Spring. Flowering trees. Green grass. Fresh winds. Sunny sky. COVID.
This is where my mind wanders every year since 2020, when the season turns. I return to the journey between the hospital and home. Every night, after fighting a losing battle in an academic institution determined to ignore and downplay the horror that was about to cross our borders. I was a fighter then – perhaps more so at that time than I had ever been before and have been since – and I was ready for the fight that lay before me. Of course I was. I had been preparing for this moment my whole life. The experiences and times of turmoil and tragedy that I overcame through my studies and intensely drowning in my work were perfect preparation for the work to come.
I separated myself from my personal identity and became Dr. King in mind, body and soul. It was time to show the world that I was not afraid, that I was brave, and that I would lead us into battle, even if it meant losing my life or my health. I lit the match, cut ties with my past at that institution, and flew to New York to join the first line of defense in a war that continues to this day.
I will never regret or minimize the role I played at the start of this pandemic as an academic intensivist. I have led the charge at the local, regional and national levels. I approached this illness as I approached anything and everything in my life, with a relentless search for perfection. I took the pain of the years leading up to 2020 and used it as fuel to fuel the fire of my soul. I couldn't and didn't want to be arrested.
And I didn't stop for three years.
And then I did it. Suddenly.
After exhausting myself in a state of disgrace and infamy, despite my intelligence and clinical acumen in the ICU, I left. I left academics, intensive care, nights, calls, vacations and weekends. I gave up everything I had worked so hard for.
I became a salaried anesthetist in private practice. And my whole life changed.
The reduced complexity of work, as well as the absence of on-call days or weekdays off after periods of intensive care, led to strain in an already precarious personal life. I worked less and more at a time. I was seeing many more patients in a day, while losing the skills I had spent years acquiring. It was such a profound dichotomy and almost a sick joke where I was both overwhelmed and annoyed.
I was extremely uncomfortable. I was afraid and embarrassed by what I was losing and what I was becoming. Who was I if I wasn't the one fighting dragons and giants? I kept asking for more. I asked for more responsibilities, more roles, more titles, more work… just more.
Because doing more meant I wasn’t failing, right? If I did more, I wouldn't have to face my sadness and disappointment with what and who I had become. I had allowed myself to drown in the fiery hell of burnout and do what I had always promised I would never do: I took the easy way out and I hated myself for it.
The problem, however, with this view is that it is deeply disrespectful to my colleagues, my office, and me. Because it's not easy.
Private or community anesthesia practice is profoundly difficult and stressful, especially in a world where there is a constant threat of private equity while keeping surgeons and proceduralists productive so hospitals can keep their lights on and their doors open. This is as the patient population is rapidly becoming sicker and less willing to undergo safe anesthetic care for the surgical procedures they need to improve and increase their quality of life.
As much as I hated myself for no longer caring for 12 to 18 seriously ill patients at a time, I couldn't recognize the amount of intelligence and perseverance I put into administering 20 to 40 anesthetics every day. I kept thinking that I had failed, that somehow this job was “less than” what I had been trained to do or capable of doing. And then my life changed.
I discovered that I was not as tortured or bitter. The stress I carried at work didn't follow me home, nor was it debilitating. I moved into my own house. I started to really do the work. I explored the trauma work I had referenced in my nationally recognized presentations during the time of COVID. I started doing what I said needed to be done so that we could heal from the pain and destruction of COVID.
I realized that not only was I repairing the damage of COVID, but I was actively trying to repair the scourge of intergenerational trauma and work addiction brought on by the tragedy that led to such a profound loss of self-respect and of self-control in the wake of wave after wave of destruction.
The problem wasn't that I was falling into the fire, but rather that I was running towards the fire to soothe the burns from the previous fires.
As many of us know, once the burn is deep enough, the pain goes away and the damage done is often less obvious, more complex and harder to heal. Repeated self-inflicted wounds were a form of emotional disconnection, a vicious cycle of moving from one fire to another so that healing from the last fire was no longer necessary because one was simply trying to survive. Much like veterans who repeatedly volunteered to be deployed, which was often simply the only thing someone could think of when the transition back to their home country was too difficult.
None of these accomplishments make me a better or worse doctor. They don't determine the kind of person I am. They do not dictate my worth, my perception of myself, or the necessary self-acceptance. But they give me pause when I start to slip into the old mindset that I need to do more. Could this cure? Or forgiveness? Or a recognition and awareness that the pain that spring has brought me since 2020 is only part of my story and not the whole of my story. The time I spent being and doing more was also the time I spent not honoring and caring for myself. And in this time of less acuteness, less intensity and less trauma, I have the right to find joy, to be happy and to have hope for a future where I no longer heal my wounds with fire but rather with kindness and grace for the person who brought me to this point: me.
Nicole M. King is an anesthesiologist and intensivist.