Lifestyle withdrawal

“Withdrawal” by Miles Johnston – on the inside looking out

Working in the ER, I used to see people in withdrawal all the time.  They were a mess.  Whether it was alcohol or opioids, their substance of choice had induced a certain abnormal chemical balance.  The mind and body adapted to the presence of the substance.  Once that substance was withdrawn, it was like removing the leg of a chair – they became unstable, uncomfortable, and panic-stricken.  That imbalance of neurotransmitters can cause so much suffering that even the strongest person will do anything to get another fix.

We all live with a certain neuro-chemical balance.  Hopefully most of us don’t mess with that balance directly and harmfully with illicit substances, but our lifestyles and choices certainly have an effect.  What we eat, how much we sleep, even our amount of “screen time” all influence our particular balance of chemicals like dopamine, serotonin, and GABA.

In trying to understand this uneasiness that I’ve been feeling in the last month or so, Linds made an interesting observation:  even though I was perhaps the most enthusiastic about this trip before we left, of all the people in our family my life has probably changed more than anyone’s.

We’ve all been uprooted from Canada, but Linds’ primary role as homemaker hasn’t really changed even if the locations have.  The kids’ lives still revolve around our family dynamics and learning.  Me . . . no more ER work, no more CrossFit, no more home renovations . . . I’m not busy any more.

I know what you’re thinking:  “Dude!  Wasn’t that the point of all this??”  And you are right. We wanted out of the craziness of “normal life” where we were busy busy busy all the time, running here and there, getting this done and that, all the while having little time left to pursue what we actually thought was important.

We didn’t want a vacation where we could take a break from all kinds of effort . . .

In “normal life” we exert effort in many directions – this is being busy.  Vacations = no effort.

We wanted time and space to focus our efforts on our first priority:  our family.

We’re often spread too thin to apply effort to things that really matter to us.

I am starting to think that part of my problem is simply that I am in withdrawal not from medicine or from Canada or from having a home, but from the crazy, frantic pace of life that I inflicted on myself for so long. I got so used to running that it feels weird to walk.  Now that I literally have the time to stop and smell the flowers, I’m almost too uncomfortable to do it.

The paradox, of course, is that even a healthy change can feel wrong for a while.  The smoker who decides to quit will feel worse before she feels better. It’s still the right choice.  Unfortunately, humans are not wired to appreciate the big picture when the little one is causing discomfort.

In the ER when we were counselling people with substance abuse problems in addition to other mental health issues (which was usually the case) we would always advise them to address the substance abuse first.   In other words, until the physiology has had a chance to reach some kind of homeostasis, there is little point investing time and effort in a treatment plan.  Biology aside, don’t put the horse before the cart.

I am not unique.   I imagine most retirees go through something similar.  They struggle to fill the void left by the workplace.  Some fill it with soap operas and game shows, but many are contributing enormously in meaningful ways.  They are passionate, generous, and focused on what they value.  And they love to instil their knowledge and enthusiasm on anyone who shares that interest.  I know several like this – you know who you are – and I am so thankful to them for their example and inspiration.

I’m not looking for happiness.  I don’t believe it is something you can chase, catch and hold on to.  I won’t find it on this trip or by accomplishing some goal I’ve set for myself.  Happiness is more like a side effect of accumulated decisions: How do you care for your relationships?  How do you care for your health?  Do you spend your time and energy on things that you think really matter?

These are hard questions to answer because we’re all works in progress.  So the answers will often involve fundamentally changing how we live and think.  That’s a big, tough job.

For now I’m going to take the advice I would give my patients:  don’t bite off too much right now.  Know that you’re doing the right thing, surround yourself with people who care, and give yourself time.

Hmm . . . I think it’s already working.

16 Comments

    1. I never would have thought I’d be publicly comparing myself to a drug addict on this blog (!). . . but I have often found that subtle, delicate issues are often clarified by considering more extreme examples. I’m not sure if this is the whole explanation – there are some great complementary ideas in these comments already! – but I think it’s part of it.

  1. Love it and I went through a similar set of challenges some years ago.

    In part we had achieved a set of financial and business goals in 2015 which meant we had technically retired from our old way of life. Within 3 months we had this persistent melancholy and sense of dissatisfaction.

    You could have put us on a a beach with unlimited drinks and food and we would have felt the same.

    The problem we realised that we had lost our sense of growth and purpose. We were living this “Perfect life” but it wasn’t developing us in either a physical, intellectual, or spiritual way. Even though we were getting everything we needed financially and socially.

    Since then I’ve concluded that happiness is tied to growth. That’s why childhood is some of the happiest times in many people’s lives ( in my opinion).

    We definitely work on our “state” but also continually develop a strategies that push us intellectually and financially to cultivate a feeling of growth. It’s made us feel significantly more at peace with travelling.

    I’d suggest that the intellectual “muscles” that you’ve developed through your career are processing your travelling experiences with ease and, as such, maybe in a state of atrophy. Not growth.

    Just a thought…….

    1. One of the best parts of traveling is meeting other people who have different backgrounds and to hear their stories. It was awesome to meet you guys and spend that time with you in Sicily.

      The idea in your last paragraph: “the intellectual “muscles” that you’ve developed through your career are processing your travelling experiences with ease and, as such, maybe in a state of atrophy. Not growth.” – this is definitely worth considering.

      On the one hand, for all the strain involved, emergency medicine wasn’t intellectually challenging anymore which is part of why it was time to leave. Even though the pace is different, there is a whole new skill set involved in full time travel which is kind of fun to learn. But you’re right – it’s not enough. And my fear of “atrophy”, as you put it, is part of what is driving me. Fortunately, there are even more opportunities for growth out here than there were back home: writing is a big one, teaching/learning with the kids is huge, and of course, learning about these amazing places we are traveling to. They’re all new realms for me. Just like any new hire, perhaps I’m going through an “orientation period” . . .?

  2. Adjustment disorder?

    Joking, joking. Everything within the bounds of normal human experience must still be labelled and medicalized 😉

    Great post. Keep doing what you’re doing. The multi-dimensional hamster wheel will always be here. Checking things off the daily list of things to do satisfies some reward centre but isn’t necessarily living.

    1. I’ll let you know when hysterical blindness sets in so that you can prescribe some therapeutic mental/emotional exhaustion on the multi-dimensional hamster wheel. I hear big pharma sponsored a study showing a statistically significant benefit of 0.00000001%. Side effects may include nihilism, marriage breakdown and permanent hysterical blindness.

      Happy to have you here, Matt 🙂

  3. Curious if you think it’s more the absence of being rooted in a community or the loss of routine?

    I take steps two at a time at work, one at a time at home. That’s a distinct boundary I draw between emergency medicine and the rest of life on my own terms.

    If you’ve been taking two steps at a time everywhere, and now you are learning to be still, it’s understandably a different world.

    Thanks for rendering it so picturesquely,

    CD

    1. Hey CD, to be honest, I don’t think it’s either of those things: community or routine. Community, to me, is about meaningful connection with other human beings. I might have even more of that now. And as for routine, it’s not so much a repeating pattern of activity that I need as specific activities like exercise and time to read, write, think . . . One thing that we have hit on though is a need for at least a bit of a plan. Now that we have one in place for the next few months I am feeling a lot better. Perhaps that is what you meant.

      I love your one step vs two step analogy. Linds saw your comment and said, “You were ALWAYS taking two steps at a time!” and of course, she’s right. I was proud of my pace, my productivity in a thousand different directions. But it is time to slow down. Not stop, just focus on a few things rather than too many.

  4. Hi Matt,
    New fan here, also looking to make serious career changes in January and feeling a bit nervous about it. I take comfort in the fact that you made a bigger leap away than me and are living to tell the tale, honestly and humbly.
    I was touched to hear that you thought you may have been too thin-skinned for emergency medicine. I think you would have managed, but we all know it’s a burn out specialty, and it’s hard to maintain empathy all hours of the day and night.
    I know you’re in the middle of your adjustment period, and travelling the world with your fantastic family, but I’m also curious if you’re keeping your license for the forseeable future, if you care to share.
    Thanks, and keep living the dream, even if the dream is still coalescing.

    1. New fan . . . wow, I’m still so flattered and humbled that clearly smart and thoughtful people are reading and commenting here. It’s just awesome.

      I’m happy to share pretty much anything at this point. Although there is some risk in opening the doors of my closet, so to speak, I believe there is greater value in being open and genuine than closed and guarded. It is what I admire in other people like my wife, so really I’m just trying to emulate people who I think are better human beings than me.

      To answer your question about my license, I am keeping it for now simply because I don’t want to close any doors prematurely. As you probably know, in Ontario you can be out of practice for two years before having to re-qualify (it used to be three). As time goes by, medicine is feeling more and more like something other people do, less a part of my identity. There are parts that I miss – the parts where we’re effective at actually helping people who need helping – but being on the front lines of a broken system was just so exhausting. I did it for as long as I could before becoming a bitter, nihilistic a-hole. When I left when people still thought I was a good doc, which is a win in my books.

      Best of luck with your career change. Feel free to get in contact if there’s anything I can do to help.

  5. I think you are right about this. You have been much more bold than me going all in. I am used to a similar rapid pace, but partially scaled back. We are taking frequent 1-3 week vacations. With that, I definitely get withdrawal somewhere around week two and am itching to get back at it. I don’t think I am ready to try and brave the full DTs yet, but am watching what you are doing with both interest and admiration.
    -LD

    1. That’s interesting. Do you feel like you’re training yourself for larger breaks or learning that you don’t want to be away longer? Personally, I always tried to give everyone the time they needed but if I had to work a shift tomorrow I would probably see half as many patients as I used to. Part of me would be fighting back against a system that is designed for efficiency over care, part of it would be self-preservation. I would like to think I will someday find a way to help fix what is broken in Canadian healthcare, but truthfully, I don’t think that is the hill I want to die on.

      I hope you will let me know how your journey goes.

      1. I probably won’t leave clinical medicine for another 5-10 years unless things deteriorate significantly. I am pretty fortunate in that my practice is ICU so it is low volume and high intensity. That could be a burn out problem in other ways, but our group has built a really nice practice model.

        I’d say that I am training for bigger breaks. While I won’t leave clinical medicine for a while I think, I will progressively do less and focus on other areas where I am needed. Right now that is with my kids and writing about finance for physicians. Training is a good word. I think those who only do medicine until the end without spending time cultivating other interests won’t do as well when the time comes. They also cannot go back in time to make up for relationships that are usually time sensitive.

        1. Agree with all of what you wrote, but your last line is key: we can’t go back in time to make up for relationships that are time sensitive . . . In my opinion, they’re all time sensitive, but it’s our kids . . . our kids. Even after only three months I just can’t imagine NOT spending this much time together. I thought it would be a strain, but it just feels so natural and necessary, at least for us. We wouldn’t trade it for anything, even more travel.

  6. Great perspective on some of the challenges people face with early retirement. You go for decades training for and then practicing medicine and then when you leave that behind there is a huge vacuum that needs to be filled with something purposeful otherwise you can fall into depression that a lot of docs face.

    Being an integral part of a team and the social interactions are some of the benefits of working and when that part diminishes or even completely vanishes there is definitely pangs of withdrawal. The key is to re-purpose your life so that you only give up the bad stuff (stress, workload) and keep the good (social interaction, contributing to society, etc)

    1. I agree – it’s a process of being more selective, designing your life according to your values rather than blindly accepting the status quo of wherever you are. Easy to say. Hard to do. But if we don’t choose our priorities they will be chosen for us.

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