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"We Are All Perfectly Fine"
As we approach that time of year when the days get shorter and the nights get longer and seasonal affective disorder impacts so many, we are dedicated to helping heal our healers and elevating the conversation around physician burnout. Reading the spectacular “We Are All Perfectly Fine, A Memoir of Love, Medicine and Healing” by Dr. Jillian Horton is like nursing on a crisp fall day a comforting cup of warm coffee that was initially scalding. Or a cup of tea if you’re not a coffee person. Meaning we didn’t want it to end because we saw ourselves in every word and every experience that Dr. Horton beautifully writes about regarding her experience of burnout as a physician. Not only did we see ourselves, but also saw colleagues and friends in her words and images, from pre-med to med school and beyond into our and their careers as attending.
In a vulnerable and brave yet also insanely humorous and thrilling at times way, Dr Horton describes her experience at a retreat for burnt-out doctors, weaving in stories from all different times throughout her career from medical school to practicing as a family doctor to being a dean of medical students. In the beginning of the book, Dr. Horton remarks: “Medicine being as difficult as I’ve said it is, nobody should be surprised that med schools need people who function like psychiatrists for students who need to be kept running in the wrong direction or basically combusting in real time. At my school, for the last four years, that person, the associate dean of student affairs, was me.”
She describes signing up for this retreat after her friend, a social worker, invited her to a talk on mindfulness given by a doctor and she wanted to “show her I was open-minded even if I wasn’t.” And thus begins her journey through this retreat with all its ups and downs, it’s silliness and seriousness, it’s zen garden and the ZENDO and mindfulness exercises, it’s flashbacks to her childhood and her disabled sister, and especially all her interactions and experiences with the other participants and all their stories and how all of it affected her as a doctor and a person.
Throughout the retreat, she learns and shares so much about herself as a person and as a doctor and writes about it stunningly, drawing the reader in with every word. At one point in the book, she asks herself “Am I unraveling?” and in that moment and all the ones that follow, we get a real inside view as to what it looks and feels like to be a burning out doctor and more importantly, as the book evolves and progresses, that if we are experiencing something similar, that we are not alone.
One of my favorite parts of the book is this exchange described in chapter 12, which is titled “Christmas is Coming,” and Dr. Jillian Horton is at the physician retreat having a conversation with a fellow doc, Greg.
Jillian: “Don’t you wish something could change in our world? Have you ever gone to an AA meeting?”
Greg looks surprised then hesitates and tries to sound casual.
Greg: “No, have you?”
Jillian: “No, but a lot of my patients go. You know the first step, right?”
Greg: “I don’t actually.”
Jillian: “They start with accepting that life has become unmanageable.”
Greg; “Well that's relatable.”
Jillian: “And you have to accept that you are powerless over the thing that's wrecking you.”
Greg: “I have more trouble with that.”
Jillian: “I don’t totally agree with it either, from the perspective of agency, but what if there is something fundamental about how medicine is affecting us that we could fix with a 12 step program?”
Greg: “You mean, medicine is an addiction?”
Jillian: “No, I'm not explaining it right. More like that the things that help people recover from addiction are the same ones that can help us feel like normal people again.”
Greg: “Like which things?”
Jillian: “Well, like HOPE, COURAGE, HUMILITY, LOVE.”
I have read this book on Kindle, listened to it on Audible, and also have the paperback. Each “copy” is highlighted and bookmarked and has multiple notes scribbled in all the margins (and on the apps) with lots of yeses and exclamation points. It is a true treasure of a book, especially for anyone who is interested in medicine or already in medicine or who loves someone in medicine. I know I myself will return to it many, many more times throughout my life and will recommend it to everyone in medicine and affected by medicine, which honestly is essentially everyone.
As Alan Alda wrote in his completely unsolicited endorsement of Dr. Horton’s book, “Her writing is brilliant and the story of her burnout as a medical doctor is just heartbreaking enough to keep you longing for the resolution you know is coming.”
See Dr. Horton and Alan Alda here in this clip from an interview where she discusses why and how Alan Alda’s role as Hawkeye Pierce in M*A*S*H* inspired her so much. https://www.youtube.com/watch?v=LGdDCP7sxoU