To my story of burnout, there’s more.

A couple of years ago, I shared personal details about my severe burnout, which led to a relatively brief but very real depression, and recovery. I was as vulnerable and honest in that essay as I could be at the time, but I held back. I didn’t share the initial problem, how things got so bad. I worried about judgment and stigma. I worried about my career. I worried about those who bullied me reading it, and I worried they would disapprove. I worried that it would come across as an excuse. I bargained with my conscious I would eventually share it once it could no longer define me–maybe in my 50s.

Despite my plans, I really can’t move on. I want to write other things, imaginative things about the human experience, but my brain keeps coming back to this truth I did not share. This simple, dysfunctional part of me that I keep covered. It should be too small to matter. Still, I look around at others who are struggling, and I can sense their effort: “I am not ok, but I need to it through this one day.” So, let’s just get it out there.

It all started when I returned from a life-changing trip to Ukraine with a cardiac surgeon developing state-of-the-art surgery programs for kids in low and middle income countries. I needed to hit the ground running, and I was on overnight call. Up til this point, I had gotten my prescriptions filled at Walgreen’s because I traveled so much and would often find myself out of town and out of medicine. That evening I needed my meds but was stuck in the hospital, so I transferred my prescription to the hospital pharmacy. Problem solved.

6 years before, I was struggling through my first semester of medical school. I was on a full-tuition merit scholarship and felt relatively confident I could hang. Of course the metaphor of drinking water from a firehose was true, and like all my classmates my study habits scaled up. The first few tests were fine, but I felt like my health and energy level were a little rocky. I had lots of GI symptoms, fatigue, and just overall felt terrible. I didn’t immediately go to the doctor for fear that they would find nothing, and also because I was too busy. However, I was forced to look for answers when my symptoms became so bad I could no longer study effectively; I finally reached a point of desperation knowing I could no longer tough it out. I remember the conversation at student health; I laid out all these issues it could be including an ulcer, told my doctor I was desperate enough to get scoped (have a camera snaked down my esophagus). He smiled reassuringly and said, “Let’s just check your thyroid and go from there.” A few days later, in one of the most validating exchanges of my entire life, he told me I had hypothyroidism and should feel much better once I started treatment.

I had this condition for years. I even ran a marathon with it, never understanding why I could run 20 miles but never faster than a 10 minute pace. I had other symptoms too, bizarre things that made me feel like I was hiding an inner hypochondriac. This diagnosis was so major, explained so much, that it pretty much split time into two: before diagnosis, after treatment. I lived with it peacefully, and I rediscovered my healthy self.

About a week after I returned from Ukraine, I started to struggle. I had severe word-finding difficulties that were humiliating on rounds and during presentations. It was almost like a stutter, and I would search for the next-best word, or change the sentence altogether. In personal conversation I would often lose my train of thought. I distinctly remember forgetting my zip code and phone number on several occasions. My brain fog was so intense and noticeable, it was like I had an internal narrator incessantly asking the question, “Why does it feel like my brain is bobbing on a string 6 feet behind me?” I would have to stop and think which operation I did on which patient; given enough time or with a prompt, it would always come to me. It was like every single thought was too heavy and needed a little boost to land on the stage of my consciousness.

I felt myself slipping, but blamed my poor sleep (many reasons for that), focused on resilience, worked out more, studied harder. Then I got to the infamous, horrifically humiliating rotation. I was careful in my former essay to say that I made mistakes, which is true. I studied every possible waking moment of the day, but the information would drain out of my mind almost immediately. I could hardly get out of bed, and I dreaded my 5 a.m. alarm. I was so tired, I would fantasize about laying down in the parking lot on my walk into the hospital, nearly every day.

I moved onto an Endocrine surgery rotation. While counseling a patient facing a total thyroidectomy, she expressed worry about life-long dependence on supplemental thyroid hormone. I heard myself say, “I am hypothyroid, too.” Then it hit me, a thought that reverberated from the top of my head and washed over me like a red hot blush: I was hypothyroid. I suddenly remembered moving the prescription, that my pills looked a little oval instead of the round ones I’d taken for 6 years. How could I be so stupid?

I checked the dose; it was the same. I called my old pharmacy and compared the generic med companies, which were indeed different. I moved the prescription back, and within a couple of days felt the brain fog completely dissipate.

I didn’t exactly bounce back though. Now I was dealing with the fallout of those hypothyroid months: humiliation of stumbling on that rotation (subsequent ones were actually fine even with the condition), and a spirit-breaking task of trying to prove myself once again. I was overcome with regret. I ruminated over every detail. I was already beyond spent, burned out, and became hopeless. This is when I took the distinct turn toward depression, with invasive thoughts now of driving my car off the road, and feeling like my husband, parents, and friends would be better off without me, even if they didn’t know it.

The happy ending to this essay is not as defined as the other one. Yes, I overcame that dark chapter and can only remember those feelings on an intellectual level now. Why am I still ashamed of my simple, innocent, biologic, medical problem?

A few years I I saw a post in a Facebook group for doctors, with a photo of a lovely female physician posing with a mug that read, “It’s not your thyroid.” The comments were full of playground banter at how the thyroid gets blamed for everything. I was shocked at how many physicians piled on.

Hypothyroidism is remarkably common. In my family across 3 generations, every female has it except one. The thyroid is nicknamed “the body’s thermostat.” If you look up the symptoms, it can have pretty varied presentations. To that doctor-with-the-mug’s defense, I’m sure it’s frustrating that sometimes the diagnosis ISN’T something that simple and treatable. It more commonly affects women than men, and much of the negativity around it feels distinctly mysogynistic. Despite the condition being common and easily treated, hypothyroid women are still stereotyped as hysterical, needy, and, most troublesome to me, weak.

Things worked out for me. I don’t think I would have pivoted career paths without a major earthquake, and for that I’m grateful. I ended up exactly where I needed to be, and I learned a lot about perseverence, balance, and mental health. I received compassion from some loved ones and mentors, who had no idea of my underlying struggles, that I cherish to this day. Nevertheless, when I read comments by other physicians about burnout, wellness, and resilience, I notice a distinct absence of discussion about our physical health. How many dark seasons of burnout may be sparked by a medical problem, big or small? How often do we neglect to seek medical care out of hopelessness, fear, or because we are just too busy? How many of our colleagues are struggling but keep it to themselves for fear of discrimination or embarrassment? Unfortunately, from my experience, overcoming the physical problem may be just the beginning.

I’m hopeful that physicians can feel comfortable in their human bodies someday; bodies that experience every pathology and condition as much as their neighbors. I hope patients are no longer disparaged for their illnesses. I hope that I continue to forgive myself for what I can’t control. I hope the mug gets thrown away.