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Exposure

07/31/18

Michael Weinstein, MD ’94, had a plan to take his own life. Now he is back to living it

At first, his story trickled out in fragments given to his wife, Lara (MD ’95, RES ’98); therapists; and friends when things finally got too heavy to hold. These days it’s different. Never one to write much beyond abstracts and lecture notes, the words come naturally, as he exercises a more authentic voice he didn’t know he had.

When he tells his story, Michael Weinstein, MD ’94 (RES ’99, Fellow ’00), often begins at a clinical distance, enumerating the struggles of an anonymous 48-year-old man. He traces his story back to his teen years and college, which held the beginnings of the depression that would come to consume him. For as long as he can remember, he figured he’d be a doctor since he was smart and strong in science. 

So he went to Jefferson. He fell in love with surgery, the decisiveness, the immediate “cure,” the bravado.

He continued into residency, working hard—all the time—in 36- to 48-hour shifts, where rewards were given in the form of added responsibilities in the OR. The attendings reminded him that they call it “residency” for a reason. His skills grew and grew, but he was haunted by outcomes that all physicians experience at the knife’s edge of trauma surgery. He began to fall into a rabbit hole of self-criticism and doubt.

A pattern was emerging.

Dr. Weinstein

The numbers are sobering: Every year 400 physicians kill themselves—a rate higher than any other profession—80 percent report being at or beyond their capacity, 49 percent report experiencing burnout often or always, and depressive symptoms tick up 15 percent between medical school and residency.

“We’re finally talking about why this is happening because we’re hurting,” says Salvatore Mangione, MD, professor of Medicine and director of SKMC’s humanities track. (See our article featuring Mangione in the Fall 2015 Bulletin.) Mangione sees burnout as a symptom of the pathology afflicting America’s medical establishment.

In the past, he says, people got sick or injured and recovered—or not. The physician had few options for effective intervention and typically served as a comforting, palliative figure. Then in the 19th century, science began to make huge leaps. By the turn of the century, medical science had the X-ray, the germ, the gene, and the ubiquitous white coat.

With them came a new ideal for the physician: an expert technician, trained to coolly read the signs and deduce the cause of an illness. The benefits of this way of thinking are obvious, in longer lifespans, vanquished diseases, and the ability to restore health overnight.

But in the exuberance to train medical scientists, curricula lost sight of one
fundamental fact—the human condition is incurable. The episodic nature of modern, big-system healthcare often means that any one physician rarely has the whole story, and even so, life comes at you fast in the car that didn’t stop at the signal, the sudden rupture of an appendix, a fluke of genetics.

 “You’re 23. You think you’re immortal,” he says of young doctors, “then all of a sudden, you realize that we come to this planet without asking, we go without asking, and then there’s pain, suffering, and death.” The most technically acute minds cannot always have a solution to the cruelty of chance and the inevitability of time and will be left, like their patients, to ask, Where is this going? Why me?

Mangione believes it is the discipline’s responsibility to prepare the next generation to hazard their own answers to the riddles of the clinic and life writ large.

Time went on, and Weinstein became an attending at his alma mater, where he enjoyed the warmth of the place and the camaraderie of a career on the front lines
of healthcare.

He reached new levels of mastery, leading surgical teams and saving lives in the bustle of Jefferson’s Emergency Department. Meanwhile, his own successes lost their luster. The critical abilities that empowered him to see the nuances of surgical techniques, to relentlessly review past cases and prepare for future ones—began to turn on him. 

He couldn’t forgive his own mistakes, lost interest in his work, and was exhausted all the time. 

He was tormented by the feeling that his inability to conjure confidence and shrug off the hurt was a weakness. He avoided interactions with colleagues and patients, and crossed the street without looking in hopes that a passing car might “solve” his problem for him.

He wanted out in more ways than one, but couldn’t imagine another life, fearing that an admission might mean forced retirement and the end of decades of work. Finally, Lara took him to see his friend and family physician—and Jefferson colleague—George Valko, MD ’86 (RES ’89), who agreed that he had had enough. Weinstein was relieved.

He took medical leave and was voluntarily committed to a psychiatric hospital in January 2016. Time there was a litany of medications, psychotherapy, and electroconvulsive therapy sessions. It turned into the straitjacket’s embrace and the view from the small window of his padded
room in the locked ward, where he was committed—this time involuntarily—after refusing to eat or leave his bed.

Escape from the locked ward became a kind of test. Could he convince the doctors, and himself, that he was well enough to leave? He returned to work in April that year, heartened, but without the tools to understand the thoughts that troubled and sidelined him. He considered the pills he had stockpiled, but again, Lara was there to keep him safe, and again he retreated from his work.

This was the darkest depression he’d ever known.

 “There are different scales for examining burnout,” says Diane Reibel, PhD ’78, director of Jefferson’s Myrna Brind Center for Mindfulness, “but they typically measure factors like depression, emotional exhaustion, and depersonalization.”

Reibel, who began her career as a cardiovascular physiologist, has taught Mindfulness-Based Stress Reduction and studied the effects of mindfulness practice at Jefferson for over 20 years.

To most people, mindfulness involves sitting in a quiet room following the breath, and this is a part of the training that Reibel offers.

Among the many practices she teaches is the “body scan,” which involves systematically bringing one’s awareness to different parts of the body. Any activity can be mindful with the right framing, a belief born out at Jefferson, which offers a mindful-
eating class, as well as one geared to elderly people. 

“Mindfulness is basically paying attention on purpose and with curiosity, openness, nonjudgment,” she says. The goal is not a blank mind or the absence of thought, but a form of mental hygiene designed to ensure we do not bring some pathogen into the operating theater of our minds. To explain this way of being, teachers often distinguish between pain and suffering. The former is unavoidable, bodies break and negative thoughts come to mind. The latter is everything else we load on top, the way we have trained ourselves to brace for a blow we expect to come.

Mindfulness, then, is about paying attention to what is happening moment to moment in the body and mind. And once aware, being able to make choices that allow us to respond skillfully rather than automatically.

Tattoos

Weinstein has been collecting tattoos since he has come back to work at Jefferson. They are creative embellishments on his body designed to serve as reminders of why he is still here.

To this day, he’s not sure why the darkness lifted when it did—a change in medications or the discovery of Buddhist philosophy. All he knows is that he holds on to the love of Lara and the kids, taking each day as it comes, paying careful attention to where his thoughts go.

A student of Reibel and her colleagues in the Center for Mindfulness, Weinstein continues to deepen his own practice and to learn how to teach it to others. Slowly, he’s begun to embody the truisms of mindfulness that our culture has imbibed for the past few decades.

The practices stimulate his curiosity and give his well-ordered, surgical mind a way to categorize experiences. Some days the negative thoughts return, overwhelming him like an ambulance siren in the city, but they always subside, dopplering into the distance.
There is tremendous freedom in this, an opportunity to act, or not.

He still sees death and dying in his trauma surgery practice, but he is better able to abide with the patients that medicine—that he—can do nothing for. He can do this because he can sit with himself.

When he came back to work, he knew his colleagues had questions, so he told them his story. The floodgates opened, as people came to him with their own stories of self-doubt and depression, reassured by the fact that they are not alone. 

He is as busy as ever. Though he has scaled back his clinical practice somewhat, his time is filled with leading and teaching. He helps to run Jefferson’s ethics committee and is among the leaders of the newly formed wellness taskforces for SKMC and the Department of Surgery. Now he’s looking after the healers. 

This is his focus: to share the gift that gave him his life back and to pass on what he has learned through trial and error. 

 “As a species, we told stories,” says Mangione of our distant ancestors. “At night, at the fire, we told stories to pass on wisdom,” a kind of experience by proxy. 

Stories are “enzymes that allow us to metabolize pain,” tools for picking up the pieces, and taking the raw facts of the matter and orienting them within our own narratives. In this way, a story is for the teller as much as it is for the listener searching for a way forward.

For Reibel, the act of witnessing with a compassionate presence the suffering of another can be healing. Humans have recognized this since Hippocrates, who observed that a patient may sometimes recover by “the goodness of the physician,” who builds trust and instills comfort.

With practice, she believes, each of us can be our own friendly audience, attending with “kindness to our own inner experience,” composing our story in real time and with an editor’s eye to clarity and getting it right.

Michael Weinstein is a physician and a teacher, a member of a community that helps to keep the human drama going.

Among the many things they do, he and his team provide a service to specialty surgeons called “exposure,” which means that during a planned procedure, they will come and clear a way through a patient’s body to the location of interest.  

He believes all surgery is about exposure—seeing how the anatomy flows together and properly displaying the piece in need of attention. Sewing, cutting, and fixing take patience and talent, but healing first calls for creating space. 

 BY ZACH NICHOLS