This is Part II of a two-part article. Read Part I here.
One of the things missing from training was follow up. You prepare for the case, you perform the surgery with an attending and then you never see the patient again.
In real life, you are now witness to, and responsible for, follow-up and that includes complications. I learned very quickly that what you see on the operating table at the end of the procedure is not necessarily what you will see as the patient heals.
There were complications. And it’s “on-the-job” training to learn to deal with them.
My thoughts at the time were “They really didn’t tell me the whole truth” and “Not everything they taught me works”. This applied to medical protocols as well. Many patients who did not have a surgical problem were not healing the way I thought they should.
Nonetheless, I was committed to being a good doctor.
At the time, my practice began to grow very quickly.
I realized that if I accepted insurance assignment (which in those years was strictly indemnity – insurance paid 80%, the patient paid 20%. There were no ICD codes or CPT codes and there were no fee schedules), I would attract many more patients. In fact, within 2 years I was up to 30 patients a day. Within 3 years I was at 45-50 patients a day. My time was shrinking with each patient encounter.
I had to move fast. I had to hire more staff. I had to move into and build out a much bigger office. Then I hired more staff. My waiting room was always full. My expenses were expanding. Each day was stressful but I was making a really great living (believe it or not, insurance payments were very acceptable back then).
What I did not realize at the time was that I was experiencing a sub-conscious dilemma.
I still suffered from self-esteem issues. Yet patients were holding me to a very high standard and were expecting a lot from me. Internally, I did not feel like I could deliver the goods. When things didn’t work out for a patient, it caused a great deal of emotional stress for me. And I was working hard. Very hard. Many nights I did not get home for dinner until 9:30-10:00 PM.
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I remember waking up one morning and felt a weird sense of pressure in my head.
I thought it was a virus. But it persisted for 3 weeks and then disappeared. So I forgot about it.
About 2 weeks later, it returned, and I also felt a little dizzy.
I tried massaging my head but it didn’t help. I took ibuprofen and it didn’t help. I took an antihistamine and it didn’t help.
I started to feel like I was in a different dimension than everyone else. Just felt generally weird and dizzy.
When I realized it wasn’t going away, I went to my internist for an exam.
He diagnosed me with a stress headache and gave me a prescription for Valium (I assume it was the drug of choice back in the mid-1980s).
The prescription dose did very little. The problem was that I had an unrestricted narcotics license.
Back then, you could purchase huge bottles of Valium for office use.
So I bought them and gradually started to abuse them. On about 15 mg, my symptoms were reduced, but I was definitely impaired. I repeated the dose every time the symptoms began to elevate.
After about 2 months of this, I began to develop bouts of tachycardia, intense dizzy spells, spasms in my scalp muscles that felt like I had an undersized helmet squeezed onto my head, a rash all over my face and feelings of impending doom.
I went back to my doctor.
He told me I had generalized anxiety disorder and recommended a therapist and a dermatologist for my rash. All the while, I was still going to work, seeing an enormous amount of patients in the office, doing surgery, doing rounds, running to the office for emergencies whenever I got a call and really feeling awful. I had settled into Valium abuse as a means of coping. Topical steroid cream was prescribed for my face.
I would apply it for a few days. The rash would resolve. I would stop the cream. The rash would flare up really badly. And the cycle repeated itself. I did not immediately reach out to the therapist because I was afraid of professional repercussions and I was ashamed about my Valium abuse. I decided that if I meditated, I could calm my mind. If I exercised, I could shed some of the stress I was feeling. And if I improved my diet (I was a sugar junkie), maybe I would feel better. I was desperate.
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At the same time, I had become a father for the first time to my beautiful daughter, had a huge falling out with my parents, my brother and I had stopped speaking with one another and my ex-wife and I were having major problems.
It really was a complete “shit show” for me.
All of my symptoms persisted. I even began to feel some weakness in my legs and some trembling that made me believe I had MS. I went to a neurologist for an evaluation. He agreed that it was GAD and that I should see a psychiatrist or therapist. I struggled with this thought. Even though I knew I had a major problem, I was more afraid of being “found out”. I continued to take Valium.
About 2 years into this awful experience, I was at a conference in New York and one of my former classmates walked up to me.
He asked, “Is everything alright”?
I said, “Yeah. Why”?
He said, “Well, since school, you lost a lot of weight and you look sallow. The boys and I thought you might have cancer.”
The truth was that I used to lift weights. At graduation, I was 185 pounds of solid muscle. I was now 145 scrawny pounds and between the rash and the stress, I did have a greenish/yellow tinge to my skin. I decided I needed to go for help. Finally.
The truth was that the things I was doing- meditation, exercise and eating better (I became a macrobiotic vegan) had made an improvement in my skin and may have started to lessen my other symptoms somewhat, but I was still in the throes of suffering.
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I began seeing a therapist.
It seemed like week after week all I did was go there and complain about everything in my life. I wasn’t feeling like I was making any progress.
Therapy was not helping fast enough. I had decreased my Valium dose but was still reliant on it. The embarrassing rash persisted but not as intense.
But one day, perhaps more than a year after I began therapy, I remember saying out loud during a session, “I feel like I’m living someone else’s life!”
My therapist then asked me a question that was the real beginning of my healing. She asked, “If you could live the life you want to live, what does that look like?” I couldn’t readily answer that question. But it unleashed a whirlwind of thoughts, feelings, fears, resentments, anger, and other emotions that made me start journaling my feelings and thoughts.
One thing that came out of my journaling was that I had lost confidence in traditional medicine since it did not help me.
I decided to see a holistic doctor for a different perspective. After some lab work, it was determined that my adrenals were stressed, my protein levels were very low and I had a fatty acid imbalance. I followed the protocol he laid out for me. Within 3 months, my symptoms dramatically diminished. I was amazed that dealing with these underlying issues instead of treating my symptoms made such a huge difference.
I weaned off Valium. I didn’t need the cortisone cream for my face anymore. I was hooked. I immersed myself in courses and read everything I could get my hands on. I was gaining insights into human pathology and healing that were NEVER discussed in my years of education and training.
It didn’t take long for me to realize that practicing podiatry through a rigid, western medical model did not resonate with me at all. It seemed so cook book. For this diagnosis, we do this. For that diagnosis, we do that. And when things didn’t work, there was no other direction to go in.
I wanted to do more for my patients. I wanted to make a difference in their lives the way my holistic doctor made a difference in mine.
The problem was, there were no other holistic doctors in podiatry at the time. I had to forge my own path. Take what I was learning and see how I could apply it to podiatric pathology.
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My life was transforming.
Therapy taught me some important things about my subconscious programming. But it had its limitations because I wanted to feel better about myself, about who I was as a man.
I came to the realization that therapy was like steering a ship while staring at the wake you leave behind. I was done with focusing on the past. I wanted to live a quality life. I wanted to steer my ship but I didn’t know where to steer it to. I knew it was all about my subconscious belief system that I was controlled by, so I immersed myself in books about neuroscience and brain chemistry.
I came across an article about subconscious reprogramming through affirmations.
The article stated, in the first line, “whatever you tell your brain, it believes and acts as if that is truth”. I had been telling myself some very negative things for many years. But the logic was solid. If my subconscious mind was programmed when I was a little boy (with no real power to change my mind), then unless I applied my adult mind and intentions to my experience, that little boy inside me will continue to run the show.
I asked myself, “What do I wish I heard from my parents that would have made me into a self-assured, confident man?” I began writing down everything I wish I had heard. I took this undertaking seriously. I repeated the affirmations as often as I could. Anytime negative thoughts began to creep back in, I would replace them with my affirmations. I recited them in front of the mirror often and would smile so I could see a happy me as a reflection of what I was working toward accomplishing. Things did not change quickly. At all. At times I would get frustrated and want to give up. But that article always popped into my head and it kept me going.
It was then that I even created a formula that would always remind me what I was doing. I stole it from Einstein’s Theory of relativity – E=MC². My take on it – Execution = Motivation x Consistency²
“It was then that I even created a formula that would always remind me what I was doing. I stole it from Einstein’s Theory of relativity – E=MC². My take on it – Execution = Motivation x Consistency²”
This formula has been the backbone of everything I have accomplished in my life.
It honestly took 2 solid years of me doing regular affirmations before I became aware that I was a completely different person. I was getting very different feedback from people. I was definitely feeling more confident and capable. It was automatic that when I had a negative thought, my brain would replace it with a positive one. That is when I knew I succeeded in reprogramming my subconscious mind. That was huge for me. And that is when I said goodbye to all of the burnout symptoms which had persisted in one form or another, albeit less consistently, for 5 years. I realized I was free!
That was when I said to myself it is time to change my practice model. It was something I craved. I started incorporating a lot more functional medicine principles into everything I did in my office and in my personal life. And I began to experience amazing things. I was changing lives. I was healing patients who were failed by 2, 5, 10 and sometimes more doctors. This felt authentic to me. This resonated with who I was. I still did accept insurance for surgical cases and simple covered services, but functional medicine patients paid me out of pocket since insurance would not cover those services. I became a really happy podiatrist!
Eventually, I transformed to the point where I know I can and will accomplish anything I choose to. I look back on who I was and sometimes can’t believe how self-assured and confident I have become. I have a positive self-image now and that was because I made the changes by doing the HARD WORK it takes to create change. I believe everything is possible.
It is now almost 34 years since I emerged from burnout a changed man. If I could do it, anyone can. I will admit that if there were physician coaches back then, I would have been first in line. But it didn’t exist. Coaching didn’t exist. So I coached myself to healing and have enjoyed a life of thriving.
I have made many other changes to my life and practice since then. And that is because I learned that fear is not real, procrastination changes nothing, everything is possible, a day wasted is a day lost forever and naysayers simply do not want others to succeed because they feel incapable of changing anything.
If you are suffering from burnout or symptoms of anxiety, depression, low self-esteem, etc., push yourself to get help. I promise you it will be a decision you will never regret!
