The Gifts of Burnout: An Evolutionary Wake-Up Call for Doctors

It has been fourteen years since I graduated from University of Michigan Medical School. I have journeyed far from the field of medicine, and yet my heart keeps hearing the call to return to my physician communities and share what I have learned. I simply cannot ignore my sense that the pain within our health care system - now felt at every level, including patients, physicians, and payors - is a resounding call to wake us up to our next stage of evolution.

It takes only a cursory scanning of the headlines of medical blogs like this one to get a sense for the unrest, the frustration, and the abundance of innovative practices emerging as a result of the rising sense of powerlessness among doctors. I left medicine immediately after receiving my MD, moving into uncharted waters after the Dean of Career Development at Michigan told me, "You're on your own. We can't help you with that." This was when, as a fourth year student, I announced I would be pursuing a career in venture capital.

I volunteered at a private equity investment firm - yes, I worked for no pay - and six weeks later, I was hired as an Associate. Within two years I was the youngest partner-level Investment Manager in the firm. No one told me this was possible. I simply would not accept anyone else's opinion of what I could or could not do. Especially after what I witnessed in my world of medical training.

One of my most vivid memories was on my Vascular Surgery rotation, where I was absolutely loving the concept of what we were doing - as intellectual masturbation material. But in practice, what I saw was my future laid out in the following scenarios. The second year resident, sick as a dog, showed up to work anyway, and, too weak to stand, lay down on a gurney in the OR while a case was going on. The third year vascular surgery fellow, a gentile Southern man, was in the middle of a lower extremity bypass graft and stepped out of the room. He lifted his mask, vomited into the scrub sink, and then reentered the OR to continue the procedure. This happened two more times within the same procedure before he completed.

Many of you reading this may be nodding and saying, "Yup. That's just the way it is. Suck it up or leave it." And my question is, "If you have trained yourself not to feel, what else might you be missing in your experience of other people?".

Later in the month, on a Saturday night call, we brought Mrs. X into the OR at about 10pm. This was hospital day 50-something for her. She had come in for a routine renal artery stent, and apparently had embolized into her IMA, killing off part of her gut. Her wound was infected, she developed multi-organ failure, and was kept alive, with an open abdominal incision, on a ventilator. She was unresponsive, and it was unclear, each day of the month we rounded on her, whether the family was aware of her prognosis. One day I spoke to her husband, and he told me, glossy-eyed, that the day before she was admitted to the hospital, they had played tennis together. He looked forward to the day they could do this again. What a far cry from the rigid piece of meat that was plugged into machinery and called "alive". I was confused, then, when we suddenly decided to bring her back to the OR to "drain her abdomen" or do something surgical, when there was no clinical evidence of any change in her status.

I will never forget the first snipping of the sutures holding her abdominal fascia together, as a wave of black liquid gushed out of her belly. We tried to catch some of it in a test tube to "send it for culture". As if we couldn't predict the lab report of "multiple anaerobic organisms not otherwise specified". Then, at around 11pm, our 63-year-old attending vascular surgeon walked in. He had street clothes on, and held a mask over his face. He leaned about ten degrees in over the body and said, "OK, I'm signing off". Then walked out.

We were left with closing her up, bringing this woman - not just a body - back to the ICU, and coming up with a story in our notes about what we did and why.

I moved on to a different rotation before she was ever pronounced dead. I wasn't there when someone had to break the news to her husband that they would never play tennis again in this lifetime. But I internalized a lesson in that month about the price of actually DOING what I LOVED. A door inside my heart closed, believing that my heart's desire - to do a job I loved, and to live a LIFE I loved - was simply not possible. I had to choose one or the other.

Since then, I have been a partner-track professional in a venture capital firm (again, something I was told would not be possible given my experience), I moved to California to follow my childhood dream of starting a violin school, built a successful six-figure business on my own from scratch, and then experienced the loss of that school through what I now see was burnout.

The gifts of burnout have been the rediscovery of my humanity, my desire, my creativity, my purpose, my own healing, and my love. I love empowering people and being co-empowered in relationships. I love seeing my ideas in action. And I love being the facilitator of true healing and transformation in people.

I have created a life in which I do what I love, and I am fully supported in the very uniqueness of my expressions of love. I have received trainings in life coaching, sound healing, traditional Thai massage, Breema bodywork, and Bio Optic Holography. I made a conscious transition from playing only classical music for thirty-plus years to improvising on my violin, voice, and other instruments. I co-created an acoustic rock duo with my partner-in-life, and we perform in public regularly. We live in a beautiful natural setting, among a community of people who value artistic expression, stewardship of the earth, and mutual support. I birthed myself as a visual artist, and have exhibited in a juried show during my first year as a painter. I have traveled the world and studied with the most inspiring people I have ever met in my life. And I share this with people, one-on-one, in groups, by phone and face-to-face.

I have avoided sharing the fullness of my learnings with physicians, other than those who happen to find me in their own internet searches. I have been hiding my joy. And now, even as I feel my fear of wading into shark-infested waters, I choose to bring my message to you. It is not necessary to settle for what others have told you is possible, or even for what you have defined in the past as possible. You are a creative force far beyond your current imagination.

I have followed the public and academic discourse on physician burnout and suicide, and I notice several things. First, the good news. It's being discussed and therefore legitimized as a "syndrome" in the eyes of the medical establishment. Not surprisingly, however, burnout is being "medicalized" as a diagnosis that must be prevented, eradicated, treated aggressively, and fought like a battle against a raging enemy among us. This is the medical mindset. It's how we were all trained to see the world - to focus on what's right and wrong, eradicate the wrong, and restore the system to its previous state if at all possible.

I have a different perspective. I see the experience of burnout not as something to be eradicated, shamed, attacked, or avoided, but as something to experience with full participation and curiosity. To see the depths of despair and loss as a form of structural tension within a system that holds great innate latent potential to launch a powerful trajectory in the direction of your greater mission in life. Yes, I believe your personal, specific experience of burnout holds the very keys to the fulfillment of your wildest dreams and desires for your thriving life.

Fundamentally, the process is one of remembering your love. Remembering your art. Remembering YOUR medicine. And LIVING YOUR MEDICINE. Yes, that means looking at yourself. Shining loving light - transcending right and wrong - on those experiences within you that require healing attention. When you have walked with courage through your own healing process, and you have touched the places within you that you did not understand how to love previously, you become your medicine. You embody the grace of healing, and you effortlessly deliver the level of care, compassion, and precision that flows through you as love.

If your heart says YES, please join me for a free introductory call to my new program for physicians, "Live Your Medicine", by registering here. Vote for your own joy, creativity, and desire by taking a courageous step on behalf of your own heart. And please reach out to any colleagues you know who may benefit from this discussion.

E-Squared Book Club: Week 7

For the past seven Wednesdays, I have shown up at 10am at Quarry Park, and at 5:15pm on the phone, ready to explore the latest energy experiment from Pam Grout's book, E-Squared, with the participants in E-Squared Book Club. For six of the seven mornings we were blessed with warmth, sunshine, and perfect conditions for sitting outside to marvel at the goodness and beauty available to us at all times. On our final Wednesday, it was looking like we might need a "Plan B". The first winter storm of the year had arrived and stayed the entire two days before. I sent out emails announcing an alternative indoor location. But on the morning of our scheduled meeting, it was clear. Not quite sunny, but definitely not raining.

We gathered at the usual spot, each wearing our rain gear, just in case.

Tammy brought her young sunflower sprouts (from Experiment #5) to plant in the clearing where we had gathered for our meetings.

Our plan was to hike about a mile up to a lookout above the labyrinth. As we began to plant the seedlings, it started to rain gently. I managed to get a few pictures before my iPad had to go back in my pack.

Then, as we walked up the path, it continued to rain. As soon as we arrived at the lookout, it was coming down hard. Tammy captured this video of me, just to show how soggy - and grateful - we were.

[youtube=http://youtu.be/3sjSxHhJA18]

Our "homework" -- after drying off thoroughly at home -- was to write a letter to each of the other members in the circle, expressing the individual gifts of our time together. What fun it was to receive in the mail, a few days later, such heartfelt expressions of being witnessed and appreciated! And what a gift to take a few moments to appreciate what was received from the presence of another.

One week later, I returned to the same spot at Quarry Park, to take a walk and to check out the seedlings. They are healthy and strong!

Now that the club is done meeting, I notice the space that was held by our circle of energy and shared intention. I am dreaming of ways to keep that going in my life, and to share it with others. We were truly nourished by holding a playful space for each other to tap in to the infinite potential available to us.

I'm also fondly recalling some of the ARTifacts we created at Amy Sullivan's Art & Inspiration gathering...these pieces were all inspired by E-Squared Book Club!

To read all previous posts from our E-Squared Book Club meetings, go here.

To find out about future events, sign up for my e-newsletter to get updates in your inbox.

Falling Down To Earth...Lessons from "Gravity"

I saw Gravity this weekend. It was date night. Since we normally watch movies on Netflix in the luxury of our own living room, with the sunset and ocean behind our backs and the fire roaring in the fireplace, the trip through traffic and the ordeal of finding a parking space in a shopping mall made me expect a lot from this one.

We decided to splurge on the 3-D version. We got a big bag of popcorn, and settled into the theater, which we had mostly to ourselves.

I was already filled with gratitude for my life on the coast after we set foot inside the neon shopping mall that contained the movie theater. At that moment, seeing the names of the food court vendors – none of which were familiar to me, feeling the fluorescence of everything, squinting at the brightness of the SALE signs in every store window, hearing the echoes and reverberation of the cavernous container of the space, I realized how long it had been since I’d shopped in a mall. When had that shifted? I recalled a time in my childhood when the only place to shop for clothes and shoes was the mall. It was also one of the main “hangouts” for kids who went out after school (of which I was not one).

I won’t talk too much about plot points here, but I want to list several of the “messages from the universe” that I feel are embedded in the movie. I’ll scramble them up so as not to have to give too much of a spoiler alert. But if you must see the movie first, I’ll warn you that I refer to some scenes in the text below.

1. We’re hurtling at light speed toward our destiny at all times.

2. There are two ways to go through our brief moment of time called life – light and floating and free, with laughter, presence, and acceptance, or tethered, struggling, thinking hard, constantly driving somewhere, not knowing where in particular.

3. As unlikely and miraculous as it was for the protagonist to arrive back to earth, her journey is a metaphor for the set of unlikely circumstances that collide to create any individual life on earth, and both are equally miraculous.

4. There are two ways to meet our inevitable demise of death – in awe and wonder, with a light heart, and fully present, or with fear and regret. The way you die is the way you live. Start living.

5. To continue living, you must continuously jettison the parts that no longer serve you. Even though at one time in the past they were essential to your survival, these parts can be exactly what’s holding you back right now. Keep letting go.

6. Sometimes you find yourself on the end of a tether, getting whipped around, believing you’ve been rescued or saved. While you’re technically alive, the ride may feel nauseating, and you’re never permanently protected by what’s on the other end of the tether.

7. Use what you have, do what’s in front of you, remember what you know, and start from where you are.

8. Be grateful for your mind, and remember to use it to serve your heart’s desires, not replace them.

9. Everything can be blown to bits, and you can be one of those bits. You can experience your own rebirth by falling back down from (your head) space into the watery womb of mother earth. You can dive deep, find air, reach land, express gratitude, and then finally find your own legs. This is the story of human evolution…from star stuff to dirt, that’s what we all are: miracles.

10. Sometimes we need to journey far, far away in order to find our way back home.

Why everyone should poop in the woods...at least once

I firmly believe everyone should have the experience - at least once in their life - of pooping in the wilderness. Of digging a hole at least six inches deep, dropping trou, and watching their own poop land in the hole. Then filling it with soil, packing it down, and returning the surrounding earth to its original state.

I believe this not just because pooping in holes has become second nature since I started backpacking, but because I experienced real compost in my friend Lydia's yard yesterday. From start to mulch. When you see one too many potted plants or cut flower arrangements in your life, you forget where it all really comes from. Not just the postcard pictures of a farm with a guy in overalls posed casually leaning on a fence that you see from the side of the road. Not the beautiful bins of colorful, washed produce (definitely not GMO and definitely organic) at the farmers' market.

No, I'm talking about what dirt really is. How our bodies - the stuff of our skin and bones - are ultimately the same stuff as dirt. How the plants growing prettily or wildly in the ground are also the same stuff as dirt. How if you have the chance to take a shovel and pull up some plants, move them to the compost heap, then come back a few months later, you might see something that looks nothing like the original plant but a lot like dirt.

We make dirt wrong. We use it to describe the things we don't want on us ("Don't touch that! It's DIRTY!"), don't want to hear ("Don't say that DIRTY word!"), and what we work hard to get rid of ("Wash your hands...they're DIRTY!").

But DIRT is US.

Would you touch compost with your bare hands?

It was a moment of revelation - of Oneness, if you will - when my friend Lydia lifted the tarp covering the fresh heap of compost made of kitchen scraps. It was hard for me to watch all the creepy crawly worms and bugs making their way through coffee grounds, pumpkin skins, paper scraps, egg shells, and leaves.

I didn't want to have to see it. I'll admit that.

But there they were, making DIRT...the vital ingredient that fuels all life, the stuff that IS life in its final form and the source of all living things. The end...and the beginning...simultaneously.

It had been so long since I'd seen, smelled, and participated in decomposition that it woke me up. But of course that isn't exactly true. I'm surrounded by life - and DIRT - at all times, I just ignore the "dirty" parts and focus on enjoying the flowers and the fruits. I let other people handle the dirt - "do the dirty work". Or I separate myself from the "dark" or "dirty" aspects of me. I try to edit them out of my experience, as if it's better that way.

worms

As I stood there, staring at the bustling city of worms crawling in and out, up and down, through the muck, I remembered. I remembered all the ways I have tried to push away the "dirty" parts of my past, to make everything look clean all the time, to live as if the flowers - the things of Beauty I've decided I want to see - don't have deep roots that crawl through that same rich soil, black and moist with powerful fuel for life. I remembered how I've distanced myself from the earth, whenever I insisted on standing tall, head held high, looking towards the horizon of some greater dream, trying to deny the "dirt" that supported me under my feet at all times.

Staring at the pile of compost as it became compost, I witnessed an aspect of Oneness we aren't often presented. If it's true that everything is energy, that every single phenomenon is in the same field of infinite potential, then it surely applies to compost too.

It also applies to pooping in the woods.

Which is why, if you ever have the chance, you should do it. But please don't leave toilet paper in the backcountry. I'm begging you.

Or go look at a pile of compost. Study and observe how life feeds on life.

And be with everything that comes up for you - all the feelings of aversion, disgust, and wanting to turn away to experience "something better" than this.

How is the stuff you consider "dirt" in your life actually the compost pile, rich with nutrients and material for your growth and thriving?

How would you feel differently about your "poopy" circumstances if you saw them simply as compost in the making, as both the byproduct of your process and the source of all that is to come?

By all means, train your eyes to see the flowers, and use your taste to savor the sweet fruits of life. But also remember, they - and we - all need the dirt to grow.

How is your relationship with Not Knowing?

"Not Knowing is most intimate..." - Zen saying

This is a note for you. You are such a good student, when there's a teacher standing in front of the class, and other students surrounding you, all learning to do the same things. You are a stellar worker, always taking responsibility for your job, above and beyond the call of duty. You take instructions quickly, correct your mistakes diligently, and do everything you can to get along with others. You are smart, capable, successful, but still feel there's something missing from your life, even though you can't quite name it.

So what is it? What is that missing thing?

I don't know.

But I'm willing to bet that your relationship with Not Knowing could use a little tune-up. A little checking in and refamiliarizing. You see, each of us was born in a state of perfect Not Knowing. The first several years of our lives were filled with the joy, awe, and wonder of discovering, playing, experimenting, failing, and doing it all over again every single moment. This is how we learned to walk, talk, and explore the world around us. There was tremendous accumulation during this time, but the overwhelming majority of space was occupied with Not Knowing, and being perfectly content with that.

Then we acquired language, and experience, and started going to school, where we learned to correct our mistakes diligently, take instructions quickly, and get along with others.

Those skills served us in advancing through lots more school, in getting a job, and then learning the ways of the business and professional worlds.

Somewhere along the way, all of that accumulation began to take up much more space than Not Knowing. In fact, we may not even remember the last time we did something for the first time.

So right now you may be wondering, "How does Not Knowing actually solve a problem I'm experiencing in my life?".

Consider how your life might be different if you reclaimed the fun of it. Not having a reason, but just doing it - you know, whatever that thing is that you've always wanted to do or try. Letting go of what experience tells you, and embracing the fresh innocence of the present moment.  Better yet, just existing without judgment.

If any of these sound scary or crazy, it may just be that you've been out of practice at Not Knowing.

And how do you practice Not Knowing? Well, not by fixing it or solving it. Not by hunting for an answer, or coming up with a plan.

But by consciously being there. And watching attentively while you are there.

Last night I went to my first ever hula dancing class. I had never dreamt of hula before, but I saw a performance locally that really inspired me, and then I found out there was a community class offered right in my town.

So I showed up.

There was a lot to learn. The teacher started out slowly, showing us the basic steps, then putting a few of them together into a simple first dance. Then we newbies were sent to the back of the classroom and were told to fake our way along with the more experienced dancers as they rehearsed songs they already knew.

I got to experience myself in the moment of Not Knowing, and to see how I stayed with myself. Now I am at a point where I can see this as a precious gift. But I also know that not so long ago, this was an edge I very carefully avoided, constructing my life so that I would never be in that position of Not Knowing.

How do you react when you are put in the space of Not Knowing?

Do you ask for more information?

Do you look around for someone who looks like they know what they're doing, then copy?

Do you sit out and wait until next time, when you'll definitely know more and do better?

Do you just keep moving, doing what you can, trusting that this is exactly where you should be?

Do you compare what you can do now to what others around you are doing, trying to figure out what's wrong?

All of these are possible ways to relate to Not Knowing.

And all of these responses - if we are able to observe them in ourselves - hold the possibility to bring us closer to knowing ourselves. Closer to becoming intimate with Not Knowing. And more grateful for being exactly where we are in any given moment.

So that is the gift of any brand new experience, whether you enter it by choice, opportunity, or crisis.

In one form or another, all of my work is an opportunity for you to experience yourself in relationship with Not Knowing. I hold open the space for you to experience how you are as you navigate this unfamiliar territory.

This fall, I'm offering you an expansive yet gentle way to become more intimate with your own space of Not Knowing. It's an oceanside retreat with me and a circle of 6 participants, called "Beyond Knowing: Many Paths to the Present Moment."

We will learn from the teachers in nature - the ocean, the sky, the birds, the trees, the sand. We will also learn from approaching and entering various portals to the present moment, which is always fresh and alive with Not Knowing. We will discover what arises when we clear our attachments to thoughts, align our mind-body-soul, and allow our innate expressions to find a voice. We will create a safe space together where we can touch the space of Not Knowing, with gentleness and firmness, full participation, mutual support, no judgment, no force, and no extra.

You will take home tools that you can continue to practice in your daily life, each time you come in contact with the beauty and terror of Not Knowing. You will also take home artifacts from your unique expressions created in the setting of the circle of support provided during the retreat, reminding you of your heart's truth, and your magical reserves of resilience. You will also have the experience - carried in every cell of your body - of having become more familiar, more intimate with Not Knowing.

You can learn all the details about the retreat here.

On the other side of beautiful

THIS was not a photo on my vision board. I was perfectly content to be performing, showing what I was able to do comfortably, easily, and predictably. I thought I was getting "good" at playing freely, improvising, and creating in the moment. The sound of Chinese Melodrama that matches the stacks of CDs we bring to every gig.

Then THIS had to happen.

By "THIS" I mean: We are at LunarBurn, a three-day outdoor festival and experiment in community living. In my mind, it's a chance to show up and spread the love. We play our first set at the PermaPub, an intimate venue with couches, a bar, and all the impromptu live music one could ask for. We aren’t even finished with a song (Led Zeppelin’s “Over the Hills and Far Away”) near the end of our set, and a guy appears onstage. He has furry white chaps over his jeans, and a grey hoody. He appears to be maybe under the influence of some substances. But what do I even know about these things? I just thought he was a jerk for interrupting our set.

Here’s my, “Get off the stage, jerk!” look:

Yep, what you're seeing is a whole lotta judgment flowing freely from me in that moment. First he wanted to play my violin. I’d rehearsed this response before, so it was easy to say, “Sorry, I don’t let anyone touch my violin.”

He wasn’t looking like he was going to leave the stage, and this being an open, community-driven atmosphere, I said, “You can play yours, and I’ll play mine.”

Then he wanted me to help him tune the thing.

Seriously??? Suddenly I was flung back to my violin school, “Doctor Chu” days, tuning other people’s violins. Spooky.

My partner Randy was way too far away on the other end of the stage, separated from me by a drumset. I was alone to deal with this. But when it was clear that The Guy – Adam, I would later learn, was his name - was there to stay and play, Randy pulled out the right song – like he always does -- and that was all it took.

Adam started to play. All kinds of sounds were flying out of his instrument, no holds barred. Absolutely no judgment.

I’d never heard such sounds before, let alone play with them, try to create with them. But there I was, on a stage, with captive audience, and microphones on. I started to play too. The interplay of sound and listening began to work its magic. Then moments emerged from the chaos that felt like oneness.

Really? With THIS jerk? Yes.

I was listening to all the sounds, noticing, admiring, perhaps sometimes even envying, the beauty that can arise from NOT CARING AT ALL, in other words, no judgment.

You must understand how deeply ingrained it is for me to take GREAT CARE of every sound from my violin. I’ll never forget sitting in a huge auditorium in Chicago watching one of the “big kids” – a high-schooler at the time – in my violin school, receiving a master class with Russian violinist Viktoria Mullova. I was about 10 years old.

“You don’t CARE!”, she said, in a thoroughly Russian, loving way. It was the kind of icy cold Russian love so commonly doled out in violin training. Meanwhile my classmate’s lips trembled, tears beginning to well up behind her eyes. Tears that represented a lifetime, from the age of three, trying so hard to prove that she cared. She was one of the stars, one of the protected ones in the group. No one had ever spoken to her like that. At least not in public. On a stage. In front of other people.

I vowed never to play like I didn’t care, if only to avoid the stinging feeling I felt that day.

So to stand on my stage with this guy – Adam – who had the audacity to walk in on us and just PLAY like he doesn’t CARE was a big moment. A moment either to shut down or to wake up and say yes to life. Shutting down occurred to me for a few moments. Remember this face?

Yeah, I was ready to shut it down. But then I remembered that I could just relax into my own place that doesn’t care so much. The place that knows I can play anything with anyone and I will be OK. The place of trust and surrender.

Because when you don’t care, you really are trusting in something greater than personalities and performances. Somewhere along the way, in our journey of recording and performing and trying to “build” something with Chinese Melodrama, I got caught up (again) in making things beautiful and perfect and acceptable and nice. I got caught up in my idea of what “good” sounds like. What I had to measure up to (in my own mind) in order to be worthy of appreciation, applause, presence, whatever. My idea of what I needed to be in order to be liked and accepted.

What I experienced by not caring so much was another layer of freedom peeled away and revealed to me. The discovery of something workable – beautiful – within the basket of sounds I’d call “dirty”. The sounds I don’t choose automatically because of the depth of my conditioning to play only beautifully. The discovery that he will never sound like me, and I will never sound like him, so there is nothing to fear. We can meet in the oneness of our combined sounds and play. Dance. Listen. See what happens.

“Beyond our ideas of right-doing and wrong-doing there is a field. I’ll  meet you there. When the soul lies down in that grass, the world is too full to talk about.” – Rumi

The next day, I returned to the stage with Randy. No Adam this time. Yet I still had the taste of the experience in my body, my ears, my whole being. I carried the permission of those “dirty” notes with me. They gave me wings to be less careful, more adventurous, more willing to be curious without worrying I would hurt or disappoint anyone. I had fun. I moved more. I felt my own joy. I invited it in. I was inspired by "no judgment".

I noticed that as I became more playful, my entire body began to participate. My feet were not firmly planted on the floor with my legs stable. My knees began to bend. My spine began to twist and turn. My feet were walking (sometimes stomping). My head was leaning. The feelings of the music flowed through my entire being, when my mind was no longer involved in saying, “Now what can I play that will be really beautiful?”.

When the music becomes a dance, when I am truly playing, then it’s not about what the notes are, but what is going on inside me as I am playing them. Even if I play every single note “beautifully”, correctly, in tune, like I was taught, it may not connect with a feeling. Because I may actually be trying very hard to create this state of “beautiful” and “correct”. Within me, I am not playful. I am controlling myself. When I am controlling myself, I radiate the energy of control.

When I lose control, anything can happen. Scary, yes. But on the other side of scary, there is beauty. Not “beautiful”, but beauty. The beauty of anything and everything. The beauty of what is.

P.S. Thank you so much to Adam, Matty, and everyone at LunarBurn who played and listened!