perfectionists and have a high sense of responsibility. In the workplace these are exactly the things patients and their relatives appreciate and expect. Other co-workers also expect the same thing from them. And what’s more, eventually the doctor comes to expect this of himself. So then he starts going home late to make sure everything is OK (a.k.a. “stable”) before he leaves. He’ll work all the ridiculous shifts and hours he is told to because he’s expected to and no-one before him has been able to change the system so he just has to submit. Of course, with all the time (and let’s not forget effort) dedicated to work and career progression, he spends less and less time with family, socializing, relaxing, and essentially doing all those things that truly enrich human life. It’s then easy to imagine how with work consuming so much of your life, a person could come to define themselves solely by their work. You start to associate success exclusively with occupational achievements and less with the attainment of personal, family, or social goals. Proverbially, you come to ‘live to work’ not ‘work to live’. And once you come to do that, it is not so far-fetched to imagine guys like Cliff Baxter who, having lost his ability to work, come to believe that he has also lost the ability to live.
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