Surviving and Transforming – My Story

Many streams feed the syndrome of “burnout,” which is only a descriptive name for an end result. No matter how it develops, it can deliver you to a place of rock-bottom transformation in your life – and everything can change for the better, from then on. That’s what happened for me. And it’s also possible for you, no matter how bad you feel right now.

It’s key, though, to have someone with you who knows (and has survived, integrated, and is willing to discuss) these experiences. From my psychiatric residency on, practicing physicians and medical trainees have come to me as a sounding board – seeking refuge in the storm of their training and lives.

Dr. Pam Pappas

So many creative, intelligent people are hurting. Most are altruistic and sensitive to the needs of others. Medical students and residents want to help; they look forward to learning clinical medicine and caring for patients on the wards.


The “hidden curriculum” in Medicine

Yet instead of wise, compassionate mentors, they’ve often found worn-out, cynical supervising residents and attendings. Having survived the hazing of internship and beyond, these professionals continue the widespread tradition of humiliating less powerful members of their team (especially medical students) and ridiculing patients as well (referring to them as “gomers,” “frequent fliers,” and worse). This is all part of the “hidden curriculum” in Medicine – a socialization process that infiltrates everything. You do what you see your mentors do; it’s learning through imitation as well as intimidation. Whatever is absorbed there unexamined, continues into the next generation. It doesn’t have to, though. It’s key, though, to have someone with you who knows (and has survived, integrated, and is willing to discuss) these experiences.

I’ve seen wave after wave of trauma, flowing from a vast ocean of suffering. Many of these people have been respected clinicians, who didn’t intend to be cruel. Still, they’ve seemed unconscious of how they were acting, and its effects on others.

I set out to help my colleagues heal by witnessing their stories, and encouraging them to voice and own their experiences. I believed they could transform their lives by doing this, and by sharing authentically with others.

Building and personally staffing a Medical Student and Resident Mental Health Service, I also created a Peer Counseling Service where students could help each other. Profound healing is possible in caring, compassionate community – and the medical students took hold of this enthusiastically.

The Unexamined Armor of Physicians

Serving these people required dealing with my own personal history, even though the effects of “abusive medical culture” were not much discussed at the time. Still less examined was the armor so many physicians wear for survival: we become workaholic, lone ranger, superhero, perfectionists. These patterns are professionally endorsed, but personally disastrous – and unless we can recognize them in ourselves, we never turn them “off” at home. The term “burnout” didn’t even appear in the helping professions until 1974, when psychologist Herbert Freudenberger described it in workers in a free clinic for drug addicts.

Some mistakenly see the burnout syndrome as a kind of personal failing: they think it applies only to over-idealistic people who aren’t “tough enough” to keep giving 24/7 like good physicians should. Wrong!

Unhealthy systems with ongoing “boot camp” mentalities can mangle good people. With insane workloads and call schedules, intense productivity pressures, very sick (and often demanding) patients, malpractice fears, EHR documentation overload, poorly prepared leaders, and colleagues who never dare show emotion or other forms of vulnerability, medical culture provides little opportunity for healthy coping.

Only survival mode is left.

Psychotherapy revealed how my own abusive family background had primed me for similar interactions in medicine – and not in healthy, preventive ways. Many of my patients had similar histories. Understanding this suffering freed me up to heal, and to better assist others. Unfortunately, maintaining a workaholic, lone ranger, superhero, perfectionist lifestyle wasn’t conducive to a healthy marriage – and mine (to a fellow physician) ended in a painful divorce. Doctor armor does NOT work well at home.


I Was the Proverbial Gerbil on a Wheel

One of my worst burnout experiences developed after some 15 years’ academic Psychiatry practice – with full-throttle patient care, teaching, and on-call responsibilities. As managed care eviscerated Psychiatry, something inside me went numb. I had picked my specialty to help people heal themselves comprehensively; insurance companies favored brief med check appointments that limited psychiatric treatments to prescription-writing alone. Though this seemed to demoralize some of my colleagues as much as it did me, most kept soldiering on. For sure I was exhausted. I’d been working until 10:30-11pm most weeknights, covering inpatient psychiatric consultations in 3 general hospitals, plus an outpatient Psychiatry practice.

My temper flared every time a new consult came in, and I dreaded going to work. Leading teams of residents and medical students, I was the proverbial gerbil on a wheel — and felt like an impostor. Sheer volume of patients never allowed time to learn what was truly happening with them, or to make much difference in their care. Often, they needed inpatient treatment – and my overworked Psychiatry colleagues upstairs refused to admit them. (Wrong insurance plan, no vacant beds today, etc). This left me on the phone searching frantically for other hospital beds, which often took hours. This was NOT my idea of being a Consultation-Liaison Psychiatrist! I wanted to help my patients heal by getting to the bottom of their symptoms, yet I was mostly serving as triage factory. This severed me from what I was best at, and from providing what patients needed most from me. Not to mention what my residents and medical students needed to be trained in.

My “I Can’t Do this Anymore” Moment

My “I can’t do this anymore” moment was being spat at one day by an angry, psychotic, HIV+ man whose threatening behavior had an entire nurses’ station cowering in their supply room. They called a Psychiatry consult to “fix” (!) this extremely complicated dilemma – which required not only me, but several security guards, gowns, masks, gloves, and IM sedation. There was no debriefing; departmental colleagues stared blankly when I tried to express my distress and ask for help. What might I have done better, to make a positive difference in the outcome? No one asked me how I was feeling. I’m sure they had all the pain they could manage, without having to listen to mine. This is a recurrent theme in medical culture.

Not long afterwards, I decided to quit my job, move to Arizona, and study Integrative Medicine by attending naturopathic medical school. I eventually moved over to a homeopathic medical college for more intensive training — and classical homeopathy became my primary way of serving patients. Before leaping into this process though, I consulted no one – which is NOT what I’d recommend anyone else do!

I Needed a Relationship of Equals, and a Thought Partner

What I most needed was time for refuge and rest, and to examine what I truly wanted to do. What I did instead, was put myself through yet another grueling schedule determined by someone else. This provided an illusion of legitimacy, when I felt like a complete failure inside. I knew how to succeed “in school” – but I didn’t know how to balance my own needs for fulfilling work, contributing to others, and a healthy personal life.


I wish someone had been available to help me sift through all the possibilities in those days – someone experienced and knowledgeable, whose only agenda was helping me clarify mine.


Physician coaches were not yet a “thing.” Yet I would have gratefully received coaching from a colleague — to develop my Ideal Job Description, and more.

I didn’t need to be a patient in psychotherapy, because I didn’t have an illness or an unexamined past.

However, I did need to be heard with the same kind of gentle, focused attention I provided to my patients. I needed help finding my feelings, because I was numb to them. I needed clear observations from a trustworthy colleague, who could offer different perspectives. I needed the caring of a compassionate psychiatrist, without making me into a sick person. I needed a relationship of equals and a thought partner in my life. I also needed someone to keep me accountable to what was important to me, so that it didn’t get buried again.

Someone to Walk with You

Through eventually developing my own Integrative Psychiatry practice, I fumbled into “discovering” how coaches help people. Several have been life-changing for me! They have attended to my soul, while also offering systems to improve the flow and fulfillment in my life and work.

That’s why I’ve gathered all my previous experience, and have now trained as a coach: so that you’ll have someone to walk with you in all these ways that I know are lifelines.

I want to help you sift through your pain, possibilities, longings, aggravations, joys, interests, talents, and dreams – and bring what you long for, into fruition. You don’t have to do this by yourself these days, unless you really want to. Another pair of caring, focused eyes can help you see important things you might otherwise miss.

You may not realize this now — but most of what you need to improve things for yourself is already inside you. In-depth conversations with someone who “gets” you, can help you unearth and gradually make this real in your life. That’s the rock-bottom transformation I was talking about before.

Being a Patient Opened my Heart Even Further

The most profound (and unexpected) training I’ve ever experienced, has been­­­ becoming a patient myself. In late November 2016 I became acutely ill with necrotizing pancreatitis, from gallstones I didn’t even know I had. This led to 2 intensely painful hospitalizations, sepsis, near death, and surgery to remove my gall bladder — as well as many months of chronic symptoms, endoscopic procedures, and need for recuperation. I learned what it was like to be treated by doctors and nurses who had energy enough to care for me, in contrast to those who were more like the walking dead. One of my physicians had been through pancreatitis himself, and was a guiding presence for me in both my hospitalizations. Without him, my sepsis would not have been recognized in time to keep me alive.


All this opened my heart and mind even further to both my colleagues and other patients. We physicians are indoctrinated to ignore or suppress our human vulnerability while churning through clinical workloads.


We forget to include ourselves in our caring activities – and it may even take a major illness to wake us up to what we’ve been ignoring. Although medical careers don’t have to lead to burnout or suicide, they often do! Being a patient has further strengthened my commitment to bringing healing and wholeness back into Medicine itself.

Disconnection from Our Patients’ Human Needs

Most physicians are service-oriented people; disconnection from our patients’ human needs can deprive us of the very reasons we chose Medicine in the first place. Burnout feel horrible to doctors, and it disrupts the excellent care we want to give our patients. We also want to be creative and innovative in our work — to bring fresh ideas and effective treatments into Medicine. Organizations and leaders employing doctors have big parts to play in these burnout trends: they can either become islands of health, or perpetrate further insanity. The intent of my work, is reaching you (and your medical organizations) long before you’re completely burned out or suicidal!

Together we can develop individualized strategies for your personal situation; we can also show employers in C-Suites and faculty in medical schools, how best to support you. Since each doctor and medical organization affects thousands of patients and their families, these efforts ripple out to infinity.


Feeling battered by the whirlwind? Become the eye of the storm, instead.

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