The Heart has a Back Door, and Other Lessons I Learned from Leaving the Practice of Medicine for One Year

Before COVID-19, I left the practice of medicine for what would turn out to become an entire year. Then, the pandemic happened, and I found my way back to clinical practice. During that time away from medicine, I discovered five things that transformed my life and practice. With the guidance of a life coach, intensive reading, and exploration of literature, I found a new way of seeing our hearts and bodies as humans in the medical profession. Here are five lessons I learned, in the hope that they might help others.

Perfectionism Doesn’t Make You Perfect

But with my coach’s guidance, I learned, little by little, that one of the dangers of perfectionism is that it leaves no room for self-compassion. For a physician who prided herself on her empathy, discovering I had no self-empathy came as a rude awakening.

But learning to embrace imperfection is not an overnight task. For anyone just starting out along this path of self-discovery, a great place to start is with the seminal work of Brené Brown.

It was only after I accepted 1) that I was a perfectionist and 2) there was another way to live that I came to understand my perfectionism had been an inflexible barrier to the practice of self-compassion.

Self-Compassion Is Essential and Isn’t What You Think It Is

We might commit to it in that wellness seminar, but do we follow through? Or do we instead make empty promises? Because secretly, we believe that we’re superhuman. Sure, we’ll get to our own oxygen mask soon, very soon, but first, we have time to take care of one more thing. …

Self-compassion means gently but firmly reminding ourselves that we are not superhuman.

If you struggle with that like I did, I recommend reading Dr. Neff’s bookSelf-Compassion: The Proven Power of Being Kind to Yourself.”(I also recommend going to the author’s website to take a self-compassion quiz. But if you score low, like I did, be gentle with yourself. Diagnosing the problem is the first step toward healing.)

External Validation Will Never Equal Happiness

I’ve come to believe that most physicians experience this triad — as a function of our own personality tendencies, combined with the covert and overt reinforcement of these factors throughout our medical training. Breaking free of it will be different for each person, but crucial for me has been learning to embrace vulnerability as a strength and not a weakness. Only by embracing our vulnerability can we live as our authentic selves.

As Brené Brown writes, “Vulnerability is the birthplace of love, belonging, joy, courage, empathy, and creativity. It is the source of hope, empathy, accountability, and authenticity. If we want greater clarity in our purpose or deeper and more meaningful spiritual lives, vulnerability is the path.”

For more of a physician’s experience on vulnerability as a path, I learned from Adam B. Hill, MD’s “Long Walk Out of the Woods: A Physician’s Story of Addiction, Depression, Hope, and Recovery.” (If you don’t have time to read the whole book, start here.)

The Heart Has a Back Door

To learn more about this, I recommend the book “Self-Care for the Self-Aware: A Guide for Highly Sensitive People, Empaths, Intuitives, and Healers.”

By keeping the back door of the heart open, I’m learning to stay present in the moment with my patients, but to release the emotions afterward. Which was the step I was missing, and the essential piece needed to then be present for my family when I return home.

The Game Is Rigged

I hadn’t fully understood the personal stress of working in a broken system (I’m referring here to pre-pandemic; a discussion of the innumerable additional pressures from COVID-19 is beyond the scope of this article) while still trying to pretend everything was fine until I recently read the book “Burnout: The Secret to Unlocking the Stress Cycle” by Emily Nagoski and Amelia Nagoski. (For an audible overview of the book, check out also this Brené Brown podcast.)

As they write, “Just knowing that the game is rigged can help you feel better right away.”

Their book is not specifically about burnout in health care, but it extrapolates very well to physicians, especially female physicians. The authors don’t shy away from a candid discussion of the ways in which the patriarchy contributes to burnout. But if the game is rigged, how do we win?

Not by proving to others that the system is wrong — because we know now that’s a given — but by proving our own character. By showing up anyway to do the right thing. Not for the system, but to hold true to our authentic selves. By not letting the brokenness erode our purpose.

There’s a validation to recognizing that we’re all working in a broken system where the game has been rigged. For me, this recognition was what helped me to decide to return to it anyway. And to decide to make myself vulnerable by sharing my experience with others. Because one of the key ingredients for self-compassion is a recognition of our common humanity.

I am more and more convinced that the way many of us were trained — to suppress emotion and evince a superhuman outer aspect — was profoundly flawed and incompatible with a common humanity. Because it turns out that emotions live in the body. They are what make us human and allow us to connect with others. Rather than putting our bodies and emotions in a straitjacket to conform to impossible outer expectations, we can recognize our vulnerability as an integral part of our humanity. By doing so, I’m discovering that I still do want to be a physician. But only as my authentic self.

originally published in Doximity’s Op-Med on 2/22/21 under the title I Left Medicine For a Year. Here’s What I Learned, and Why I’m Coming Back

Physician/writer. Essayist, published in NEJM, JAMA, JAMA Oncology, Journal of Clinical Oncology, and The ASCO Post. Doximity Op-Med Fellow.