Examining happiness vs fulfillment

Is it possible to be happy while working within a broken healthcare system?

“Do you think I’m a happy person?,” I asked my therapist this week. “You can therapize it after, but just gut instinct, am I happy?”

She nervously chuckles and proceeds - “My initial answer is yes. But the answer behind that is you’re so hard on yourself it’s hard for you to be happy.”

We’ve been working together for about 2 years now, and I’ve gone through break-ups, a new relationship, and trying to unravel my identity from work. It’s a slow, arduous, and painful unlearning, and I’ve just hit a point where I’m sick of my own narrative and rhetoric. I don’t feel stuck necessarily but there is a deep knowing that I can’t continue with my stress being as high as it is.

Now I don’t think I’m a negative or miserable person by any means. I am fulfilled and I genuinely love my life. But I work a lot, I feel incredibly anxious most of the time, I find myself endlessly scrolling and getting trapped in comparison games, and I’m often burnt out and exhausted to the point of feeling paralyzed.

And while my job is wonderful, it’s incredibly hard to reset my nervous system after a sad or challenging patient outcome (nearly daily). I feel perpetually behind, like I’m never doing enough, and that patients are so unhappy with me because of the limitations of the system.

This constant overstimulation makes it challenging to process in the moment. So I’ve learned to compartmentalize, to numb out, to stuff it away until I have the energy to unpack it - which often leads to dissociating. So not only and I not processing these heavy emotions, but the feelings of overwhelm, distraction, inattentiveness, exhaustion, and paralysis compound. I come home and can’t fathom using any more brainpower so end up scrolling endlessly which further incites inattention, dissociation, and distraction.

(ty to my friend Meg for the quality memes that appear throughout this post)

There are some days I feel like a complete fraud and failure. So then my brain jumps to, ‘hmm where else am I not doing enough in my life?’, ie. friendships, relationships, hobbies. I start to recall all the negative things about myself and my life rather than the positive. Furthermore, because of the chaos and endless multitasking of the day, things outside of work that are quiet and normal are intolerably boring. I crave more of the chaos that initially made me feel so awful.

Since this negativity feedback loop happens so often, I start thinking this is now part of my personality. I’m a stressed person. I’m an overwhelmed and reactive person. I’m a sad and negative person. Rather than, “oh I feel stressed in this moment! There, there, it will pass!”

AND what is taught in PA school and in the medical field is a weird and warped hyper-fixation on professionalism. Which is sort of a way of saying ‘take it, don’t complain, it could be worse elsewhere, don’t show emotion, deny your humanism and just keep going.’

Now this didn’t all come out of nowhere. I’m a neurotic perfectionist who genuinely enjoys working. And I’ve found a way for a lot of my identity to be tied up in work. (Side note: whoever said love what you do and never work a day in your life was wrong. More like love what you do, form that into your entire identity and personality, and work every day of your life).

While this has allowed for some success in my professional life, I can’t just turn this off in my personal life, and I think it’s been pretty maladaptive. I don’t particularly enjoy feeling like this - that there’s always something I need to be doing, that I can’t ever fully turn off or relax and feel guilty when doing so.

But now that I’ve reached all of my goals that I dreamed of as a lost 22 year old, I’ve realized that while I love a lot of my life on paper, this constant cycle of self loathing, high stress, and exposure to so much suffering has prevented me from really enjoying and experiencing my life. The self-preservation tool of dissociating and numbing out has made it so it’s hard to experience the big and juicy positive emotions. Since I’m blocking myself from feeling the depths of so much sadness and anger on a daily basis, I’m now operating in a much more narrow range of emotion, which is hard to reconcile.

This ultimately leads to the cyclical guilt of the “I have so much, I’m exactly where I’ve always wanted to be, so many have life worse off than me - WHY AM I NOT HAPPY!!” variety.

Now I know a lot of this absolutely has to do with my job. I see sick people all day long and so my brain starts to think that this small subset of the population is the entire population. The people who are well and get better don’t have as much need to come back and say they’re getting better, so it’s not an equal balance.

This has really changed the way I see and interact with the world. On an hourly basis I’m making direct eye contact with the inequitable and unjust System - seeing how different people have access to different layers of health, working within a system that values profits over people, seeing the deep-reaching effects of trauma on mental and physical health, walking with people during their hardships (grief, chronic illness, mental illness, addiction) when resources are scarce, and seeing how policy and politics adversely affect healthcare via white supremacy, (lack of) gun control, reproductive healthcare and abortion.

Important: I note this with the utmost humility, as being present with people during these times is one of the greatest treasures of my life. I am so incredibly honored to be able to form partnerships with patients. This commentary is absolutely not a complaint about patient care or being with patients, as I genuinely love that. It’s instead a product of what being inside this very broken system is like.

I am so very fulfilled and I feel deep purpose. I acknowledge that what I do is important and necessary (even though some days it doesn’t feel like it is). But there is a layer of happiness and unbridled joy that feels…missing?

I’ve started wondering, despite this fulfilling and purpose-driven work, is it possible to truly be happy - to feel ease, joy, and wonder regularly when you’re exposed to so much stress, sickness, suffering, and injustice on a daily basis?

Do I think every day will be sunshine and lollipops? No. Nor am I expecting that. But I’m tired of coming home and filling up my cup *just enough* to go back to work to be depleted again. Or going on vacation and feeling back to baseline for it all to dissolve after returning to work for a mere few hours.

And I do not think the answer is simply quitting my job. Because the people I work with are wonderful and I dearly love the patients I have the honor of seeing and spending time with. The aim is to find joy in and during the work, despite the heaviness of it, so that I’m not always just getting by - starting with a full cup to have it entirely depleted by the end of the week, scrambling to get back to baseline over the weekend or on vacation. I want the cup to be abundantly overflowing so I have enough to give to patients, and enough to keep for myself and loved ones.

I have amazing friends and family, love where I live, have settled into the most easeful relationship of my life, have been granted with so much privilege and the ability to be well. I want to find more happiness in the day to day and not to be so overshadowed by sadness and suffering, overstimulation and overwhelm, distraction and disassociation.

Because in this work (and in many other realms of life), it is just so easy feel bitter, helpless, and hopeless. Because how are the little things enough when the big things are so catastrophic? This isn’t just a silly little change - this is an effort to feel happier right where I am, in this moment, despite the devastation of the world we live in.

A bit more about me - I’m dry, sarcastic, and feel that *eye roll* is a core personality trait. I’m not someone who any of this comes naturally to (my parents bought me a book called ‘don’t stress the small stuff’ when I was in middle school and I’ve tried meditation so many different times though it’s never cemented as a permanent habit). While I don't want to lose my sass, spark, and edge, I’ve accepted that being so meticulous, so ‘on’ all the time isn’t exactly serving me and may be holding me back. It makes it so it’s really hard to forgive myself when things go wrong or not *exactly* right. I’ve accepted that I’d like to bring a bit more softness to my life.

I have this idea of doing something called a ‘30 soft’ - not nearly as intense as the viral 75 hard, and the goal is lightness and happiness, not looking a certain way or having to follow a set schedule. There’s room for flexibility and imperfection. From the list below, my goal is to aim for 5 of the bullet points per day. I may do more, I may do less; perfection isn't the goal. And I expect every day to be different and therefore to have different needs, hence this list allows for some variability.

30 soft - 5 bullet points most days within the next 30(ish) days. And *presence*, really experiencing it, while doing it.

• immerse in nature

• get outside

• do one thing for the sole purpose of it feeling good. No other reason.

• keep my social media restrictions

• vagal nerve stimulation: laugh, sing, breathe deeply, chant, cry

• sit in silence for 10-15 minutes

• romanticize one small thing

• one act of service for others

• one act of friendliness towards others

• write down persistent negative thoughts and reframe them to positive ones

• write down a list of things that went well at the end of the day

• 3 things I’m grateful for

• list of things I like about myself and unique things I bring to the world

• pay attention to what soothes/recharges me, write it down, and carve out time for it

• do nothing. Like really do NOTHING. without guilt

I will also be (hopefully) interviewing people who have done this purpose-driven, though exhausting, work for decades, who are making the world a better place and who have truly persisted - to see how they maintain their happy spirits.

And I’ll be reading and listening to books, podcasts, articles of happier nations to see if I can adopt some of what they live by (emphasis on appreciation, not appropriation).

Let me be clear - this is not an eat, pray, love. I’m not quitting my job or moving across the world or country. I’m celebrating what I already have, bringing some brightness to the shadows, enjoying the process of the thing, rather than focusing so much on doing or finishing the thing itself.

Important to note - what I already have is A LOT. I am white, able-bodied, thin, and cis-gendered with access to friends, family, therapy, and a healthcare team. I have enormous amounts of privilege and I will continue to acknowledge this in weeks to come.

It’s not going to be aesthetic, there might be typos, there may be poorly edited videos but who fucking cares. It’s aim is to be messy and human and JOYOUS.

Thank you for being here!

In humility and hopeful happiness,
Katie

This newsletter is a reflection of my thoughts and thoughts alone. It is not medical advice, nor is it a reflection on current or prior employers.