Beginning, Middle and End by Dr. Tjorvi E Perry

Stories have a beginning, a middle and an end. Most of the things we do as physicians lend themselves well to story-telling precisely for that reason, they have a beginning, a middle and an end. Medical school had a beginning, a middle and an end. Our residency and fellowships have beginnings, middles and ends. The care we provide for our patients even has a beginning, a middle and an end. At a more granular level, the journal articles we read have a very structured beginning, middle and end. So do our admission notes, progress notes and sign-outs. We read books from cover to cover, guidelines and protocols from top to bottom and H&Ps from beginning to end. We feel unrest with even the slightest deviation from this structure. Beginning, middle and end, beginning, middle and end.

Conditioned in this structure for decades now, I’ve convinced myself the more a story has a clearly delineated beginning, middle and end, the more believable it is. Imagine hearing a story that starts by describing how two men dream of soaring through the air and ends when one of them declares, “It is possible to fly without motors, but not without knowledge and skill”. Or consider a story that starts as a young clinician-researcher warns WWI army physicians about how antiseptic agents, when applied to the surface of a wound, might make deep wound infections worse, and ends as this young researcher goes off on a family vacation for the entire month of August. Without knowing what “knowledge and skill” the Wright brothers gained during their countless hours of designing and testing their contraption, or without knowing that upon Alexander Fleming’s return from his vacation on September 3, 1928, he would soon discover Penicillin, these stories seem uninteresting and irrelevant, at best.

It’s been just over a year since my diagnosis. Merriam-Webster defines Burnout as “1. The cessation of operation of a jet or rocket engine” or “2. Exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration.” My days are still turbulent, with many ups and down. As I reflect, my last decade of life seems a blur. Thinking back further though, I remember being well and feeling happy. I remember laughing with friends, playing outside, sleeping well. I remember my life when I hadn’t the slightest concern for what time of day it was, or whether acquiescing to someone’s demand might later give me the upper hand. I’m grateful for these memories because they motivate me. I’m also clinging to these memories in the hope of finding my way back. In order for me to reclaim my wellness, for my story to seem interesting and relevant, it must have a beginning, a middle and an end.  

So how do I tell my story of burnout? My story of extreme mental and emotional exhaustion. Of anger and isolation. Of fear and suffering. The reality is, I don’t know how. I don’t know how to tell this story so that even I understand it, let alone those around me. I can’t figure out if my story begins when I was in elementary school or if it begins when I was in medical school? Does it begin when I first fell in love, or when I got my drivers license, or when I got married. Or maybe when I had my kids? Does it begin when I failed my first exam, gave the wrong medication for the first time, or maybe when I witnessed my first death? Or maybe it all starts with my parents? Or maybe their parents. My fear is that if my story isn’t perfect, with a beginning I can defend, a middle I can justify and an end that stands to reason. I don’t understand it. And if I don’t understand it, how will others begin to understand. For those who have walked this path, a common logic; there is only value in perfection. If my story lacks perfection and if what I experienced doesn’t much matter, then what am I worth?

But I know what I’ve experienced, I remember feeling it. I understand with every day that passes that entertaining stories are built around facts and not feelings. And at my core, there are no facts, only feelings. I understand with every day that maybe my story can’t be told in a way that brings immediate clarity or instantaneous gratification, no matter the detail. In fact, the more detail I ascribe, the harder it is to understand. To me, it’s the difference between feeling a light breeze slip across your forearm and detailing the impact a gust of wind might have on a pile of leaves.  

For now, I think I know this; my wellbeing is not a story that has a beginning, middle or end. It’s a messy mire of moments of awareness strung together by well-intentioned defenses of delusions, attachments and aversions. My wellness moves forward and backward, up and down without provocation or predictability. During a moment of awareness, my wellness feels perfect, but loses it’s perfection from that moment to another. And as I move between moments, the best I hope for myself is to have the courage to let go to begin again.  


Dr. Tjörvi E Perry lives just outside Minneapolis with his wife Kata, his 3 kids, Edda Brynja (21), Kári Karl (14) and Anja Valborg (10) and their Wiemeriner, Misty. Born in Reykjavik Iceland, he grew up on the north shore of Boston. He completed his anesthesia and cardiac anesthesia training at the Brigham and Women’s Hospital in Boston. He went on to receive his Masters degree in translational and clinical research at the Harvard Medical School. He is currently Assistant Professor and Chief of Cardiac and Thoracic Anesthesia at the University of Minnesota Medical Center.