CMDA's The Point

What Comes After the “But?”

September 15, 2022

by Autumn Dawn Galbreath, MD, MBA

I’m broke, but I’m happy,
I’m poor, but I’m kind,
I’m short, but I’m healthy, yeah.
I’m high, but I’m grounded,
I’m sane, but I’m overwhelmed,
I’m lost, but I’m hopeful, baby.
What it all comes down to is that everything’s gonna be fine, fine, fine
‘Cause I’ve got one hand in my pocket and the other one is giving a high five.
(“Hand in My Pocket,” Canadian singer-songwriter Alanis Morrissette, 1995)

If I’ve got you humming that song, I can guess your age within a decade or so…and you can guess mine. And those who don’t know the song will be doing one of two things—YouTubing it or asking their grandchildren to YouTube it for them.

Of course, I don’t open with these lyrics to tease you about your age or even to necessarily endorse this song or this singer. I present them as a reflection of the jumble of emotions many of us are feeling these days, both in healthcare and in the world at large.

Coming out of the darkest days of COVID, I entered 2022 feeling bludgeoned by the experience I had just endured, both in medical practice and in society around me. I felt emotionally broke, overwhelmed and lost, to use some of Ms. Morrissette’s words. I was drowning in negative emotions and feeling psychologically depleted. My natural response was to grit my teeth and force myself to keep going. To get through each shift by ignoring my feelings and retreating into my knowledge. To emotionally detach from the patient in front of me because all I had to give was my knowledge and training. I could no longer give empathy, compassion or support, because my supply had been exhausted.

As COVID has lessened in intensity during 2022 and I have had the ability to reflect, I see so many things I couldn’t see then. I see that I was burned out—a syndrome defined by the World Health Organization as the triad of feelings of energy depletion or exhaustion; increased mental distance from one’s job; feelings of negativism or cynicism related to one’s job; and reduced professional efficacy. It seems so obvious now, looking back on my inability to find the resources that I want to give to my patients.

I suspect many of you in healthcare can look back on the last two years and see a similar pattern. The specifics are different, but the pattern is the same. We have been sucked dry by a profession that used to be rewarding. We have been overwhelmed by the sheer volume and drained by the depth of patients’ emotions in clinic every day. We have sought resources in those places that used to comfort—friends, family and church—and we have often found dissension and criticism. We have felt alone. Many of my Christian healthcare friends have described themselves as “homeless” during this difficult time, unable to find the solace their tired souls desperately needed because their communities were so busy fighting over masking, social distancing or how to vote on election day.

Where do you go when you feel homeless? That has become the central question for me during this time. Patients are still getting sick and injured, though not necessarily with COVID. They still need their healthcare professionals to act from a place of fullness, energy and compassion when they come to us for help. They still feel scared, fatigued and confused by their health and look to us for advice. And yet many of us are coming up dry. As I evaluate the state of my soul and psyche and as I mourn the loss of depth with many members of my community, where can I go to be refilled? Where can you go to find the energy and passion you used to have when caring for the ill and the broken in your practice?

While Alanis Morrissette is not a believer as far as I know, she seems to understand a key principle of faith that I was taught many years ago: What matters is what comes after the “but.” When we speak of our struggles, “but” is a telling little word. There is a huge difference between, “I know God is in control, but I am so exhausted,” and, “I am so exhausted, but I know God is in control.” The first gives more weight to the problem, and the second gives more weight to the Problem Solver. You may be thinking this is just semantic, but I challenge you to pay attention to how your mind orders these sentences. Ms. Morrissette generally ends with the positive: BUT I’m happy, I’m kind, I’m healthy, I’m grounded, I’m hopeful, reminding herself that, even though she has struggles, the good outweighs them. How much more should we as people of faith be cognizant of the great source of renewal that is available to us?

I continue to feel ill-equipped to provide the kind of care I want to provide, as I have not yet fully healed from the wounds inflicted by the last two years. And I struggle to find the energy to pull myself out of my “funk.” However, I have committed to do one thing: reorder what comes after the “but.” I will choose to emphasize the Problem Solver rather than the problem. It may be a small step, but it’s a step onto the right path. The solution to feeling homeless and empty is to seek out my true Home and be supernaturally refilled. And if I continue to give only lip service to the God who can refill me, I progress further down the path of self-sufficiency, exhaustion and burnout. But, if I put my trust in Him, I step onto a path that ultimately leads to fulfillment and rejuvenation.

“My flesh and my heart may fail,
but God is the strength of my heart and my portion forever.”
—Psalm 73:26, ESV

Autumn Dawn Galbreath, MD, MBA

About Autumn Dawn Galbreath, MD, MBA

Autumn Dawn Eudaly Galbreath, MD, MBA is an internist in San Antonio, Texas, where she lives with her husband, David, and their three children. Though they met in medical school, David now owns a restaurant in the San Antonio area. Between the two of them, they have experienced multiple career transitions, and weathered the resultant stresses on their marriage and family. Autumn Dawn speaks to the issues of Christian marriage, being a working mother in the church, and being a woman in medicine with an engaging humor that brings perspective to these difficult issues. Autumn Dawn earned her MD from the University of Texas Medical School at San Antonio, where she also completed her internal medicine residency. She earned her MBA from Auburn University in Auburn, Alabama.


  1. Avatar Amy Givler on September 22, 2022 at 6:45 am

    Thank you, Autumn Dawn, for once again pointing me to the Solution (who is a person!) rather than the problem.

  2. Great article, thank for you your honest sharing and always pointing us back to the Source!

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