“I started planning my escape in late 2020. I would find a way to quit health care, to cease being a practicing physician altogether. Living the life of a doctor-mom, I felt consumed with daily obligations and duties.
Guilt plagued me for feeling burdened by this life, for feeling it was a monotonous prison. The guilt soon transformed to anger. I was not showing up to my life in a meaningful way. I held many limiting beliefs that blocked me from change. How did I get here? A child’s dream of becoming a doctor sustained me into adulthood. The dream was an all-encompassing mass-like occupancy in my brain with space for few other dreams. Upon becoming an attending, my dream was realized, but I found myself with a huge void where this space-occupying lesion once lived. Now what? In the absence of childlike wonder, it did not occur to me to create new dreams.”
Cathi Whaley is a hospice and palliative care physician.
She shares her story and discusses her KevinMD article, “Permission to burn the manual.”
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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.
Transcript
Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Cathi Whaley. She is a hospitalist and palliative care physician. She wrote the KevinMD article “Permission to burn the manual.” Cathi, welcome to the show.
Cathi Whaley: Thank you so much for having me. It’s a wonderful opportunity to share.
Kevin Pho: We’ll get to the article in a little bit, but first off, can you share your story and journey to where you are today?
Cathi Whaley: Sure, absolutely. I was born in Little Rock, Arkansas, to a pediatrician father, and I knew from the beginning that I wanted to be a doctor. That was not a pressure point from my family; that was really my own drive. I was very fascinated by science and germs and all those good things, so very early on, that was a goal that I fixated on, and all of my expectations for myself were really driven toward that goal.
But then, when I finished residency, immediately prior to starting fellowship, I really realized that this was not what I had thought it was going to be. I think that’s a very common sentiment that you hear medical professionals say: This just wasn’t what I thought it was going to be. In large part, it was realizing that I had drastically become somebody I did not like. So I was experiencing burnout at that point.
I then went into palliative care fellowship, and that was a bit of a reset for me because the circumstances had changed. I was doing a different role, and so that helped a little bit. Then I went out into private hospitalist practice, helping a community hospital start a palliative care program. Again, that helped a little bit, but inevitably, burnout always returned. It was like I would change the circumstance, and then, given enough time, I was right back where I was. So the problem wasn’t the place; the problem was me.
So I finally landed in my current role, and I’ve been there for four years. When I made the transition from my previous place of employment, it was largely that I was trying to renegotiate my contract, and I was trying to renegotiate it in a way that would give me that reset I craved without changing jobs, and we could not come to terms with a negotiation that accomplished that. So I took a leadership position in another hospital that was enough of a departure from what I had been doing that it felt like the reset. But then, two years later, right before the pandemic hit, I was just at rock bottom, absolutely rock bottom, where I realized, “I don’t want to do this anymore. I don’t want to be a doctor anymore. I will do anything but.” And so it became this panicky drive to get out of medicine at all costs.
What came from there was, I really thought I didn’t have any other skills or really couldn’t acquire any other skills, because I always thought, “I’m a doctor. This is what I worked so hard for.” But I became so desperate that I actually started studying real estate, which had always been something I was very interested in. In the process of this, I actually encountered some physicians turned life coaches, and listening to them, I just had these aha moments, like, “Oh, this is what I’m missing. This is what I need.” So then I started being coached, and then I decided to go for coaching certification to offer it to other health care professionals.
And so now I’m on this mission to try to say the things that I needed to hear two years ago, when I was at rock bottom and just feeling like I was trapped and trying to claw my way out. That’s really how Permission to Burn Your Manual and some of the articles have come about, trying to say the things that people may need to hear in order to jostle themselves into realizing they have choices.
Kevin Pho: I certainly want to hear what some of those things are, but before we get into that, let me ask you: You talked about in your story that you’ve had multiple episodes where you felt burned out, you felt you were at rock bottom, and you said you didn’t like the person you had become. Paint us a picture of what exactly you felt during those lowest times.
Cathi Whaley: Sure. In general, I find that as a health care professional, you learn to talk to yourself very negatively. Prior to starting medical training, I possessed self-compassion to some extent, and I was not all that perfectionistic. But over the course of training, I became much more impatient, much more perfectionistic, and much less self-compassionate. And then it’s almost like I assumed this culture of medicine and I propagated it.
Looking back, I very much remember the moment when my not beating myself up because I had missed a point of the history was horribly frowned upon by a surgery attending. This was when I was a med student, and I was sitting there saying, “OK, this is my first rotation of third year, and I didn’t know that the man only had one kidney. OK, well.” Because I didn’t turn beet red and just beat myself up in front of the man, that was taken to mean that I didn’t care. And so that actually became a huge issue in my surgery rotation. I had to have meetings at the end. They gave me a C, saying that maybe this wasn’t the right fit.
Now, I wasn’t shooting for surgery, but that was one of those moments where I really realized that it’s not OK to mess up. It’s not even OK to mess up when you’re learning. You are expected to be perfect, right? So then I start striving for that, and then when I’m an upper-level resident, I expect that for my trainees, right? So what I learned, what I became, is what I taught others to learn and become, and that’s disappointing.
Kevin Pho: All right, so let’s talk more about your KevinMD article. It’s titled “Permission to burn the manual.” Now, for those who get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?
Cathi Whaley: Sure. The manual is a very common thing that’s discussed in the context of life coaching. The manual is most often referenced in terms of other people. So we have an expectation of how our spouse behaves, and we have a list of shoulds, like, “You should have taken the trash out when I asked,” etc. So it’s basically a book that paints the expectations and how we sort of judge and value others.
But for me, when the manual came up in learning, it really sort of hit me like a thunderclap: “Oh, my God, I have a manual for myself, and it’s a toxic manual, and it’s holding me back, and I need to burn this thing.” Like, bonfire-burn it, like the bras.
So I had been sort of pondering the manual, and then I also happened to see an interview, a very long interview, with Dr. Jill Bolte Taylor, the neuroanatomist who had a hemorrhagic stroke in her late 30s, about her whole process through the stroke, right? And so, as I was reading it, I saw so many similarities between her stroke recovery and the path and journey I was on, realizing that I was really harnessing neuroplasticity to retrain my brain and sort of let go of the things that weren’t serving me, but really cultivate circuits in my brain, and thoughts and ideas that were serving me. That also helped me enjoy today and not constantly be looking at how big the gap is, how long it is until I’ve accomplished something.
Her book is a lot about sort of right brain, left brain, and I would say that from reading her book, I really realized how left-brain dominant I was and how much medical training only strengthened that. And so it really sort of cut me off from parts of creativity and the big picture. I became very data-driven, and unfortunately, I really just didn’t know how to be that way at work and turn it off and be different at home. It just became pervasive.
Burning the manual really became realizing that there are infinite possibilities, right, that I could do and be anything, but that I was the one holding me back, because I had this manual, which was based on being a doctor and all the things that I had done to try to achieve that point. And if “doctor” is written in big, bold letters at the top, there wasn’t room for anything else. So in order to sort of reinvent myself, to have a phoenix-rising moment, I had to burn it first. I had to say, “I don’t have to have this anymore. It’s optional.”
Kevin Pho: So we talk about burning the manual proverbially, as you said, but what are some specific techniques? Tell me a little bit about that journey, where you burned the manual. What are some specific things that you were coached about, and some specific things that you did?
Cathi Whaley: Right. So definitely, one of those things would be pursuing real estate. I now have a real estate company that’s very small, but we’re running rentals, and that’s doing very well. In the past, I always told myself that I only knew how to be a doctor, and I also told myself that I shouldn’t do anything else but be a doctor, because I had worked so long for it. I had a lot of limiting beliefs about what my capabilities were. I also always told myself that there just wasn’t enough time to do anything else. And I mean, there is a finite amount of time, but when you sort of take control of the mental drama that you have, you find that there’s a lot more time, because you quit spinning your wheels. So that was certainly one of them.
The life coaching was another part of it, realizing that I didn’t have to be a doctor forever. Now I’m actually happier practicing than I have ever been. I find a tremendous amount of satisfaction and enjoyment from going, but I also realized that I don’t really know a health care professional who isn’t where I was two years ago and who doesn’t really need help sort of digging out of the hole and realizing their potential.
And probably the biggest thing about burning the manual was really, instead of looking to the evidence from the past to decide what I was capable of, because I think that’s what we often do, it’s like, “I know how to cure this because I learned how to be a doctor,” or whatever, right? So instead of deciding what I was capable of based on the past, I decided: What do I want to be capable of in the future? And that’s what I set out to learn. That’s what I set out to create. I mean, if there’s one thing that health care professionals are good at, it’s learning, you know? But in my mind, I was just a doctor.
Kevin Pho: And I think that you’ve hit on one of the themes that I always try to promote on this show and on my blog, which is that physicians are more than their degrees, right? And exactly as you just said, there are a lot of physicians who are now in the place you were two to three years ago. Now you’re speaking to some of those physicians on this podcast, so, yes, I’m sure they’re motivated by your story. Tell me what kind of advice you have for them in terms of burning their proverbial manuals.
Cathi Whaley: So I think when you’ve experienced trauma, like many physicians have over the last two years, we sort of short-circuit our imagination and our ability to dream. So if they can take one tiny step every day towards a dream, something new that’s not based in the past, something that just fills their cup, I think that really will move the needle.
Something I did, for example: I never have been a writer, and I’ve never been a podcaster, but when I felt like I had something to share, I was just like, “Well, I am now,” right? So I wrote you articles, and I recently started a podcast called Permission to Burn Your Manual to say those things. And so if there’s something that they really feel a mission towards, or something that’s a craving or a dream that they really wanted to do, take one small step towards it, right? Because those small steps add up to massive action over time.
It can be extremely overwhelming, but, you know, all you’ve got to ask yourself is, “Do I have a strong why for why I want to do this, and what’s one thing I could do today that moves the needle in that direction?” Because the tiniest movement of the needle can translate to huge change.
Kevin Pho: Now, you’re talking to an audience on KevinMD and on this podcast, which mostly agrees with what you say. You know, I say this all the time, that physicians need a passion, sometimes outside of clinical medicine. But stepping outside our world, what’s the general response that you get to your story? Do you have physicians who say, “Why are you focusing on these other things? You should be 100 percent focused on patient care. You’re not a real doctor by doing this”? Did you get that kind of pushback when you share your story?
Cathi Whaley: So I do, on occasion, and I usually tell them, “Try it. Try listening to my podcast. Try reading an article.” Because overwhelmingly, when someone has come at me with, “This has nothing to do with being a doctor. I don’t understand why.” You know, doctor is just a role. But in that role, I want to serve. I want to help people be better. I want to help people have quality of life. And that is no different than what I’m doing now. It’s just that I have a different title. In this title, I’m a life coach, a physician life coach, right?
And so overwhelmingly, when someone has said to me, “I don’t see what this has to do,” I’m like, “Go listen to the first episode of my podcast.” And what I get in response is usually, “OK, I get it.” I’ve had some people say that they think that this sort of work is essential to the survival of the profession. So I wouldn’t knock it until you’ve explored it.
And I do think that there are a lot of people who are in so much pain, they have so many pain points, that they have a hard time even considering that it could be better, because they’ve just sort of given up. And so I’m here to say no, it absolutely can get better. I had given up too. I really had given up, and I thought, “Oh, my gosh, if I have to live like this until retirement.” It just made me want to vomit. I’ve done the work. It’s actually simple work; it just requires your efforts. But everybody is more than just a doctor. Their authentic self is enough. They don’t have to make themselves into anything; they just need to let themselves out.
Kevin Pho: We’re talking to Cathi Whaley. She is a hospitalist and palliative care physician. She wrote the KevinMD article “Permission to burn the manual.” Cathi, what’s something that you know now that you wish you knew back before you started this journey?
Cathi Whaley: I wish I had known that contorting myself into this person that I thought I had to be to work in medicine was a lie. It was a false choice. Would it have been me going against the norm to have maintained my own sense of self-compassion and let go of the perfectionism and all those things? Absolutely. It might not have been the norm, but it was still a choice I made back then, and if I had a do-over, I would not necessarily choose that for myself again. Though it did put me on this journey, and I’ve had a lot of wonderful experiences.
But if I could talk to somebody who has started training, I would make it clearer that it’s not an either-or choice. You don’t have to be the person they’re going to try to make you in order to survive in health care. You can just be your authentic self, and it’ll be OK.
Kevin Pho: And my final question: What are some of your take-home messages that you want to leave with the KevinMD audience?
Cathi Whaley: Well, I would say, I think health care professionals have been waiting for the system to change so that we could change, so that we could feel better. We’re constantly talking about how the system is not working, and I think all of that’s true. But I also find a common theme: We’ve all felt really alone, because when we talk to our peers, we talk about the system, but we don’t talk about our personal pain points. So I think it’s really time to start talking about it, talking about it beyond the system: How is this affecting me as a person, and how do I recover what I’ve lost?
And so if someone can really start shaking that off and doing that work, we as the profession are going to change, right? Because right now, we’ve just been behaving like the perfect person who is in this dysfunctional system. They don’t have to change so long as we keep being the person who works in that system. So if we’ll shake ourselves off and help ourselves recover and start talking about the personal pain points, I think there is potential for the system to change. But waiting for the system to change first, I think, would just result in the profession dying on the vine. I got tired of waiting.
Kevin Pho: Cathi, thank you so much for sharing your story, time, and insight, and thanks again for being on the show.
Cathi Whaley: Thank you so much. I appreciate your time.
