September 4, 2015

Melissa’s Story Part I – The Journey of an Ob/Gyn Physician

Melissa with dog

In medical school and residency, wild horses could not have torn me away from a medical career. Sure, I was exhausted and overworked but I was learning to deliver babies, to operate, to help people navigate some of the best and worst moments of their lives and I loved it! Not once did I feel I had chosen the wrong career path or wish to be elsewhere. I knew with great certainty medicine was where I belonged forever, and even went so far as to harshly judge my colleagues when they made negative comments about our chosen field.

I trained prior to implementation of the resident work hour restrictions and upon graduation entered a solo practice in a rural community. After three years there, I felt the inklings of career frustration but pegged it entirely on the cumulative exhaustion of ob/gyn solo practice and perpetual call responsibilities. To remedy my situation, I joined a group practice with partners and shared call thinking this would crush the perplexing thoughts tickling the back of my mind. I felt better for a short time but as years passed, my frustration grew and I began to feel like a caged animal alternating somewhere between numbness and rage. I cared for patients every day; however, I did not feel like a physician anymore.

My day to day energy was seemingly consumed by clicking computer boxes to create charts that satisfied billing requirements, by nursing protocols that had no relevance to actual patient care, by compliance meetings and safety mnemonics, and an ever expanding set of meaningless initiatives. My choices about what tests to order and what treatments to initiate seemed dictated by the threat of possible lawsuits more than their clinical relevance. In the delivery room, the actual childbirth seemed far less important than the nursing charting process, and in the operating room the actual surgery took second stage to being in compliance with the OR rules and stating the “fire risk” before each case. Where had the medicine in medicine gone, and what the heck was I actually doing every day?

For a while I forged ahead despite my feelings because I felt I needed the money. Let’s face it, the income was good and I could make purchases or travel without much regard for cost while still saving for retirement. Was my daily work so taxing that I couldn’t continue simply for the money? Ultimately, my answer was yes. I realized that somewhere in the prior ten years I had lost my compassion. I had absolutely no desire to continue on that path indefinitely no matter what the cost. My humanity was not for sale.

Then came the big question, what would I possibly do if I were not a working physician? I examined this situation from all angles, as giving up medicine felt like chopping off my own arm. Being an MD consumed most of my time and much of my identity. Imagining a life without it was almost impossible. Despite my apprehension, I decided to take the plunge. In order to fairly investigate what this type of change would realistically mean for me, I saved up some money ($40,000 to be exact) and took a six month personal leave of absence from my job. I had no real plan other than to feel what my life would be like without eating, breathing, sleeping (or not sleeping) medicine.

I spent the first month catching up on sleep and on all the life chores that had been sitting indefinitely on my to-do list. Lightbulbs got changed, the garage was cleaned, the dog got washed, the carpets shampooed, the planters weeded, and I visited the dentist. The next few weeks involved visiting family and friends that I had neglected and taking long walks with the dog. Then, of course the inevitable struck, now what? I was forced to face the reality of my situation: my existing medical practice was intolerable yet I could not live on $40,000 forever and I only had 4 months left to craft a plan. I searched my soul and came to realize three critical truths.

First, the lack of compassion in my daily work was unacceptable. I felt robotic in my practice responding more to outside system pressures than to the individual human in front of me. Second, I felt trapped by my income. I had not been careful with my spending and while I had no serious debt, I was still living in such a way that I required my inflated paycheck to sustain my lifestyle. I calculated that had I lived on $50,000 per year and saved the rest, I could have been set for life by now instead of feeling trapped. It was time to curb my spending. Third, despite my frustrations, I was not prepared to part entirely with patient care. Not only was my personal identity inextricably wrapped up in it, but I truly enjoyed the part of medicine where I actually cared for the patient. I did not miss charting, computers, or protocols, but with time away, some of my original interest in the field began to reemerge.

In light of the above three factors, I decided to explore some alternatives. In my remaining time off, I tried a locums assignment in an underserved area, became a licensed massage therapist, took a real vacation, and looked into international medical opportunities. Determined to liberate myself from my salary, I moved out of my house and into an apartment and cut my spending dramatically until I required well under $50,000 annually. With some new skills and reduced cost of living, I now knew, if worst came to worst and I truly wanted out, I could quit my job anytime and work as a massage therapist or do a few locums assignments and be absolutely fine. Surprisingly, the mental freedom that came with this realization actually created the space for me to consider returning to work without the same animosity that I previously held.

Research into international opportunities eventually led me to a seven-week assignment in South Sudan with MSF (Doctors Without Borders). While there was limited access to laboratory tests, medications, and procedures, there was also minimal charting, no insurance companies, no computers, no lawsuits, and no nonsense. The entire experience involved 100% clinical assessment and direct patient care. Overnight I wasn’t called unless a patient was literally dying (compared to hourly calls for Colace or Tylenol orders in the States). For the first time in years, I felt like an actual physician. I was using my brain and my skills in truly life-threatening situations. I celebrated with patients and families when things went well and felt genuine tears of sadness (versus fear of lawsuits) when things did not.

At one point, in South Sudan, when I was visibly distressed over the impending death of a hemorrhage patient with DIC, her husband actually consoled me stating “It’s okay doctor, you have done your best, now we will wait here with her.” What just happened? The situation was incomprehensible. The family of a dying woman was comforting me, the doctor, who was supposed to save her life and was not succeeding. Ultimately, by some miracle, that patient ended up surviving and the family was no more and no less thankful. We were just all there together doing what we could for her. At that moment, I realized that somewhere in my 6 months away from work, I had found my compassion and oddly enough it had manifested in the context of medical care, the very same practice that had originally stolen it.

So, what does my life look like now? I work some days in ob/gyn clinic and take some night and weekend call. I do a bit of massage therapy in a local spa. My schedule is flexible on both fronts and I am in the active pool for possible international assignments with MSF meaning that I will likely spend one to four months per year in maternity hospitals in third world countries. I also have active credentials with a locums company and can take assignments that suit me if and when they are offered.

If you are thinking to yourself, that’s good for you but my employer would never let me keep that kind of schedule, think again. In retrospect, my biggest issue was that I felt trapped in the current system and I kept comparing working in what traditional medicine had become to not working in medicine at all. My linear brain couldn’t see alternatives outside the norm in terms of work schedule or lifestyle. Once I took my blinders off, I was able to see that my happiness hinged on flexibility and I took steps to ensure that freedom. The most frightening part was asking my employer and my partners if I could work a non-traditional, flexible schedule of my own creation knowing that if they said “no,” I would be faced with quitting completely or returning to work. By cutting my expenses, I was able to enter into that conversation with confidence and I was prepared to walk away if needed. Surprisingly, they simply agreed to the modified schedule with no fanfare and here I am.

Now, when I show up to work, not only do I feel more compassion in my day to day patient interactions despite the persistence of bothersome health care system problems, but I have reclaimed a passion for medicine. My day job funds my ability to participate in international missions with MSF, and participation in MSF keeps me in touch with hands-on patient care enough to participate wholeheartedly in my day job. Offering relaxation massage therapy on the side reminds me that I can walk away from medicine altogether anytime and, oddly enough, in that freedom I have found an inherent desire to continue with medical practice. I no longer feel trapped and having reinvented my life once, I also no longer fear the process of making dramatic change again should the need arise.

A big, “Thank you!” to Dr. Melissa Wolf for sharing her story. Please stay tuned next month for Part II, where she takes us to the South Sudan on her adventure with Doctors Without Borders (MSF).