When I was in the fourth grade, I left school early one day unbeknownst to anyone. I misread my watch when the teacher was switching subjects, and she stepped out of the room for a minute. I thought it was 12:05 — time for lunch. I gathered my bag, walked out of the school, and stood by my mom’s car waiting for her to take me home for lunch. No one else was around. I waited. And waited a bit more … and then I had a sinking feeling that something was wrong. I looked at my watch again — 11:10. Uh oh … it was not lunchtime, and now I was standing outside the school by myself without permission! I panicked and rushed to my classroom, hoping no one would notice. I eased through the backdoor and walked over to my seat as if nothing had happened. Clearly, I was so embarrassed that I remember this minor event three decades later.
I look back on that incident and still feel anxious thinking about what I would have done or said if anyone had “caught” me. I would have burst into tears and apologized profusely for doing something without permission and making a mistake. Even as an adult, it takes effort for me to overcome this need to follow the rules and behave at any cost. I still worry that I am somehow flawed if I don’t do these things. We are all, of course, flawed. We will make mistakes, and perfection is an impossibility.
This example of a mistake may seem silly and inconsequential, but it is just one example of how we create rules for ourselves, even as young children. It’s an example of the pressure I put on myself. I carried these rules with me into adulthood, into medical training, and into my medical practice. Other rules I created include, and are certainly not limited to: I can work hard and not show fatigue. I can step up to help others even when I’m exhausted. I can say yes even when my plate is full. I can appear perfectly calm and collected even when I am a mess inside. I thought these were valuable skills I brought to the table. I even went back to work after being diagnosed with a miscarriage. That’s what you do, right? We are strong and carry on even when the personal costs are high. This is what I taught myself as a child, and it is what was reinforced during my medical training. Don’t show weakness, imperfection, or any need for personal space. Give it all to others all the time. Your needs are secondary.
These false beliefs we develop as children tend to serve us well. They are rewarded because they are “good,” don’t make trouble, make great grades, and help others. These skills are rewarded throughout medical training, too. We make great residents and leaders because we put on a good facade.
The problems come when we realize this is not an authentic way to live life. The cracks begin to show when we need help to cope with difficult situations. The biggest cracks begin to emerge as we defy our need for rest, relaxation, and fun.
What is that? How do you do that after years of running and engaging with this hustle culture that rewards you for staying late, working the longest hours, and being the most available to everyone all the time? What does rest even look like, and really, we can rest? Is it OK to take a break?
When I talk about rest, I am not talking about a weeklong vacation where after three days you start to let go of all the things, rest for two days and then start thinking about work the two days before you return to the office! I mean real rest. The kind of space where you don’t check your email, you don’t see the group texts from the office, you don’t check your inbasket to be sure someone is covering that patient’s lab work.
The business of medicine has created a culture in which doctors aren’t allowed to rest and truly disengage. Ever.
This, however, is actually a false belief — my rules governing what was OK and not OK as a child fed into my adult life. I created rules, boundaries, and stories that reinforced that I wasn’t “good enough” if I didn’t work like this. The system reinforced these beliefs and needs to change, and we can also take the first step toward healing ourselves.
So many limiting beliefs, false stories, and irrelevant rules contribute to this hustle culture. It doesn’t benefit you, your institution, or any part of the health care system for you to continue to believe these things.
If you need permission … here is your permission to rest. I give you permission to dream about what your ideal day might look like and, please, take the time and space you need to dream it into reality. Break these limiting rules that are fueling the inferno of burnout doctors are experiencing.
I am recovering from burnout and still learning how to rest well. My desire for an extended rest seemed like a fanciful lark at the time. I told my team I was dreaming about a month off, but I didn’t really need it. I would be OK. As soon as the words were out in the universe, though, that need for rest kept coming back. So I gathered up my courage and asked for four solid weeks off. My break would begin in a month after I had finished my inpatient service week so that I, of course, wouldn’t inconvenience my team.
And then I had a tough day, broke down, and called in three days before my scheduled time off started. Lesson learned — when you need time off, take it! Don’t wait.
Please, give yourself permission to rest. If you need rest, take it. If you need a break, there are people available to help you figure it out. You are valuable to your institution, and your needs are important, too. You are valuable to your family. You are valuable to yourself. Take the rest. You need to be your best self.
Here is your permission to rest. Take it and enjoy the heck out of it.
Laurel Kilpatrick is a palliative medicine physician.
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