Burn Out: Stories about mental exhaustion

According to the APA Dictionary of Psychology, burnout is defined as “physical, emotional or mental exhaustion, accompanied by decreased motivation, lowered performance and negative attitudes towards oneself and others.” This is what our storytellers are experiencing in this week's episode.

Part 1: During her pediatric residency, Erica Martinez finds herself struggling to feel empathy for some of her patients.

Erica Martinez is a physician finishing her last year of a three year residency training in pediatric medicine. Originally from Minnesota, she moved east for college and earned her MD from New York Medical College. She is passionate about both children’s health and physician wellness, and she enjoys knitting tiny baby hats in her spare time.

Part 2: While working as a doctor in South Bronx, Karinn Glover feels overwhelmed and powerless when trying to help a patient with substance use issues.

After graduating from Howard University with a BA in History, Dr. Glover worked at Essence Magazine and as an Account Executive for Verizon. She followed her curiosity about medicine and ultimately attended SUNY Downstate College of Medicine and obtained an MPH from Columbia University's Mailman School of Public Health. Currently Assistant Professor of Psychiatry at the Albert Einstein College of Medicine, Dr. Glover teaches psychopharmacology and psychotherapy to Psychiatry and Family Medicine residents. Her career as a consultant and educator have informed her expertise in the fields of health equity, workplace mental health, and organizational success.

Episode Transcript

Part 1

When I was in medical school, our dean of students, Dr. Radloff gave us a lecture series on empathy. We discussed what it is, what it looks like and why it's important for doctors to have it. It was clear from her tone that good doctors have empathy and, at the time, it seemed really obvious. Of course, good doctors have empathy. But since graduating medical school and starting off my career in pediatrics, that obvious thing has been one of the things that I have struggled with the most.

Three years after those lectures, I'm about halfway through my pediatrics residency and I'm starting a busy rotation through an intensive care unit, a pediatrics intensive care unit. On my first day, all I can see are doors. And each door contains a family with a kid who's sicker than they have ever been before.

All of these doors face our small office in the center made of floor to ceiling glass walls. We look like a tropical fish tank in a waiting room with the fish darting around back and forth, swimming in circles while the onlookers are just trying to get better.

Erica Martinez shares her story at Jewelbox Theater at the Rendezvous in Seattle, WA in May 2023. Photo by Elizar Mercado.

It's incredibly busy. I'm putting in orders as I'm answering phone calls, as I'm calling consultants and I'm talking to families and I barely have a second to think. The phones are ringing nonstop. And every time I answer, there's a beeping in the background that indicates there's another person waiting for me to hang up to give me more things to do.

Our to do lists are getting longer faster than we can cross things off and everything happens stat in an ICU. But I'm picking up so many phone calls that I can't actually do the things that everybody wants me to do. I'm exhausted. I'm overwhelmed and I'm stressed.

In Room 518 is a 16 year old girl named Brianna who has cancer, osteosarcoma in her right leg. She's coming to us after a 26 hour long surgery where they removed the middle of her leg and reattached her ankle and her foot backwards to make a new cancer free knee joint. She's an excellent prognosis as soon as she recovers from this procedure but it's going to take months, if not years, for her to walk again. And even that, with the help of prosthetics.

The procedure was long and she had several complications and so she's coming to us with a lot of anesthesia on board and she has her breathing tube still in place. We make a plan as a team to let her wake up slowly and then take the breathing tube out so it can be done safely.

I'm the only resident on overnight. And while I have supervising doctors, they have infinitely more things to do than me. So when Brianna starts to wake up with her breathing tube still in place, I'm the only one who's immediately available to help her.

By her side, I see her alternating between awake and anxious and breathing through a straw that is her breathing tube, but then she'll fall back asleep and the machine will take over breathing. There's so many sedatives on board that if we take that tube out now she's more than likely to stop breathing. And the reality is, it's just not time to do it right now.

I can feel the situation escalating and she's upset and her mom's upset and I reach out in a kindness, trying to be caring and I tell her, “Wow, Brianna. I love your earrings.”

Wrong choice. Her mom looks at me with hatred in her eyes as she tells me, “Get out of this room. You can watch from outside.”

And as I leave, my heart is pounding and my legs are shaking. As I look back in through the window, I see her and I see myself the way her mother sees me, a bad doctor, a bad person, the kind of person that her daughter needs to be protected from.

And even after she goes home fully recovered from her procedure, it still makes my heart pound to walk past Room 518.

Just down the hall, in Room 514, is a young mother who brought in her three year old son from Mexico with a desperate attempt to cure him with the best medical help. He has a large aggressive abdominal tumor called rhabdomyosarcoma and the tumor is taking up most of his belly. His skin is stretched so tight across his belly that it's literally splitting down the middle. And his lungs have no room to inhale. They're being squished from below.

Alex was already assigned to a different resident when we arrived, but when we heard about his case, that resident asked me if I could take over for her. She told me, “I can't look at my son and not see him and I can't look at him and not see my son.” So Alex becomes my patient.

It's hard to go in his room. The air is heavy and humid with suffering. Alex’s stomach is losing the battle for space with his tumor and he doesn't eat much. So as the tumor grows, the rest of him wastes away.

But Alex loves bread. He asks for it all the time. He nibbles on it throughout the day and, when he goes to bed, in his tiny hands are two pieces of bread that he clutches like a security blanket.

Alex's case is tragic and it's sad. With the best doctors and the best medical care, we cannot cure him of his cancer. But in his room, I also find light and inspiration.

Near the end of his life, we ask special permission from the hospital to take him up to the roof so he can breathe fresh air. And as I'm up there with Alex and his mother, I'm surprised by how at peace I feel. Even though he has the saddest case that I have ever heard, it feels easy to feel sad with Alex and his mother because sadness and sharing that space is all we have to offer.

Two rooms over from Alex's, in Room 512 is a 16 year old boy named Garrett who had fought with his parents. After the argument, he went to his grandfather's medicine cabinet and took handfuls of whatever he could find and he washed it all down with a half a bottle of Windex. By the time he was found, he was unconscious and he was flown over by helicopter. By the time he got to us, he was intubated with a machine breathing for him. But he recovered quickly and he was doing really well, so it was, overall, a really hopeful case.

Now, his mother had been at work when he was found and she had driven over all night to get to us from out of state. She was frantic and angry and stressed and scared but we had a wonderful conversation in the morning about the plan for the day. We're going to talk to poison control and we're going to call the gastroenterologist who can use a camera to look in his throat and see what damage the Windex has done.

A couple hours later, I'm on rounds with the whole team and I'm getting ready to present his case. I'm outside his room and I stand up and I say, “In Room 512, there were no acute overnight events.” And in that moment, Garrett sits up out of his coma, takes a deep breath and projectile vomits blood all over the room.

I was so shocked. The best I could do was just pause and say, “Well, I guess there is now an acute overnight event,” before I rushed into the room to see what was going on.

Garrett's mother was furious and she moved around the bed with superhuman speed to get in my face and yell, “You said you would call the gastroenterologist. Why haven't you called him?”

And I know that a caustic substance like Windex can take time for the damage to develop. If you look too early, you can convince yourself that there's no damage only to have it develop later. And that knowledge is making me calm and reassured. But I can see the fear in Garrett's mom's eyes and it tells me that she knows her son is dying, even though I know he's not.

And I can understand her pain and her frustration. It looks like we aren't doing anything to help her son. But in that moment, all I can think of is how hard it is to show empathy to this woman who's screaming at me when, two rooms over, it was so easy to share that space in that sadness with Alex and his mother.

I feel this cold, heartless exhaustion bubble up through my chest. I realize that it is so much more complicated than good doctors have empathy. And when I really feel the pain of every family in the ICU, it can make it very hard for me to do my job.

Now, there's no doubt that I'm meeting all of these mothers on the worst days of their lives, at the bottom of their own personal pit. And it can feel like to have empathy is to climb down into that pit with them and breathe in that pain. On a good day, rested and refreshed, it's easy for me to climb down into pit after pit after pit, but there are days when those holes are just too numerous or too deep. And there are days when the pressure of all of it gets so much that it feels like this thin wall of glass that protects me from all of the awful things that I see every day can crack or shatter.

Every family in the ICU is having the worst day of their lives. For the most part, they get better and they go home and they are replaced by new families having the worst days of their lives. And I am there every day. It can be exhausting to live every day of my life in those dark places.

There are days when it is hard to have empathy and that does not make me a bad doctor.

Thank you.

Part 2

So, I was driving into the desert of Namibia for about two hours before I realized that I was crying. How did I get there?

I'm Black and I am the descendant of people who were trafficked, tortured and brutalized and raped and stolen, kidnapped and taken to the United States. I am the granddaughter of someone who saw his cousin lynched in South Carolina when he was a teen. He basically recognized that if you wake up and go to bed every day in a Black body, you're not safe.

Karinn Glover shares her story at Caveat in New York, NY in April 2023. Photo by Zhen Qin.

That's no way to live so he and my grandmother, with their third grade education, moved to Harlem, like millions of other Black people from the South, and basically looked for a better life. What they didn't count on was another kind of heartbreak and trauma which was witnessing three of their five children succumb to the opioid epidemic in the ‘60s and ‘70s.

And so I was raised witnessing the suffering of my cousins, who I loved and wanted to protect, but found myself powerless repeatedly. So I went on to embrace a career where I get to sort of reach into people's lives and fix what's wrong. Help them be better parents or better children or better aunts and uncles and community members.

So, I went to work in the South Bronx where, essentially, it's the lowest income congressional district in the United States. I had patients who came to me with any number of issues, trauma, depression.

One patient, I'll call her Cheyenne, came to me with a complaint of depression, except the more we talked, the more it became clear that her depression was linked to crack use. She would come to me and very acutely dysphoric, as we would say. Just very down. And I would have to say, “When was the last time you used?”

And she would say, “That was— I don't know. Nobody's using.”

And I would say, “Ah, look. I got your urine tox right here. There's nothing in the urine that shows up as cocaine except cocaine.”

And she would say, “No. Nobody's using coke. No. You got it all wrong.”

And we would go back and forth and I would have to like hold firm and also sometimes have a sense of humor and just go back and forth with her. Like, “What could it possibly be? What do you think?”

And she would just go, “No, no, no, no, no.” Then, finally, she would go, “I know.”

And I would go, “Okay, so now what do you want to do with that?”

So she would essentially argue back. At some point, she decided to go to rehab. She was a mother of four and she started to turn her life around. See, she was the descendant of Black people who had left the South looking for safety, looking for a better life, kind of like my folks. And she was raised by a parent who was addicted to alcohol.

She knew, when she was about 14 or 15, that home wasn't safe so she went to live in the street. And so she hustled and she made a way for herself. She had sex for money, sex for safety, sex for drugs. Her own father introduced her to cocaine and crack when she was 16. She made a way for herself. In the process, she contracted HIV. She still pressed on and became an activist and struggled with substance use.

And so there was always a level of respect that I had to have for her. I mean, I have for all of my patients but, in light of her almost nakedness, her willingness to show up repeatedly, I had to keep on honoring that and keep on working with her, even though sometimes she would show up agitated and angry and irrational. We worked together.

She went to rehab and then came back and brought her son with her, her youngest child, an 11 year old with sort of the same broad smile as she has and the same very sensitive eyes as she has. And so we got to know each other a little bit and I got to know her family.

So there we were, kind of working together. She really got to a point where she wanted to reconcile some things from her past and she went to visit her father.

Right around that time, I was starting to feel kind of burnt out. Starting to feel like my work was having limited usefulness for the population that I was working with, because societal forces seemed to constantly be dragging them down. Just when they would start to get their lives together, their housing would, literally, the ceiling would crash in and they would have unsafe housing where there's asbestos in the air. Their neighborhoods were unsafe. They were being unfairly policed in ways that constantly had them in and out of the carceral system.

So I just constantly felt overwhelmed and like I was powerless like when I was a kid. That's not what I went into medicine for, right? So a certain cynicism had come over me. I knew I needed to get away.

So, I booked a trip to Southern Africa. A friend of a friend of a friend was getting married. I didn't know them. I was like, “I'll just be there.” So, there I was buying my ticket to Southern Africa.

Just before my trip to Johannesburg, I got a phone call from Cheyenne. She called and said, “Look, I'm on the Amtrak. I'm on my way to New York. I'm going to see you tomorrow. I talked with my father and we need to talk about what happened.”

I said, “Sure.”

I get to work the next morning, kind of bopping into clinic and my staff said, “Did you hear what happened to Cheyenne,” and I said, “No, but I'm gonna see her later.”

They said, “No. No, she died.”

I just kind of froze because I was already like teetering, right? I just knew I wasn't going to be the same. I couldn't even go to her funeral because I had to get on a plane because I was going on this trip to relieve myself of my burnout.

I found myself driving into the desert in Namibia following the glow of the brake lights of my friend Don who was driving the truck in front of me, completely disoriented driving on the left side of the road, as they do there, driving a stick shift and just feeling really out of sorts. Suddenly, the brake lights went super bright and I realized I was close and about to hit Don's car. His truck stopped suddenly. I wiped my tears and got out of the truck and realized we had to stop because we were actually surrounded by a bunch of animals, zebras. It was astounding.

I looked up and our crew of friends, about seven of us, just sort of stood there, like what is this. Looked up and the Milky Way galaxy was right above our heads, like just above our heads. It felt like we were in space. In that moment, I kind of recognized that the same Milky Way that was over us was the same Milky Way that was over our ancestors. It made me realize that forces way powerful than I were constantly at work. I was doing my part but also maybe I didn't have to, because some of this struggle will go on and so will the world continue to spin.

So I took a break from medicine, from direct clinical care, and I went back part time, eventually. That turned out to be good, except four years later there came COVID and my patients started dying and some of my colleagues and some loved ones. I started to have that extremely powerless feeling again and felt overwhelmed and cynical and frustrated by what our leaders were doing and saying and the reactions of people in and around healthcare and in our system, because right around that time George Floyd and Breonna Taylor's killings were quite prominent and traumatizing. And so I knew that I just needed a break again.

So, I participated in a community talk around vaccine hesitancy and medical racism and sort of thinking in my mind like I cannot wait till I just get to take a break because I just don't know that I'm having an impact anymore.

I was on a panel discussion talking about medical racism and the legacy of experimentation and exploitation on people of color in medical systems. My co panelist had this really broad smile and these very sensitive eyes. He was about 18 years old and he was an activist. He bore a striking resemblance to my patient. I looked at his name and I realized that he was her son that she used to bring to me for visits when she was sober.

So, I realized that sometimes we, in healthcare, don't get to have quite the impact that we want on our patients and our patients’ lives. That there are forces that are so much bigger than us that seem to have a greater impact. But I think I just want all of us to know that, sometimes, the impact you hope that you're having on your patient and realize you're not having, you are actually having on the generation they gave birth to.

Thank you.