The Straw that Broke the Camel's Back

“A series of irritating occurrences that eventually lead to one final thing that causes a person to lose their patience or react in a strong way.”

Sounds a lot like post-traumatic stress or burnout to me!

Everyone’s life experience is different, but you might be able to relate to mine.

In my first full-time job as a surgeon, the irritating occurrences were many. In one very difficult operation, a surgical device attached to the patient’s femur trapped my hand with an excessive amount of force. A scrub nurse trying to assist me inadvertently increased the force on my fingers. Over the next minute, which felt like ten, I finally released my hand just before I would have passed out. With the assistance of the residents, we proceeded to complete the surgery, and the patient’s outcome was good. In our system of training and practice, I never would have considered taking time off for an injury such as that.

How about the time I sustained a needlestick injury during suturing a wound on a patient that was Hepatitis C positive? The future wonderful news that both my positive and the patient’s positive screening tests were false positives did not seem to allow a full recovery from the stressful decisions that I had to make regarding very high-risk anti-viral drugs for myself, as well as the risks to my wife and our sex life.

My job also had lots of unreachable dangled carrots. In addition, the inefficiencies in providing quality patient care and associated emotional challenges were numerous. One time, I was accused of Medicare fraud by the mother of a high-level physician administrator for whom I bent over backward taking over the care of her wrist fracture treated four weeks earlier in another state. I converted a plaster splint to a removable wrist brace, which had the same CPT code and led her to believe Medicare was being billed twice. The brace company and I both had to eat the cost of care on that one, but the harder pill to swallow was that the patient and her son never appreciated the lack of fraud. In another instance, we were accused of malpractice by a patient who had tremendous muscle disruption of the gastric muscle from the 2000 or more pound object that fell on his leg. At the time of fasciotomies, he had no muscle ischemia for an early compartment syndrome. He felt he could not work more than 8 hour days or run on the treadmill the same after a year. He sued and the university settled because the nurse had not adequately documented the notes while in pre-op.

Despite these events that could easily lead to paranoia, I have remained completely dedicated to the welfare of my patients. What is best for my patient? How can I see that my patient receives the care that they need? What can I do to provide my patient with the most straightforward path to recovery? Unfortunately, one day, when I saw my patient being blocked from surgery, it was the straw that broke the camel’s back. My sudden reaction brought out a lot of negative energy. This uncharacteristic, as well as unacceptable, behavior, resulted in some anger management counseling as prescribed by the hospital administration. As this was the first event in my file, I was able to recover my job and my career. Interestingly, the comments provided to me and my superiors after this event included signs that I was burning out. While I accepted responsibility for my actions, the overall system did not change. No one offered assistance for burnout. No one actually seemed to care. And I kept performing at the high-stress level expected of someone in my profession because the system doesn’t offer reciprocity in its relationship with physicians. The system gives very little, and it takes a tremendous amount from us.

Camels are amazing animals capable of surviving the very harsh conditions of the desert. In particular, they are able to go for a long period of time without water. When they do drink, they can drink up to 20 gallons or more. Like the camel, the surgeon appears to be sustainable with very little self-care. The surgeon trains to handle limited energy, some amount of sleep deprivation, high adrenaline situations, several thousand pieces of straw, and other adverse conditions like the barren desert with very little water. Surgeons are capable of going a very long time without normal wellness efforts and activities. Or so we think. We adopt the old adage of “don’t fix something if it ain’t broke.” But why don’t we try to fix something before it breaks? Before it burns out. How do we know what will be the final straw? How can we prevent the break before it occurs?

Through the evolution of the surgeon and adaptive training, the surgeon and physician learns to carry every increasing burden. The system continues to put more and more straw on our backs. We are expected to carry the straw longer distances.

Now I have choices. I choose how much straw I am willing to carry. I also choose to drink lots of water. We also have a choice to change the system, so that we do not overload our physicians and we provide wellness to both patients and our colleagues.

If not, eventually not enough wellness and just one more burden will be the straw that breaks the camel’s back.

At SurgeonMasters, we are committed to helping physicians struggling with burnout. We offer coaching services, wellness programs, podcasts, webinars, and much more aimed at arming physicians with the tools they need to thrive in their careers.