Another step back, or, This is what it looks like to recover from severe burnout

I am in that featureless, dimly lit middle stage on the journey out of burnout.  They say with attention to the issue, it gets better and that with time I can be fully invested in my work.  Right now it varies day to day.  Some days I drag myself out of bed late, reluctant to meet people and be happy.  Some days I rise from bed fresh and invigorated; I cherish these days as harbingers of change.


I laugh with coworkers.  I bring coffee, help decorate our new clinic.  I like the patients I see.  I am lavish with my emotional coin since urgent care requires so little of it overall.  No one asks me to be their everything here, so there is no emotional abyss of investment to guard against, so I can be generous with myself.  I encourage, educate, rebuke, reassure.  I remind myself not to get too possessive or protective of these people; these are not my patients.  They are just patients.  I get to do immensely satisfying things like sew lacerations and fish things out of ears and burr metal flakes out of a man's eye.  I puzzle over rashes.  I argue about antibiotics.  I work twelve to fourteen hours a day, then drive home and smile easily at my husband.

At work, I get a card someone left at the front desk.  A card?  For me?  Yes, says my receptionist.  I don't tell her the truth: I don't want a card. 

It has my name on the front.  I open it and read it aloud to my nurse.  It is from a patient I saw a week ago who was in emotional crisis.  I remember that we talked for a while and after I determined that she was not in imminent danger, I started her on some medications.  I told her she needed a therapist.  I remember that I tried to show her kindness but not too much.  

The language of the card is effusive.  My compassion and flexibility floored her, she writes.  My prayers gave her strength.  She tells me I saved her.  She asks if she can see me again at the urgent care clinic.

I read the letter feeling as though someone has started to press down on my neck.  My nurse cries and says she has goosebumps, which is a helpful signal to me to pause for a moment.  I just want to run, but a reaction is required here.  I mumble something about how touched I am, but really I'm uncomfortably reminded of how much of my shows of compassion are a farce, external signposts that freely promise warm, green destinations but lead instead to cool grey expanses of indifference.  I push away the dread and remind myself that navigating a continued doctor-patient relationship with this woman is not my job anymore.

How nice of her, I say.  But no, she can't come and see me again.  I put down the card and pick up the next chart in the rack.