• Rosalind Kaplan, M.D.

Reflections - One year into Recovery

In just a few days, it will be my anniversary. Not my wedding anniversary. It's the anniversary of an ending and of a beginning. On June 20, 2018, I walked out of my office at an academic institution where I practiced primary care medicine and taught medical students. I loved my primary care patients and I loved the students. I was in a fine institution with a good reputation. It should have added up, but it didn't.

After over 25 years of happily practicing medicine and teaching, the previous few years were a terribly unhappy time, and a time of intense questioning. Through these years, I'd had several moves from one practice to another and a move from one institution from another. I'd put heart and soul into my patient care. I'd survived the shift from paper charts to EMR, from one EMR to another, from academics to private practice and back again. I'd survived a long illness, and the deaths of both my parents. I'd raised two children in the midst of it all and sent them out into the world. I'd learned to write and written a book. I'd owned and run a practice and then given that up. And I'd lived, off and on, with depression and anxiety, as well as chronic migraines, and forced myself through it without skipping a beat.

I'm sure that many of you reading this have been through some, or many of these passages. Some of them are good things. Launching my children was exactly what should have happened. Writing has been a hugely positive force in my life. The sad things I lived through were part of life, things that happen. I know people have been through much worse. But for me, there was too much accumulated trauma and fatigue, and not enough space in my life to recover. A negative interpersonal environment in my office and the constant demands of an overflowing inbox and incessant administrative demands with inadequate support staff finally overcame the joy I felt in patient care and teaching. Some people call this burnout. I just called it time for a change.

And what a change it has been! My life is full- with medicine, writing, teaching and family. I wake up each day now with lots of things to do, and a feeling of lightness. I'm still making a living. I often feel joyful. This is the power of taking stock and making change. The journey has been frightening, and sometimes I'm still scared or unsure, but I've found my way out of a pretty bleak place. What is more frightening than the change is the idea that I could have stayed in that darkness.

My first move in all of this was to take care of myself. I was still in my academic position and realized I was spending way too much time working when I wasn't well myself. I cut back on my hours and I pursued better care for my depression and for my migraines. It took a lot of work to seek out the right neurologist, psychiatrist and therapist. I had to do a lot of self-advocacy. I don't really know how someone who is not very knowledgeable and connected manages. I used my training and my connections to get help. It really drove home to me how important it is for primary care doctors and other caretakers to advocate for patients who are struggling to find good care for mental health and secondary or tertiary care problems. I also was lucky to be able to afford the mental health care I needed. So many of our patients don't have the luxury of choice in mental health care, since many of the best practitioners don't accept insurance. And while I wish they did, I understand the reasons they don't completely. The reimbursement for such care by insurance companies is terrible. What happened to the parity that we talked about so many years ago? This is a crisis in itself.

Once I felt better, it was much easier to make decisions. I didn't make the decision to leave primary care in a state of illness or depression or in some kind of a crisis. I wasn't in a fog. I did it with complete clarity. I knew the risks I was taking, but I also knew that it was time. I wanted to write, and I wanted some formal training. I wanted an MFA and I knew I wouldn't get anything out of a program if I was working, even part-time, in primary care, because I could never have a real day off. It shouldn't be that way. There should be ways to have shared care and good coverage. But it wasn't going to happen in the dysfunction of my academic practice. I applied for low-residency programs so I could leave the door open to work- maybe locum teens, I thought. Or maybe doing medical writing. I wasn't sure. But when I got into the writing program of my choice with a partial scholarship, I was ecstatic.

It was pretty scary to have no job at all. I've always worked. The 'need' for income is a relative thing, but for me it was important to be contributing in my household. It was a matter of self-respect as well as economics. And my identity has always been that of a physician. You can take the doctor out of medicine, but you can't take medicine out of the doctor.

Initially, I just used contacts I had from doing some medical writing and found a very part-time freelance gig writing medical content. I thought maybe it would be enough, but after a few months, I missed patient care way too much. I talked to Locum Tenens companies, but was offered jobs that felt like too much- there is such a shortage of primary care docs that every job was at least 30 hours a week, or full-time, and many were not just looking for temporary help- they really needed someone to try it out and then hopefully stay. I wasn't about to put myself back in that situation. So when I put my CV up on Doc Cafe and got a call from an urgent care company who was interested, even in someone really part-time, I was intrigued. And they were willing to teach me all the things I didn't know.

I will say that the first time I sutured in 30 years was VERY frightening. My hands shook. But after a few shifts, I was more than competent at suturing, stapling, splinting, reading X-rays and a variety of other skills that I had either never imagined myself doing, or I had forgotten I already knew. All the years of hospital and ER work, and my very rigorous residency training (a lot of see one, do one, teach one) made the shift into urgent care easier than expected. I'm still learning, of course, but there's always someone to call for help.

This month is different than usual for me. I have the whole month off from Urgent Care. I took a trip to Wales to the Dylan Thomas Summer School for Creative Writing. It was 12 days of immersion in Welsh language, history, literature, as well as daily writing workshops with amazing professors and readings from talented Welsh poets and authors every evening. Take a look at the photo below- just one little corner of an awesomely beautiful landscape. It was a once-in-a-lifetime experience! I will spend the middle of the month with my family, working on my son's wedding plans and hosting his fiancee's shower along with her mother and some other relatives. Then I'll go to Boston for the residential part of my MFA. When I come back, it will be July, and my usual juggling of MFA, freelance writing and Urgent Care will start. And I'll be teaching a writing course to med students in the fall!

I really didn't imagine being this busy or this happy when I left my career in primary care. I miss the long-term patient relationships and think about many of my patients every day. But the way I see it now, I was lucky to have those wonderful patients and the privilege of taking care of them for so many years. Now I have new responsibilities and different privileges. I am grateful to my doctors, who helped me get well, my professors and the other students in my creative writing MFA program, who are incredibly generous to their fellow writers. I am grateful to the people in the publishing world and the people in the medical world who took a chance on hiring me and who taught me new tricks, and to my family and friends and medical colleagues who have supported the changes in my life and helped me find my way this year.

This is my anniversary post, but it won't be the last post. I'll keep my finger on the pulse of change in the medical world. Hopefully I'll be part of that change...

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