The Burnout I Didn't See Coming

Dr. Katherine Reeves performed 3,247 surgeries in her career. She remembers the first one — a laparoscopic cholecystectomy, second year of residency, attending physician watching her every move. She remembers the last one — a Whipple procedure, eight hours, perfect margins, textbook closure. What she remembers most, though, are the two hours she spent every morning for six months sitting in her car in the hospital parking lot, unable to open the door.

"It wasn't sadness," she says. "Sadness would have been an emotion. This was an absence of emotion. A geological emptiness. I would arrive at the hospital at 5:30 AM, park in my usual spot, turn off the engine, and then — nothing. I couldn't move my hand to the door handle. Not that I didn't want to. I couldn't. My body would not obey. So I would sit. Sometimes I would listen to the radio. Sometimes I would stare at the concrete wall. Sometimes I would cry without any feeling. And after two hours, something would release, and I would go inside and perform open heart surgery."

She was, by every external measure, at the top of her field. Chief of cardiothoracic surgery at a major academic medical center. Research grants. Invited lectures. A waitlist for her clinic. She was the physician other physicians referred their family members to — the highest compliment the profession can offer. And she was quietly, systematically disintegrating.

The statistics on physician burnout are well-known now but were rarely discussed then. Approximately 42% of practicing physicians report symptoms of burnout. Surgeons are among the highest-risk specialties. Female surgeons have rates of suicidal ideation that are two to three times the general population. But statistics don't capture the parking lot. Statistics don't capture the two hours, every morning, in the dark, unable to move.

"The system doesn't allow you to be broken," Dr. Reeves says. "If you need help, you might lose your license. You might lose your privileges. You might lose the respect of colleagues who will decide, silently and permanently, that you are weak. So you hide. You hide the drinking. You hide the crying. You hide the parking lot. And you perform open heart surgery."

Her breaking point came not from a surgical complication but from a moment of clarity. She was driving home after a 16-hour day — another Whipple, another perfect set of margins — and she realized that she had no memory of the surgery. None. She had performed an 8-hour operation on complete autopilot, her hands moving with a skill that had become entirely mechanical, her mind somewhere else entirely. She could not recall a single decision, a single maneuver, a single moment.

She pulled over and called a colleague — a psychiatrist she had known since medical school. She told him about the parking lot. She told him about the emptiness. She told him about the surgery she could not remember performing. And he said four words that may have saved her life: "I've been there too."

Dr. Reeves took three months away from surgery. She entered treatment for depression and burnout. She started therapy. She started medication. She told her department chair the truth — the full, unedited truth — and discovered, to her astonishment, that he told her about his own parking lot.

She returned to surgery. She performs fewer Whipples now, and she is a better surgeon for it. She makes the residents leave at a reasonable hour. She asks them, individually, how they are doing — not how their patients are doing, but how *they* are doing. She tells them about the parking lot. She tells them it gets better.

"I used to think strength meant never needing help," she says. "I was wrong. Strength is admitting that you do. It's opening the door. It's getting out of the car."