I’m healthy. I’m fit. I practise yoga. I can stay calm during any crisis (medical or otherwise). I’m the eternal optimist. I’m resilient. I have all the personality traits and coping skills necessary to manage any stressors that come my way. Except I couldn’t this time. This year there was nothing I could do to protect myself from the illegal working hours I was forced to do, and my inhumane treatment at Hospital X (which you can read about here).
A little bit of stress can be a good thing – you may have heard of the Yerkes-Dodson law, which describes this phenomenon. The body’s “fight or flight” response is activated, and you become alert and ready to take on whatever battle is in front of you. The problem with chronic stress is that these systems are persistently activated and you deplete your energy stores. Your body doesn’t get a chance to regenerate.
It was only when I studied the physiology of chronic stress that I slowly started to accept what’s happened to me these last seven months. As a doctor, I like to know how the body works. After reading about the body’s response to chronic stress, all of my symptoms made sense.
When I resigned from my toxic job, I felt a huge sense of relief. I can finally sleep again, and do so without any ring tone disruptions. I thought I’d rest for a few days and get back to my usual self again. “I can’t wait to go for a run,” I thought. But I was wrong. I couldn’t run. I couldn’t even get out of bed… and I couldn’t sleep. Even now I wake up spontaneously every few hours. My body still thinks it’s on call and can’t fall into a deep sleep despite having tried 7 different medications, and currently taking 4. I can fall asleep easily… I’m not one to ruminate about anything… but I just can’t maintain sleep.
The biochemical changes that take place in the body during chronic stress are very complex, but I will narrow it down to three important players: serotonin, cortisol, and adrenaline.
As stress accumulates, you feel a sense of low morale at first, and then fatigue, which turns into mental and physical exhaustion, and finally you’re burnt out. By the time you experience physical and cognitive symptoms like I did, it is way beyond burnout. You are seriously sick.
In my previous article I described how my gut broke down. There was one time I had to excuse myself from the operating theatre because my gut was so painful that I couldn’t sit down. I had to wait for it to pass before walking back in and getting on with the operation. That’s when I knew there was something seriously wrong… until then I’d ignored all of my signs of distress because that’s what’s expected of us.
Even after I left the job, I had post-traumatic symptoms that taunted me. I thought I could hear my phone ringing, even when it wasn’t. And when it was actually ringing, I froze and I couldn’t pick up the phone. I had this headache that didn’t go away for a few months. My neck and shoulders are still rock hard despite going for massages and acupuncture, which usually do the trick (a sign of too much adrenaline causing my muscles to contract and seize up).
My body doesn’t want to exercise. My BMI officially entered the “overweight” range. Whilst I was working, I was eating so many processed, sugary and fatty foods to keep me going. Even last week I had my cholesterol re-tested and it’s still very high. The normal range is 4.0 – 5.5. Mine used to be low, but it is now 7.3, seven months after I stopped working, despite having transitioned to a healthy plant- and wholefood-based diet. I don’t even want to know what it would’ve been whilst I was slaving away.
And lastly, my brain. I’ve been told by many surgeons that I’ve got the best memory of anyone they know. If you tell me a random story about your neighbour’s cousin’s pet owl, I will remember it 2 years later. I’ll even remember the owl’s name. But now? I can’t even remember what happened a few hours ago. I’ve also had a few speech problems, like jumbling my words or not being able to find the right word. I’d even catch myself doing things like putting facewash on my toothbrush. My brain was tired and declining, yet the hospital was still making me operate on people. Crazy, and negligent.
Physiology of chronic stress
How did all of this happen? In response to stress, your adrenal glands (which sit just above your kidneys) release cortisol and adrenaline (the red and green circles I drew in the picture above). In acute stress, it mobilises energy stores by acting on the liver and muscles to release glucose and lipids into your bloodstream. With chronic stress, they remain elevated and your body becomes unable to regulate the blood levels of sugar and fat. I’m lucky I did not develop diabetes but that explains my high cholesterol.
In addition, sleep deprivation increases your cortisol even higher, which affects your sleep rhythm. Working such long hours inside a hospital doesn’t help. I never saw the light of day, which is important in the production of melatonin, which is a hormone that is released at night to help you sleep. Spending all day indoors at the hospital, and driving home in the dark meant that my body wouldn’t have produced enough melatonin.
Sleep deprivation and stress also affect your levels of leptin and the microbiome, which I’ve previously blogged about here. Leptin is a hormone that usually tells the brain that you’re full, and therefore can stop eating. Hence, it’s a key regulator of appetite and weight management. However, in sleep deprived states, the levels of leptin drop. Similarly, the amount of good bacteria can be halved by just two bad nights’ sleep. There are certain “bad” bacterial strains that then overgrow in their absence and make you gain weight.
The gut is also affected by high levels of cortisol and low serotonin. Cortisol make the nerves to the gut more sensitive to pain, which is why people can have tummy aches when they are stressed. 90-95% of the body’s serotonin is made in the gut, and it plays many roles. In the gut it is involved in peristalsis (moving food along). Therefore a lack of serotonin can cause constipation.
Moreover, serotonin and cortisol affect the brain. Sleep, mood and appetite regulation are all affected. In particular an area of the brain called the hippocampus gets affected, which is responsible for making new memories and learing. This explains my short-term memory loss.
Lastly, I’ll talk about adrenaline and the brain. Adrenaline is released during stressful and emotional experiences. Not only is there a rise during that acute event, adrenaline modulates the formation of your memory of that experience by promoting the sense of fear. There is elevated arousal and fear that becomes integrated with that memory, which is particularly profound in post-traumatic stress.
All of these detrimental effects on the body from chronic stress are morbid. I know several surgeons who have had heart attacks. In my specialty in particular, where we spend long hours peering down a microscope with our head and necks still, there have been many surgeons who have needed neck operations. We are literally killing ourselves for this job.. and it’s made me wonder whether it’s worth it.
After my resignation I had a senior surgeon say to me, “You are good at surgery, so surgery is what you should do.” I thanked him politely, and for a moment I felt enthused that maybe I can return to it… but when I got home, I thought to myself, “just because you’re good at something, it doesn’t mean you should do it.” Plus, selection seems to have nothing to do with how good you are at your job, but how brown your nose is.
A few years ago, a pompous colleague with a terrible tremor and colour-blindness was accepted into the advanced training program. He throws colleagues under the proverbial bus, and – he can’t operate. Those who know him don’t want him operating on them or their family members… I think that says a lot.
So… even though I have gone through a devastating experience this year, it has made me realise what my priorities are:
- Health is the most important thing. If you don’t have your health, you can’t do anything.
- If I continue to pursue surgery, my physical and mental health will continue to decline and I will die. I am not being dramatic here – my elevated cholesterol and stress alone make me vulnerable to a heart attack.
- Just because you’re good at something, it doesn’t mean you should do it.
- I was too attached to the idea of being a surgeon. Yoga has taught me that we shouldn’t attach ourselves to objects, ideas, or other people. Attachment is the root of suffering, as Buddha has also said. So now I detach from what has been my identity for a long time. I am not Miko the surgeon. I am just Miko. And I am enough.
- Ultimately, I want to still help people whilst leading a happy, and healthy life. This is completely incongruent with a surgical career, but I will find something else that will align with my values.
Please take care of yourselves. It’s a reflective time of year – the perfect time to think about what you want in life, and what you need to do to get it. I hope you will find something that allows you to manifest your values, liberates you, and gives you a sense of contentment.