The lessons God taught a burnt-out medical student

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From Luke’s Journal 2022 | Rest | Vol.27 No.1

My year out of medicine began with me rocking up to the head of 4th year’s office in scrubs, after a long day on the O&G ward, asking if he had time to answer a ‘quick question’. “Only if it’s quick!” the doctor answered brightly, with minutes ticking down until his next Zoom meeting. I sat myself down in the opposite chair: “I’m wondering if it’s possible to take a year off medicine.”

That kickstarted a chain of meetings, where I presented my reasons formally to him, then to the Student Support Officer, my GP, and the Head of the School of Medicine, before filling out a formal submission online, and then waiting agonising weeks for my request to be approved. It felt like jumping through hoops with a broken leg, and by the time the email of success landed in my inbox, I had no energy left for happiness, only relief.

I told the faculty and friends around me that I was taking a year off to “clarify my life direction”, “broaden my experiences” and to “have more time for ministry”. In reality, the biggest reason was that I was burnt out, and had probably been running on fumes since late 2019. Several years of intense study, personal challenges and burning the candle at both ends had left my tank dry. I was so tired that I’d come home from placement during long lunch breaks to crawl into bed; so emotionally exhausted that stories of suffering filled me with dread rather than compassion; and so troubled that my deepest questions about life and faith spilled to the surface like worms on the pavement after a downpour: 

“What’s the calling of my life?” 

“Why am I doing medicine?”

“If everyone is going to die eventually, isn’t the most important thing their spiritual state?”

“Why doesn’t God do more to save those who haven’t heard or understood the gospel?”

“Is He truly good if He doesn’t save all?”

I shared with a friend that I felt like international student ministry and living cross-culturally by share-housing was eroding my sense of self and making me less sure of who I was. Whilst I still believe there is a deconstructive element to cross-cultural ministry,¹ I can now see that part of my experience came from the “depersonalisation” that occurs in burnout.

“Several years of intense study, personal challenges and burning the candle at both ends had left my tank dry.”

“Burnout is an untidy agglomeration of external symptoms and private frustrations!”² proclaimed the internet. It was my reality.

If the statistics are to be believed, 76% of employees feel burnt out at least “sometimes”, while a further 28% of this group experience burnout “very often” or “all the time”!³ You’ve probably read articles on it, been to a seminar about it, or laughed at a meme about it. You may have been through it!

The ill-defined problem can refer to anything from the Irreversible Tragedy in Ministry (see chapter 12 of David Bennett’s biography of Hudson Taylor for a good example of this)⁴ to a throwaway comment after a tiring week: “I’m just so burnt out!”. A condition that is poorly researched, not recognised as a mental health condition by the DSM-V,⁵ and a frustratingly nebulous extension of normal fatigue and stress, it is difficult to pin down what we’re actually talking about. As my Dad once said, “If you read the list of symptoms for burnout on the internet, it sounds like it’s diagnosing everyone!”. And in a world where we are groaning for the New Creation (Romans 8:22) and are not truly at rest in our bodies (2 Corinthians 5), you’ve got to wonder if the inability to find refuge on earth is just part of the human condition.

However, the most helpful definition I’ve found on burnout is the Maslach Inventory triad:⁶

Emotional exhaustion – feeling emotionally depleted and worn down⁷

Depersonalisation – feeling cynical, detached, and treating others impersonally

Reduced sense of accomplishment – loss of satisfaction and achievement at work, as if your efforts no longer mean anything anymore⁸

For me, the last point manifested as existential and spiritual questions, where I felt disillusioned about the purpose of my life, and why God had even created the world if this was the way things were.

If you’ve read that triad and feel exposed, or someone close to you has raised concerns, that may be as good a sign as any that you are burnt out. It’s more than just stress, it’s more than just fatigue, and it requires action. The danger of continuing in this state is harming relationships, becoming increasingly pessimistic, and even developing concurrent mental health conditions like depression. For myself, I realised that if I continued like this, I would become a cynical doctor who resented my patients and a hardened Christian whose faith was characterised by duty rather than joy. To confront the issue I took a year out of my degree, stepped back from volunteer ministry, and met with a psychologist and mature Christian to work through the internal factors and theological struggles that were driving my burnout and stalling my recovery. For you, it might mean dropping some commitments, taking extended leave, visiting your GP for an action plan, or even a career change. My aim in this article, however, is not to change your workplace’s culture, manage your burnout, or even to pretend that I am qualified to do so. What I would like to do, is share three gospel truths that shone more brightly for me during a season of burnout, and which I hope can be beacons for you:

1. ‘Then God rested’

“Six days you shall labor, and do all your work, but the seventh day is a Sabbath to the Lord your God. On it you shall not do any work, you, or your son, or your daughter, your male servant, or your female servant, or your livestock, or the sojourner who is within your gates. For in six days the Lord made heaven and earth, the sea, and all that is in them, and rested on the seventh day. Therefore the Lord blessed the Sabbath day and made it holy.” Exodus 20:9-11

One of the beautiful truths of Christianity is that God invites us to rest. A rest for our bodies, with a Sabbath one day a week (Exodus 20:9-11); a rest for our souls, with a Saviour to follow whose burden is light (Matthew 11:28-30); and a rest for eternity, as we enter the finished work of Christ by faith (Hebrews 4). Instead of “rest” being a legalistic command, it is actually a gift from God to enjoy. Lili Reichow, in her L’Abri lecture “Come & Rest: An Invitation to the Exhausted” makes the point: 

“Yes, rest is re-energising… but if we rest so that we can continue to be busy, so we can continue our activities, we’ve missed the point… because rest comes from Christ and is an offer to be enjoyed, not a pragmatic offer so that we can continue to do something! This is an exercise of re-centreing of identity – we don’t need to be perceived as those who can do it all, who can hold it all together. [We can] embrace being beloved children.”⁹

If you’re feeling run down, embracing the Sabbath again might be just what you need. Or you might need an extended break. Or you might need to explore the 7 different types of rest that Dr Saundra Dalton-Smith outlines in her TEDx talk: physical, mental, sensory, creative, emotional, social and spiritual.¹⁰ God’s command to rest is not a call to a life of monasticism or leisure, but it is a call to embrace regular patterns of rest, and to come and rest in the arms of a loving Saviour who has all things under His control (Matthew 11:28).

2. Creatureliness

“When [Elijah] came to Beersheba in Judah, he left his servant there, while he himself went a day’s journey into the wilderness. He came to a broom bush, sat down under it and prayed that he might die. “I have had enough, Lord,” he said. “Take my life; I am no better than my ancestors.” Then he lay down under the bush and fell asleep.

All at once an angel touched him and said, “Get up and eat.” He looked around, and there by his head was some bread baked over hot coals, and a jar of water. He ate and drank and then lay down again. 

The angel of the Lord came back a second time and touched him and said, “Get up and eat, for the journey is too much for you.” So he got up and ate and drank. Strengthened by that food, he traveled forty days and forty nights until he reached Horeb, the mountain of God. There he went into a cave and spent the night.” 1 Kings 19:3-9

A man who had lived his entire life for God and one of the most iconic prophets of the Old Testament, Elijah, has reached the end of his rope in 1 Kings 19. He is depleted physically and spiritually. But instead of God exhorting him to continue or rebuking him (“this wouldn’t have happened if you had taken more sick leave when you were ministering to the Israelites!”), God gives him a meal, rest and some water. He is ministered to by angels! This highlights the second truth I want to share: God calls us to follow Him in our creatureliness.

Part of the literature around burnout involves the idea that unrealistic expectations about yourself and your capacity create a gulf between your “actual self” and your “ideal self”, leading either to low self-esteem about where you are,¹¹ or relentless striving to close the gap.¹² If that’s true, then surely Christians should be even more prone to burn out, because we feel that difference acutely! 

“For I do not do the good I want to do, but the evil I do not want to do —this I keep on doing.” (Romans 7:19)

“We all, like sheep, have gone astray, each of us has turned to our own way” (Isaiah 53:6)

“For everyone has sinned; we all fall short of God’s glorious standard” (Romans 3:23).

If you are a Christian doctor, you may not only feel like you have fallen short in your diagnostic acumen, but also in your church involvement, your Bible reading, your character, or your love of God. However – and this is an important distinction – humans had limits even before the fall, and limitations are different to sin. That is to say, our limitations are not part of the curse, or something to be pushed back against in hope of the New Creation, but they are actually part of us living in a right relationship with God, as creatures depending on their Creator.

Jen Wilkin puts it this way: 

“Why am I limited and God is not limited? Is it because of sin?

That’s what we think in our head, 

Well, that must be Genesis 3. Genesis 1 and 2, where everything was gonna be awesome, I was probably going to be unlimited. 

But then you start looking at it and you’re like, 

No. Actually Adam and Eve were created in the image of God, but not as God. 

They were created with physical bodies which were limited—they could only be in one place at one time. The idea of rest is in the creation account. They needed to rest. Their strength was not inexhaustible. There was food given to them, so they needed to eat to sustain their energy. They needed to reproduce themselves. There are all of these things that you begin to see, 

Oh wait a minute. The reason that limits exist for humanity is because God designed us to be limited. 

Then we can begin to ask, 

What lessons might we learn if we reflect on the fact that God is limitless and I am actually limited by design? 

Maybe those limits were given to me so that I would turn to the Lord in them.”¹³

Our inability to do more for the Kingdom is frustrating, but it isn’t sinful. Feeling too tired to lead a youth group after a 60 hour work week is discouraging, but understandable. This is exactly what is happening in 1 Kings 19 – God is calling Elijah to follow him as an embodied image-bearer living in a fleshly temple, and is ministering to him in that space – with food, with sleep, with water, and with words of encouragement directly from the mouth of the Almighty.

One of the jobs I worked in during 2021 was caring for a teenager with a drug addiction. He was not a believer, but he did spend a bit of time exploring Christian themes. One song he used to play over and over went like this:

“I know I’m made of clay that’s worn
Blighted by imperfect form
But I will trust the artist molding me
I am creation, both haunted and holy
Made in glory… Creature only.”¹⁴

If you are consistently pushing past feelings of dread because the sense of guilt or obligation is stronger, it will burn you out. Now this is tricky, because there are times when we shouldn’t honour our feeling of dread – after all, we follow a Saviour who took compassion on the crowds and ministered to them even in His grief and fatigue (Mark 6:30-34). But it does mean that we should be wise in how often we do that and take caution against ignoring our creatureliness. And it does mean that we should remember the Saviour who stood in our place and died for our sin – serving Him out of a place of being justified already, rather than needing to earn our status before Him (Romans 3:28).

3. An Eternal Source of Refuge

Finally, I want to ask you, reader: where is your Refuge? Your Hope? Identity? Confidence? Trust? Because it will burn you out to put your trust in your own ability to control the world rather than in God.

Is your refuge in your own ability to conquer death with life-saving medical treatments, or is it in God, the author of life who defeated death and “brought life and immortality to light through the gospel” (2 Timothy 1:10)?

“If you are consistently pushing past feelings of dread because the sense of guilt or obligation is stronger, it will burn you out.”

Is it in Knowing Everything, as a medical student about to sit an exam or a consultant who likes to stay on top of all the latest literature, or is it in the God who knows every hair on our heads, and the movements of every macrophage? (Matthew 10:30, Psalm 139)

Is it in being faultless in your diagnosis and bedside manner, or is it in the faultless Lamb of God who does not turn a blind eye to our imperfection, but who absorbed the full weight of it and washed us clean through His death on the cross? (1 Peter 1:18-19)

Is it in the value and significance you have because of the letters after your name, or is it in the new name that the Son of Man has given you? (Revelation 2:17)

Is it in the refuge that you can find in busyness, or luxurious holidays, or alcohol, or pornography, or an idolatrous use of even innocuous things like Netflix and comfort food… or is it in God Himself, who is our fortress and refuge? (Psalm 91)

Because the only true and lasting place you will find refuge is in knowing the God of the Bible, and the only way to know Him is through His Son, Jesus Christ. There is a lot in this life that we can’t control, and a lot of occupational factors contributing to burnout that we can campaign against, but ultimately have to live with for now. But what we can hold to during a life of little refuge, is the everlasting refuge we can find in God. This does not take away the tricky tension between God’s sovereignty and our responsibility – trusting the God who inscribed the Ten Commandments on stone tablets with His finger doesn’t mean that you don’t need to take notes during ward rounds anymore, for example (Exodus 31:18). But it does mean that any action you do will stem from a quiet confidence in the God who alone can wipe away every tear (Revelation 21:4).

In the end, my year away from medicine was more crisis-filled and stressful than any other year in my life – I managed to rack up 500+ points on the Holmes-Rahe scale, and make it back to my final year by the skin of my teeth. But nevertheless, I recovered, and God answered my prayers for a wider life experience, more time to read, and a deeper relationship with Him. The experience of having everything stripped away taught me to depend on God in a way I’d never had to before, and learn to find ultimate refuge in Him. I pray you have a smoother road than mine, sibling in Christ.

But I pray too, that you come to know God more richly. My brother, my sister: if you are burned out, please know that there is a life of joy waiting for you on the other side. You will be able to see in colour again.

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References:

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7. Preventing Burnout [Internet]. CALE Learning Enhancement. [cited 31 January 2022]. Available from: https://inside.ewu.edu/calelearning/psychological-skills/preventing-burnout/#:~:text=Burnout%20is%20characterized%20by%20the,depletion%20and%20work%2Drelated%20exhaustion.
8. Burnout triad: Manifestations of the 3 core features [Internet]. Empendium.com. [cited 31 January 2022]. Available from: https://empendium.com/mcmtextbook/table/031_0798
9. Reichow L. Come & Rest: An Invitation to the Exhausted [Internet]. labriideaslibrary.org. [cited 31 January 2022]. Available from: https://www.labriideaslibrary.org/IdeasLibraryDatabase/Come-%26-Rest%3A-An-Invitation-to-the-Exhausted
10. Dalton-Smith S. The 7 types of rest that every person needs [Internet]. ideas.ted.com. 2021 [cited 31 January 2022]. Available from: https://ideas.ted.com/the-7-types-of-rest-that-every-person-needs/
11. Higgins E. Self-discrepancy: A theory relating self and affect. Psychological Review [Internet]. 1987 [cited 31 January 2022];94(3):319-340. Available from: https://www.researchgate.net/publication/19545638_Self-Discrepancy_A_Theory_Relating_Self_and_Affect
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13. Wilkin J. The Freeing Reality that You Are Not Enough [Internet]. Crossway. 2020 [cited 31 January 2022]. Available from: https://www.crossway.org/articles/podcast-the-freeing-reality-that-you-are-not-enough-jen-wilkin/
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Recommended resources:

• “My Burnout Prevention Plan” – Valerie Ling
• “Zeal without Burnout” – 7 keys to a lifelong ministry of sustainable sacrifice, Christopher Ash
• The Centre for Effective Living – a NSW Christian psychology practice that specialises in burnout