I used to work with veterans who sought mental health care. Many developed PTSD after witnessing their comrades get injured, blown up, and die. Some of these veterans had visible wounds, as one would expect, but almost all of them had invisible wounds. The latter were worsened by survivor’s guilt or shame that they failed to protect their buddies or complete the mission. Many had guilt about getting med evac’d. They didn’t want to talk about their shame because of feelings of failure. Veteran after veteran would come into my office, lonely and isolated, feeling forgotten, purposeless, and worthless and wishing for the comfort of death. No matter how much I would tell veterans that they are not alone, that if only they would reach out to another veteran for support, they would tell me, “I have to fix myself. I can’t do anything else or help anyone else. I don’t want to bother other veterans.” And as a civilian doctor, my word did not carry much weight. I was not a peer. I had not “seen the elephant.”
And then, I looked deep within myself to try to understand why veterans would not reach out to each other. And I didn’t have to search much further to see how physicians and veterans are more alike than different.
We physicians have a calling to medicine, service, and healing. We embark on a long journey of training and demands until we finally become attendings, giving up much of our freedom and a big chunk of life in service of this calling. Veterans also have a calling to serve the country and embark on the basic and advanced training, giving up much of their individual freedom and sometimes family, in order to fulfil the calling to serve the country.
We physicians sacrifice time, energy, resources, relationships, and finances, shoulder-to-shoulder with other pre-meds, medical students, residents, and fellows. By virtue of the experience, work, blood, and sweat, we have a bond with each other beyond words. We slog through sleepless nights together, and, yes, like the combat soldier, we see a lot of death. We share the joys and triumphs of our patients with our peers and colleagues. We have in common the long nights of studying for board exams, the stress of loans, and the unknown outcome of the match. We all experience together dedication to fulfill the calling and the commitment we made, and encourage each other and watch each other struggle on the way.
Similarly, Veterans experience together basic and advanced training, see each other through the sleepless nights. Veterans know the effects that service has on other veterans. Hardened on the same forge, they know what it means to “have your back.” Their bond from the trenches goes beyond words, forged by violence, where seconds make the difference between life and death.
We physicians have ingrained in us putting our mission first: taking care of the patient. Veterans have drilled in them that the mission comes first. We physicians have instilled in us that other physicians come second, after the mission. We will help each other if we can and encourage each other. While in service, veterans also learn that other veterans come second after the mission.
Both physicians and veterans learn by default that self, the very physician, and the very veteran come last, in the purpose of serving the calling first and then serving other fellow physicians and veterans.
The holy hierarchy thus becomes mission, other fellow veterans, and lastly, self. And in medicine, the order is similar: Serving patients, other fellow physicians, and lastly, self. And both veterans and physicians give up everything they are and everything they have to preserve those priorities. In the best of times, society commends them.
What happens when a wounded veteran or a physician cannot serve the mission or fellow?
As the veteran feels isolated, lonely, and ashamed, embracing blame for getting injured and not being able to serve the mission and team, so does the physician. As a physician, I have born my share of battle wounds from the health care system and have blamed myself for having failed patients or the system’s expectations, no matter how unrealistic or biased. I worked harder, blamed myself more, questioned myself further in a self-degrading manner, without any logical evidence to back up such mental flagellation. This is what I catch myself saying to myself, “But how can I justify not being able to continue fulfilling the mission of medicine and being there for my colleagues? Something is wrong with me for not being able to fix this for patients and my colleagues.” And with all that comes unhealthy, paralyzing shame.
And so I heard myself encouraging my veterans to connect to other veterans with similar experiences, to get courage, strength, and support, to break the isolation, and I heard my veterans resist seeking the healing connection with each other, and the contradictory feelings of weakness and that they should be able to fix it on their own. At the same time, I could hear my own resistance. It is hard for me to reach out to another physician who is struggling with the current health care system, on the verge of burn out or suicide, because then I would feel like I am weak for not having fixed my own problem without help. Battle wounds are part of being in battle, so are the wounds that we physicians bear from the health care system. And when I stop judging and blaming myself for not having been able to please a health care system that wants profit above patients, a health care system that drove me to the ground for the sake of the dollar, I feel less shame. I still haven’t figured out how to heal my battle wounds and to feel like I am back in control again so that I am able to serve the mission and my fellow physicians. But, I know enough to know that I am not alone suffering my battle wounds in health care.
In writing this, I heed my own advice to my veterans, which is reaching out to connect to other fellow comrades who have been in the trenches. So, I write to let any physician reading this know that you are not alone suffering from health care’s battle wounds. I am there with you, and I don’t want to do it alone anymore. I don’t have answers yet, but in time, I hope and trust you, and I and many others can find the path back to the heart of medicine together. I hope we can find a way to prioritize our own health instead of continuing to run on empty.
This is my call to action for the wounded healer project, for all of us physicians: Putting ourselves first and coming together with other fellow physicians, and lastly, serving the mission. It is not really possible to serve the mission well without fellow physicians, and there are no fellow physicians without each one of us coming first.
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