When I was younger, I thought everything was possible. Travel at the age of six to a new country and go into public school not speaking a word of English? Heck yeah, learning a new language will be fun! Join the cross-country team in eighth grade even though I've never even been on a hike through the woods? Great, sounds exciting! Go away to Harvard to major in biochemistry and pay for all of it myself by working multiple jobs? Sure, anything to help out my family. Go to Penn Med and take a sculpting course in addition to med school classes because I'm curious about it? The course was free! Why wouldn't I take advantage of it? Match at Pitt EM, one of the country's most competitive Emergency Medicine residency programs and be only one of two women out of a twelve-person class? Excellent, I love hanging out with guys; bring on the challenge! Fly in air medical transport helicopters as a flight physician and take shifts driving the physician response vehicle? Awesome, more adventure!
Early in my medical career I realized that emergency medicine was the best fit for my personality. I craved the acute care and the adrenaline of caring for crashing patients. High adrenaline was something that spoke to me not only professionally but also personally. I started to identify as Wonder Woman. I intended to never yield. During an initial meeting with my residency director to identify my goals I clearly remember saying, “I want to be strong. To be able to handle anything. To not be considered weak.” Being called weak was the worst insult you could give someone in medical training. That was not going to be me.
After graduation from residency I decided I wanted to challenge myself by working in a small community hospital where “I was it”. Pretty soon it became apparent that in order to be available as an actively participating mom and wife, I had to switch from the typically irregular ER schedule and instead work exclusively nights. I coached my daughter’s soccer team, made dinner every night from scratch, and worked four nights a week. I also trained for and completed my first marathon and took up triathlons, eventually completing a full Ironman. I was making it all work. I was spinning many, many plates on sticks in the air. I was living my dream!
And that brings my story up to my early thirties.
I'm not sure what happened after that. But the plates started to fall.
In reality I was able to handle things pretty well for a while. Four nightshifts in a row, Monday through Thursday, every week. Running afternoon soccer practices and weekend games. Cooking dinner, taking care of the house, trying to be a good wife, caring for my aging parents… it was manageable at first. Yet steadily, year after year, Monday afternoons brought me closer and closer to tears, realizing that I was about to jump into four nights – again. Every Monday afternoon I could be found delaying my nap by drinking sauvignon blanc and sitting on the floor in front of my couch, crying. I was getting emotionally, physically, and spiritually exhausted. I was not only caring for my kids, my husband, my neighbors, my community, my soccer players and my family, but I was about to jump into caring for every patient and every concerned friend and family member in the ER – again.
I finally succumbed. I couldn’t do four nights anymore. Luckily for me I was married to a pediatrician who understood and encouraged me to cut back. That sounded amazing – that should solve the problem! I decided to cut back to three nights a week. It was great… for a while. Then somehow, slowly, like the proverbial boiled frog, I was eventually overwhelmed with working even three nights a week.
I felt like a failure.
The pressures of being an emergency physician with ever-increasing demands were getting to me. More requirements, more metrics, patient satisfaction scores, increased micromanagement, EMR, time stamped charts with administrative oversight – it was becoming overwhelming. I was losing sight of why I went into medicine in the first place. I dreaded driving to work and finding a full parking lot. I imagined keying those cars in the lot on my way in. I’d watch people walk through the emergency entrance and think to myself, “You don’t look sick, why are you even going in?” I felt every patient that checked in was only interested in putting more work on my shoulders and making my life miserable.
I eventually cut back to two nights a week. At this point I was starting to question whether the answer was ever-decreasing numbers of shifts. Why was I feeling this way? Where had my love of medicine gone? I was a strong woman, damn it! I was an Ironman! I was a Greek immigrant who managed to become Valedictorian of the largest high school in the country and was accepted at every college I applied to. I was a double-Ivy league trained, badass physician. I had saved many lives and healed countless more.
How could I possibly be feeling this way? What had I become? Was I weak?!?!
Burnout had become my reality and I had no idea how to pull myself out from it.
I decided I should put my foot down and schedule a meeting with my ED Director to make some more “cutting-back” demands. During that fateful meeting something spoke to me. I suddenly became overwhelmed with a need to help my physician colleagues with their own symptoms of burnout. I voiced this need and was quickly promoted to the role of Director of Wellness. My desire to cut back ironically resulted with the same schedule and an increase in responsibility. Yet somehow I felt energized. For the first time in many years I started to be excited again.
I figured if I was going to help others with burnout I should start with my own. I researched ways to foster a culture of wellness and positivity. I started meditating. I focused on excellent nutrition and added yoga to my exercise regimen. I became mindful at work. Some people talk about how these things are not the answer for burnout, but they were pivotal in opening my eyes to endless possibilities. I was better able to ground myself, center myself, and look around. They showed me that I had a purpose. Yes, I had a purpose before, but this was different. This was becoming a passion.
We live such a structured existence for most of our lives. Every step of the way between birth and graduation from college, med school and residency is strictly regimented and planned. You’ve got to study hard to get good grades in high school. After high school, go to the best college. After college, go to the best med school. After med school, go to the best residency. After residency, get the best job. Somewhere in there you may get married and have a family. You are told you should raise children with the best education, best ethics, best nutrition, best physical fitness and best extra-curricular activities. You do your best to guide them towards a productive adulthood. But after that? After that, you’re on your own. There is no script. What happens then?
We have no roadmap beyond that. It all becomes hazy, a bit of a blur. I remember lamenting to one of my PAs when I was working full time nights, “Is this going to be the rest of my life? Am I going to work four nights a week, try to recover on the weekends, and come back to do it all over again until I die?” I couldn’t see beyond a monotonous eternity, even when I had cut back to two nights a week. If emergency medicine was the only career I was meant to have, then I felt sure that I should look forward to work at least some days. So, what was happening?
My crisis came in a combination of burnout and the dissolution of my marriage. I felt like I was on the edge of a precipice, staring down at an endless, dark chasm. Everything I had worked so hard to build was falling apart in front of my very eyes.
I started to really look at my life. What was I good at? What did I love? What would let me pay my bills? What was good for society? The answers to these questions are the reason for your being on this earth. It’s your special niche. It’s uniquely yours. The Japanese call it “Ikigai.”
It often feels easier to continue traveling down well-rutted roads than to veer off through branches and brambles, until something comes to block your path. You then have no choice but to search for a different way around. This is when you get to search for your Ikigai. This is when you get to write your story. You’re not following a predetermined, predictable road any longer. You can look inside and self-discover. What are you excited about? What is your view of your best self? When burnout hits and continuing forward down the same old path isn’t an option anymore, where do you go next? Can you open yourself up and examine deeply what ignites your fire and expands your soul?
For me the answer to burnout and despair was the discovering of my purpose: my passion to keep myself as healthy as possible mentally, emotionally, physically, and spiritually in order to, by extension, help others achieve their goals and find their Ikigai. My passion was both inside and out of the Emergency Department. I started a story-sharing website and became a certified health and wellness coach. I channeled my love for food into culinary medicine lectures and cooking demonstrations. I joined my local triathlon team and for the next year have signed up for two Ironman events, a marathon, and a multisport race across New Zealand. I’ve started lecturing on a variety of wellness topics at conferences around the country, including the first annual ACEP BalancED conference this past February and the first annual Lehigh Valley Lifestyle Medicine conference this past April. And perhaps more importantly, I’ve been able to rediscover my love for emergency medicine and this has allowed me to keep working my nightshifts and to keep healing my patients.
If you find yourself in the midst of your own personal and professional crisis, think of it not as a curse but as an opportunity. This is your chance to refocus on what is important to you and where you ultimately want to go. What is your life’s purpose, your life’s passion? How can you take your career and make it uniquely your own? How can you help yourself thrive and then share that abundance with the world? When you have an answer to these questions, you will finally become the superhero you’ve always dreamed you would be.
By Kathy Parmele, MD, FACEP
Katerina (Kathy) Tsapos Parmele, MD, FACEP is a board-certified Emergency Medicine physician, Director of Wellness for CalvertHealth Emergency Medicine, a member of the Council of Directors for True Health Initiative, and an active member of the American College of Lifestyle Medicine. She graduated magna cum laude in biochemistry from Harvard, received her MD degree from the University of Pennsylvania, and completed Emergency Medicine specialty training at the University of Pittsburgh. She is the founder of HealThySelf HealThyWorld, LLC which aims to spread the lifestyle medicine message to clinicians in order to help pay it forward exponentially to their patients, and is a certified Wellcoaches® Health and Wellness Lifestyle Medicine Coach. She is a self-proclaimed amateur endurance athlete, having completed 14 marathons and 4 Ironman triathlons to date. She is also an avid Greek cook and spreads the culinary medicine message to others one delicious forkful at a time. She lives in Edgewater, MD with her two children and two dogs.