This is a very personal story. I wasn’t sure to publish this note. But after some years of practicing medicine I realized, that there are so many physicians out there who might be in the same trouble.. It is no longer a secret, that health care jobs are associated with psychological problems and that there are far more cases than the published numbers. I would write this story in multiple parts, because otherwise it would be too long and boring. I do hope, that this story doesn’t end here.. Because I still believe, that as long as it not good, it is not the end yet.
Writing has helped me a lot in getting through difficult phases and to sort out the messed up thoughts in my head. That is why, I would like to share this. On turning 31 I now can really say, “das Leben ist wirklich kein Ponyhof”. Well, one or another could probably be inspired by this..
Ever since I can think, my life is full of plans. I arrived in Germany the very first time as I was 17 years old. After a year of experiencing the german high school, it was set in my head, that I had to come back and study medicine in Germany. So directly after finishing high school in Indonesia, I left all of my family and friends in Indonesia in order to study medicine and become a physician in Germany. I planned to be a physician by 25. I planned to finish my doctoral degree by 28. I planned to get married by at the latest 29. And then I planned to have children, while I continued to pursue my career in the university. I pictured my life to be a mother and wife, a physician and a researcher, a writer and a traveller in my free time. It was all about plan.. But then one by one started to fall apart.
The initial plan was to be an internist/nephrologist, which then didn’t come true because of my growing anxiety towards emergencies and the increasing sleep disorders due to irregular sleeping rhythms. This I realized after working for about 3 years as an internal medicine resident. I was never a physician who jumped on emergencies and stuck needles or catheters into body cavities. I have been rather a physician, who’s into solving “riddles”, holding patients hands, researching. It was the rare, complicated cases that “turned” me on.. But on becoming an internist, I realized, that I will ALWAYS be confronted with emergency. I will always be confronted with night/weekend duties and on-calls.
I do love the kidney very much.. Emergencies were the only cause. The anxiety grew constantly and it grew even bigger every time I had too little sleep. At times that I didn’t do any night shifts and I had good regular sleeps, I wasn’t too anxious about emergencies. It might have been the combination of sleep lacking and my dislike about emergencies. It wasn’t that I got paralyzed, every time any emergency case happened. I could still think clearly and do things precisely. But it was always the aftermath. Every time I witnessed death or terrible pain (which was pretty much daily in the emergency unit or in the wards), I had nightmares.. Nightmares that were extremely disturbing for days and sometimes weeks, that I didn’t dare to sleep.
That was the reason why, some time last year I switched the plan. I don’t know until now, whether it was the right decision. I did have some options.. My boss and everyone in the department were actually very satisfied with my work. I didn’t show my anxiety until I couldn’t help it anymore. And that was probably the mistake. If only I had looked for a professional help earlier.
At that time I drew some alternatives..
The first alternative was to hang on in the department and having a coach/therapist in parallel, who could have possibly helped me get through my anxiety. I decided not to do that, because at that moment I was too fed up with the working situation. And I was probably very curious too about trying out other disciplines. Probably I just wanted a fast exit.
The second alternative was to change direction completely. To get out of the clinical medicine and to focus more on research and lectures. I was thinking about theoretical disciplines, such as pathology anatomy (where I did my doctoral degree), microbiology, clinical pharmacology or clinical pathology. I did apply to a lot of departments in the university and fortunately got accepted in almost every program I applied to. That way I could avoid any emergency case completely. But getting into a theoretical discipline would mean no patients contact at all, whereas I do love treating patients. During med school I had fun in almost every discipline. That was probably why I went to the internal medicine in the first place, because you have every aspect of everything in the internal medicine department.
It is indeed a big advantage of residency program in Germany. As a doctor your doors are wide open for practically everything. You can switch from one department to another, as long as they have openings and you have a pretty much convincing Curriculum vitae. But you see, too many options don’t always make things easier..
I got really confused with all the options open. I had job offerings for microbiology, clinical pharmacology, human genetics, occupational health. I could even go back to pathology.. But in the end I opted for occupational health.
Why occupational health? I like consulting.. Occupational medicine is a discipline which connects medicine to all aspects of life. It is about prevention, health, being the first health care contact of healthy young people / workers who otherwise are not doctor-goers. It is too about finance, management, law and regulations. Point is, I was thinking – without actually knowing too much about this particular discipline – that by doing occupational health, I can still do medicine in a wider spectrum and on top to it I get to learn so many new things. But it is indeen totally a different thing than the internal medicine or working in a hospital. During medschool we didn’t really have much contact with this particular discipline, which is a total pity!
Of course the pressure of being an occupational consultant is much more different than the stress in an emergency unit or an intermediate care unit of a high end university clinic. I no longer had to jump from one emergency case to the next. I don’t have heart attacks, post-transplant conplications or gastrointestinal bleedings anymore. But there is another pressure, which is called corporate pressure. It is a lot about customers satisfaction and getting as many clients thus profit as possible.. As an occupational consultant in training I don’t get to decide much. I got the tasks from my bosses and I needed to show them, that I could manage the tasks. I needed so badly to prove myself to my clients, to my boss, to my family, to myself. It was a great shock for everyone, that I left nephrology / internal medicine. And I believed, that one or another was extremely disappointed with my decision. That was why, I needed to show myself and people dear to me, that occupational health is just as “good” as the internal medicine. And that here I can succeed too. I started working long hours on my own. The job was challenging and exciting, that I wanted to excel at it as fast as possible. I handled too many clients and corporates. I had far too many plans, more than that I could manage. I spent a lot of my free time to do learning and research. I forgot about other priorities. I succeeded at first, before I realized that my battery was long used up and expired.
So many plans.. some of which fortunately came alive too. I have been so blessed. But probably I have been to busy planning and working on the next plans, that I haven’t been grateful.
I betrayed my own needs. I got mad at myself, every time a plan didn’t work out as it should have been. I forgot, that behind every worked-plan is also another power, which is totally out of my control.
I was trapped in a circle of physical and emotional exhaustion. Suddenly medicine didn’t look as exciting as it used to be. It turned into something I HAVE TO do, just because I had been spending a third of my life studying it. I began to doubt my profession, my passion about medicine and worst myself. I didn’t sleep anymore, instead I used my sleep to dream about my job and unsolved problems of work. I grew to be an extreme anxious person. It was the same problem all over again and even worse. I started doubting about my culture, the religion. I doubt about everything that had been right. I blamed everything and everyone, especially myself for this mess. Everything seemed not good enough. I was sliding down an icy road and didn’t know how to stop. I didn’t know how to pull the emergency brake. I crashed.
So now I know how it feels, to be overly exhausted and helpless. I personally experienced this helplessness, just as some patients whom I have treated. You just want to be in bed, because you only want to sleep, but you can’t. You keep trying harder and harder, but it still doesn’t feel right. It still isn’t good enough.. And then you can’t try anymore.