New memoir shines light on doctor burnout
Who worries about doctors? Not the doctors, apparently, but they should, especially in these desperate times.
Doctors are often taught to maintain patient confidence by putting on armour, carrying a hard shell like a tortoise, being a corporation of one while inside they might be melting.
This helps no one.
Dr. Jillian Horton’s “We Are All Perfectly Fine,” a memoir about her life in medicine, makes an impressive case for training and maintaining doctors in a new way, finally.
As often happens in publishing, the book’s cover is as pale and uninteresting as its generic subtitle, “A Memoir of Love, Medicine and Healing,” which is fine as far as it goes — look at the subtitles on the sugary self-help shelves. “Love, Loss & Gratitude.” “Hope and Recovery.” “Activism, Sex and Survival.” “Vulnerability, Hope and Loss.” The men’s section is just as hackneyed. “Adventure, Wilderness & Love.” “Work, Brotherhood and Transformation.”
But Horton has actually written something very unusual. She is truthful about medicine as a career, and analyzes its flaws in a precise and courageous way. It is a hidebound profession and senior doctors will not be pleased to be told that their rigid guidance has caused younger doctors much pain, moral injury over the inability to reach patients with consideration and compassion, and most intractable of all, self-neglect followed by the dreaded burnout.
Horton was born in Brandon, trained at McMaster, and works in Winnipeg as a general internist at a rambling, beat-up hospital that, like so many Canadian institutions, does its best.
Her childhood was truly difficult, including a schizophrenic brother and a sister brain-injured after medical error, with the emotional neglect that afflicts remaining healthy siblings.
This, I imagine, is the irony of the book’s title. Why do we demand that doctors profess perfect mental health? Who does that assist?
Horton has gems scattered throughout, moments of insight earned at great cost that one doesn’t read anywhere else. (Canadian doctors are notably good writers. Take James Maskalyk and Vincent Lam. Why is this?)
She doesn’t chat with people, she takes their histories, the way doctors do as if all relations are medical. Horton has a rare talent for dialogue. She is a sensitive person, so rare in medicine. She faces the cruelty of other women, the entitlement of cosseted medical students she supervises, the cold reproof of senior doctors, her own blocked grief, her small moral flaws, the iceberg inside her. In other words, she is an adult human female, with all the burdens that entails.
Horton, married with three children and relentlessly busy, finally went to a U.S. meditation retreat for an emotional and intellectual excavation of her career.
Burnout comes from the particular pressures of medical life, including shift work, exhaustion, lonely coronavirus deaths, impaling families with bad news about a loved one, mistakes that ruin a patient’s life but lawyers won’t let you apologize, a heartless moment a doctor remembers forever and for which she lacerates herself.
She talks to another burnt-out doctor about a possibly apocryphal internet scheme called the Blue Whale, where a person is driven to suicide by a series of desensitizing acts. Could medicine itself, both its training and performance, be the Blue Whale? Is that why so many doctors kill themselves? She considers the young radiology resident who worried about failing, who felt foolish and unpopular, said he was fine, and then walked into a river to drown.
Horton tells about being young, new, on call, at work and awake for 96 of 144 hours, clouded with exhaustion, and terrified of making a mistake, and then she did. Her supervisor remained cool, clinical, comfortless. “That’s why we call it a teaching hospital, Jill. This is how you learn.”
“I learned only one thing that day,” she writes. “It was my fault.”
Do doctors suffer from a pay-for-service model that draws them into working to death? Post-pandemic, we want to live more intelligently, shift the frames around what we do for a living, including medicine, child care and long-term care.
“We Are All Perfectly Fine” will change how doctors are trained and treated. It is one icy medication, but like the vaccine, it will bring us into the light.