One Foot in Front of the Other By Dr. Jennifer Baxter

Originally published at https://www.weareunsinkable.com/unsinkable-adult-heroes/one-foot-in-front-of-the-other and reposted here with permission.

Six years ago, my life changed dramatically. One moment that triggered a cascading trajectory of radical shifts in my career, my daily life, and my relationship with myself. Prior to my injury, I was a young rural family doctor “doing it all.” I had found a beautiful community to call home, purchased our first home with my partner, and was building my family medicine practice while working at the local hospital caring for admitted patients, working in the ER, and delivering babies. It was the culmination of everything I had trained and prepared and hoped for.

A few months after settling in, I tried out the women’s ice hockey league. I had played field hockey, and could more or less skate, but had no experience with the sport to speak of. During a scrimmage at the end of the first practice I reached for the puck, tripped, and my head impacted the ice. It hit hard. I got up, perhaps a little stunned, and decided to call it a day. I made my way home without thinking much of it. I continued on with my work that week, migraines escalating, however didn’t think much about it – they had plagued me for years. It was ten days after the impact that I finally realized something was wrong. There was a different character to the headaches. A short walk would bring one on. I spent an entire day in bed. I sat in a conference and couldn’t focus for more than a few minutes at a time. I was assessed by a colleague and diagnosed with a concussion. We navigated markedly reducing my workload for the remainder of the week. I was scheduled to be off for a few weeks, for my wedding, and took this much-needed time away from work. I was confident I would return as scheduled, back to my usual self.

We had a very small ceremony planned for our wedding, intending to hike to the lookout where my partner had proposed. My mom was preparing a Thanksgiving dinner for our celebratory meal. I will be forever grateful that this was our plan. It was exactly what we wanted, and I could not possibly have managed a larger gathering. I was challenged enough by my symptoms: slowing of my cognitive processing so much so that it was evident to others, word-finding difficulties, and as little as five minutes looking at a screen would make me nauseous and cause a headache. I was uncertain whether I could physically handle the hike, but some combination of adrenaline, will power, and love got me to our spot on a truly beautiful fall day, where we were officially married, and shared our first dance looking out over the mountains cascading into the ocean.

After this I was completely spent. I tried attending a training course and struggled with my symptoms and inability to focus. I tried going back to work, and after just a few hours I was physically and cognitively exhausted. I was advised to defer any further return to work by the specialized concussion clinic I attended. Every few weeks we would re-evaluate my progress, and I would be frustrated and downtrodden when I was told I simply wasn’t ready. I am grateful that I listened to the team around me, and for the incredible support of my colleagues, but I felt like a burden. I knew my responsibilities now lay on others, and I desperately wanted to be back doing what I loved.

Eventually I started a very slow graduated return to work, incrementally increasing what I scheduled and allowed myself to do. Everything revolved around my work, and I paced myself to this alone. I had very little left at the end of a day or week for anyone, or anything, else. A year after my injury I started working towards delivering babies again. Sharing such an intimate moment as a family is formed is indescribable, and was a source of great joy for me. And yet consecutive nights assessing labouring mothers and delivering babies were my undoing. The unpredictability of this work was not something I could manage. After accepting that I needed to stop putting these demands on myself, I stumbled my way through the next month or two, miserable, with symptoms escalating again despite progressively reducing my work demands.

It took sitting in a therapist’s office and hearing the diagnostic criteria for a major depressive episode read to me for me to recognize that the diagnosis fit. In my mind, I was still getting out and going to work, so it couldn’t be that bad. It took multiple care providers telling me in no uncertain terms that another leave was necessary for me to get back to myself and my work in a meaningful way before I listened. It wasn’t until I addressed my declining mental health that I saw meaningful recovery again. I grieved the loss of the career I thought I would have. I came to recognize the underlying patterns and habits that were perpetuating my condition; my perfectionistic tendencies, my need to constantly be “doing” and striving and valuing productivity over all else. I let go of the idea of “getting my life back”, and came to learn how to live the life that was in front of me. Without a clear goal of what recovery meant, I was able to lean into what was possible. It took months, but I finally got to a place where I was more whole again.

I returned to my job and gradually increased my workload all over again. By early winter of 2020 I was doing well, working part-time in my office practice, and caring for patients in the hospital. And then the COVID-19 pandemic arrived, and everything changed. I sat in a meeting with my colleagues, where it was decided we needed a group of physicians to manage our local COVID response. For the first time in three and a half years, after so much bowing out of commitments and responsibilities, I felt that I had something to offer again. I volunteered to lead it.

The first few months were made possible purely by adrenaline and caffeine as we reacted to an ever-changing reality; creating protocols and procedures and planning for the worst. I joined the team caring for patients with suspected or confirmed COVID. I had one night when I was called in to deal with a very sick patient, and it took me a week to fully recover. I appreciated then that night work is simply not something my brain and body can manage. It takes me too long to physically and cognitively recover, and doing it again before I am well only compounds it all. I have now set this as a hard limit for myself, and have been fortunate to find ways of contributing in my community while respecting this boundary. I rediscovered my love and passion for managing acutely unwell patients, and was inspired to return to working in the Emergency Department; something I had thought I had been forced to give up for good after my injury, and which brings new meaning and purpose to my work.

There have been ups and downs in my mental health over these past nearly three years of the pandemic. It has been some of the most rewarding and simultaneously most challenging work of my life. I have been exhausted, down, burnt out, without interest in or motivation to do things that once brought me joy. I have sunk into the depths of depression, and dug myself out more than once. I relied heavily on my team – my healthcare providers, my family and friends – to navigate what I needed most when I struggled to see, or to make these decisions, for myself. I prioritized and focused on parts of my work at a time, when doing it all was too much. I came to accept that managing my own family practice was not the right fit for me, right now. I continue to work on minimizing the shame I feel at “not being able to handle it”. I lean into self-compassion, both tender and fierce. I remind myself that no one else is judging me for my choice. I let myself feel and grieve the loss of something I had thought would be the foundation of my career, and the discomfort in uncertainty of what my career will look like moving forward. I lean into my work in the ER, in mental health, and into the administrative role I now have which allows me to think about big-picture, systems-level issues and work to address them. I remind myself that choosing this change is choosing myself, erecting firm boundaries that will keep me well and contributing to my work, my family, and my relationships for the long-term. I remind myself of the contributions I do make, instead of fixating on those I do not.

I continue to pace myself in my weeks, and when I over-reach, I feel it. I work to identify my priorities and values and structure my life, including my work, to honour them. I am still working on not comparing myself with my colleagues whose bodies and minds allow them to work differently than I do. I am choosing myself, and my wellbeing, as well as prioritizing showing up in all areas of my life, not just at work. I am a person who deeply values meaningful relationships, and I am working hard to ensure that I have the time and energy to appreciate and contribute to these. I was a competitive athlete earlier in my life, and I have worked hard to get back to challenging myself physically. I do so now with compassion, matching my physical exertion with my current energy levels and other demands, giving my body the time to heal, rest, and recover.

This spring I walked 785km, one foot in front of the other, from Lisbon to Santiago de Compostela, following the yellow arrows of the Camino Portuguese. It was challenging both physically and mentally, marred by stress fractures that made the last 10 days increasingly difficult. To get through, I leaned into self-compassion, asking myself what I needed most. The fierce side of self-compassion knew I needed to keep walking to complete the pilgrimage. It was important to me, and I knew stopping would hurt too much, in its own way. The tender side of self-compassion recognized that we needed to modify our route for me to be able to complete it. We were a team of three, and we did this together. I accepted the help of my mom and our friend as they took some of the weight from my pack, and encouraged me to take the breaks I needed. Accepting help is one of the hardest things for many of us, and I have learned to lean into it with greater humility, compassion, and grace. For a life lived, and a journey taken together, is much richer than one travelled alone.

Taking a self-compassionate approach to my life, and to the challenges that inevitably arise, is what keeps me Unsinkable. It is what allowed me to walk, one foot mindfully in front of the other, to the Cathedral in Santiago where I placed my foot alongside those of countless pilgrims before me on the scallop shell marking the completion of our pilgrimage. It is what allows me to show up daily, in a healthcare system in crisis, and find meaning in the work I do. It encourages me to shape my career to fit my needs and desires. It inspires me to embrace meaning outside of work. It allows me to create the life I want to live, showing up wholeheartedly, with the boundaries I need to be well.

Dr. Jennifer Baxter is a rural family physician living and practicing on the Sunshine Coast, BC.