The prodigal physician

When we tell people that we sold our house and most of our stuff to travel around the world with our kids, the response is often: “Wow, you’re brave!”

But it’s not true. Bravery is action in the face of risk. Traveling is many things – exciting, challenging, uncertain – but it is not particularly risky.

What was risky was to continue doing what we were doing: the kids trapped in a struggling educational system, me being worn down by a broken health care system, Lindsay watching us, powerless. All of it costing money and, more importantly, time that we could be spending together as a family.

Once we wrapped our heads around the idea of full time travel, the risky thing would have been to stay.

A break vs. a change

Some families travel as a break from normal life. We traveled to find a new normal. What would that look like? We didn’t know, but as Albert Einstein said: the definition of insanity is doing the same thing over and over again expecting a different result. Perhaps we could try a few things and see where that landed us. The worst that could happen would be a discovery that good ol’ “normal” was as good as it gets and we could jump back on that bandwagon with confidence and enthusiasm.

Alternatives to “normal”

Almost nine months later, we have seriously investigated several alternatives to “normal”. Lifestyles that would have seemed radical a year ago are now on the table as viable options: buying a boat and sailing around the world, slow travel in various exotic locations, settling down and starting a life somewhere else. Paths that once seemed far-fetched are now laid out in front of us, waiting for us to make up our minds.

Leaving medicine

All of these options had one thing in common for me: leaving medicine for good – and I was ready for that. The state of emergency departments in Canada is dismal; burnout is rampant; and there aren’t many signs to be hopeful about the future. On the other hand, communities need their emergency departments more than ever; from a knowledge and experience point of view, I am at the peak of my career; and, just as I was “burning out”, several exciting projects and opportunities were opening up for me.

I turned my back on all of those opportunities, because I was out of gas and the thought of exploring the world with my family was infinitely more appealing. For months I’ve been describing medicine as a chapter in my life, rather than the whole book. I was ready to move on.

A funny thing happened in Hanoi . . .

But a funny thing happened about a month ago in Vietnam. I was working out at a dusty old gym in Hanoi and it occurred to me that I am not ready to close the door on medicine. If we were to continue traveling beyond a year, it would simply be too long an absence from the ER. My skills would wane, my knowledge would be out of date – I wouldn’t be able to return.

More importantly, I realized that the thought of working in the ER again did not elicit involuntary shudders and overwhelming nihilism. This was a change. There was even a little . . . could it be? . . . excitement? There are lots of things about emergency medicine I grew to resent over the years, but the core mission of helping people when they need it the most was – and still is – thrilling. The fact is, I have a skill set, developed over those years, that makes me particularly suited to that role.

Skill, challenge, and meaning

It’s a little like studying to play the piano. After years of practice and performance it becomes part of you. Songs that would be hard for some, impossible for others, jump from your fingers. Challenging pieces are even more fun: when the level of difficulty is matched by your skill, nudging it higher – that is the soul-swelling meaning of all that hard work, maybe even part of the meaning of life. What would make you stop playing?

In medicine, every patient brings with them a problem to solve, one that they couldn’t solve themselves. They need a doctor to shine a light, revealing the necessary information and assembling those scattered pieces, carefully, with kindness, into something that is understandable. Perhaps not a diagnosis, but at least a plan. Calm the fear. Order the chaos. That’s the kind of music we play.

Playing a broken instrument

Much of time a doctor’s work is gritty and graceless. It’s not like sitting down in front of black and white keys that are always arranged and behave the same way. The instrument we’re trying to play is the health care system and it’s a great big blundering, broken machine. Parts are missing, others don’t work right, and there is almost no margin for error.

So, we’re often frustrated because we feel capable of creating beautiful music but have to settle for a squeaking, honking rendition of what good care would look like. We know how the song should sound, we talk about how it should be performed and yet . . . Patients are disappointed. We’re disappointed.

Frustration tolerance

Like so many others, this constant frustration wore me down (keep this in mind next time you see a doctor). Some physicians seem to accept the limitations of the system better than others: dangerously long wait times, hallway medicine, limited access to essential resources . . . I could never box these problems away. Instead, unable to lower my standards, I suffered them alongside my patients (and was guilty by association). Death by a thousand cuts.

And yet, who better to navigate this convoluted mass of keys and strings and tubes? The patients are still arriving – scared, hopeful, needful. Their problems don’t stop, and after they endure the torture of the waiting room, who are they going to see?

After thirteen years of emergency medicine, I hate the system because I know the system. And it might not be pretty, but I can make it play. A good pianist can still pull songs from a broken piano.

The prodigal physician

I’m no martyr. I’ve proven that I can leave. But can I find a way back? Not for the money, rather for the meaning that comes from using unique and hard-won skills to solve important problems: to help people who need helping.

I’ve said before that leaving medicine was like the end of a relationship for me – I could only imagine going back if either the system had changed or I had changed. Perhaps I was wrong. Perhaps the relationship has a future with some new ground rules.

We’re coming home

So here’s the plan: We’re not sailing. We’re not moving to Malaysia. After we complete a full year of travel (August 2019), we’re moving back to Canada. A smaller house in a more affordable area – a home! We will homeschool the boys. Live modestly. We will still travel – a lot. And I will work – just a little – in a new department that I hope will better align with my values about medicine.

I might not be strong enough to pull this off. But, to all the future patients I thought I wouldn’t meet, I will try.

40 Comments

  1. Matt….your family truly inspires me. I think your plan is a great one. Funny thing is that as I read your comments and feelings about medicine I feel like I could substitute the word education in my version. You are an amazing doctor as I can personally attest to and do make a difference in people’s lives. You have literally saved some. Your gift needs to be shared but not in the standard way and I am glad you have found your way.

    1. Thank you, Naz. That means a lot to me. I also know the struggle I have had in medicine is not so unique. We know so many wonderful, capable people in education who are hamstrung by a dysfunctional system. We can only hope that, for the sake of our children, they can find a way to make their roles both effective and sustainable.

  2. So funny, I was thinking about all of you and pondering if you would come home and what that would look like. I admittedly was thinking about how challenging it would be for the kids to sit at a desk all day after this incredible adventure and way of learning. This plan you have makes my heart sing… for all of you!! Wishing you much love on the remainder of your year long travel and hope we reconnect when you get back to Canada xo

    1. We’ll have to get Linds and the kids to write their own posts about this decision. Suffice it to say, everyone is on board with the idea and the kids are VERY happy they don’t have to go back to a classroom. As a parent, being present for the process of your children’s learning and seeing the bubbling enthusiasm that goes along with it is a wonderful thing.

  3. Wow what an experience and happy you are moving back to Canada. Just wanted to put a plug in for the Haliburton Highlands as your new home. Housing is affordable, limitless opportunities to get involved for every interest and every stage of your life. Awesome home schooling program at Abbey Gardens – great educational outdoor learning environment. Awesome school of Art & Design at Fleming College. 4 season town we were blessed with a record snow fall this year. Great skiing, snowmobiling, snowshoeing, ice fishing.
    Natural & cultural opportunities are endless here thats why we chose to retire here surrounded by fresh air, forests and beautiful lakes. Land of opportunity. We desperately need doctors here. Nadine Artemius founder Of Living Libations just built their new headquarters here. Lindsay you would love their products check out Renegade Beauty. Come & explores Haliburton Highlands. Haliburton is an awesome place to live.

    1. Hi Helen – that was a very compelling plug for Haliburton Highlands! – a gorgeous part of the country, but a little distant from the ER I am hoping to work in. Still, I have a feeling Linds will be looking at real estate up there . . . good to research all our options 😉

  4. I am thrilled that you have decided on your next step. I am happy to hear you will still be sharing your talents with patients who really do need you. If this doesn’t turn out to be what you thought, you can always step back and remodel and redefine your lives again. What a fantastic lesson for the boys to see they are never stuck. If they plan and make responsible decisions, they can do anything. You guys are such an inspiration 🙂

    1. We are viewing this as our next adventure. It will be a lifestyle we haven’t experienced. Kind of like travel, we will give it a year and reassess. If there’s one thing we’ve learned from all this it’s that we don’t need to feel stuck. There is always room for change and adjustment. Sometimes that change is external, sometimes it’s internal. Most of the time they push and pull at each other.

  5. Thank you for this moving and eloquent post. The broken instrument analogy is apt for so many of us in other walks of life as well.

    Burnout is epidemic, not only in medicine… our stress levels reflect our sense of powerlessness, as we watch chest-thumping political leaders around over the world send human canaries out to see just how much injustice and inequality people will tolerate.

    We bumble along, frustrated and disappointed that we cannot do better, for more. The music plays in our heads – while we struggle to do the best with what we have. I’m reminded of a line in “The Year of Living Dangerously” (film, at any rate) while observing the misery of an urban slum: “What then must we do? We must give with love to whoever God has placed in our path.”

    We are among those kindred spirits that have not met your family in person, but feel connected with you and inspired by you, on your important journey. We hope you’ll keep the blog posts up when you get back home, so that we can learn about the negotiations, the adaptations, and the relationships needed to find meaning and purpose.

    1. Medicine is what I know, but the frustration and exhaustion are widespread – this is what I’m hearing over and over since I started writing about it. It is sad, but perhaps the conversation will allow us to better define the factors at play and start to turn the tide. Idealistic, maybe, but what is the alternative? Clearly you understood exactly what I was talking about with this post and that alone gives me hope.

      I certainly do intend to keep blogging.

  6. It will be great to see you, Lindsay and the boys back in Ontario. Looking forward to hearing about all of your adventures in person. Sounds like you have a great plan in mind when you get back.

  7. It is so exciting following your travels. Please pass along my well-wishes to your bigger boys. We speak of them fondly and often at school!

    1. We’re so happy you’re following along. We miss your high (but fair) standards as a teacher and the care you always took to make the classroom as good as it could be. Even though the boys are excited to continue homeschooling, they definitely miss you, their friends, and kindie duty!.

  8. Wow, exciting news! My first stop was to go back to the top and make sure this wasn’t posted on April 1st (April Fools’ Day), but, no such luck. This is the first time I’ve ever felt any measure of sadness over someone else’s travels coming to a close! I was thinking that your new normal would be going from place to place semi-permanently, maybe eventually slowing to the point of spending 6 months per country, or whatever the max tourist visa allowed is in each stop. I’ve also wondered whether you’d end up doctoring as a volunteer/missionary doctor with the whole family serving at some humanitarian mission outfit, perhaps in S.E. Asia, Africa, Turkey, South America, or wherever. But to echo Marla’s comment, I do really hope you’ll keep blogging about your experiences and continued travels (albeit limited to weekend trips and summer trips), even once you have a fixed base to call “home” again.

    1. This is definitely not the end of our travels! In fact, we are doing our best to design our new life around continued exploration of this planet – hopefully three (or so) months of the year. I think having a home base might make traveling even more exciting.

      In terms of international medical work, which is something I am very interested in, maintaining my skills and licence will actually keep that door open. Being out of practice for too long would close those doors too.

      And I think blogging has become a regular habit!

  9. Have really enjoyed following your travels around the world with your family. Happy to hear of your decision to come home after travelling for a year. The new location sounds inviting and a great place for the kids to grow up. Sounds like less pressure for you and your better half with a different career in medicine. I will be watching for your column in Canadian Money Saver in the near future. Thank you and good luck on the rest of your travels! Sincerely Herb and Jess

    1. Thanks for the note, Herb and Jess. It’s a nice feeling to have gained a new appreciation for “home”. And this is a plan that the whole family is excited about, which is awesome.

  10. Quite a reveal! The plan is sound, the aim is true, and as a fellow Emerg Doc recovering from burnout I have great personal interest in the outcome.

    I very much look forward to the remainder of the family’s posts on why this is also the right move for them, as well as understanding why the boys wish to continue home schooling.

    I’m far from alone in sharing gratitude for your openness about your family’s journey and how it dovetails with your personal struggles and search for purpose, via medicine or otherwise.

    All these course corrections, dramatic and small, are adding up to a wonderfully intentional life from where we stand.

    Fondly,

    CD

  11. That’s big news, and with the enlightened perspective you’ve earned over the last year or so, I expect you’ll be happy and energized with the new role.

    Best wishes on the next life transition.

    Cheers!
    -PoF

    1. Want to hear something really funny? I was listening to a podcast that you were on (What’s Up Next) that day in the Vietnamese gym when the epiphany struck!

  12. Now THAT will be brave.

    Trying to struggle for the mythical? “balance” in an active life is the hardest thing. I hope you find the right way for you.

    I do believe “Flow” is real and worthy. Balancing challenge on skills in just the right proportions.

    For now, at least I’m content. I do part-time in clinical practice. The rest is for me, my family and other projects I enjoy.

    Now that I practice medicine less, I enjoy it more.

    I hope you find the same.

    1. The more docs I hear about who enjoy medicine more by doing less of it, the more hopeful I am that our little plan will work – thanks for sharing that.

      I’m also happy that you recognized that I was referring to the phenomenon of “flow” . . . I was reluctant to name it since some might be unfamiliar, but it is definitely a pillar of human contentment and contribution.

  13. Hi Matt,
    First of all, congrats to you and Lindsay and the kids for figuring out what will work for you next year and beyond.
    Your patients will be grateful for your piano playing (this can be literal; two of my med school friends used to play at the Cancer Centre), and I bet the Lindsay and the boys will thrive with homeschooling.
    That said, I feel a bit sad for myself. You’re right that travelling around the world is not a death-defying trip to Mars, but it’s rare that I meet other physicians who are keen on FIRE and actually jump into the RE part. The vast majority keep on practicing, which is terrific as long as they’re happy, and I know their patients are lucky to have them. However, I was excited to ‘meet’ an Ottawa ER doc who actually walked away from it all, because no matter how crazy it seems for me to focus on writing, you’d done me one better. You were kind of a mental pioneer for me.
    Of course that’s silly because we’re all machete-ing our own way, and the most important thing is do what’s right for you and your family, but I wanted to explain why I, at least, thought you were brave.
    Best wishes for all of it,
    Melissa

    1. Hi Melissa, glad to see you here on our little blog. Funny enough, seeing what a prolific writer you are was one of the little pushes I needed to start this blog and write the way I do – so I thank you for that. “Doctor” does not have to consume our identity.

      On that note, I appreciate that seeing someone else break out of a stereotype, forge their own path is exciting and validating when you have similar motivations. But I don’t think you need me or anyone else to know that focusing on your writing is a noble path for you. And I’m sure you are inspiring others with your decision.

      I also don’t think that any of our decisions need to be considered permanent. If one thing is clear, it’s that no one has this life thing all figured out – hence our fascination with all of those who make their struggles of understanding public. I see life as a series of experiments: for us, suburban “normal”, full-time family travel . . . and now a hybrid of the two. We’ll try it out for a few years. It’s our new adventure. I would bet that three to five years from now, we will be on to some crazy new idea.

      “Walking away from it all” adds drama to the narrative. It’s what we needed to do. But, rest assured, the story continues.

      (BTW, for those who aren’t familiar with the term “FIRE” from Melissa’s comment – it means “financially independent, retire early”)

  14. Amazing!! I have lived vicariously through your blog posts over these past months. You and your wife have given your boys an adventure of a lifetime not to mention they learned and experienced things they might never do sitting in a classroom. Enjoy the rest of your adventure!

    1. Hi Lisa – thanks for the comment. When we ultimately screw them up at least we’ll be able to point to this trip as evidence that we tried! 😉

  15. Thanks for sharing this post and your journey so far!

    My husband and I, both resident physicians, have been struggling at various times with the same system issues and feelings of – well, hard to delineate when it’s so jumbled. Different specialties, same heartbreak.

    I think back on first day of medical school and all the optimism that I (and so many of my classmates, I think) came in with. Things are somewhat different now, and some of us in the longer residencies haven’t even started our careers yet. It’s not a matter of giving up entirely on changing parts of the system that just aren’t working right, optimizing processes…but there’s a lot more tiredness. And then comes the secondary burden of feeling guilty and inadequate – and a fraud? – for not feeling 100% blessed all the time for being in medicine.

    Anyways, all this to say – thanks for the glimmer of hope. This was a week with some morose discussions with peers, looking ahead to our future careers. I will be passing this post along to try to lighten their spirits too!

    1. Hi Dr. FIREfly – welcome. You know what’s worse than a new doctor who sees the warning signs and is struggling to find a path in medicine that works? – the new grad who ignored the warning signs and burns out within a few short years. I’ve seen it happen too often.

      Judging by your blog, it looks like you’ve done a lot of thinking about this already, and if you make financial independence a priority (i.e. don’t live like a doctor!) I’m confident you will have the ability to find a sustainable, rewarding place as a physician. Your patients will feel that you are there because you want to be, not because you have to, and that alone will make you a better doctor.

      Feel free to get in contact any time if I can help.

  16. We’re a little late to the comment party here. Your post was big news at our house but realized we forgot to comment. Like Travelin’ Dad, we admit we are disappointed to see that your trip will end as soon as ours will begin. We’re sad we won’t meet up but we’re happy to take the baton! Thanks for sharing the evolution of your professional dreams; we can’t help but wonder how our year will end up. Unlike our “big family” friends, we have always had a return date planned…but now we’re curious to see if we’ll balance the scales and change our minds to stay out indefinitely. 🙂 I guess that’s the beauty of these experiments in worldschooling: you never know what they will bring. Enjoy your last few months and yes please keep blogging!

  17. Hey Matt,

    Changing gears has saved my soul and career. It has also saved our family. Although it has meant leaving the ER after 16 years and moving out of a home we built, it was the right decision for us. We are happy, truly happy.

    The inspiration and extra push we needed to finally make the ‘move’ came from you and your family. Your decision was bold and smart. Family, health and mind first. Thank you!

    Cheers!

    1. I’m truly happy to hear this, Rocco. As challenging as it is, medicine can be a seductive mistress. I will take no credit for your decision to redesign your life – that belongs to you. We all have our moments of weakness; it sure helps to be able to look around and see colleagues who have successfully altered their fight plan to avoid a crash (aviation metaphor just for you :)).

  18. Would you consider medicine, but not Canada? I honestly didn’t comprehend how much I diskliked the overall feel of Ontario — from the colors to the climate to the contours — until we left. I can’t quite put ever moving back into my head. Maybe some place like Vermont, yes. But not Ontario.

    It’s pretty, pretty, pretty nice in California.

    1. Ha ha! I know there are a few American doctors who read this blog, but knowing what I know about the system down there (very similar burn out rates – maybe even higher), I can’t imagine practicing in the US myself – especially in the ER.

      The climate in Ontario is definitely challenging, but, to be honest, we actually miss the seasons! I’m really glad to hear that you guys have found your happy place in California (and I would love to visit!), but what do you think about the research that casts doubt on the link between climate and contentment?

  19. I really enjoy reading your blog and hope you continue sharing your travels and your life. Safe travels!

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