Here is the full transcript of Dr. Liz Aguirre’s talk titled “End Professional Burnout: Become More Energized and Less Stressed” at TEDxManitouSprings 2023 conference.
Listen to the audio version here:
TRANSCRIPT:
When I graduated from medical school in 2006, I took the Hippocratic Oath, which included an oath to do no harm. After over 10 years of practice, I have to confess that I have broken that oath hundreds, if not thousands of times. I broke that oath by hurting myself. I thought I was doing the right thing.
After all, becoming a doctor meant working long hours. Going 24 hours or more without sleep was an expectation at times. Drinking an entire pot of coffee was pretty standard for me. Okay, maybe two.
Actually, I have to be brutally honest that I have, in fact, drank three pots of coffee on numerous occasions, and despite that hyper-caffeinated state, I’ve also fallen asleep standing up. When I got home, the insomnia would hit. The next morning, I was too tired to eat and I went straight for the coffee pot once again. I often went 16 to 18 hours with no food.
Of course, now I know that’s called intermittent fasting, so maybe that wasn’t so bad after all. I’m also embarrassed to admit that when I was in my hangry sleep-deprived state, I wasn’t the nicest person. I took it out on the nurses that I worked with, but it wasn’t just the nurses. I took it out on my family and friends as well.
Self-Neglect and Burnout
By the time we reach the point of neglecting sleep, which is one of the most basic human needs, we have done a whole lot of harm to ourselves leading up to that point. Those closest to us try to tell us, but we don’t listen. Any time my husband tried to point out my need to take a break, it always led to a sarcastic rhetorical question, with what time?
Lack of sleep and working long hours are examples of how self-neglect shows up in our lives. This leads to frustration, overwhelm, and eventually burnout. But the question is, why do we neglect ourselves? More importantly, why are we trying to pretend that everything is okay?
Before we can create change, we have to understand why this is happening in the first place. It took me a long time to figure out the answer to this question, but it’s finally crystal clear. The answer is fear. In order to change the culture of self-neglect, we must face our fear and make a conscious decision to prioritize ourselves.
Personal Experience
I thought working harder was the only way to succeed. It’s what I did to prove myself, to prove my worth, to prove that I deserve to be in the room. I challenged my body to its limits time and time again, and eventually my body stopped accepting the challenge. I developed unbearable migraines.
I couldn’t focus, and I was snapping at my beautiful children. I became a version of myself that I didn’t even recognize. Pushing our limits can be a good thing, and it’s necessary for growth, but not when it’s at the expense of our very precious human life. The truth is, fear was driving my decisions without me even realizing it. And this is the case for so many people.
Throughout my medical school training, I was afraid that my classmates would figure out that I wasn’t really one of them. I was a small-town girl who grew up in extreme poverty. I spent years with no running water or electricity, and I spent a lot of time and energy trying to hide that.
Most people didn’t know that I dug out of a dumpster for food, but that was my reality. Between the ages of 10 and 13, yes, 10, Dumpster Day was a regular part of my life, and it was a happy day, because this was the day of the week that I got a gourmet meal when scraps of meat were tossed into the trash. But one night, as I was running home with my big black trash bag, that happiness disappeared. I heard screeching tires and saw police lights come on behind me.
I was so scared. I didn’t think it was a crime to dig out of dumpsters, but for whatever reason, in that moment my mind thought it was. I dropped my bag, and I ran as fast as I could into a field of tall weeds. I’ll never forget the feeling of those weeds slapping my face, or how they felt poking into my body as I dropped to the ground, trying to stay as still as possible, all the while my body was shaking uncontrollably.
The police officer got out of his car, and after searching for what felt like an eternity, he left, but I remained paralyzed. As I laid there with tears running down my face, it was in that moment that I made up my mind that I would never live in poverty again. Sometime later, I heard my mom calling my voice, but I still couldn’t move. It was only after I heard the panic rising in her voice that I finally found the strength to get up, but I made it just far enough to collapse in her arms.
All of us carry dramatic, and sometimes traumatic stories. We carry guilt and regret that lives under the surface of our conscious mind and drives our actions. The night I made that promise to myself is the night that my self-neglect began. For my young mind, the only solution I had was to work harder.
I told myself I would work harder than everyone else, and I would never give up, no matter what. But what I didn’t realize is this led me down a path where I was no longer making conscious decisions, and instead, defaulting to a decision that I had made in a moment of intense fear.
So how did I come full circle? How did I get from that scared young girl to this strong, confident woman standing on stage today?
Working Through Fear
Well, here’s another confession. I’m still scared. The key is not to eliminate the fear, but to learn to work through it. How do we do this? It’s a process. First, we must become aware of the fear and take time to examine it. Many times we don’t realize it’s driving our actions.
Once I did this, I went from saying things like, “I don’t have a choice,” to understanding that the path I was on was my choice. We always have a choice, even when it doesn’t feel like it. What is it that you are afraid of that’s driving your actions? Once we take time to confront that fear and understand why we’re making certain decisions, it becomes possible to choose something different. Then the new question becomes, what do you really want?
What is it that you are no longer willing to live without? What are you choosing out of fear that you need to let go of to create space for the things that matter most? Many times we don’t make conscious decisions because of this what-if scenario that plays on repeat in our minds. But when we confront that fear, we can develop a plan for how to work through it going forward.
Next, we have to learn to be vulnerable. I spent so much time hiding from my past stories and allowing them to make me believe that I wasn’t good enough. Even now, the uncertainty and fear continue to set in, but having this awareness makes it possible for me to course correct. Learning to be vulnerable means asking for help from those who can help guide us to see things more objectively.
This can be a friend, a mentor, a coach, a therapist, or even an online network. And trust me, I’ve had a lot of coaching. Lastly, it’s important to eliminate unrealistic expectations. I found that so many of the expectations were my own expectations that weren’t even real. Is it realistic to stay up all night studying for a test or to work a triple shift? Do we really need to be doing what everyone else is doing? The answer is no. We get to choose.
Challenging Beliefs
I want to challenge the belief that we have no choice because it’s our job. Or the belief that we have to do something a certain way because it’s always been done that way. It’s simply not true. It’s time to move past the point where self-neglect is acceptable and somewhat expected to a place where we set healthy boundaries.
Self-neglect leading to burnout is a pandemic hidden in plain sight. And it’s not just health care. Long work hours are common for oil and gas workers, truck drivers, sales managers, corporate executives, legislators, and many more. In fact, over the last few decades, several well-known disasters have been led at least partially to employee fatigue.
Some examples include nuclear plant catastrophes, the Challenger space shuttle accident, and the Exxon Valdez oil spill to name a few. Lack of sleep has negative consequences. It weakens our immune system and leads to illness. It causes mental impairment.
The National Institute for Occupational Safety and Health explains that being awake for 24 hours is similar to having a blood alcohol level of 0.10%, which would be above the legal level to drive in the United States. This is a risk not just to ourselves, but to everyone around us. A physician’s training is called residency because historically, working long hours meant that they were practically residents of the hospital.
After my first year of training, the Libby-Zion law went into effect, and it established that residents could no longer work more than 80 hours a week or 24 hours in a row. At the time, there were arguments that this was impossible to limit to 80 hours. There were debates about the fact that patients’ care would suffer and residents wouldn’t get adequate training, but these debates forget the very reason the work hour limits went into effect in the first place.
Her name was Libby, and she was a college freshman who died in a New York hospital while being cared for by two residents who were working long hours and exhausted. As a result of this case, the New York Health Commissioner decided to challenge the systemic problems with long work hours in physician training. Even today, physicians in training continue to prove that it’s possible to find success and still work less.
Eighty hours is still a lot, though, I have to admit. This is the part of the talk that I did not plan. One of my very best friends was supposed to be here with me today, and she called me yesterday and said she couldn’t come because she missed her flight, and she was very upset.
But for me, I had a little bit of relief, because she had called me the night before and explained to me that she was working a 16-hour day, and her plan was to go home and sleep for two to three hours, and then drive an hour and a half to the airport. If you’re a person like that, like I once was, your mind’s going to offer you the same words that she told me yesterday, and they hurt me to my core. She said, “You don’t understand, I have no choice.” She threw my own words back at me.
Those are the words I used to say. We always have a choice. Doesn’t feel like it, but we do. Remember that there is a point to diminishing returns where no matter how hard you work, you are not accomplishing more. I went through professional burnout three times, I know. That means I’m triple certified in burnout. I thought when I reached my goal, I would slow down and be happy. But we don’t do that.
We continue the same lousy habits. As a result, the unhappiness continues, and burnout pursues. But when we say, “Me first,” and prioritize our essential needs, we become a much more powerful version of ourselves. The result is a paradoxical outcome, where we’re more energized, more productive, and capable of greater success with better time management.
In other words, we get the job done better and in less time. A change begins with each one of us individually. When we show up as the best version of ourselves, this is the ultimate success. Not only do we achieve the goal, but we get to enjoy the accomplishment.
I hope you all will join me and say, “Me first,” to challenge the status quo, create healthy boundaries, and set an example of what’s possible for generations to come. Thank you.