PracticeBalance

Pursuing simplicity in work, home, community, and self

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In his book Is It Worth Dying For?,  Robert Eliot describes his experiences with stress, culminating in his own heart attack on the job.  He identifies five stages on the downward spiral to burnout: Job Contentment, Fuel Shortage, Chronic Symptoms, Crisis, and Hitting the Wall.  Here, I continue with my journey from a fuel shortage state to the recognition of some serious health problems.

The Annual In-Training Examination, a practice board exam of sorts, loomed forth.  Score expectations were high at my level of training.  All the while fulfilling clinical duties, volunteering to write case reports for publication and pioneering a new research project, I resolved to crush the exam.  My studies spilled over into the weekends and free afternoons, leaving little time for my husband or any self-care.  In my efforts to lose the weight I had gained over the past two years, I was waking up extra early to perform short bursts of exercise in addition to eating a very restrictive diet.  However, my well-intended discipline only served to lay the groundwork for major bingeing on call nights and long hospital shifts.  The activities I once loved, like rock climbing and camping, fell by the wayside… along with my friendships.
  
Some changes in my health began to surface.  I had difficulty getting moving in the early mornings, which often required me to leave the house before 6 AM.  My workout performance declined, and I felt fatigued doing basic activities – like walking stairs – that had previously not been difficult.  My skin turned sallow and for the first time bags formed under my eyes.  My clothes were tight.  Most concerning, I had not ovulated in several months.  While I chocked this up to the ongoing stress, I had just turned 35… My husband and I were discussing starting a family soon.  How could I physically or mentally become a mother under these circumstances? 

All the discrete aspects of this situation formed a hill of evidence that I was sinking.  I finally carved out time to go see a physician, who ran some lab tests.  One of my hormone axes, the one that signals estrogen, was completely non-functioning.  While this is a pattern most common to menopausal women, it can be seen in cases of extreme physical or mental stress.  Cases have been reported in professional athletes such as gymnasts and ballerinas, anorexia nervosa patients, or during very stressful states such as the death of a spouse.  My doctor said, “It’s rare, but I have seen it, and it will probably be reversible after you finish residency.”PROBABLY reversible? 

 In The Gifts of Imperfection, Brene Brown distinguishes the term courage from its colloquial synonym of heroic by pointing out its original root meaning as “speaking one’s mind by telling all of one’s heart”.  Courage is thus not necessarily about being brave in a life-or-death sense but about being openly vulnerable.  I had to find my courage for the next inevitable step… Although it was a difficult decision with complex impacts on both me and my training program, I decided to take a leave of absence from residency.
 
In my next posts, I will discuss my research to find a personal stress management plan, and I will outline many of the resources that I used to construct it! Thanks for following!

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  1. Looking forward to the next installation. The parts where you share your own story are very interesting to me and I commend you for being willing to share such personal details.

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