I Thought the Pandemic Would Break Me | Dr. Karen Dorn

Dr. Sue: [00:00:00] Hey, all. Welcome to Still Practicing. This podcast is a place for pediatricians and others to find community in sharing experience, learning from one another, and hopefully being inspired to seek better balance. Every other week, we speak to a pediatrician who has experienced burnout, uh, used different strategies to recover, and is discovering what fortifies them in medicine and outside of medicine too.

Today's guest is Dr. Karen Dorn. She's an MD and hospitalist in suburban Minneapolis, Minnesota. She and I have known each other for 33 years, and I am so excited to have her here to share her experiences and to [00:01:00] help me with the first episode of the Still Practicing podcast. Um, watch for her cat, Bernard, who makes a couple of appearances during our recording, and there's some good references to Gabriel Garcia Marquez too that you won't wanna miss, not to mention the molasses flood of Boston in 1919.

We'll be right back with Dr. Karen Dorn. Hey, Karen. Hey. Thanks for joining me. Thanks for taking the time to be on the very first episode of the Still Practicing podcast. 

Dr. Karen: Well, I hope I live up to your expectations. 

Dr. Sue: Oh, my goodness, no, no problem there. Um, yeah, no, we're just gonna, we're just gonna have just a fun conversation about, uh, life in medicine, how it's been treating us over the last 30 years that we've known each other.

30 or 31 years, do you think? 

Dr. Karen: No, I think it's right at about 30. 

Dr. Sue: Yeah, 1994 [00:02:00] we were in the same medical school class at the University of Minnesota. 

Dr. Karen: Oh, '94, yeah, so- 

Dr. Sue: Yeah ... 

Dr. Karen: 32. 

Dr. Sue: Oh, my gosh. Almost. Almost 32. 

Dr. Karen: Plus we knew before the ... We knew, I- 

Dr. Sue: I was wondering- I knew before that too ... if we knew each other just that year before through our mutual friend.

Dr. Karen: Right. So it had to have been, like, '92, '

Dr. Sue: 93. Wow. That's crazy to think. It doesn't seem like, uh, that's possible. But yeah, it's been, uh, of course, a real pleasure to have you in my corner all these years, and hopefully to be in, in your corner too. 

Dr. Karen: Absolutely. Couldn't have made it through many places without you.

Dr. Sue: Same, for sure. Um, I thought we might talk, uh, a little bit briefly about our early careers, our early careers in medicine. Um, we of course went to the University of Minnesota Medical School together from '94 to [00:03:00] '98, and then our paths diverged. Tell me, tell me about your early career. 

Dr. Karen: So, well, I chose internal medicine.

One thing I was gonna say that was s- super interesting, just to me anyway, was that, do you remember when we did our clinicals and the first rotation that we took was surgery? 

Dr. Sue: Mm-hmm. 

Dr. Karen: Because neither one of us were gonna do surgery. 

Dr. Sue: Yep, 

Dr. Karen: yep. Uh, anyway, so we, I think we both knew right away that we were gonna choose kind of more of a thinking career as a, as opposed to, I don't know, a doing career.

Dr. Sue: Mm-hmm. 

Dr. Karen: Um, but yeah, I chose internal medicine, and I went to HCMC, which was a great experience. 

Dr. Sue: Hennepin County Medical Center in Minneapolis. Yeah. Level one- 

Dr. Karen: Yeah ... 

Dr. Sue: trauma center, speaking of the surgeons, but you were there to help them care for all their patients. 

Dr. Karen: I was. Um, and then I did primary care for six years in small town Minnesota, [00:04:00] and then became a hospitalist, which for sure is my calling.

Dr. Sue: Yeah. Uh, an adult- And- ... medicine hospitalist, of course. Um- Yes ... practicing in suburban Minneapolis. 

Dr. Karen: Yep. 

Dr. Sue: For how many years? 

Dr. Karen: I've been here since 2008. 

Dr. Sue: Nice. Yeah. Wow, that's a long time, too. Time flies. I'm curious, um, to hear a little bit about your experience being a physician pre-pandemic, and maybe the portion of your career that was working as a hospitalist.

And then, uh, I'll kinda mirror some of my experience over that same arc of time. How was it to be in medicine? 

Dr. Karen: You know, it was, it was good for the most part. There was a big, uh, difference between doing primary care and hospitalist medicine, for sure. Um, and I was lucky because I work with a really great group, [00:05:00] so I felt very comfortable, felt supported.

Um, I felt like people were respectful and- trustworthy and that they trusted my opinion. So I thought it was really good. I enjoyed my job. 

Dr. Sue: Yeah. Well, good. I would say, um, there are lots of similarities in, in my experience too. I chose pediatric medicine, um, and did my training at the University of Minnesota at Fairview and, um, practiced in Minnesota for five years and then came to Montana in 2007.

And, um, not long after being here, opened my own practice, and have owned my own practice since 2009. And yeah, always have felt like I was working with good people. Um, had [00:06:00] a really busy practice life in the first, um, 10 or 15 years that I was in Montana. I was doing inpatient pediatrics as well as, uh, full spectrum outpatient care.

And it's a rural place out here, so, um, almost no pediatric subspecialists in the state when I arrived. And we were doing a lot of fairly intensive inpatient care of neonates and, um, and often older kids too who were sick with really life-threatening problems, and that was really challenging and, uh, exciting at times, scary at times, but also really gratifying.

Um, and I always felt like I had the right people around me to provide that care safely, um, and to ultimately get kids where they needed to be when they needed a higher level of care [00:07:00] than can be provided in rural Montana. I was really enjoying my career pretty, pretty completely, even though there were challenging things that came up, um, even though, you know, of course, running a practice, you know, means that There will be hard things from time to time.

It never felt terribly daunting, um, to be in the practice of medicine. Was that pretty true of your experience too, that it wasn't, it didn't feel really terribly taxing? 

Dr. Karen: Yeah. I mean, I felt supported by not only my crew but the administration and again, I think a lot of it has to do with our connection with the people that we take care of and how they respond to our care.

Um, and that's still, you know, a big part of why I get a lot of rewards from practicing medicine. Um, so yeah, it was, it [00:08:00] was a really good experience for me. When I first started medicine, when I finished residency and I first went into practice, I couldn't wait to pay off my loans and quit. I remember 

Dr. Sue: this- 

Dr. Karen: I'm pretty sure- Yeah.

Pretty sure there's a good percentage of people that feel that way. And the more that I've done it, um- The more retrospectively I feel lucky to have chosen a career that actually works really well with me and my personality, and gives me a lot of sense of completion, and that's important. 

Dr. Sue: And what do you think was different in those early days when you were first in practice and you were like, "Ugh, I have this debt that is keeping me here"?

You just didn't- I think I- ... have that experience yet, or? 

Dr. Karen: Yeah, I think it's confidence. I didn't feel confident. I felt scared. [00:09:00] I felt like I wasn't doing the right thing, or I might hurt somebody, or just- Mm-hmm ... I think the usual things that good doctors should think about, right? Right. Be overly, um, concerned.

And then the, you know, the longer I was in practice, the more comfortable I became. And, and not just with the practice of medicine, but also with my own insight and m- my sense of what's going on with people. 

Dr. Sue: And so it sounds like before the pandemic, you never experienced anything that felt like burnout.

It was more like that confidence piece and sort of getting your sea legs, but, but basically you were content in prac- practice for the most part. 

Dr. Karen: Absolutely. 

Dr. Sue: Tell me about the experience you had as a hospitalist during the pandemic. 

Dr. Karen: The pandemic was such a bizarre experience. I mean, there [00:10:00] was, at the beginning of the pandemic, um, when there was this unknown illness and we had no idea who had it, who didn't have it, what to do, we couldn't test for it, there was a very altruistic sense, um, between all of the doctors and the nurses and all of the peripheral staff where we just wanted to take care of people.

It was scary. We didn't have enough PPE. Um, but it was, it felt really good to be helping people, even though it was so frightening for them. They were just incredibly sick, and the hospital initially was very slow 'cause nobody was coming to the hospital 'cause they were afraid they'd get COVID, and then it just blew up.

And- Yeah ... we were full, taking care of people- On medical floors that typically handle [00:11:00] orthopedic surgeries, you know, elective orthopedic surgeries, and they were on full, uh, we say is respiratory support, um, without actually being on a ventilator. So people stepped up. Perf, you know, our, the peripheral people, the nurses, the nurses' aides, they stepped up to take care of things that they had never taken care of before.

Yeah. Which was, it was just, it was in- it was really incredible. It felt like a whole team was taking care of people, and we were all on the same side. So it was pretty remarkable. 

Dr. Sue: Yeah. Yeah, I, I remember, um, that same moment of feeling like The medical profession, and maybe even more broadly, that we were all in it together.

And I certainly felt called to, um, provide expertise [00:12:00] a-as it was needed, and also felt a little bit of resentment that we didn't have a system that would provide adequate PPE. That's one of my pretty prominent memories of the beginning of the pandemic, was that not only doctors, but other essential employees were, uh, maybe sacrificed is not the right word, but, um, I felt like there should have been a way to allow essential employees, first responders, and certainly doctors in settings where they were doing procedures where exposure to themselves was pretty high risk.

Um, there should have been a system to provide adequate masks, and I remember being pretty bummed that the government couldn't sort of, um, the government or that other sources couldn't rally [00:13:00] and create that. And, uh, oh my gosh, I remember in the first months, there was no COVID in Montana, and, uh, it took some time for it to percolate to us.

And so, uh, we would watch the PBS NewsHour every, every evening, and of course, they would feature thirty deaths a day of, um, often physicians and nurses and respiratory therapists and, and other essential workers and famous musicians and, um, it was, uh, definitely a scary time. And in a way, and pediatrics got less scary once the disease actually arrived and the experience with it was that it did not appear to be highly dangerous for most pediatric age patients.

Obviously, there were categories of risk that became apparent, [00:14:00] um, but in general, in the very beginning, we didn't know how hard it was gonna be on kids, and it was a little bit of a relief to see them weather the disease, uh, a little bit more easily than their, than their parents and certainly grandparents.

Um, so that was one of my early memories of, of the pandemic. I also remember very early, I think even before, uh, things were shut down, pediatricians, general pediatricians in Montana started Uh, a weekly Zoom meeting so that we could talk about what was evolving, um, talk about best practices a little bit.

And in the first or second meeting, there was a pediatrician who was worried about the potential financial, uh, or economic instability that the pandemic might bring to her practice. And I remember at the [00:15:00] time thinking, "Well, that sounds really unlikely to me to be any kind of an issue, um, in a, in a pandemic, you know, infectious disease kind of event."

Uh, but she turned out actually to be right on that in pediatrics, there was huge economic stresses for, for practices, uh, private practices, which is what I was engaged in. Uh, because initially, we had about a seventy or eighty percent drop in our patient visits, uh- Yeah ... and that's because everyone was staying home.

Mm-hmm. And half of what we do in pediatrics is infectious disease management, and- Wow ... people weren't getting sick with COVID or anything because of that, uh, good public health strategy to try to, uh, keep people from dying. And on top of that, uh, people were reluctant to come to clinic for [00:16:00] routine well care and for the same thing that you mentioned, fear that they would get COVID, I suppose, just either from clinic or from being out in the world, and everybody was very hunkered down.

So we had, we had several months of, um, very low volume of patient visits and contracting our hours. We quit doing weekend hours, we quit doing evening hours because there was just no demand even for regular patient visits. So, um, it was, like you said, a really bizarre, uh, bizarre time, but oddly, um, kind of a collaborative time in the beginning.

And then, and then once the disease hit, just like for you guys, we were just bombarded. And we had contracted our staff a little bit, our provider, um, [00:17:00] um, group shrunk a little bit, and then we were insanely busy for, I don't know, a year and a half where- We were just busting, uh, at the seams and really working hard to create enough capacity to see all the patients, um, which got to be tiring.

It was a bit of a rollercoaster. We then, um, we then had a challenge in our practice where there were just three providers, three full-time providers, and we were working at our limit, and one of them abruptly needed to adjust their schedule down significantly, um, to meet some important family needs. And we made a hire of a physician that turned out to be a poor fit for our group, and we didn't retain them.

And then we were really stressed because we were basically two and a half full-time providers [00:18:00] seeing easily four full-time providers worth of patients every week and trying to puzzle out how we would, um, take the time necessary to hire the right person while we were starting to feel tired, overwhelmed, and even like maybe some of the camaraderie amongst us was starting to fray just a little bit because of, because of those kinds of stresses.

I'm interested in what that period of time felt like for you in practice when you were in the really busy part. Did it ever get Overwhelming in your group? 

Dr. Karen: Definitely. Because it was so busy, they would, and I give, you know, Fairview credit for this, they would open up extra shifts so people could pick up.

And so people were picking up extra shifts. We were working all the time, and there [00:19:00] was always a need for another provider to come in and take care of all of these patients. And we would have these meetings through Teams, right? 'Cause before we would always get together and eat, and, you know, and that was a sense of camaraderie too.

But now it was all through Teams meetings. Um, and one of my partners, this remarkable, uh, young female physician, she had been with the group, like, five years, so she wasn't super new. But she started talking in the meeting, saying that she felt helpless. "I feel helpless." And which was kind of how we all felt, but never really s- spoke up about it.

And it was because it was not only exhausting just putting in the hours and taking care of patients, but it is emotionally draining to see so many people dying. We saw [00:20:00] so many people die. Um, when that first wave hit, I was in, um, the ICU, which is a 12-bed ICU, and 10 out of those 12 beds, 'cause it was all full, were COVID, and they were all, you know, critically ill.

And that, during that week that I was in the ICU, I had a 70% mortality rate, which is ... I cried every single night that I went home, and, and there was nothing that we could do. There's a saying, it's from a Gabriel Garcia Marquez book, Love in the Time of Cholera, and I just remember it, um, 'cause it just makes so much sense to me.

And speaking now in 2026 about what was going on in 2020, the phrase in that book that I remember says, you know, "Nostalgia is a seductive liar." And I look back on that [00:21:00] time, and it was something that, you know, you, you survived, but I forgot how, how hard it was, like how heartbreaking it was. Um, so yeah, I think we all, you know, as a group, we felt incredibly stretched, very thin, um, and yet incredibly sad.

Uh, so yeah, it was tough. 

Dr. Sue: Yeah. Yeah, I was in that period of time, uh, as that busyness was dragging on, so this was probably 2022, I was really starting to, um, struggle like your partner maybe, who was able to articulate that she was feeling helpless. Um, I was feeling pretty trapped and helpless, and I was really fantasizing a lot about leaving Bozeman, leaving medicine.[00:22:00] 

Um, I thought a lot about moving to Hawaii. I don't know why I imagined life in Hawaii was perfect, but I, I must have because my mind very regularly wandered there Um, and I remember it becoming really challenging to focus on just very ordinary mundane tasks like charting, um, and other administrative tasks just became really inefficient to complete, which is not my usual MO.

Usually, I'm, um, a pretty highly efficient person and, um, pretty competent with, um, certainly the management of, of a medical practice, and it was not new to me at that point. And I was becoming, um, irritable, um, and annoyed by things that I wouldn't ordinarily be annoyed by, and definitely [00:23:00] was feeling sad.

That just was getting more and more and more sad. Um, and then I, and then I finally started to fantasize about not being in Montana and not being in Hawaii and maybe just not being anywhere. And I felt just really intensely squeezed, really like I was in a vice, and I couldn't get out of it. And that my strongest sense at that time was that I couldn't change it.

There wasn't a thing I could do to alleviate that And that is when I started to realize that this was different than tired, this was different than depressed. This was really a pretty intense burnout that had gotten, uh, going, um, without me really [00:24:00] appreciating it was happening until I felt like I was pretty much in extremis.

And, um, that was a scary time because I just felt, I just felt like I, I was ineffective. I wasn't gonna be able to fix it, which I count on myself being able to fix problems. Did you experience anything like that in the aftermath of the pandemic? Did you ever get to a point of feeling kind of demoralized or what you would conceptualize as being burned out?

Dr. Karen: That first year was kind of this really unifying feeling of, you know, helping people. And what changed for me, um, particularly in hospitalist medicine or taking care of people in the hospital,

is when the vaccine came out and there was so much controversy about the vaccine, and it [00:25:00] really changed how people saw me. You know, they would, they would come to our hospital for help, but they were against the vaccine, um, and very vocal about it. They would demand ivermectin. And that was the first time, you know, besides kind of smattering of instances in the past, you know, just unusual ones, where there was a percentage of the population who even though they were coming to me for help, didn't want or didn't trust the help that I could provide for them, and that was-- it was just so bizarre Um, that it changed me, um, and that was when I felt burned out.

But it wasn't just that I felt burned out in my practice, I felt burned out in life. I was, I was mad [00:26:00] at people in the grocery store that weren't wearing masks. I would ... 'Cause I, I was seeing all these people die in the hospital. I'm like, "It's a mask, for Pete's sake. It's not that big of a deal." Um, but yeah, I think that's when things got real for me- Mm.

Dr. Sue: Mm-hmm ... 

Dr. Karen: and when I started to really think about, "Hmm, is this the right place for me?" 

Dr. Sue: Hmm. Yeah, for sure. I, uh, shortly after that point of kind of realizing that what I was dealing with was not maybe just a bad mood or depression, but, um, was burnout, I started seeing a therapist, really good therapist, um, that I was lucky enough to- Uh, partner with, and, um, she really helped provide a little bit of outside perspective for me about [00:27:00] the fact that there might actually be change that was possible.

I maybe didn't have to, um, you know, wrap my car around a tree to get out of it or burn the building down. Not literally, but, um, I didn't have to destroy it maybe to, um, find my way back to what I had for twenty years just loved in my work. Um, and, um, I really appreciated having her help not only to kind of navigate that process of trying to constrain my work into a container that was a more appropriate size so that there was room for me to thrive and, and have a life, um, but also to, you know, spend some time, really probably a whole year, um, [00:28:00] reflecting on, you know, what the cost of that burnout was for me.

I really still mourn some of the, um, fraying of relationships that happened during that time, and I wish I had had more awareness or just self-concept that burnout could happen to me. Um, I knew people who burned out around me, but I just didn't ever spend a lot of time thinking about it. Um, and I just really didn't-- If you had asked me in twenty nineteen if I was ever gonna burn out, I would have said, "Well, pediatricians are the least likely to burn out, first of all."

And then I would have said, "No, I don't think so. That's, you know, right, 'cause we work with kids, it's great." And in a way, I think it makes it harder to acknowledge that you're burning out, you know. You, you are privileged to get to care for the best people in society, you know. You are able to [00:29:00] support parents and, in doing, uh, their best job of providing for their kids and helping them grow and have everything that they need.

It is, it is a real privilege, and you get to be there when things are good in pediatrics and when things are really going poorly, um, especially in practice in our part of the country. Um, but getting, um, you know, getting burned out was really You know, costing me even a feeling of connection to that joy.

Mm. I, I still mostly loved being in front of patients, but getting in front of patients, like getting myself into clinic and knocking on the door and walking in, all of that was so arduous in that time because, um, I just, I just was not able to connect to, um, all that had made it [00:30:00] so enjoyable before. Even though once I was in the room I could, I could feel that again, but I had so much dread for, um, maybe the business side of things, but also just the, um, just the, the burnout, the exhaustion, and the cynicism that comes with that, um, and feeling ineffectual.

I just, um, I dreaded going to work. Um- Mm ... for a long time actually. I would, I would get like, you know, physically anxious on my way to work while, while Mark was driving me. Karen, you know Mark, my spouse. Um, and, uh, yeah, he did a lot of, uh, positive talk about, you know, how it was, it was all gonna be okay, and he turned out to be right, but there were a lot of days that I wasn't sure that he was right about that.

Um, and I think part of it for me too was I was dealing with this, uh, loss of my sense of [00:31:00] security that my own ability to manage anything the business could throw at me was- Mm-hmm ... not panning out. And the business was throwing things at me that, um, were really feeling corrosive and difficult. And, uh, I wonder if when you were in that place if there was anything that you identified that you needed to change or were able to change, or how did that improve?

Dr. Karen: You know, I didn't do anything that would address it, to be honest, which is kind of my MO. You mentioned this be- back when we were talking before, but I, I had started biking right before the pandemic. Mm. And I did a lot of biking because that was what you could do, you know? It was outside. And I think that gave me a lot of clarity in it.

I would bike to work, and I would bike from work. And biking to work [00:32:00] gave me an opportunity to just like clear my mind, and then biking home did the same thing to me or for me. It just was a, a place that my brain could just let go. I don't know how else to describe it. But one other thing I did is I played a lot of games on my phone which was really, it was a huge distraction.

It was a way to kinda c- finish work, right? And then come home, and then part of my brain is completely occupied with a puzzle, right? Just a puzzle to get me from end of work to home. And, and I needed that, and I found that to be, you know, really successful for me. 

Dr. Sue: Mm-hmm. 

Dr. Karen: But I also didn't have the extraneous stressors that you had.

I am a... I work with a group That group is really supportive. [00:33:00] I don't have to hire anybody. I don't have to fire anybody. I mean, I don't, I don't have any of that stuff. My work is at work, and then when I'm home, I'm homed. So I can't imagine what that was like having to deal with all of that with the people that you trust kind of not having your back and amongst everything else that was going on with the pandemic.

I can't imagine. 

Dr. Sue: Yeah. It was, um, it was, uh, I'm sure in part due to the fact that I was very not good at asking for help. I think, I think- Mm-hmm ... it's very possible people would have shown up in that moment if I had been able to understand, see my way to the fact that I needed help and, and to figure out what kind of help that would have been.

But in those moments, it felt like, um, [00:34:00] do you know the story, um, in Boston in the early 1900s, there was a big, um, molasses manufacturing plant, and they had a big, um, storage thing that held the molasses, and the container broke and flooded this part of Boston with 2 million gallons of molasses, like a 25-foot wave of molasses.

And I became aware of that story somewhere around the same time that I was having this experience. And I just felt like- ... yes, that's where I live now. I live in the molasses- In it ... flood. And I, I couldn't move, and I couldn't even, I couldn't even ask for help. So yeah, it felt like profoundly lonely. Um, and I felt very much like people wouldn't or [00:35:00] couldn't show up for me, especially or even when I was in this really severe moment of suffering.

But I don't know that they could appreciate even what was going on with me. Um, and I, and I'm quite sure that I was not at that time articulating it. I think in retrospect, I've been able to understand it, and I share lots more vulnerability with my staff and my team now. Um- Mm ... they all know that I was extremely crispy burned out, and that I make decisions now for me to avoid, um, sliding back in that direction.

Um, and I make decisions for them to help prevent them from ever having to go through that. And we have a lot of conversation about that. But yeah, it was, it was, uh, yeah, it was, I think, brought on by the [00:36:00] pandemic, but you're right, it was, um, you know, due to a lot of preconditions too that, um, that had previously been pretty darn enjoyable, but all of a sudden weren't.

Dr. Karen: I think, too, that we have similar personalities in that we think people should have the same work ethic that we have, and you know what? They don't. And that is, was really s- that was a surprising thing for me to figure out. Plus, um, it's hard, it... Maybe it's just women, I don't know, but as a woman in a highly kind of trained profession, and maybe it's my age too, um, it's hard to ask for help.

It's, it's really hard to admit, I don't know, weakness, defeat. I'm not quite sure what it is, but that is really difficult. That in itself sometimes feels like a failure, which it shouldn't, [00:37:00] but seems to. 

Dr. Sue: Yeah. Yeah, no, I, I think the fact that it's, uh, not asked for very often by probably a lot of people, probably both genders, maybe more women in a historically male-dominated field, um, yeah, just is, is proof of what you're saying, that it's hard to do.

And those, those folks that, um, might have a, have a different work ethic than us are advantaged in these situations because- They are ... maybe they have more self-protection. 

Dr. Karen: They are, actually. It's, it's kind of crazy, but I have to just... The whole molasses story, do you know what it reminded me of? 

Dr. Sue: No. 

Dr. Karen: So it reminded me of an Onion story.

Do you know the story I'm talking about? 

Dr. Sue: No. 

Dr. Karen: There was the great pudding disaster where the pudding factory exploded. It was the biggest snack-tastrophe in history. 

Dr. Sue: I don't know anything about this. 

Dr. Karen: It's The Onion story. [00:38:00] 

Dr. Sue: Oh, it's from The Onion. It's... It was- Oh, it's Onion, the newspaper. 

Dr. Karen: Right. 

Dr. Sue: Right. Ah. The greatest- So I was-

snack-tastrophe. I mean- Yes ... they just could have taken it right out of the paper for Boston. I 

Dr. Karen: know. 

Dr. Sue: Totally. It was legit. Hilarious. Yeah, thank goodness for- Yeah ... The Onion- 

Dr. Karen: Yes ... 

Dr. Sue: and their work in the world continues in meaningful ways. We'll take a quick break, and we'll be right back.

And we're back with Dr. Karen Dorn. I'm curious if there's something that you thought was not attainable in your professional life, um, when your experience was difficult that you have now. You've maybe touched on that already a little bit. I think, um, what I'm alluding to is when you were talking about, um, this leaning out of medicine in the early part of your career, [00:39:00] and somehow having gone through this long career that's been arduous at times and included this global pandemic, you actually, uh, on this end of your career, are still leaning deeply into medicine.

I don't hear you talking about retiring or cutting back. I just hear you loving it more and more. 

Dr. Karen: I, I do. I mean, I, I love my job. I get a lot of satisfaction of it, and you know what's gonna be really hard is leaving. 

Dr. Sue: Mm-hmm. 

Dr. Karen: It'll be really hard to leave this profession. It is part of who I am, and I didn't anticipate that early on, and I think I still have something to offer.

It's interesting, you know, there's all different kinds of personalities in medicine and, um, all different kinds of brightness and intelligence. And [00:40:00] at least the group that I work with, we have just this really nice blend of these strengths and weaknesses that are really complementary, and so I do, yeah, I do love it.

But I did go to 75% time. 

Dr. Sue: Ooh. I did. Uh, I am down to about 25 or 35% time, I suppose, if you include the administrative work, and some weeks it's 50%, but I'm really, uh- Um, working hard to contain my work life in a way that makes room for other things that are fun, um, and feel important. And I've had to, um, learn to let go of the idea that, um, I can have a perfect pediatric practice through just force of will [00:41:00] and making myself constantly available and being available to wrangle any situation and, um, depending on the idea that I don't need help from others.

Um, I've had to let go of a lot of that, and, and the great thing is I still really enjoy seeing patients, and I no longer sweat on my way to the office. Um, I'm happy to go there, and I'm happy to support other providers when they have a question about their patient, or if somebody gets sick and they need coverage, it's easy for me to provide some of that because I'm not stretched to the thinnest- Yeah

possible version of myself. And, um, I'm glad for that because, one, I didn't burn it all down and run from the building with my hair on [00:42:00] fire. I was able to, you know, finally ask for some good help and make some really meaningful change. Uh, and, and the, the payoff or the gift in that is that I get to do my job for more years than I otherwise would have been set up to do.

There was a point where, you know, I thought, I thought my time left in practice was brief. Uh, and I'm, I'm glad to have come out of the other side and, um, yeah, be able to enjoy that again. And, and I feel like you, like I still have a lot to offer in that setting. I have a lot of, you know- a lot of gray hair now and, um, uh, a lot of experiences as a parent and experience supporting lots of other parents through all kinds of difficulties.

So, um, you know, that experience end of thing is well-developed and, and I'm [00:43:00] happy that I still get to put it to work at this point. So, um, we're, we're, uh, in the same boat that way. And, uh, I'm glad you cut back to 75% time 'cause then it means we can do some other fun stuff together too. 

Dr. Karen: More time is good. I think it's just gonna be that way.

I'm gonna have to just cut back, cut back, cut back, cut back, cut back, cut back. You know, probably still stay casual. 

Dr. Sue: Yeah. Yeah. Um, what besides biking helps fortify you or helped in the hard times connect you to feeling like yourself or keeps you in, in your good, healthy mindset that you have now? 

Dr. Karen: Well, I like alone time.

I need that. It helps me recharge. I like time with other people too, but I don't know that there's anything I specifically do. I have a lot, I get a lot of enjoyment with my cats, to be honest. 

Dr. Sue: Yeah. 

Dr. Karen: And they offer me a lot of comfort, [00:44:00] and I don't know what else to say. It's, it's more than comfort. They make me laugh.

They cuddle with me. They bring me love. 

Dr. Sue: Yeah. Yeah. You've got great cats, a long history of great cats in, in succession- Yes ... I must say. Yep. Do you have a creative process that I don't know about? 

Dr. Karen: No. Not 

Dr. Sue: at all. Maybe Words With Friends counts as a creative process. 

Dr. Karen: I do make kind of silly posters for people at work.

Dr. Sue: Ooh. 

Dr. Karen: But they're stick drawings and things like that. 

Dr. Sue: Yes. 

Dr. Karen: That's as creative as I get. 

Dr. Sue: I like that. 

Dr. Karen: I do like to ... Yeah. I'm not famous for them, matter of fact. 

Dr. Sue: Excellent. I gotta see some pictures of those sometime. 

Dr. Karen: Oh, 

Dr. Sue: you will have to. And you were about to say you do like ... 

Dr. Karen: Um, oh, I still love to read. I had to take a break from nonfiction for a while because the world just became too, too real and too much.[00:45:00] 

Like, I needed escape. Um, and that's, I find that to be really helpful. 

Dr. Sue: Well, that's remarkable for you. I've, I've always known you to be primarily a nonfiction reader, so- I know ... that's a big shift. Yeah. We have to compare notes then, 'cause we'll probably have more in common that we would like to share with each other in the, in the book department.

For me, the stuff that fortified me when it was bad was pretty much exclusively time outside. Even when it was bad, I was still foraging for mushrooms in the rain. We would go out in all the, all the worst weather in the spring in Montana and just walk around in the woods and stare at the ground Um, and we did quite a bit of that, and I still look for rocks, and- Mm

I still swim and still, [00:46:00] still was swimming, um, when things were not going well. Somehow I was still finding time to do those sorts of things, and all those are still total favorites that, um, definitely fortify me. And, um, you know I'm a maker. I, I have never met a craft I didn't like, and I love to sew clothes and make my own clothes, make my own patterns for clothes, and sew quilts and make my own patterns for that.

And- Mm ... I like to make, um, little polymer clay treasures. You know, that clay that you bake in the oven? 

Dr. Karen: Mm-hmm. 

Dr. Sue: Yeah. Um, that's- Bakeable ... a big thing. And, uh, time with my people, time with my family, and time with old friends and, and colleagues. And as my [00:47:00] patients are getting old and graduating out of the practice of pediatrics, I'm now able to, um, form friendships with their parents, you know, all my, all my favorite parents.

So that's the stuff that, uh, keeps me feeling like myself. I also have a really regular mindfulness practice, which you know about. I have a lot of training in, um, teaching mindful self-compassion, which interestingly, when I was feeling terrible, was completely inaccessible to me. I could not- Wow ... settle at all.

I could not do anything breath-based. Um, it was, um, just totally, uh, uncomfortable and, um, I, I just couldn't do any of it. Um, I think because I let myself get so deep in the weeds. I think now, um, if I had to [00:48:00] relive that situation, I could have used that in a more skillful way, um, and it would have been helpful.

Uh, but interestingly, in the, in the woods, uh, in the weeds of that experience, it was not very helpful, but now it is useful to me and I, um- I think my burnout is all gone now. Um, I think it's been gone for over a year. Although interestingly, a year after I, um, changed my schedule, I thought, "Oh, my burnout is over," and a year later I could go, "Oh my gosh, it was so not over yet."

Um- Yeah ... so I think though it's mostly over, but, um, I have a patient in my practice who has OCD, and she named her OCD. And though this is not like OCD, um, my burnout is a little like that. Like he's still here in the corner. Mm. And I can watch my brain, [00:49:00] um, do things that set me up to slide back toward that.

Um, and, and I can also, um, take action more skillfully to, to prevent that. In 2024, um, I started a pediatric urgent care and, um- Oh ... that was a very fun thing to do. Uh, and provided, um, extended access to all the kids in the community, not just our patients, but weekend and evening appointments for any kid, um, who could get to our office.

And as soon as I started that, I was like, "Okay, I'm gonna open a pediatric urgent care, and then I'm gonna open six more in Montana, and then I'm gonna go..." And, and I actually had to be like, "No. Slow your roll. What are you doing? That's not, that's not what you need to be doing. That's, that's the wrong thing."

So it's funny. I don't, I [00:50:00] don't have a name for my burnout, although I should. That would be really not a bad idea. Um, but I, I keep an eye out for him for sure, 'cause I, I definitely do not want to- Uh, recreate the, the conditions for that to happen again 

Dr. Karen: Prevention, right? 

Dr. Sue: Yeah. Yeah, and I hope that's, um, something that talking about this in this- Yeah

kind of format might be useful to people to prevent that kind of suffering. Although there- Yeah ... are probably a lot of people like me who are like, "Ah, that's never, never anything I'm gonna experience." And so it, it may be harder to make the case for prevention, but at least we can make the case for, um, the fact that this happens, and it's common, um, more common post-COVID- Yeah

across professions, and particularly pediatrics. S- something like 55% of [00:51:00] pediatricians will experience burnout in the latest data, which is a big jump for us. Um, but not only does it happen, is it, is it common, um, it also can heal. And that's, uh, that's what I'm hoping we'll, we'll be able to do with the podcast, is just help reassure people about that.

And, and maybe people will intervene earlier in their process to avoid the worst Or 

Dr. Karen: recognize it. 

Dr. Sue: Yeah. 

Dr. Karen: Right? 'Cause that's the hardest part, right? You were in the thick of it before you could even recognize what was going on. 

Dr. Sue: Yeah. Truly. Truly. 

Dr. Karen: Mm-hmm. So you guys have had some pretty, um, kind of awful family things happen lately.

How's that been affecting you? 

Dr. Sue: Yeah. Um, you know that I have four brothers, and, um, in February, my oldest brother [00:52:00] was murdered, and, uh, he had just retired from a long career, a successful career of work. Um, and he had three young grandkids, and he was really genuinely happy in life. And, um, we were all appreciating that about him, um, in the, in the year and, um, some before he was killed.

And of course, it's been just the most dreadful experience. And, uh, to lose a person in this way means you're just sort of swallowed up by the criminal justice process, um, that turns out to be slow and really disappointing at times, and really complicates grief. And, uh, I was, I was just in Germany for a week, and I thought, "Oh, this will be good.

I can get [00:53:00] away. I can leave all of this criminal justice stuff behind and all the fretting." And I got to Germany, and what was there waiting for me was just a big pile of grief. And, um, I spent the whole week sort of blessedly feeling connected to my brother. Um, he was really into sun therapy. Um- Oh. He was a superb outdoorsman, and he really just every day was outside in a significant way, and, um, that included watching the sunrise in his driveway most days, and he would call it sun therapy.

So I did a lot of sun therapy in Germany. I lit a lot of candles in a lot of churches. Oh. And it was not what I was looking for out of that trip, but it turned out to be the first kind of extended period of [00:54:00] processing the intense loss, uh, as opposed to dealing with the way he was lost. It was, it was just really time centered on, um, you know, the, the pain of, of being without him and knowing that, you know- We won't be the five of us ever again on, on Earth, you know.

Um, which makes me think of my mom, and that's, that gets me teary because we were a collection for a long time, and, uh, now we're making our way without him. And, um, shortly after he died, uh, I wondered, I didn't really know what I was gonna even do, um, with my job. I didn't know if I would return to work at all, um, because I'm the personal representative of his estate, which should be a real cushy gig, but in this circumstance, turns out not to be that cushy, and is probably, you know, [00:55:00] fairly time intensive for at least two and three or four years possibly.

Um, and I spent about, uh, a month just trying to, uh, feel my feet under me. And, um, the podcast was already being planned, uh, but we hadn't launched yet, and I was contemplating whether to continue or not. And, uh, my brother and I, my, my next oldest brother, Mike, and I were talking about the strange silver linings of losing Bill and, um, those being so much time together with family and so much appreciation for choices he made to really try to build connection with his people.

Um, and not just his family, but it certainly included all [00:56:00] of us. Um, you know, he was, he was the guy who would call and say, "Hey, do you wanna go to the hot springs? Hey, do you wanna go have dinner?" And he was really good at sharing all kinds of his fun with other people. He was really into, um, outdoor motor sports and, you know, he never bought a snowmobile.

He bought four snowmobiles so that he just knew there'd be three people he would have to take with him, and they wouldn't have snowmobiles, so he had to have four. Um, and being reminded of how he was not only trying to build connection with his family, but, um, with his employees and with people in his community, and was always trying to do more of what was fun.

And not only wanted to be in the sunshine, but wanted to maybe at times be the sunshine for other people Um, and of course the most important reminder [00:57:00] in the loss of him is don't wait. Don't wait, uh, because you don't know how much time you have. So it became real clear in that conversation that no, we should all, we should all keep stepping forward.

We should all be doing the things that we think are fun. We should all be connecting as deeply as we can for as long as we can. 

Dr. Karen: And learn from that sentiment too. Buy four snowmobiles. Not one. 

Dr. Sue: Yep. 

Dr. Karen: Right? 

Dr. Sue: Yep. '

Dr. Karen: Cause that's, it's people who make life worth living. It's not reading a book. It's not riding a bike.

It's people. 

Dr. Sue: Exactly. Yeah. I mean, um, in the end that is, that's what matters. That's, that's what it comes down to, is our connection to each other. And you know, medicine is a really great and important way to be in connection with people. Um, but you know, not forgetting, um, to cultivate, [00:58:00] um, warmth wherever you go if you can.

I really appreciate you being here and sharing the first episode of Still Practicing the podcast with me. 

Dr. Karen: It was my pleasure. Thank you for asking me. I love you, Sue. 

Dr. Sue: Love you too. This next story comes from an individual on Reddit who shared that four years ago they were leaving emergency medicine due to burnout.

We're not supported by our employers or systems. This has been the case since I've been an attending, but became much more apparent during the pandemic when hours were long and benefits were cut, when masks were taken off our faces, when we got sick and were told that it must have come from community spread, not the mass of COVID patients coding and being intubated.

I would also emphasize the distrust of the healthcare system by so many people. It's not the majority, but I would say at least one in ten patients these days come into my ERs [00:59:00] with some degree of hostility and distrust. It makes work miserable, and there's no remedy. The distrust will continue. The demands from administration to move faster, never make a mistake, do more with less resources, click every box, hit every metric will continue while avoiding meaningful changes that actually impact patient care.

And our wages will go down or not keep up with inflation. As there is no solution I see coming and no way am I, I am able to make an impact, I'm done. I'm leaving clinical medicine, and it is in some ways horrible to do so. But it isn't just me. So many fantastic people from amazing nurses to educators and other physicians are just done.

It'll be interesting to see how this goes It's really interesting to look back on this submission that was written in twenty-twenty two. [01:00:00] Um, I think if I had been responding to it then, I would have said I understand every word of it and I don't see what there is to do except leave. And I too would have shared concern about what that will mean for all of us and our ability to access care from good people, um, who just can't, uh, get through the, the difficulty that was, that was so long-lasting back in that window of time.

Looking at it today, uh, of course I see opportunity for this person to potentially, uh, work with a professional to help with some perspective-taking and really trying to identify what part of this work they could continue to [01:01:00] do and would enjoy continuing to do and feel gratified to provide. Uh, and I would wanna provide some reassurance that it is possible to make change, uh, maybe not in this particular big system, but to make changes for yourself where maybe you are moving to a different setting or, um, reasserting boundaries, uh, within the setting and, and then exploring whether or not it's possible to continue and, uh, it may not be.

But, uh, when I read that in some ways it's horrible to leave clinical medicine, I certainly hope that, uh, this person found some space to explore what was possible. Do you have a burnout story? I would love to feature it on the show. Share it with us [01:02:00] for a chance to have it read on an upcoming episode.

You can email us, hello@stillpracticingpod.com or visit our website, stillpracticingpod.com. You can also check out sudaniels.md on TikTok and Instagram or Facebook to keep up with me and the pod. Check out our Human Content Podcast family on Instagram and TikTok at humancontentpods. Thanks to everyone who listened to the episode.

Please come back and listen again. Uh, send us a message or leave a review on your favorite podcasting app or on YouTube, and I'll give you a shout-out. Speaking of YouTube, check out our full episode videos on YouTube that will be posted every other week at Still Practicing Podcast. Thanks again for listening.

I'm your host, Sue Daniels. Our executive producers are me, Aron Korney, Rob Goldman, and Shahnti Brooke. Our associate producer is Sundus Hassan Nooli. Our [01:03:00] editor and engineer is Andrew Sims, and our music is by Omer Ben-Zvi. To learn more about Still Practicing's program disclaimer and ethics policy, submission verification and licensing terms, and HIPAA release terms, you can go to stillpracticingpod.com and reach out to us at hello@stillpracticingpod.com with any questions, comments, or smart remarks.

Still Practicing is a Human Content Production