What Now?

How one doctor copes with stress

It’s been four months since October 7th and more than two months since my last confession – I mean blog post. Needless to say, the two are related.

What more is there to say when the world is full of lies, hypocrisy, and malign projection? When realistic options and likely outcomes range from bad to worse? When the current situation, awful as it is, may one day be seen as but a prelude to something much bigger, much darker?

Nothing to say that others can’t say better.

As for other topics, inarguably more appropriate than war to a doctor’s blog, while they haven’t gone anywhere, it has felt almost profane to dwell on them by comparison. To borrow from Wittgenstein, I find myself in a mental state where what I cannot talk about I must pass over in silence.

But then I remember the purpose of this blog – to give a glimpse into a doctor’s life. So why not share how I’ve been coping with all the psychological and emotional stress? After all, here we are, at the dawn of AI, where a doctor is still a human being – with personal, familial, political, financial, or existential pains and joys – sometimes large, sometimes small, but never absent.

In response to inner turmoil, I tend to direct my energy outward.

If I feel depressed, I’ll go for a run. If I find myself ruminating, I’ll reach for a journal article and learn something new. Watching my kids play sports is therapeutic wish-fulfillment – conflict and competition played out on a field with referees, fair play, and mutually agreed-upon rules of the game. Work – especially the patient-care part – directs my mind to other people’s problems, grants me the privilege to apply my skills productively, and quiets the internal noise.

Sometimes stress provides its own remedy in the form of the response that it demands. In other words, action. In other words, the answer to the question, what do I need? may well be the question, what needs to be done?

In other words, life goes on.

I learned this lesson when my daughter, Georgia, was found with congenital heart disease as an infant. The shock of her presenting crisis and initial diagnosis; the uncertainty and dread of her surgeries and prognosis; the constant care she required – replacing nasogastric tubes that she had pulled out in the middle of the night while she screamed bloody murder stands out in my mind (lucky I was a doctor – or unlucky?) – it all left little room for anything else.

And yet, what about her siblings? Didn’t they deserve normal lives? They forced Rachel and me to be present for them – with love and attention – providing a kind of respite that would otherwise have been completely out of reach.

I suspect that many doctors are the same – for better or worse, we are trained and biased toward action. We compartmentalize and externalize emotional stress rather than let it settle and spread internally.

I took a little poll.

A neurosurgeon family member describes having a pilot or quarterback mentality when it comes to stress – “eat, make the next decision, move on” (yes, first eat); a neurologist friend “surfed a lot in residency”; a cardiologist colleague takes “long walks with his dog” (nothing like a dog to draw you out of yourself); a gastroenterologist friend “turns off all electronics, goes to concerts, builds Legos,” and… plays with her dog.

It all seems pretty typical. Maybe doctors are not that different from “normal” people after all. Or maybe any difference is more a matter of degree than of kind. In any case, speaking for myself, I feel lucky that my inner self can turn to the outer world – which, along with infernal strife, mercifully provides solace in at least equal measure.

Not to mention inspiration.

Kobi, our youngest child, recently had his second ski race of the season, a Giant Slalom at Windham, our home mountain. Every racing parent is expected to volunteer for a home race. Since I am one of the most experienced, I offered to gate-keep, which means standing on the side of the slope, inside the red B-netting, to referee and help out in case of a crash.

Little did I know about the arctic freeze.

It was well below zero on the hill that day. There were 197 racers, each with two runs. By convention, girls go first, boys go second. A frigid wind whipped across the snow. Soon enough I couldn’t feel my feet. At the point when it felt like hypothermia was setting in, I expectantly checked the bib of the next racer: #19.

Of the girls.

Then I saw a favorite thing – a young racer outside her comfort zone, urging herself on as she hurtled down the slope, barely hanging onto the edge of control. Her voice reached me across the course, You can do it, Kristin! Weight over your skis! Come on, Kristin! Don’t be afraid…!

For a moment, I forgot my pain, as her valiant spirit won me over, and her skiing became about more than just skiing, and I thought to myself, or rather to her, Send it, Kristin! Harness gravity! Exploit the thing that drags you down!

I’m sorry for all the parabolic anecdotes about ski racing – I know that for many, if not the vast majority, it must be pretty unrelatable as a metaphor for life. But to me, ski racing is such a true and natural metaphor that I simply cannot resist – damn the torpedoes, full speed ahead. That part, at least, may be relatable.

One more before I let you go:

Our kids had a grizzled ski coach named Mergs. Tall and stooped, with a weather-lined face and unruly white hair, he looked like an alpine Ichabod Crane. His laconic advice to young racers crouched at the start – all eyes on them, nerves taut enough to snap – was simple and perfect and still resonates with me today.

“You got this,” he would say. “Just point your nose down the hill….”

It’s the same difference between Dunkin’ Donuts and Moe’s Doughs (126 Nassau Ave); between Haagen Daz and The Screen Door (145 Driggs Ave); and yes, between Optum, Sinai, or One Medical / Amazon and Westside Family Medicine.

What distinguishes the latters from the formers? For one thing, they are all motivated by more than just profit. Does that mean that, in this day and age of corporate conglomerates and private equity-backed mergers, they carry with them the seeds of their own destruction?

Probably. At least in the long run. But, as John Maynard Keynes famously said, in the long run, we are all dead. In the meantime, they also carry the seeds of something else.

Jacobs wrote, “…lively, diverse, intense cities contain the seeds of their own regeneration, with energy enough to carry over for problems and needs outside themselves.” Walking around Greenpoint in the wake of Covid, it’s hard not to feel that, at least in parts of Brooklyn, the seeds of New York’s post-covid regeneration are sprouting in just the way that Jane Jacobs envisioned.

Dr. Bertie Bregman
Dr. Bertie Bregman
Full Stack Family Medicine is a newsletter about what it’s really like to practice medicine and run a medical practice in New York City.
This blog will be a mix of stories, advice and discussion – topics will diverge widely, but they will all share a point of view!