Me #1: God, I don’t want to write this!
Me #2: But it has been on your “to do” list for a long time.
Me #3: Hayward, get a grip on yourself, you can do this and it will help.
I am sitting at my desk, alone in my house, staring at a blank page on my computer screen. Do I really want to share this with the world? Where do I start? How do I start? I know that once I write that first sentence, all the rest will flow like a river. I just need to write the first sentence.
Although I had never been diagnosed with anxiety, my career as a physician has always entailed a high degree of stress; and this has had consequences.
The Stress of Running a Solo-Private Medical Practice
When I was running my solo-private practice, there were always competing demands for my time; patients waiting to be seen, patients or physicians on the phone waiting to talk to me, staff issues, scheduling problems, dysfunctional equipment or software, clinical issues my nurse needed resolved, medical issues I needed to read about, and sometimes daycare issues.
When I was in my office, I was perpetually stressed.
While I did not enjoy that feeling, it came with the job and my training had taught me how to ignore (or repress) the stress so I could perform my job to the best of my ability.
When I was home I did not want to feel that same stress. Of course, that was not always possible as being married with 2 kids and pets will sometimes be stressful.
Nevertheless, I tried to avoid or mitigate potentially stressful situation, when I could.
I learned not to watch stress-engendering movies or TV shows, such as would occur when a person in the drama was about to experience physical or psychological trauma. When this happened, I usually walked away or changed the channel.
I learned to restrict my cinematic repertoire to mostly Disney or Pixar-like movies, animal shows (animals eating animals did not set me off), cartoons, romantic comedies, harmless Youtube videos, educational shows, and the like.
And it was (and is) not uncommon for me to go to a movie with my wife and walk out as soon as the movie gets stressful. I will then bounce from movie to movie within the venue, until I find an acceptable, non-stressful alternative, and wait for my wife’s movie to end.
Unexplainably “stressful” theater, like a well-done version of Ibsen’s “The Doll House” or O’Neill’s “Long Day’s Journey into Night” does not engender that inner tension I experience when watching a flat screen. I know this is not rational, but that is how my body works.
Thus, for the first 3.5 decades of my career as a physician I felt I learned how to manage the stress in my life.
The Stress of Being an Employed Physician
In 2019 I closed my private practice and began working as an employed physician in my hospital’s ambulatory endocrine clinic.
Unfortunately the hospital’s bureaucratic policies prevented me from providing care to my patients at a level which met my personal and professional standards.
I made repeated entreaties to the hospital’s most senior bureaucrats that the office was being run inappropriately. I told them that the recent resignation of half of the clinic’s professional staff was objective proof that changes needed to be made, but my pleas went unheeded.
This additional and unexpected stressor ultimately convinced me that I had to retire prematurely from the career I loved.
What I did not fully appreciate when I retired in 2022, but came to understand later, was that the irreconcilable conflict arising from my hospital’s bureaucratic policies and my professional obligations led me to incur some wounds that have yet to heal. (See my essay Moral Injury.)
The Stress of Our Political World
At the same time that as I was adjusting to a higher level of stress in my new career as an employed physician, many reputable political thinkers began to express concern over the state of American politics. They opined that the Republican Party had abandoned any fealty to the concept of democracy and their standard-bearer called for the “termination” of the US Constitution and publicly supported American Nazis.
As an American Jew, and as someone who wrote about fascism, I am keenly aware that there are many parallels between American politics today and Germany of the 1920s and 1930s. As history has shown how this political trajectory ends, I viscerally fear a Trump return to the Oval Office as it will end badly for America’s democracy and her minorities.
Without a doubt, today’s political scene has greatly magnified my anxiety.
Now, when I experience any type of anxiety provoking event, my perceived level of stress is of a greater magnitude than I had experienced at anytime in the past. And this new, higher level of anxiety has impacted my life.
For most of my adult life I would occasionally wake at 2 AM, read for an hour and then go back to sleep, waking up refreshed to the sound of my alarm.
Now I sometimes wake at 2 AM with a knot in my stomach, and will remain awake for several hours, or even until the morning.
I used to immensely enjoy arguing politics. As our political system verges toward fascism and many political conversations devolve into shouting sound bites, I am more circumspect with whom I will discuss politics. This has also led me to avoid talking to certain friends and interacting with some people, even though I know they are good, moral people, albeit they embrace an anti-democratic America.
While I was always committed to improving the design and functioning of the US healthcare system, the open wounds left from my most recent interaction with our healthcare system have convinced me to avoid this activities.
For example, in 2017, prior to the events which have exacerbated my anxiety, I attended the MIT Grand Medical Hackathon, a conference devoted to developing innovative solutions for our woefully dysfunctional healthcare system. At the end of the conference, my team presented our “solution” to the judges, but we did not win the contest.
In May 2023 I attended my second MIT Grand Medical Hackathon but left the conference prematurely as my anxiety made it impossible for me to concentrate on the issues being discussed.
As any interaction with the healthcare industry now ramps up my anxiety, I plan to let my medical license lapse when it next comes up for renewal.
Moving Forward with My Anxiety
While I recognize that my anxiety is a trivial problem compared to the anxiety that occurs as a result of truly traumatic events, it nevertheless impacts what I can and will do.
I have not yet figured out how to eliminate my anxiety but I have found that cycling and writing are helpful, whereas meditation was not. At the present time I do not feel the need to consider either counseling or medical therapy.
So, three times a week I “self-medicate” by cycling the Minuteman Bikeway from Somerville to Bedford and back; under a canopy of trees, past the village centers, fields and brooks, past the hawks, turtles, coyotes, rabbits, foxes, and owls, knowing that the ride will help quiet my mind, as too will the passage of time.
Hayward Zwerling, M.D.
28 November 2023
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Addendum: A slightly different version of this essay was originally posted on 10 November 2023