My wife had been the maid of honor at her college friend’s wedding. The friend, from a well-to-do family in New Jersey, was marrying another former classmate, the son of an influential man in the New York City meat business.

The reception was at the Plaza hotel in Manhattan. I was seated at a “leftovers” table with the relatives I think each side was hesitant to claim, while my wife sat at the dais. At my table were two sisters, cousins of someone. The younger one was married and seemed quite happy, while the other, seated to my right, had a depressive aura that somehow permeated our conversations.

This manifested with tales of rotten boyfriends, miserable jobs, etc. Finally dessert, the cherries jubilee, was being served. As the waiter finished topping my ice cream with the cognac-flamed cherry sauce, he approached this sad sister, and the flame in the sauce went out.

She stared at the extinguished sauce for a moment, then scanned her table companions, while saying, “That’s the story of my life.”

A very attention-getting article about burnout among physicians was published in 2012 (Arch. Intern. Med. 2012;172(18):1-9).

Of 7,000 doctors surveyed, 45.8% reported at least one symptom of burnout. The study’s authors say that’s an “alarming level.” The highest rates of dissatisfaction were among emergency physicians, practitioners of internal medicine, and family doctors.

Having worked as an emergency physician for more than 30 years, this caused me to look back at some of the variables that seemed to affect those around me who coasted vs. those who struggled. Although a retrospective study might call into question statistical significance, I ended up with a conclusion best summed up by a few pearls I was fortunate enough to integrate into my career view:

A perplexed man once visited a wise man. “The sages tell us to bless God for the bad just as one blesses him for the good, but how is this humanly possible?” he asked.

“That is a good question. For an answer, you must visit a farmer I know,” the wise man replied. The man found the farmer. He had never before seen anyone who suffered such hardship.

“The farmer lived like a pauper. There was no food in the house, and his entire family was beset with illness. Yet he was cheerful, constantly expressing his gratitude to God. The man wanted to know the farmer’s secret, and he finally asked him the same question he had asked the wise man.

“That is a very good question,” said the farmer. “But why did the wise man send you to me? How would I know? He should have sent you to someone who has experienced suffering.”

I think I heard this from Kwai Chang Caine on the Kung Fu TV series: If you raise up hope, it becomes part of your being. If you raise up despair, it becomes part of your destiny.

I recall an uncountable number of times over the years, various folks [consultants, patients, friends, etc.] would ask me how I could work in my trauma center with all the chaos. We lived daily with inadequate staffing by nurses and support personnel, inadequate space [emergency department boarding, plus inadequate capacity], downward pressure from payors mixed with worsening payor mix [i.e., increasing uncompensated care], critical medicine shortages, don’t forget grid locking EMRs, yada yada yada.…

Having done a fair amount of consulting around the country, I had seen emergency departments with much worse conditions than ours. To those asking me about my stressful working environment, I would often echo the farmer’s comment to the perplexed man. I also asked myself, even with focused efforts to fix broken processes, does that mean it’s OK to remain in an environment based on perception?

Buddhist philosophy explains suffering is strongly predicated on one’s perceptions. That certainly doesn’t preclude a poor farmer from moving to a different town with better opportunities or even deciding to become a welder. I was fortunate to have grown up with parents who, despite surviving the Holocaust in Europe during WWII, were able to impart the “hope” part of the hope vs. despair formula to me.

But I also learned to adapt to change, so I began diversifying my career with several successful non-clinical career activities. So I look back with a feeling of gratitude that I was able to avoid having the flame on my cherries jubilee career sauce “burn out.” I am equally thankful for allowing myself to have several other desserts on my plate just in case.

This ACEP News issue has an article on ENT issues in pregnancy. I hope, by making columns such as this engaging and valuable, I can add a bit of fuel to the readers’ flames.