Physician, Heal Thyself

Abstract

The work will always be there. No person ever said on their deathbed, I wish I spent more time at work. Work smarter, not harder. I had heard these words used many times to tell colleagues that overworking was not the path to happiness. But to me, they were just words. There were patients to see, grants to write, papers to publish, students to teach, and administrative work to complete. There were not enough hours in a day. I had always tried to put my family first, not missing lacrosse games or swim meets or karate tournaments. I got home for dinner with my family as often as I could. I tried to make my time with my wife and sons the best possible. But still, the work was there and saying no was a hard thing, as it is for many physicians. I had also tried to stay in reasonable shape. I ran triathlons during residency and fellowship, and my wife and I completed the P90X program a few times. However, it seemed as if there were always times when work and life got in the way. I realized years ago that my peak performance time for exercise was 11:00 a.m. I had played basketball at 6:00 a.m., lifted weights at 7:00 p.m., and enjoyed my share of midnight runs, but the hour before lunch was always best for me. As I approached 50, I watched my waist size increase slowly and made promises to myself that I would be in better shape on my 50th birthday than I was on my 40th. My reality changed in the blink of an eye just before my 50th birthday. I was scheduled to give a faculty presentation at noon and finished the slides an hour early. I tried to stick to my plan and ran over to our campus gym to get a quick lift in. Just as I finished, I had chest pain that I attributed to indigestion. After all, I had no risk factors for cardiac disease. Then came the intense diaphoresis and dizziness. This was something real. I was having a cardiac event. Although my life did not flash before my eyes as happens in movies, my thoughts did focus on my wife and boys. I could not leave them. There were still so many memories to be made. I sat on the floor and asked for help. I was in the right place at the right time. Our flight ambulance crew was meeting nearby, and soon I was surrounded by a team of nurses and paramedics. Five hundred yards in the ambulance, a brief emergency room stop, and very soon I was in the cardiac catheterization lab. A totally obstructed left anterior descending coronary artery was opened and stented. However, the reperfusion triggered a lethal arrhythmia. They began CPR. On me. In under an hour, I had gone from doing pushups to requiring chest compressions and chest countershock. When I awoke, I realized that my life plan had to change. I needed to keep those promises to myself. I came to the stark realization that life can change in an instant and that I had to place things in the proper perspective. I needed to walk the walk. I would work smarter. I would put my family first. I would try to live my life without regrets of what might have been. I could not and would not have my life defined by my job. Instead, my job should be only one part of who I am. I began cardiac rehabilitation with feelings of great trepidation. I had already progressed through the glad-to-be-alive stage and had not yet hit the why-me-and-not-someone-else stage. I was still in the what-if-this-happens-again phase of recovery. But everyone recommended cardiac rehab, so off to the gym I went. I chose my peak time, 11:00 a.m. Ironically, I was back in the same gym where I had my event, and I was afraid to do anything at all. With the assurance of the cardiac rehab staff, I was able to take those first few steps toward recovery. After a few sessions, it became just another scheduled meeting and part of my day. It was not sneaking in a workout. It was an appointment on my schedule, and that made all the difference. On the treadmill in rehab, had an epiphany: Employers and insurance companies should encourage and even incentivize this. This is the way we should be tackling our health care problem in this country, and it has to start from the front end. Doctors need to lead by example. Hospitals need to follow that leadto ensure that their employees can be models for patients to follow. With the 100-hour workweek and the national epidemic of obesity and heart disease, we need to do something proactive. As an associate dean, I have seen firsthand what happens when faculty do not take care of themselves. Outstanding, productive faculty are compromised by preventable diseases. Innovation and medical advances suffer because, as physicians, we feel we are invincible until we are not. We all agree that lifestyle changes are best for our patients and the overall health of the population, yet we do not take the time to heal ourselves. We need to change our thinking about health maintenance. The time for exercise has to be flexible. The location for exercise has to be convenient and at hand. If you want surgeons to have time during the day for exercise, the gym should be near the operating room. If you want family practitioners to schedule workouts, the gym has to be close to their practices. Finally, employers should reward this type of behavior. Many companies have built fitness into their business culture. Why can t hospitals and medical practices do the same? Why not for ourselves? And, while we are at it, let s have the dietitians and nutritionists right next door. We still do not practice what we preach. It s time to change that. Audio. Michael A. LaCombe, MD, Annals Associate Editor, reads Physician, Heal Thyself, by N.J. Thomas.