After 28 hours I didn’t care if I made it home alive

After months of long hours and fractured sleep as a resident, followed by a stressful 28-hour call, I sat in the parking lot of the hospital and buried my face in my hands. I was weary to my core—my limbs felt heavy, and my mind was numb. When I finally started the engine, a terrible thought swept through me: I don’t really care if I make it home alive.

Would you ever cancel patient appointments to get more sleep?

I had lost my vitality and my desire to keep going. It wasn’t just the lack of sleep, the patient who had died that night, or the list of modules I needed to complete by the end of the week. It was a bone-deep weariness amidst a day of constant rush. The stress and fatigue had caught up with me and were threatening to steal my life.

It was the face of my 3-year-old daughter that kept me on the road that morning. It was the devastating image of her growing up without a mother that led me to journal about these thoughts. Too afraid to seek help, I typed into a blank Word document instead, and the disturbing thoughts seemed to return with deep exhaustion and lift with rest.

Back then, I didn’t know that sleep deprivation was an independent risk factor for anxiety, depression, and suicide.^[] I didn’t know that physicians have the highest suicide rate of any profession or that only 1 in 5 doctors seek mental health support.^[][]

The intrusive thoughts finally disappeared after a series of easier rotations and adequate sleep. It was like coming up for air after being trapped underwater.

I kept this part of me hidden for years because I felt both defective as a physician and alone in what I faced. Only now can I fully see the pervasive level of burnout and exhaustion in healthcare, and I’ve become creative in setting up my life to protect my health and relationships. I’ve become committed to advocating for my fellow clinicians and challenging the norms that we must work incessantly to be “good” doctors.

Most of us in medicine love our work but not the conditions in which we’re asked to do it. Weakness or a lack of resilience doesn’t cause burnout. Overwork does, along with sleep deprivation, staffing shortages, excessive charting demands, insufficient time with patients, dealing with insurance denials, and lack of adequate support, to name a few.^[][]

This isn’t just my personal experience. Even the CDC has acknowledged this epidemic among healthcare workers, with more than half of us reporting feelings of burnout, going so far as to recognize that the solution lies in systemic changes, not only personal responsibility.^[]

I have seen the positive impact of providing sufficient support and staffing at work, increasing physician autonomy and flexibility, allowing for reasonable workloads, eliminating low-value work, and reducing sleep deprivation in training and practice. Institutions that are willing to adopt some or all of these practices have healthier clinicians with more meaningful careers.

Most importantly, we should create a culture where receiving mental health support is not a barrier to success but an essential component of it. To do this, we must increase accessibility and reduce the stigma associated with seeking help.

I’ve tried to cultivate well-being over exhaustion in my career with several carefully selected choices. I chose to specialize in medical oncology, a field with meaningful patient relationships and few overnight emergencies. I work in a large academic practice, which allows me to limit overnight call and weekend shifts. While still working full time, I have two flexible days where I often attend meetings, catch up on clinical work, and write fiction. I also work closely with a registered nurse who supports me in clinic, helps with insurance issues, and answers inbox messages.

My family and I have chosen to stay in Indiana, where the cost of living is low. We bought a modest home and live below our means. I generally have a regular sleep schedule, exercise consistently, and go to therapy. My family and I take a vacation once a quarter. While I’m still learning to set boundaries, I’ve started to slant towards what feels like thriving.

I recognize that having a meaningful career and maintaining your health along the way is an ongoing process, a series of continual decisions. I’m further along this journey today than a decade ago. So, no matter where you are or what you’re facing today, know you can keep moving towards greater well-being. You can create a successful path that doesn’t rest on self-destruction or erase who you are along the way.