The Real Cost of Being the Best

In 2019, I was interviewed by a national medical publication about my career. They asked me about my research, my patient outcomes, my teaching awards, my path to becoming the director of the cardiac catheterization lab at a major academic medical center. I answered all their questions with the polished humility that physicians learn to deploy in interviews — grateful, hardworking, fortunate. What I did not tell them was that I had not spoken to my oldest daughter in three months. I did not tell them that I kept a bottle of wine in my office and that most nights, I finished it before I went home. I did not tell them that I had stood on the roof of the parking garage the previous week and thought, very calmly and very seriously, about whether stepping off would be easier than going to work.

I didn't tell them any of this because I didn't think it was relevant. I thought burnout was for other people — the ones who couldn't handle the pressure, the ones who went into medicine for the wrong reasons. I was Michael Reeves. I had been chief resident. I had trained at the best programs. I had published in *Circulation* and *JACC* and *The New England Journal of Medicine*. I was immune to burnout the way I was immune to the common cold — by sheer force of will.

Burnout doesn't work that way. It doesn't announce itself. It accretes, like plaque in a coronary artery, until one day the vessel closes and the heart stops.

My vessel closed on a Tuesday. I had a full day of procedures — four catheterizations, one of which was an emergency STEMI that came in during the third case. The STEMI patient did well. The fourth case was a routine diagnostic cath, nothing complicated. In the middle of the procedure, I felt my hands start to shake. Not the fine tremor of caffeine or low blood sugar — a coarse, uncontrollable tremor that made it impossible to manipulate the catheter. I stepped away from the table and told my fellow to take over. I walked out of the cath lab, down the hall, into an empty consultation room, and sat on the floor with my back against the door. I didn't cry. I didn't move. I just sat there, for what I later learned was forty-five minutes, until one of my colleagues found me.

That was the moment I finally admitted I needed help. I took a leave of absence — the first significant time away from work in my entire career. I started seeing a therapist. I stopped drinking. I called my daughter. I began, slowly and painfully, to rebuild the life that my career had hollowed out.

I returned to practice six months later, and I am a better physician now than I was before. Not because I'm more skilled — I'm not, my hands are still not quite as steady as they were — but because I finally understand that the physician is part of the treatment. A hollowed-out, exhausted, disconnected doctor cannot provide the care that patients deserve, no matter how many procedures they've performed or papers they've published. I tell my residents this now, and I watch their faces as they politely pretend to listen while privately thinking, like I did, that it won't happen to them. I hope it doesn't. I hope they're smarter than I was.