I lost my beautiful son Evan to suicide four weeks ago. He was a second year internal medicine resident—a very smart, loving and funny man! He left a lengthy letter and in it he stated, “I do not want any attention drawn to this.” I have been crying all day reading your book and blog and I’ve seen the trailer of the film you all are making. I admire your work and if I can help one student, resident or doctor to seek help it will be worth ignoring his wishes.
You see Evan was always a really bright child. He was very caring and compassionate. I never saw any signs of depression. He did well in college, excelled on his MCAT and excitedly headed off to medical school. I am a nurse and I tried to get him to choose another career! I told him how overworked and exhausted the doctors were. That they had to deal with patients, insurance, call, weekends, etc. He chose that path anyway and, of course, I was very proud.
In his letter he wrote, “I guess we all know that I chose the wrong field. I actually think it would’ve been a good fit for me a few decades ago, but I don’t like what it is currently. Like every damn field in the world right now it appears that profit is the driving motive and things will continue to get worse as more profit is extracted. It is also not the career my mind was built for. I’m better at deep knowledge of a narrow spectrum, not of the broad and somewhat shallow. This discontent was something I was never able to reconcile fully. I would work long hours and in my spare time I would fret about my situation. I felt I was too far behind to get where I needed to be. Now I’m left with a job I can barely stand and a mountain of debt (which FYI should be absolved upon my death).”
Our family, of course, is heartbroken, lonely, miserable and questioning what we could have done differently. He went on to mention that he first thought of suicide in med school and has thought about it almost weekly since that time. What hurts me the most is that I had NO idea that he was that miserable!!! Everyone says med school and residency is tough and we thought this was normal. Like I said at the first, he was very funny and made fun of himself. He did tell me a while back that he didn’t like it. He said, “I just wanted to be a scientist that helped people and that is not at all what I do.”
So my beautiful, loving son got in his truck, drove home to Texas and took his own life! In this tiny town there were over 500 people at his memorial service! If he would have just reached out to anyone! Is there anything I can do to help? I have no idea how to fix our medical system, but this epidemic must be studied and stopped!
Evan’s loving mother,
Oh, I am so sorry to hear about the suicide of your beautiful son, Evan. Such a terrible loss for us all! Please know that I am here for you 24/7 if you ever need me. Talking about your feelings and connecting with others is therapeutic for many who have been through suicide. I will connect you with a support group that I created for parents who have lost their children to suicide during medical training. Writing is healing too. I’d be honored to celebrate your son’s life on my blog so that we can help other medical students and doctors know that there’s no shame in asking for help. You can even honor Evan on a tribute page in the forthcoming documentary film, Do No Harm (now ranked #1 of all 500 films on Kickstarter!). I’ll call you in a moment. Thanks so much for your courage in reaching out and being willing (amid your grief) to help others.
Christine Sagan opened her clinic in a broom closet. She says, “I never thought in a million years that hundreds of thousands of dollars would be just rolling in.” Here’s how she did it . . . (download/listen to MP3 below):
Christine Sagan: I’m Christine Sagan. I’m a family nurse practitioner and I live in Anchorage, Alaska. So before I came to Breitenbush retreat I was pretty miserable. I had for about six years not liked my job and I didn’t think there was any way out. I thought on the outside everybody would think it was a great job. I worked at a holistic health center and I had flexibility. I worked three and one half days per week. I kept justifying and minimizing my situation thinking that I was comparing it to everybody else and thinking it’s not that bad. But it was that bad in lots of different ways and it continued to take a toll on my mental health and my ability to show up. So after a change in contract and a pay cut, I decided that I was done with that place and was looking for solutions and I Googled around and I found Pam.
So I was really looking forward to Breitenbush just to get out and have fresh air and super excited to be off the grid and not deal with WiFi and just kind of disappear and get back in touch with my own thoughts and not have all the busyness and distractions. When I showed up here it was one of the largest groups. It was 54 people. I really didn’t know what I was getting into or what to expect and it was super-humbling to hear everyone’s stories.
Starting as a nurse at the bedside 17 years ago, there was definitely a hierarchy in the hospital—like this is the doctor and they tell you what to do—and it always put doctors on a different pedestal, but when I heard their story I was like, “Oh, you’re just like me! Oh, you’re human. You have the same crazy story I have!” And all the sudden when I took that barrier down about who they were and who I thought they were in the medical system and I had compassion, I realized that I could have my own compassion for myself and for the other doctors I worked with and I realized that we were all really were the same going through the same thing. We just had different tolerances for B.S.
I came to the retreat in May and it was pretty solidified by then. I had been working toward it, but I was still scared. I was 10% there and there was no way by the end of the year I’d have any plan in place. So I felt mentally solidified that I could exit. Didn’t matter really where I was going to go. I was actually okay if I didn’t even have a clinic. Just leaving was victory for me. So I just got even more excited. I almost feel like I came out of the winter and it was spring and there was this renewal of spirit, of like I can do this and I’m going to be okay and I’m making too big of a deal out of stuff and I’m just going to do the next right thing. So I continued to find opportunities to grow and that next six months I was out.
Someone from the hospital approached me who invited me to use space at the hospital and I could build it any way that I wanted and there was a budget for it and I had to sign a lease. At first I was a little fearful of it, then I thought, well, I’m going to work and it will work out and it will be okay. I’m not going to worry about it, I’m just going to work.
So the space presented itself which got more exciting. It was like okay I’m really working toward this. I put it out there and started sharing with people and patients. This is my idea and they started shoring up support and helping me come up with designs and websites and someone did all my photography and I talked to my brother and was like I need a name and he came up with a name and that resonated with me. It was exciting—like birthing a child.
My boss eventually found out that I was exiting and I don’t think he knew much about the details other than that I was going to leave so he fired me. And I felt pretty happy and at peace with being fired. It was like that’s so cool, I’m really free! I didn’t quit you. You had to quit me. What was really funny is the last official day of the contract would have been the 31st of December and my last day of work was December 22nd and I had planed on working through because in my mind I was like I need revenue because I don’t know if I’m going to have that many patients. So the last day was the 22nd on a Monday which is really random and I decided to give myself the gift of Christmas and not work for 4 days and I decided to open my clinic Vitae Integrative Medical Center on December 28th. The funny part was that my boss offered me my job back the next day with even more of a pay cut. He knew I was fearful and vulnerable and I called my dad and he’s like, “Why would you work for this person?” and I was like, “Okay. Right!” and I kind of just got back to that spiritual sense of being able to ask my higher power, “Am I doing the right thing?” And I remember sitting in the break room and my boss had texted me, “Hey are you signing the next contract?” and I just sat for a moment and I heard this loud NO! And I was like, “NO!” And he got more angry at that. Oh wait I have a voice! I can say NO! And it’s a complete sentence.
I would tell my patients, “Oh by the way, in a month I won’t be here.” And they were so excited! I thought, wait a second, are you guys all in on the secret that you were just as unhappy as I was in this space? Nobody told me. So they were super happy and people offered to work for me and I had all sorts of crazy offers. Since my space wasn’t open, they offered me a closet for $200 per month. I said, “I don’t have anything right now because I wasn’t planning on being in a closet.” So they gave me a Pap table, they gave me a desk, I got a computer. And people showed up on time and I had a full schedule (because peoples’ insurance was paid up) so the 28th to 31st I had 40 patients and they showed up at the closet and they knocked on my door and I let them in and checked them in and out and I took payment.
I kept thinking this is so funny because Pam always said, “Do everything yourself” and I thought no, no, that’s not going to be me. I’m not doing that. But it was a wonderful blessing because it was humbling and I was able to just show up and I heard their stories about why they showed up and followed me. I had no idea they were going to follow me. That was my biggest thing. I don’t even know. I’m going to go out there completely blind and I don’t know who will come. I don’t know if anyone really likes me enough to follow me. Are they attracted to the clinic or to me? And that was such a weird mind trip. It’s almost like a popularity contest. Who’s going to stay and who’s going to go? But it was shocking that I had 40 patients the first week. What was really cool was that the three months I worked in the closet (and they would make jokes about the closet, it was just so humble and sweet) the money from insurance came through exactly on the mark that I opened my new space that cost more and I had enough revenue to pay all my bills and my staff.
Pamela Wible: So what has this done for your personal life and your sense of wellness?
Christine Sagan: So I would say that at points during the stress and the unhappiness it polluted all of my relationships. So it was sort of this, I’m unlovable and I’m not going to try. And my husband and I did talk about divorce quite a bit. I feel like in the last year—because my spirit has come alive with who I am—it is easier for me to show up and say what I need and mean what I say and be able to make amends and just be real and not be afraid all the time. So I feel like our relationship has really blossomed and we’re doing really well. So it’s kind of an interesting gift when you have yourself that all the sudden your relationships get better.
Also I started traveling as a young person and that’s one of my happy places to go and see the world and when you’re working all the time you took little breaks but I decided I’m just going to go see the world! So it’s kind of funny. I opened on December 28th and on like February 20th I’m like I’m tired. So I forwarded my phone to my brother and I went to Hawaii and took my kids for ten days and just played. We played and we didn’t have to do anything. And I thought oh that was too easy! So in May my kid finished her first year of middle school and I said, ”Let’s go on a trip” so I took her down to Nicaragua which is really random into this roadless island and I had learned how to dive when I was 18 and hadn’t dove since my 20s so I taught her how to dive and I got to dive again and it was just kind of like this youthful rebirth like, “Oh, okay I can play and have fun!” And again I didn’t have to ask anyone to be on call. I didn’t worry. I was in Nicaragua and I couldn’t log on to the Internet and I got to just go to bed and walk on the ocean and just have quiet time and realize there is so much more to life than working. So I’ve continued to make goals of what’s the next trip.
I feel like it is just the perfect balance of work and rest and fun. It’s intense being in the medical field. You’re taking care of people and I feel like I have myself and there are great outcomes and they enjoy being there but at the same time I still need rest from hearing people’s stories all day and really caring and being empathic. Same thing other people have said (see Dr. Kayla Luhrs interview), I’ll tell people, “I’m going to go to Mexico next week” and they say, “Oh great! Where are you going? Go to this place and here’s this and they’re constantly excited for me and want me to have fun and be rested and practice what I preach and I come back and say, “Oh I learned this,” and they’re like, “Oh great!” It’s like having an extended family and everyone cares about you and they want you to be well so you can show up.
Pamela Wible: Do you feel like you’re living your dream?
Christine Sagan: Yes, I feel like I’m living my dream in terms of I’ve been consistently happy and now it’s like this obligation to the medical community so in my own little way I meet doctors who are on their own and I’m encouraging them or encouraging people to go out on their own and try to create collaboration and community and and just having the heart to show up and not be exhausted by it. I just have this joy of giving it back and moving it forward.
Pamela Wible: Can you talk about salary potential?
Christine Sagan: Okay. Money. So this is interesting. When I first came up with my business plan I really meditated on what’s my mission, what’s my vision, what are my values and what am I doing. Over and over again I would make sure that was really ingrained in what I was doing and really prominent on my website—this is my mission. Part of that is that I wanted to attract who I wanted to work with. And a friend of mine who is wise said, “If your bottom line is money, you won’t be successful.” So I thought, “What else is your bottom line?” She said, “Think about what your bottom line is?” Wait, the bottom line is people. If their needs are being met I don’t have to worry about my needs being met. They’ll be met. So I had this trusting approach. I’m not going to worry. It’s all going to be okay.
So I have never not had a full schedule. I kept getting more and more booked out so I had to stop taking new patients. Then I decided to hire other people to help out. So I’ve hired a part-time doc and I find their same story. I say, “What’s your story?” They tell me their story just like everyone else has shared their story and then I think I want to provide something that is safe. Not everyone wants to be on their own so I’ve had other people come to work in my space so that produces revenue. Part of what I want to do is work smarter and not as hard and so I have recognized other revenue sources. For me I chose to take insurance because I feel really strongly that people are paying for insurance and insurance should be used and we should bill insurance for the services at top dollar.
I went to a talk and I used to feel bad about making money because it is almost like you have to sell yourself and whatever you are selling and so I remember listening to this talk and I thought oh, okay. What I decided was that I am now unapologetic about my worth and what insurance is willing to pay and what I’m going to charge my patients. I feel if I lessen what I am worth it doesn’t really make any sense for me. I might feel anger or bitter and resentful or something. I charge what I charge and I get paid for it by insurance and then patients get better. They are invested in their health and they show up and they are willing to cash-pay me, they’ll do whatever. So all of my bills have been paid. I’ve always been ahead of schedule. Everything in the office I own. I own every computer and every desk and I’m not in any debt and I never had to take out a loan. It just came and everything is moving forward as awesome as it could.
Pamela Wible: Would you say you could make two, three, four times what you could make as an employed nurse practitioner?
Christine Sagan: Yes. Yes. So what’s funny to me is that it ended up in the end (because of course I’m just going through the motions and I have no idea what the bills are going to be) so at the end of the year I made five times what I made before.
Pamela Wible: In your first year?
Christine Sagan: Yes. And it was funny I was like, “Oh wow! I just compressed five years of my life and I lived it in one. Now I have so much more freedom to retire early. And it’s just funny because my bottom line was never money—that was never my goal. My goal was to make what I made or at least pay my bills or not go into debt like that was my basic goal. I never thought in a million years that hundreds of thousands of dollars would be just rolling in. But it allows for the freedom to not be worried and then to dream bigger like okay, whats next?
Pamela Wible, M.D, is a practicing physician who has devoted her life to preventing medical student and physician suicide and helping healers heal to live their dreams in medicine. She is author of Physician Suicide Letters—Answered.
Angela Jiang: Good morning! As the class Vice President, it is my pleasure to welcome Dr. Pamela Wible to our graduation. Dr. Wible is a family physician and a pioneer in the ideal medical care movement. After completing a family medicine residency and working in different family practices for over 10 years, Dr. Wible found that neither doctors nor patients were happy with a system that felt much like an assembly line. She decided to follow her vision of practicing medicine in a way that could please both herself and her patients, and invited her community to design their own ideal clinic.
At Stritch, one of the first things we learned was how to treat the human spirit. It’s fitting for Dr. Wible to join us on this momentous day, since her clinic pretty much sounds like a spa for the human spirit. She offers relaxed office visits, house calls, and she has never turned anyone away for lack of money. With her patients, she wears glitter, throws Pap parties, and delivers balloons and homemade soup to patients during house calls. Since her clinic opened in 2005, Dr. Wible’s innovative practice has inspired hundreds of other physicians to create ideal clinics nationwide.
In addition to her devotion to changing health care, Dr. Wible is also passionate about physician mental health. She operates a suicide hotline from her home, and believes in nurturing the invincible human spirit in us all. For her contributions to physician mental health, she was named as one of 2015’s Women Leaders in Medicine by the American Medical Student Association. Dr. Wible’s commitment to promoting mental health and innovative approach to health care has led to Ted Talks, two bestselling books, features in textbooks, and interviews by CNN, NPR (listen to award-winning NPR interview), and many other news outlets.
With someone so successful in pursuing her passions to lead our beginning as physicians, we are lucky to have Dr. Wible here to speak about how we can keep following our dreams as we leave Stritch. Please join me in welcoming Dr. Pamela Wible.
Dr. Pamela Wible: Wow! I feel like a proud mother getting ready to watch 151 doctors take their first steps. It’s so exciting!
When I found out that I “topped the list of inspiring individuals” nominated by your graduating class, I was shocked. I quickly accepted the nomination and invitation by Dean Brubaker, and then hid her letter and didn’t tell anyone (even my mom) because I was pretty sure once you all figured out what I actually talk about, I’d be disinvited. I’ve actually been disinvited as a featured speaker at a special event here in Chicago by the largest medical association in the country when they discovered that I speak on doctor suicide. So thank you all for having me. I promise my commencement speech is not on suicide.
Life is a continuum between self-destruction and self-actualization, between losing and living your dream. Today we are all gathered here for one reason—to celebrate your dream.
A dream that many of you have had before kindergarten. Back when your parents wondered why you kept doing surgery on your dolls and applying wet toilet paper casts around your Barbies. Some of you felt the calling in high school. You saw yourself on mission trips, in emergency rooms, and maybe one day in your own little clinic back home. These images of healing those in greatest need, of saving a life, energized you and filled you with joy, the same joy you felt when you got your acceptance letter and on your first day of orientation. And you feel it again today. Your dream—sometimes forgotten—still fuels you. And it follows you. Even if you ignore it.
Love, hope, dreams are fluffy words in medicine. Not easily measured or reimbursed. Not valued like GPAs and board scores. Yet—in the end—your dream is the only thing matters. It’s what tethers you here on Earth.
I know. I talk to a lot of hopeless physicians who have given up on their dreams. They search for exit strategies at conferences on non-clinical careers for doctors. They grumble about the “government” and the “system.” Some even take their grief out on you “lazy” new doctors. You “special snowflakes.” They warn, “let’s not turn medicine into some coddling group hug where anyone with a brain can get through.” Why do they lash out at you? Maybe because they see the sparkle in your eyes, they feel your passion to serve. Your dream is still alive—and you remind them of what they lost. They used to be you.
You are not them. Loyola has prepared each of you to lead an extraordinary life as a physician, to uplift the human spirit, embrace diversity, respect life, and value human dignity.” And so you must stand up against human rights violations in medicine. Bullying, hazing, and sleep deprivation will not make you a better doctor. We’ve already wounded far too many of our physicians with antiquated teaching methods. It is time to heal our healers.
And so I ask that you always have compassion for those who have come before you. As you begin your careers, many doctors are counting down their days till retirement, living lives of silent desperation. Learn from them. But don’t follow in their footsteps. If one day you find that you do not love your work, do not love your patients, have lost all hope—you must first find yourself again. How can a hopeless doctor give hope to patients? If you feel trapped, if you feel like a victim, then you are teaching your patients (and the next generation of physicians) to be victims too. Doctor means teacher.
Medicine is an apprenticeship profession. So let us learn from those who work with joy. Like Dr. Tameika Lewis (a gynecologist in Orlando) who dances with her patients in the park every Saturday morning. Like Dr. Jennifer Zomnir (a family doc outside of Dallas) who takes her kids with her on house calls and sees all patients over 90 for free (because she doesn’t want them fiddling around with paperwork). Like Dr. Keely Wheeler (a psychiatrist in Tulsa) who takes her patients with her to the gym to work out. Is that awesome or what? When I first met Keely she had gained 80 pounds working for a big hospital system and rarely saw her husband. He basically used to bring her dinner while she was charting at night, that was their marriage, sneaking her Whataburgers under the bullet-proof glass receptionist window. Then check this out: within 2 years of launching her dream clinic, Keely lost 125 pounds and does marathons. People keep asking what diet she’s on. She says, “I’m on the I love my job diet”
It’s been a total blast to help these physicians launch their dream clinics. Sometimes I feel like I run a wildlife sanctuary for wounded healers. They come to me nearly dead with PTSD, depression, suicidal daydreams and I guide them back to their real dreams.
But what if you can’t find your dream? What if you don’t love your job? Please promise me that you’ll to do one thing—ask for help. That’s what I did.
My dream was to be a small-town family doctor doing house calls and trading for produce, but I could never find my dream job out there (and I signed a lot of contracts with a lot of hospitals and they never let me do this, they wouldn’t let me barter or anything, wouldn’t let me see patients for free, you know It was against the rules). So I really felt more like a factory worker practicing assembly-line medicine, so 12 years ago I did something that doctors never do—I asked for help. I asked my entire community for help. I invited them to design their own ideal medical clinic. I literally called up the newspaper and announced that I was hosting town hall meetings throughout the county. Ultimately, I collected 100 pages of testimony, adopted 90% of what my community wanted (and I literally told them I’d do whatever they want as long it was basically legal), and within one month we opened—with no outside funding! The first ideal clinic designed entirely by patients. My dream came true. So did theirs. Because I asked for help.
So if you can’t find your dream job out there, create it. You are in the top 1% of intelligence, compassion, and resilience in the country. You can totally do this! Whether you want to design an ideal clinic or an ideal hospital, your community wants to help you!
But doctors suck at asking for help. Have you noticed that? So start practicing this weekend. Ask your family and friends. Ask me 24/7. Just got to IdealMedicalCare.org. Call me. Email me. I actually return every single phone call and letter. And I have no staff. The people who help me are my community. I have a lot of unpaid staff. The thing is when doctors ask for help the most amazing things happen.
Dr. Lissa Lubinski (a family doc in Washington state) just had a town hall this past March and 52 citizens showed up to help her launch the first community-designed clinic on the Olympic Peninsula. Dr. Mary Ellen Hoffman (a family doc in upstate New York) shared her dream with her community and a neighbor was so inspired she came over with a plate of homemade chocolate chip cookies and a $100,000 check! Would that help your student loans if a neighbor found out that they were living next to this really cool resident with an amazing dream and they brought you a big fat check? What’s better than a surprise $100,000 check—with cookies? Well, I know. My mostly uninsured patients give me tips. They pay me more than what I ask for. They write in the memo line of the check “for love & guidance” and they draw little hearts. Every time I get one of these checks, I feel like I hit the lottery.
So what else will patients do for you? Townspeople have raised thousands of dollars through bake sales and spaghetti dinners to help doctors launch clinics. They’ve given doctors free rent on main street. Patients have volunteered to sew gowns, blankets, decorate clinics, even work in the office for free. Why would patients do this for a doctor like you? Because they need you. The real you. The one in your personal statement. The one who is not afraid to live their dream. Because your dream is their dream.
So graduates, my question for you today is: what would happen if you started sharing your dream? What would your community do for you? What if you actually asked for help? You may be surprised.
Three tips for a successful career in medicine
In closing, I’ve got three simple tips that will nearly guarantee your success. Three tips (one for today, one for next week, one for July):
#1) This afternoon when you are celebrating with friends and family, I invite you to share your dream—the biggest, boldest, you-hit-the-lottery version of your dream. Just stand up, tap your glass with your fork, introduce yourself as Doctor for the first time and share your dream. To parents, family & friends: your job is to listen to this beautiful person in front of you and nurture their dream. Record the moment. Get out your iPhones. Share it on social media, and please tag me on Facebook. I’d love to celebrate with you and share your dream with the world. Ya never know who will be so inspired that they’ll write you a $100,000 check—or more! Be optimistic!
Graduates, you can’t do this alone. You must learn to ask for help because there will be times in residency and beyond, when you haven’t slept in days, when you’ve had an unexpected death, when you question WHY you are doing any of this. And in your darkest moments, you’ll need to watch the video. Save it. It may save your life. So that’s #1—share your dream with your loved ones today—and me today— and ask for their help.
#2) Next week, I want you dig out your personal statement. Read it and update it with all your cool new ideas. Decorate it with glitter stickers and smiley faces and little hearts. Then get it framed and hang it right next to your diploma. Without your dream, your diploma is just a piece of paper. There are far too many discouraged doctors with walls full of diplomas and awards. Remember: it is your dream that will bring your diploma to life.
#3) In July you start residency. Share your dreams with each other. Be like a dream team. Medicine is a team sport (and we’re actually all on the same team). Help each other become the doctors you always imagined. And here’s a big bonus. Discover your patients’ dreams. What inspires them? What’s the real reason they keep coming back to see you? I bet it isn’t to get to goal on their HgA1C or to perfect their low density lipoprotein level, or to make sure their MRI is clear of metastases, it’s to survive long enough to make it to their 50th wedding anniversary or to witness the birth of their first grandchild, or to live long enough to watch their favorite granddaughter walk across this stage and graduate from medical school today.
Congratulations and I can’t wait to see what you all do!
In today’s podcast (and video), Kayla Luhrs, M.D., reveals how she recovered from the trauma of her medical training to live her dream in medicine. Listen in and be inspired . . . (full transcription & commentary below):
Hi, my name is Kayla. This is my second Breitenbush retreat. My last Breitenbush retreat started on the day I officially gave my 90-day notice for my job. I literally pulled over on the side of the road on my way here because I knew that was the only way that I would have the courage to do it and to not pick up the phone and say, “Oh wait, wait, I changed my mind.” So that took an immense amount of courage.
How do you keep yourself energized and motivated? How do you inspire other people to be excited and enthusiastic? How do you get patients with self-inflicted illness (like smoking and overeating) all jazzed up about changing their lives? A medical student recently asked for my guidance on inspiration and keeping a positive attitude amid so much pain and suffering. He wondered how I “willingly drink in the most heart-wrenching of fodder, yet exude even larger volumes of love.” Listen in to a small section of our mentorship call above as I share how you too can be inspirational.