Burn Out

From day 1 of residency this word was on my mind. We had a seminar during orientation about how to avoid burnout giving tips on taking care of yourself and finding things that you enjoy and making time for them. It all sounds like a decent plan, though no one was really paying attention as we were all so wide eyed thinking about our first day as a resident physician. Over the next year it was as if this became a bad word. Although we were all either burnt out or close to it, no one could admit it because then they would require us all to take more seminars or lectures on avoiding burnout. And it seemed like all those told us to do was be more efficient and do fun things when you go home. But what about when you’re simply too tired to do ANYTHING much less something fun? What about the times when you do only what needs to get done and then just go to sleep?

The sad truth is most residents regardless of where they go to residency or which specialty they chose want to quit by the end of their first year. I didn’t think my intern year was THAT bad in all honesty and at certain points I even said I was enjoying it, believe it or not. But then second year hit with all its new responsibilities. Along with a change back to 28 hour shifts. So, not only figure out how to supervise new interns, and run the team, and take admission from the ED, and make sure no one dies and preferably no one gets worse overnight, but also do it while adjusting to working 28 straight hours. It was rough, and I dreaded work most days, but I can look back and say I know I’m a better physician after coming out of it. But man after 2 grueling months of inpatient medicine, I was burnt out to say the least.

Seems reasonable, right? I mean anyone working those hours under that stress would be, honestly. I mean I know my coworkers were also feeling it. The problem is, as a follower of Christ, a servant of the Most High, I shouldn’t be burnt out, no matter the hours or the stress. Frankly, that is my mission field. When everyone else is burnt out and exhausted and used up to the max, I should be different.

And this doesn’t just apply to residents. I know everyone has those times in their lives when each day seems an endless checklist of things to do and just move on to the next. There’s no joy, and you seem stuck. Maybe it’s a busy day with the kids and you never seem to get enough sleep, or finish the laundry, or the kitchen sink clean. There’s always more to do. But as a believer practically how do we live differently? Because we all know there are times when even though we get up and get in the Word and pray, it seems dry and God seems far. It also gets lost on the ‘to do’ list.

This is where I was at the end of last month. Thankfully, by God’s grace I had vacation scheduled for the first week of this month. I spent the first several day catching up on sleep, and then went to a conference for medical mission work. Basically, a great time to zoom out and refocus.

Here’s the thing, I wasn’t made to be a doctor, or a perfect resident, or a perfect cajon player for the worship team, or a perfect daughter, sister, or friend. I was made for the glory of God, period. Yes, God has allowed me to be a not perfect version of these things, but first and foremost, my purpose for existence is His glory. So, when I use all my energy, and strength, and mental fortitude for these other things, I burn out. It’s inevitable. Because, I’m missing my purpose for existence. I remember in medical school, when God had so grabbed hold of my heart that I was studying the human body in light of who He is, and it was as much worship as Sunday mornings. It seems simple, but just like anything else it takes discipline. I must get up and read the Word and pray to get my heart right every day. I need a daily reminder of who it is that I serve. I need a reminder that I’m not going to work out of obligation, or because of how much debt I’m in, or even because there are tons of sick children that need help (even this motivation leads to burn out). I’m going to work because this is where God wants me to serve Him right now.

The crazy thing is the difference it makes. I’ve realized how far I have fallen mostly in my hunger for the true milk of the Word. I used to crave it and never get enough. I used to be at least more satisfied with Him alone. And, I want that back and more.

I have been reading “The Shadow of the Almighty,” on the life of Jim Elliot. I have been both encouraged and humbled, lots of humbling. My faith is so small, like do I even have a mustard seed? But oh that He would let it grow. My heart echoes these prayers of Jim, “He makes His ministers a flame of fire. Am I ignitable? God deliver me of the dreaded asbestos of ‘other things.’ Saturate me with the oil of the Spirit that I might be aflame. . .Make me thy fuel, Flame of God.” “Oh that Christ were All and Enough for me. He is supposed to be, . . . but oh to be swept away in a flood of consuming passion for Jesus, that all desire might be sublimated to Him.”  

These my prayers going forward also that He might increase and I might decrease, that my eyes and thought would remain on Him, and that as He saturates my life, it will overflow on others. This is my attack plan against burn out.

A Different Kind of Culture Shock

Sitting in the closet of a local cathedral I opened my computer and connected to our makeshift Internet, and waited for my first patient of the day. I felt at home in these surrounds; dirt floors and dust that made clean floors impossible, concrete buildings with tin roofs, and meals that always had rice as a base. This was my fourth medical brigade and though the culture and people were all too familiar this one was totally different. For starters, this was my first brigade as Doctora Janie instead of estudente de medicina. Being one of the providers brought much more responsibility and fatigue, but also great reward. The most striking difference this trip, however, was the stark contrast between my world view and that of the other 54 people on this brigade. I was very much an outsider. 

I did get to see some interesting cases this trip. And seeing them on my own was very empowering but also terrifying. I saw chikungunya, epidermolysis bullosa, club feet, pyelonephritis, and an undiagnosed congenital heart defect. The medical aspect of this trip was wonderful. And thankfully there is a great clinic in Santo Domingo that will be following up with these patients. Collectively as a team we saw over 1,000 patients. A successful trip by most accounts. But why am I here again? I do not fit in. By their account, we have done a great thing worth celebrating. But really, what have we done? I know life is eternal and if I am not impacting eternity, what help am I really giving? I have struggled most of the trip with this, wondering if I should ever do another trip like it ever again. When Christ is not the center, what's the point? Why am I here again? Especially when my little sister required a C-section to deliver her twins at 35 weeks and I wasn't there. I wasn't there when she hemorrhaged and needed a transfusion. I wasn't there when my nephew went to the NICU and my family had a million questions I could've helped with. Yes, I made some new friends and strengthened others, but was that worth not being there for my family? Why is it that the only type of culture shock I experienced was with that of my own culture and how disgusting it is.

Well, I don't know why, and I don't have to. 

One of the things I've noticed about myself is that God seems to come into much clearer view when I'm out of the States and away from all the distractions. It seems so much easier to sit at His feet. I finally had the time this week to read a book that has been sitting on my night stand for weeks, it goes through some of the attributes of God and how unlike us He is. This has been a wonderful reminder of who my God is. If nothing else, God has shown me more of himself, and more of my sin this trip, and I can honestly say that is enough. He is enough. He was there with my sister and nephews the entire time and He was and is more than enough.

This past year has made me a much better physician but it brought much depression and anxiety with it. To the point that I didn't recognize myself anymore. I couldn't process anything so it all got stuffed on top of each other until I just about blew up a couple of weeks ago. I didn't have someone to talk through things with and I honestly had a hard time talking to God. The motto God gave me when He called me into medicine was: "He is worth it. He is enough." I kept telling myself that, but I wasn't feeling it. I have been able to process difficult things alone with Him before, so why do I need a physical body to talk to now? I know the root of depression and anxiety is sin. Period. It's unbelief plain and simple; not really believing I'm secure in Him, not trusting Him to take care of the big things and the small details. When I finally had a vacation, I was praying the Lord would show up and blow my mind with Himself in such a way that made my walls fall like Jericho. But He didn't. I had a relaxing wonderful vacation but I still couldn’t completely clear my head of all the mess. But one morning as I sat on a bus in Santo Domingo Ecuador leaving the places where we served over a thousand people last week, and my head finally felt clear, free and I can honestly say I have peace again. I was exhausted from little sleep all week, but I wouldn't trade that place right now for anything. No distractions, serving people in a way that pushed me to my limits physically, mentally, and spiritually, God emptied me of myself. 

What mercy! What grace! That our Lord would pull me out of my surroundings and distractions to truly set my focus on Him again. How simple it seems that the answer to all of life’s questions is God Himself. And yet, how difficult that can be. I cannot will myself to know Him more, I cannot study and work harder to know Him more. I could read the Bible 10 times through and spend every waking hour meditating on its meaning, but apart from the grace of our Lord opening my eyes to is beauty and power it would have no impact on my life. How sweet and kind our Lord is that He reveals Himself to us and in so doing gives us all we need for life and godliness (2Peter 1:3-4). God lifted my spirit last week in a way no person or experience could, and I am so grateful. Dear reader, as you find yourself cast down, depressed, anxious, or just caught up in the everyday without joy, I urge you to run to Christ and beg Him to allow you to know Him more. 

The Abundant Life

What happens when the day to day becomes mundane and you find yourself just surviving? I know we all experience it from time to time. Discontentment with life, not knowing why we are doing what we are doing or more importantly not knowing what we are missing.

Tomorrow I start the last month of my intern year of residency. That first year that is notorious for the grueling hours and hard work. That time where you have your degree and are officially a doctor, but people still smirk when you call yourself one because you really don’t know anything and everyone loves to remind you of that. You thought medical school was hard? Well, welcome to residency. Yeah, you don’t have to spend 80 hours a week on your bottom studying, but now you’ll spend 80 hours a week learning on your feet. Okay, I am being dramatic. I did not work 80 hours a week at work every week. But, on inpatient months I did average 72. I’ll be honest, I expected residency to nearly kill me and it wasn’t nearly as bad as I had imagined. The Lord has been good to me in the daily grind and kept me going. Most people don’t make it a few months without trying to figure out how to opt out and quit gracefully, but we are all in too much debt to quit now. I can honestly say that I never once wanted to quit, and that is only by the grace of God.

With that being said, this has 100% definitely been the hardest year of my life (again a little dramatic I know). And, it’s not so much because of the work. I enjoy what I do, and the people I work with. I don’t even mind working 72 hours a week (for the most part). It’s the way residency completely over runs my life that I don’t like. When you don’t get Sundays off all month, it’s hard to get involved in church and meet people outside of work. When you typically only get 4 days off a month and work 11-13 hours shifts daily it’s hard to keep up with friends and family. When you sleep, eat, live and breathe medicine, yes you learn a ton about medicine, but it’s really hard to just live. Life goes on around you almost as if you’re a spectator to its production. Even studying 80 hours a week in medical school I still felt like I was part of life. I didn’t miss out too much on things with family and I can honestly say I still had fun outside of school. But, this year I don’t know where I’ve been.

The most concerning part of this is its impact on my walk with God. I’ve always felt God so much closer in my darkest times, and I really thought this was my darkest time of all. But, where has He been? I still went to church as I could, and I still got up early to pray and read His word before work, but it was all empty. Why have I not felt Him near when I know He lead me here? What am I missing? He led me to a great church here and even a great Godly man, but why has it been so hard to stay involved and why didn’t that relationship work? Can’t He see I’m trying here? I kept thinking maybe I’m just at that point where I really do need a better half to get me back to where I was. Or maybe it is just residency and it’s not going to get any better until it’s over. I started just surviving. Forget everyone and everything else and just get through this. No, I wouldn’t come out and say that but that’s how I felt. Always looking to the next thing.

But, a strange thing happened. As I grew colder and colder and father and father from God I was miserable. Still going through the motions, desperate to break though somehow, but I was just so tired. Lord, I don’t get it. Where are you? Aren’t you enough, even for all of this? Even when I’m trying to walk this road alone, aren’t you enough? What am I doing wrong? For the past month or so, I have been seriously trying to get back to where I left the road less traveled. No more just going through the motions, but really taking time to remember who I’m talking to when I pray and really trying to sit and listen when I read. I snapped out of it when someone challenged me on the doctrine of the perseverance of the saints. I know I believe that once a child of God always one, that no principalities nor powers nor any other created thing could separate me from God’s love. But it made me question myself, what if I could lose my salvation? What about Billy Graham’s mentor who walked away from the faith after years of evangelism? Am I walking worthy of the calling? I was awoken again to the seriousness of the matter. Lord am I really yours? I couldn’t brush it off no matter how tired, or how far God felt.

So, where do you start? Well, in the beginning was God. Thankfully, last year I was introduced to one of the most raw, ‘this is how it is’ Bible Studies about knowing God. It breaks down who God is and why that matters. It also points out (if you let it) major areas of sin that block our ability to see Him. I pulled this study out and started going through it slowly. Lord, please, open MY eyes, search me and know me, grant me the most precious of gifts- to know you. I’ll say that my desire to know God has brought with it a revelation of how sinful I am, and far from this God of light I really am. The past few days especially, I felt more and more the weight of sin. I am so incredibly selfish with my time and sleep, so incredibly prideful thinking I don’t need God, and I really don’t believe God is who He says He is or will do what He says, because I don’t live like it. I came to the point where I honestly cried out to God, am I even yours? You are the Father of Light and in you is no darkness at all. This morning, I found myself in 1^st John, that blessed book that John wrote so that we may know. As I read through the tests John places before us, I prayed. Lord show me my heart that only you know. Show me if I am yours. Oh, the joy that rushes over when that still small voices whispers your name! What joy and peace to know you are beloved! Nothing compares.

I had been wondering the past few days, how do I love my coworkers and patients when I am so selfish and just want to be done so I can go sleep? How can I have the right motives to go above and beyond for them when I get frustrated so easily? How am I supposed to be different, when I feel like this inside? But, today, praise be to God, He answered my prayers. In His grace he restored my joy and lifted my head. Today, going to work after refocusing on the Gospel and who God says I am gave me joy to work and love harder and longer. Today was a rough day at work, and I am more tired than usual, but it didn’t matter. With the Gospel as my foundation once again today felt right. That’s how God is enough, always enough no matter what.

“I came that they may have life, and that they may have it more abundantly.”

Let’s be clear though. None of this was because of my great effort to return to God. On my own I would not want Him (they loved the darkness rather than the light, there is none who seeks after God). This was the gracious work of a loving God wooing me patiently back to Himself. He did not have to show me my sin, or remind me I am forgiven. And most importantly, He did not have to forgive me. Oh praise the Lord, Oh my soul!

So, here’s to the abundant life. If you are reading this and your life doesn’t feel abundant, cry out to the God of salvation whose grace is greater than all our sin.