Have you noticed that the current battle lines are all drawn around conflicting fears? My fear of losing my freedom is more legitimate than your fear of the virus. My fear of vaccines is more legitimate than your fear of living in a world without them. My fear of economic ruin is more legitimate than your health fears. My fear of conspiracies is more legitimate than your fear of misinformation. What if we focused on supporting each other and caring about the fact that there is so much fear right now? Fear is a healthy emotion designed to keep us safe from possible threats. My fear is not more legitimate than yours. I care that you are afraid. I want to help create a world with far less fear and far more compassion and empathy. If we focus on what we love rather than what we fear, we can create a new way of being with each other.

Words matter. They can actually be more impactful than actions. Words incite wars, peace treaty agreements, long-term commitments and social contracts. Without communication we are impotent…powerless. A word that has been invoked a myriad of times online, across multiple platforms, is the word “VIRAL.” How many times have you heard someone describe a Facebook, Instagram, Twitter or YouTube post as going viral? We wait with baited breath for our communication to multiply exponentially, traveling the globe. We covet recognition, fame and fortune. Now that we are experiencing the very REAL impact Covid-19 is having, we understand the concept of what going viral REALLY means. 
Honestly, I am reticent to ever use that word again to describe the propagation of an idea or content. We are experiencing collectively the speed with which a deadly virus can reproduce, drift and shift.Perhaps taken in this context, the naysayers and disbelievers will pause. The “overnight” sensations that have been made through a viral post are commonplace. We have seen the effects of these posts that inspire, educate, provoke or destroy. This contagion is no different. Its destructive force is felt physically, financially, psychologically, collectively. This virus is real. Its destructive impact is real. Please, take it seriously. Protect those you love. Advocate for the physician, nurse or health professional who is courageously fighting on your behalf. The speed at which this virus travels is mind blowing.
Right now we are immersed in the language of this pandemic. Let’s use the viral energy for good. Let’s infect our world with acts of viral courage, viral compassion, viral kindness, viral empathy. If we do, our healing and recovery is assured.

Having worked with physicians over the last 20 years, I have come to recognize a familiar pattern. It is a pattern of trauma which begins in medical school, sometimes earlier. Unlike other high stress professions that acknowledge the risks, physician stress is mostly ignored. When it’s not, the physician is pathologized, made to feel as if they are the problem. The pathologizing starts early. Desperate to get into med school, then desperate to graduate, desperate to match into residency, desperate to specialize, get into a fellowship, a group practice. And so, what I call the desperation cycle begins.

Medical students are thrown into the rigors of study in much the same way military personnel are thrown into the boot camp experience. Most are told that medical school will be HARD. More than hard. To quote one instructor, “Med school will break many of you sitting here. You are not as bright as you think you are. In fact most of you are average, or less than average.” These students who have been the “brainiacs” in previous educational environments find themselves challenged and critiqued, told they are not up to snuff and better crank it up. Dealing with the impossible pressures totally re-frames their sense of self. The system of breaking down physician confidence has begun. 

The AVERAGE cost of medical training is 170k. Most students graduate owing far more. The financial commitment, delicately balanced on a fragile foundation of low self-esteem, becomes a constant destabilizing and threatening reality.

Once you manage to get through medical school with all its test taking, hazing and competition, you move on to the Residency experience. Attempting to “match.” “Attempting” because there aren’t enough residency positions to go around. In fact, there are 11,000 fewer residency positions than there are applicants. The competition is fierce and desperate. It is tragic that many contemplate suicide at this juncture, before they even qualify to practice medicine independently.

For those who do match and find themselves in the pressure cooker called, residency, they arrive exhausted, financially insolvent and with an eroded sense of self. This is where pimping, humiliation, training/mentoring and physical abuse happens. Interns are pitted against each other, required to work up to 36 hours, ignoring their basic needs. It is not uncommon to hear of residents falling asleep in the parking lot of the hospital in which they work, or at the wheel while driving home. Full blown psychotic breaks, seizures and medical errors often sabotage careers for even the most promising in their field. By the time residents complete their training, they are often too depleted to even entertain the idea of Fellowship beyond residency. Entering the workplace already entrenched in the Desperation Cycle, physicians prepare to….PRACTICE MEDICINE?

Trauma is a far more pervasive issue in medicine than anyone is talking about. We know physicians live highly-stressed lives, but we are reticent to talk about the trauma inherent in the field. Many are afraid to talk about living in secrecy with Post Traumatic Stress, because it can be a career killer if you acknowledge your suffering. Physicians joke about OCD, anxiety, burn-out, rarely admitting that they are REALLY struggling with PTSD. Time to tell the truth. There are strategies to heal.

Once you are ready to acknowledge your trauma history, what should you do?

• Don’t keep it a secret.
• Use centering and grounding practices. 
• Slow down the trauma response.
• Differentiate the physical versus the emotional.
• Disrupt the trauma cycle with tangible interventions.

Post Traumatic Stress Disorder (PTSD) often coexists with depression. In fact, a third of returning veterans have depression that accompanies their PTSD. If you are struggling with profound sadness, isolation, irritability, sleep disruption, appetite changes, trouble concentrating and are tempted to self-medicate with substances, you may be experiencing PTSD co-existing with depression. Don’t accept the very first diagnosis you were given if it feels like something more complex is going on. The good news is that PTSD and depression (experienced as a result of trauma) respond very well to treatment. It is not hopeless. You are not weak or flawed. You deserve to feel good again.

“I can’t believe that I am this exhausted,” his voice was incredulous on the other end of the phone. “How did this happen? All I’ve ever done is live by the golden rule. I’ve put others first. I’m not a jerk. I try to be patient and this is what I get?” I was talking to a man who had just been sued by a long-time patient and was now being pressured by his group practice to settle. He just couldn’t wrap his head around the fact that his selfless service to patients and practice was valued so little.

This happens to many of us. We are taught early to live by the golden rule, yet aren’t given all the information we need to attend to ourselves first, before helping others. Denying our own needs in the service of others is called CO-DEPENDENCE. Co-dependence is not the goal. Because the mission of medicine is to diagnose or cure illness, it is easy to develop a “savior complex.” I believe that is why preventative and lifestyle medicine is so popular. The idea of diagnosing, treating and “saving someone” from their disease process is no longer a viable model. We are (more and more) drawn to the wisdom of helping others learn to care for themselves, averting the chronicity of disease.

If we want to serve others truly, we must first serve ourselves. This requires interdependence, not co-dependence.

How can you tell if you are relating at home and at work from a co-dependent place?

1. You struggle with feelings of low self-esteem. It feels like you are never enough at home or at work. You are forever “making up” for ways in which you feel like you have let others down.
2. You have poor boundaries. People take advantage of you and you don’t know how to change it. It feels like you give and give and give with little return.
3. You want more for others than they seem to want for themselves. You SEE their potential and try to convince them of their value, often to no avail. You leave the interaction feeling discouraged and depleted.
4. You put others before yourself. Aren’t we supposed to deny ourselves when we serve? The answer to this question is a resounding, “NO!”
5. You struggle with perfectionism. Negative self talk like: “I’m doing something wrong. It must be my fault that people don’t get better, don’t understand or appreciate what I have given them. If I just try harder or get it perfect, then people will appreciate me.”

If you find yourself in the words above, don’t panic…there is hope. The first step is to identify your innate communication style and gently nudge yourself toward more assertive communication patterns. If you can effectively communicate with your loved ones and patients, you create the perfect opportunity for constructing healthy boundaries. Boundaries are not just about saying, “No.” Boundaries are about knowing when to say, “Yes.” A resourced, rested and happy individual finds the exercise of creating boundaries exciting and invigorating.