Alarm. Study. Class. Study. Eat. Study. Bed. Alarm. Study. Class. Workout. Study. Study. Bed. Alarm…Repeat. Repeat. Repeat. Sometime in the future substitute work for class and study.

My sister and I have a term for the life leading up to burnout. We call it living like a robot. It’s a life where work and/or school consumes you and sometimes you fit in sleep and things that make you happy. Most of the time in the robot life you simply work and wish you were sleeping.

The robot life is unavoidable sometimes if you have hard goals. I have always justified it by knowing when it will end. I’ve had several bouts of that life with years of rest between. Most of my undergrad I was a robot. My two years of post-bacc, pre-med studies plus all the work piled on top were some of the worst years I’ve known. Medical school is the first time I’ve not worked as I studied since middle school. It’s nice to have one job, just medical school. But, honestly, it’s still hard.

Medicine is cursed with a heavy dose of the robot life. This is partly because physicians have peoples’ lives in their hands, so expectations are high. It is partly because the type of people who become physicians are A types and have high personal goals. It is partly because health is ubiquitous and illness unavoidable. As humans, our ability to reach our full potential is partially determined by our health. If we are in pain or ill, we can’t do all the things we would if we felt well.

Medical school and then working as a doctor are challenging because the hours can be long. They’re also draining because the work is complicated and requires focus and lots of puzzling through piles of clues to find the best answer. The pressure is high because the puzzle directly impacts a human’s life. And depending on the gravity of the puzzle, the answer might impact a whole family.

Time and intellectual challenge aren’t all that makes medicine difficult. It’s a team sport, so office politics and business relationships come into play. But even teamwork isn’t the hardest part of medicine. Medicine is an emotional job. People who come to us as patients die. They lose function. They lose the ability to lead the lives they’ve always led. There are many happy outcomes, but not all patients’ stories end with joy. The sad outcomes add up as time goes on.

My time in healthcare as an EMT showed me that no individual patient impacted me unbearably. However, there are days when I feel the weight of all the patients I’ve helped. For example, I felt heavy after the last CODE I worked before I left the ED for medical school. A CODE is when you do CPR, shock, ventilate, and take other measures to try to revive a person whose heart has stopped.

That night I closed the curtain on a 30-something-year old with a wedding ring who hadn’t been identified yet. He was dead before he arrived, but we did CPR anyway. I was one of the last to leave his room. I never leave a dead patient before ensuring they’re presentable for family. CODEs are messy. If the family isn’t there to see us work, I see no need for them to experience the mess. I knew sometime in the night his partner would learn he was dead.

Tucking in that patient right before I ended my shift was hard. The death rested on top of the morning I walked into the ED to find teens on the phone crying. They, the teens, were calling their family to tell them their mother and uncle had died. Odd to have children deliver news most adults barely can. The sadness those teens felt added to the day I cleaned two CODEd patients back-to-back so they wouldn’t be bloody and dirty when their family arrived to say goodbye. After tucking in the second of these, I walked out of the room to find a visitor approaching. I interceded and joined her, but only upon entering the room did I realize she, the daughter, didn’t know her mother was already dead.

The sad endings add up. But, so do the good journeys and happy endings. The patients who turn our days around by sharing the most amazing stories or giving advice that is perfectly wise. Days in healthcare are brightened by visitors who show raw love toward someone stuck in a hospital bed. I’ve seen true love hiding in ED rooms on multiple occasions. It was working with old couples in the ED that showed me how I’d like to age.

It’s no surprise between the stress of the job and the rigor of the schedule that doctors and medical students burn out. However, knowing our challenges gives us the knowledge we need to persevere. Even within the field of medicine there are many decisions we can make to suit our goals. It begins with specialty and is followed by location and type of hospital. We have the information we need to know how a specialty, location, specific hospital, and extra projects we take on will impact our life or encroach on free time. We can decide, within the scope of meeting our obligations, when we wish to do extra and when we wish to do the minimum. Most importantly, we know that no state is permanent unless we let it be. 

I think at the root of avoiding burnout is being honest with ourselves and checking in with ourselves. There are stretches of school and work that must be survived. The robot life must be lived sometimes. But, amidst the madness we must decide when it will end. We can choose to rein things in when needed. We can choose to prioritize family or life outside work. Of course, to do this, we must know ourselves and what makes us happy. Once we know where we find happiness we can fight for it as fiercely as we fight for our patients. In the end, if we are not well, we can’t help anyone else at the level we can when we are in good health.