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The Mountaintop

Burnout is the current buzzword in healthcare, the subject of endless articles and editorial commentaries. Fatigue, depersonalization and cynicism characterize this happiness-ruining and career-destroying disease, which has reached epidemic levels among healthcare professionals across the country.

by, Scott Conley, MD

Burnout is the current buzzword in healthcare, the subject of endless articles and editorial commentaries. Fatigue, depersonalization and cynicism characterize this happiness-ruining and career-destroying disease, which has reached epidemic levels among healthcare professionals across the country.

 

Yet all I know was that my heart, despite pumping heavily as I climbed the steep trail on an unusually warm April day, felt dead.

 

The rebel in me had decided to skip the next lecture at the 2018 CMDA National Convention in North Carolina and get some fresh air. “I prefer the hike up Rattlesnake Mountain,” the front desk attendant had quippped. “There are no snakes up there, but its name sounds cool and the view is great.” That was enough for me.

 

Just near the summit, the well-trampled dirt trail gave way to large boulders, slowing my ascent. The sweat was worth it. Though rocky, giving the mountain a bald and bumpy head,

the summit was perfect. My guide had been right—I could see 360 degrees around and straight out for miles. And the view was as lumpy as the summit. Green-carpeted mountains filled the landscape, occasionally nestling homes in their laps. A cloudless sky arced down toward the horizon, ending abruptly at the most distant mountains. A gentle breeze cooled my skin as I leaned against one of the bigger rocks and breathed in deeply. No one else had made the hike, leaving me alone on the hill to take in the view and be still.

 

But as my gaze into the distance finally returned to my mountain, the totality of what I saw startled me, even though I had begun to see evidence of it on the hike up: burned-out trees surrounded the summit and extended down the mountainsides, the blackness a stark contrast to the verdant hills nearby. Rattlesnake Mountain had endured a fire three years ago, the unintended consequence of a harmless debris burn by a local neighbor.

 

That’s me, I thought as I stared at one of the charred corpses just off the summit—burned out, lifeless, a smoldering remnant of a doctor, torched by a wildfire in medicine that was certainly unintended but that has spread across the land. I’ve been scalded by the escalating demands of productivity and quality. I’ve been choked by the thick smoke of administrative busywork. And the worst part? I am so busy trying to contain the fire and not get burned in the process that I am losing the ability to be present with and compassionate for patients. I can barely remember those early years of zeal and idealism and pure medical care before the inferno started.

 

Ideas on how to contain the fire have emerged. Sweeping changes are needed, the experts declare, from the individual clinician to the national level. Yet those of us closest to the flames fear the tempest has gotten too far out of hand to ever see clear sky again.

 

I looked out a second time from the top of Rattlesnake Mountain, this time covetously, at the other mountains still vibrant and full of promise. A corollary of the familiar proverb about grass being greener came to mind. Certainly, I had wondered, even internet-searched, about alternative careers for physicians. Maybe I could find happiness on another hill….

 

But then a gentle breeze lifted a divine whisper through those scorched branches to my mind as I stood in solitude and reflection:

 

Remember, you are still on the mountaintop.

 

I live in one of the richest countries on earth. And though I may not technically be a part of the infamous 1 percent (I am a family doctor after all), I would be in the top 5 percent of incomes in this country. I practice medicine at a wonderful family practice with coworkers I enjoy and respect, in a healthy and foreword-thinking hospital system. My patients are good folk and have trusted me with their lives. I am healthy and my family is thriving. My daughters won’t have to worry about college debt. And even as I write this, I zip through the Italian countryside on a Frecciarossa headed to Rome during a two-week holiday (as they call it here).

 

I am still on the mountaintop.

 

But really, while I am thankful for all those blessings, they are base-camp stuff. All are temporary and could vanish in a heartbeat. True summit-level realities spring from my relationship with God and are described so well in one of my favorite songs:

 

I was blind, now I'm seeing in color

            I was dead, now I'm living forever

            I had failed, but you were my redeemer

            I've been blessed beyond all measure

            I was lost, now I'm found by the father

            I've been changed from a ruin to treasure

            I've been given a hope and a future

            I've been blessed beyond all measure

            I am counting every blessing, counting every blessing

            Letting go and trusting when I cannot see

            I am counting every blessing, counting every blessing

            Surely every season you are good to me

“Counting Every Blessing” by Rend Collective      

 

I am still (and will be eternally) on the mountaintop.

 

Early in residency I shadowed an orthopedic surgeon who spent most of our day together whining about how medicine was changing for the worse. Resentment quickly flooded my mind as I pictured this surgeon getting into his Porsche after work and driving home to his million-dollar mansion. I vowed at that moment to never be like him when I grew up.

 

On that rocky peak nearly 20 years later, I realized I had broken my vow.

 

I need to constantly remind myself I am still on the mountaintop. This discipline, the practice of gratitude, douses the flames and provides relief from the heat. It rehydrates and produces life, even in charred places. Gratitude remembers.

 

Before brushing my teeth each morning, I have embarked on a new routine: to wake up on workdays and reflexively think of all that I have in Christ and all that is right and good in my life and career, rather than slap the snooze button with a groan and pull out of my mental nightstand the list of reasons why I dread going to work. Then, during my commute, I often play the Rend Collective song like it’s my theme song. And during the day, when I feel the searing from the flames that surround me, I go back in my mind to the mountaintop for lessons learned that April day and practice gratitude again.

 

I realize that simply to count your blessings sounds like a TV preacher answer or a Mr. Rogers quip. But what is the alternative? Will I truly find what I am looking for on one of those other hills? Will I make my day any better by incessantly complaining about it? Instead, I aspire for my thoughts to be like David’s, who wrote in Psalm 16: “The boundary lines have fallen for me in pleasant places; surely I have a delightful inheritance” (Psalm 16:6).

 

Gratitude is not denial hidden behind a smiley-face mask; instead, it is a choice to remember, to focus on the eternal and to not allow external circumstances to poison my inner condition. Besides, I am roused by Jesus’ promise in Matthew 25: “…whatever you did for one of the least of these brothers of mine, you did for me” (Matthew 25:40). In his book Gracias, Henri Nouwen writes of this Scripture passage, “A grateful life is a life in which we come to see that the Lord himself is the gift. The mystery of ministry is that the Lord is to be found where we minister…Our care for people thus becomes the way to meet the Lord.” It’s easier to practice gratitude knowing I am going to meet and serve God each day at work when I care for my patients, even when it doesn’t feel like it.

 

I will fight alongside my brethren in healthcare to make medicine better and resist anything that threatens the physician-patient relationship, which is under constant attack. But even if nothing changes in healthcare, even if the wildfire continues to engulf, even if the best-laid plans to improve healthcare and reduce physician burnout fail, I need tools to survive—no, thrive, shining like a city on a hill—for another 20 years in this profession. Remembering I am still on the mountaintop has helped.

 

About the Author

Scott Conley, MD, has been a board certified family physician for more than 16 years. Currently, he practices in a large family medicine office in Central Pennsylvania and precepts young doctors at a nearby residency clinic. Dr. Conley is the author of Through the Watches of the Night, a collection of spiritual reflections for medical students and residents, published in 2017. He lives in the Lancaster, Pennsylvania area with his awesome wife and two favorite daughters.

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