July 25, 2019

My Journey to Wellness

Burn-out. Depression. As emergency physicians, we’ve all encountered these feelings at one time or another. Some deal with it better than others. Others leave their career in medicine. The latter situation is causing concern in the medical community, with many seeking ways to develop better support systems and changes to the culture in which we practice. It’s this focus which is critical if we hope to decrease stress and maintain career longevity. I believe following the principles of wellness is one of the ways we can accomplish this goal.

Becoming interested in physician well-being was not a goal I set out to achieve. It was serendipitous. I have practiced emergency medicine for almost twenty-eight years, and still find satisfaction in caring for patients. I am resilient. When I contemplate how my wellness journey began, I recognize that my education in the discipline began in childhood. Born in the early 1960s -- a decade of inner-exploration -- I remember having a big poster of Max Ehrmann’s “Desiderata” in my room. It’s a poem meant to offer inspiration when faced with life’s hurdles.

My parents exposed my sister and me to literature, art, dance, music, and travel very early in life. We had strong social connections to our grandparents, aunts, uncles, and cousins. As a child, my mother taught me deep breathing to release stress and frustration. One of my cousins, who was swept up with the culture of the sixties, taught me how to meditate. I also kept a journal, although back then it was called a diary, and wrote down all my thoughts and feelings in it. I had no clue how important those things would become later in life.

My stress level in college was relatively low. With the exception of Organic Chemistry, I enjoyed my classes. I had a great group of friends and professors who were genuinely supportive.  I always knew I would be a doctor, so I chose not to be a typical pre-med student.  I majored in Religion because I loved learning about other people’s beliefs and cultures. It provided me with a more global understanding of others’ perspectives on life. Retrospectively, it was another piece of the groundwork for my future wellness practice.

With regard to stress, medical school was a whole different ballgame. A day did not go by that I did not feel the demand to perform.  As a visual learner, straight didactics were a big challenge for me. Most of the other students had been Biology or Chemistry majors, and had taken some of the introductory classes in college. Since I wasn’t a science major in college, I battled a much steeper learning curve. I studied fiendishly and worked with my study group until I understood the material. Yet at the end of the first semester of my second year, the level of stress reached new heights.   My grandfather died.  It was devastating; I was extremely close with him, and I had trouble dealing with the loss. When I asked the Dean to allow me to take my finals at a later date, he actually gave me a hard time about it, wanting me instead to force my way through it.  In the end he acquiesced, but that “toughen up, you’re a doctor” message stuck with me for a very long time.

I did my residency at Lincoln Medical and Mental Health Center in New York City’s South Bronx.  It was the polar opposite of the small suburban community hospital where I did my transitional internship.  I couldn’t believe the volume of patients that came through that ED. It was a never-ending stream of pathology, 24/7.  I also wasn’t prepared for the level of violence that was pervasive throughout the community. There was a daily revolving door of people assaulted, shot, or knifed.  The schedule was brutal. When I wasn’t in the ED, I was either sleeping or reading. I barely saw my family, went out with friends, or exercised. The experience changed me. Over those three years I lost my compassion.  I was hardened.  I was exhausted.  As soon as I finished residency I moved to Southern California.  It was the furthest place in the continental United States from the South Bronx.  For the first couple of years in practice I had regular nightmares about residency.  Once I settled into a “normal” lifestyle, the bad dreams stopped.  I have no doubt it was because I was able to re-establish my social circle and do things that interested me outside of medicine.

I met my husband in 1996 and got married two years later.  In 2000 I received my MBA from the University of California, Irvine.  At the time, I thought I wanted to go into the business end of medical practice.  Teaching never entered my mind.  By 2002, we moved back to New York where I took a position as an EM physician and the Medical Director of Quality for Southside Hospital, where I still practice.  I moved on to other administrative positions, including the Director of Throughput and Efficiency. It was my dream job: combining clinical knowledge with my knowledge of quality and utilization. Unfortunately, the dream came crashing to an end when budget cuts discontinued the position.  The hospital and the nation’s economy were in a funk.  I had friends in danger of losing their homes and going bankrupt. Luckily, I was offered a full-time position in the ED.  Although I was depressed over losing my previous job, two months of soul searching brought me to the realization that I was still able to do something that gave me satisfaction.  By allowing myself time to process my feelings, and ultimately choosing to change my perspective, I regained a sense of control and purpose in my life.  It was another step in the direction of practicing wellness.      

Fast forward about five years. My family and I took a trip to Israel. It was life changing and affirming.  No matter your religion, Israel is an extraordinary place.  It’s a desert, and for all intents and purposes, nothing should grow there.  But no matter where you go, there is life and things flourish.  Although there is an ever-present danger, most Israelis live in the moment. As we concluded our vacation in the southern resort town of Eilat, Islamist militants fired four rockets in our direction. Fortunately, the Iron Dome missile defense system intercepted two of the weapons, while the others fell harmlessly into the Red Sea. In the morning, when we asked our taxi driver about it, he replied simply, “That’s Israel”.  It made me understand the importance of being in the moment, and savoring life’s experiences and encounters. It was a defining experience for me.

In early 2017, my ED Director asked me to develop some wellness programs for the staff. The hope was to equip them with skills to deal with the high levels of stress inherent to emergency medicine. He knew I practiced yoga and was into nutrition, but I did not have any formal wellness training.  I started reading: Zinn, Seligman and Lyubomirsky.  They were pioneers who were able to put a scientific basis to practices that could help physicians deal with the never-ending demands on their careers.  I also took online courses.  What I learned prompted my desire to study more.  I wanted to help educate my fellow physicians who were looking for ways to deal with the pressures of caring for patients in the emergency department.  We began having mini mindfulness sessions whenever possible in the ED to help reduce stress levels and reenergize us during our shifts.  Even the original naysayers found value in those five minutes.  I developed a wellness educational program for the hospital’s family practice residents.  It was informal, and I always made time at the end for group discussions about each topic’s applicability to “real life”. It was a successful series and is serving as the basis for the wellness curriculum established for our first emergency medicine residents who start this summer.

By putting the wellness word out there, I have met multiple like-minded people throughout the Northwell Health System that have been supportive and informative. I now sit on Northwell’s Governor’s Board for Physician Well-Being, the Graduate Medical Education Committee for Resident Well-Being and am collaborating with people at the Zucker School of Medicine at Hofstra/Northwell in the hope of developing wellness programs for the medical students. As previously mentioned, I am the Director of Wellness for our upcoming resident class as well. I take pride in having a multi-level program that teaches students, residents and attending physicians beneficial skills to help make their lives happier, more productive, and less stressful.

The practice of wellness is not one size fits all. Each individual must choose what best suits his or her life’s philosophy.  I firmly believe that as physicians we must nurture and embrace our own humanity in order to be whole and present for ourselves, our patients, and our loved ones. The cornerstones of my personal wellness beliefs are based more in the social-emotional aspects of well-being than the concrete ones. For me, that means taking care of some very basic needs, and I’m not talking about food and water.  Spiritually, I have a solid understanding of who I am as a person and how I want to live my life. Emotionally, physically, and socially, the practice of mindfulness, exercise, journaling, healthy eating habits, and using my support systems to deal with stress is essential.  For the times when none of those seem to help, a piece of chocolate work wonders.

I never planned to become a wellness champion, but looking back on my journey to get here, I have no doubt I found the right destination.

Heidi Levine, D.O., MBA