I felt accomplished as Chair of Psychiatry for a large 4-hospital health network (and the first female to hold a Chairman position), the head of a happy family (myself and my 2 young autistic children), and a health nut in top physical condition. The fact that over the past several years I had been suffering from episodes of increasing fatigue and corneal ulcers had concerned me initially due to my extensive family history of heart disease and cancer. After my doctor reassured me on several different visits that I was healthy I decided that it must just be stress.
At no point during this process did I ever take any time off from work or even consider it. Self-care is not taught to doctors or medical students. Doctors are taught to have perfectionist expectations of self, and the harshly self-critical stream of thought running through my head was,” I should be able to manage this stress. I need to do better.”
So I worked even harder at being a better doctor and a better mother. I focused on the wellbeing of my patients, my staff, my students, and my children. I was building success upon success at work and my children were thriving. Whatever was happening to me went under the radar for several more years. Deep inside I sensed that something was unraveling but I was too focused on my department, my patients and my family to notice.
One cold December day I woke and discovered that I was suddenly having problems with weakness in my legs and difficulty walking. The illness had finally successfully overcome my denial. It sent me back to the doctor and I embarked on what was to be a two-year unsuccessful quest for a diagnosis. My symptoms worsened until I could neither walk nor work.
Doctors tend to avoid the patient role due to a perceived loss of control. Each of eight visits with neurological experts over the next two years was like a nightmare. The complete loss of control and fear only grew with time. I felt shame facing a colleague in the role of a helpless patient. I felt it was important to share with these doctors some of my early symptoms of fatigue and corneal ulcers but either they didn’t want to listen to me or they ignored what I had to say. I concluded that I was no longer respected as a physician. I felt a strong need for some show of compassion or reassurance from these doctors as each of them, in turn, told me that the neurologic diagnosis was uncertain, and sent me on to the next, more specialized, neurologist. However, they remained business-like and aloof.
Meanwhile, “back at the ranch”, my successful secure life was being turned upside down. I had lost everything that had defined who I was. At the top of that list was my job, running and being fit, taking care of my children, dancing, skiing, singing, and all the social relationships I had through those activities. Along with the grief and loss came a feeling of terror that, after all the years of sacrifice and hard work, I might lose it all.
Due to low self-esteem, physicians tend to identify with their only perceived area of competence that is medicine. Their time and energy gets over-invested in work which leads to a loss of life balance, along with avoidance of, and loss of contact with, one’s deep essential self. A sudden inability to work or pursue that one area of competence creates a loss of identity and a crisis. Emptiness, lack of purpose, grieving, anxiety, sadness, isolation, eventually turns in to anger (often directed at medical caretakers) and guilt (“I’m lazy and I should be working!”)
About one and a half years after the day in December when I first noticed my inability to walk my fiancé abruptly ended our engagement, simply stating that he did not want to be married to someone who will always be sick.
That final loss caused the last of my fragile defenses to crumble and sparked an intense search for direction and meaning. It forced me on a difficult and painful trail of self-exploration. Medicine, the approval of others, and all the other superficial life “opiates” that made me think I was strong, smart, attractive and that I mattered, were gone. The only place left to look for strength and answers was inward.
As a result of this painful “cracking open” I finally found my deep essential self. My heart, my mind and my life began to change. By releasing other peoples’ ideas as to who I should be and what I should be doing I began taking charge of my own life and my own decision-making. Having just been told by the eighth neurologist that he could not identify my illness I decided to follow my own diagnostic skills (which I had shared with all of the neurologists), and made an appointment to see the national expert in the rheumatologic disease I was sure I had, which, by then, was in a very advanced stage. After waiting 3 months to get an appointment, the rheumatologist at Penn instantly made the diagnosis and started treatment.
As I explored my deeper self I became keenly aware of my own values and thoughts. I no longer had a need to define myself as a doctor. “Medicine is my work and only a part of me”. Balance in life gradually seemed more realistic and natural. I realized that I could care for myself and envision a future that is consistent with my values and dreams. There was no one to please but myself. As my trust in myself deepened I experienced a tremendous sense of relief, freedom, and an awakening of happiness and creativity in spite of all the losses which remain to this day.
It was this deep essential self, now such a friend to me, which helped me to see my “noble purpose”. I can use my strengths and talents in service to others while taking care of myself and setting healthy limits. I can listen to the true callings of my heart and pursue them using my talents and skills in order to improve the human condition and to serve others. Medicine has become a calling, a passion to heal and lessen suffering. I will teach positive health to any and all physicians who will listen to me so that no physician will fall ill, as I did, due to neglect or lack of awareness. I will teach doctors positive emotional as well as physical health so they can learn to deliver compassionate and preventive care to their patients. And I will teach them positive health education so that they can lovingly teach wellness to their patients and medical students, thereby creating a healthier and happier world.
Meaning is an integrating factor in people’s lives, involving the achievement of happiness, the ability to withstand distress and to attain transcendence beyond our solitary selves.
The sense of purpose is the motivational component of that meaning. My story is an excellent example of the revealing of deep meaning and understanding in my life due to a dramatic loss. Before the loss I had mistaken superficial preoccupation with deep meaning, not understanding that purpose is a central, self-organizing life aim that comes only from the deepest essential self. It is s a central theme of a person’s identity.
Goals that are self-concordant, self-determined, and autonomously motivated result from living one’s purpose. This results in a deep passion to pursue the goals related to one’s purpose. I passionately pursue my goals through medicine and physicians’ health.