Hektoen International

A Journal of Medical Humanities

The doctor behind the labcoat

Varun Raj Passi
Bangalore, India


Coping with burnout

“Sanjeev’s Phantasms” by Chetna VM.

Sanjeev knew he was not asleep, and the very fact that he was conscious enough to know this made him worry. The relentless clicking of the wall-clock above his bedstead amplified his anxiety. He knew that the more clicks he registered now, the less sleep he would get, and in turn the more agitated he would be the next day (or perhaps the same day, but Sanjeev was not foolish enough to make the rookie mistake of verifying if it was past midnight). This vicious circle of distress could only be broken by his two favorite companions lying on the side-table: a bottle of Ambien tablets (which, alas, was empty) and a half-full box of Marlboro cigarettes.

He felt a sudden hankering for a cigarette. He knew that nicotine was a stimulant and therefore would not help him fall asleep. He also knew that without Ambien’s helping hand it was unlikely that he would get any sleep at all. It made perfect sense to sacrifice the miniscule possibility of sleep for the delicious warmth of the Marlboro. It really did not matter much anyway. Sanjeev had gone without sleep for days on an end in the past when he was a student and wore this fact as a victory sachet. Burning the midnight oil was not enough; he had routinely felt the need to push himself to study until it was at least the devil’s hour. A regular dance with the devil would ensure that he would get all the requisite certifications that he would need to eventually execute God’s plan. Or so he thought.

He lit the cigarette and took a long and deep puff. A few seconds later he could feel the blood rush into his brain, pulling thoughts with it as it filled his veins and sinuses. Tobacco had a tendency to make him contemplative, a minor and tolerable side-effect. He began speculating if there were any other factors behind his sleeplessness, besides of course the lack of Ambien. Could it be his incessant worrying? Unlikely. He had felt this way for years now. Could these emotions even be characterized as incessant or, more importantly, as worry? And, even if it was worry, it was both a natural and necessary emotion in his line of work, a strict guide that would ensure he did not stray from his path.

Recently, he had seen a decline in his ability to care for patients. He found it difficult to think quickly while on rounds, frequently forgot to ask his patients important questions before prescribing medicines, and hoped that they would leave his outpatient department (OPD) as fast as possible.

While this did perturb him, what he found more unsettling was that with the passage of time he was finding it more and more difficult to care. His worry (if it even was that) had shifted from being about the wellness of his patients to his inability to even care about their wellness.

He took a few deep puffs. He felt more vexed. He looked at the wall in front of his bed. A framed copy of his degree hung on it. “Dr. Sanjeev Kumar, MD,” he repeated to himself. He wondered if all his knowledge and all the certificates he had earned were meaningless now, for he could not even do the most basic job that was required of him.

He did not like this particular chain of thought. He saw that his cigarette was almost reduced to a butt; it was time to get hooked on another chain. He put another cigarette to his mouth. This time however, he vowed to himself that he was not going to allow thoughts to rush in with the blood. Or at least thoughts about the hospital or thoughts about work. Thoughts about far off beings and places, thoughts about aliens and romance, thoughts about monsters and knights and heroes and zombies were welcome. The rest of this night (or morning), he decided, would be spent in the company of smoke and fantasy.

When he was close to finishing his half-pack, and deeply engrossed in imagining himself as a knight fighting against monsters who had captured the maiden he was supposedly in love with, he saw a faint glimmer of sunlight find its way through the aerosolized carbon particles that had swallowed up all the free space in his room. He picked up on this sign and diagnosed that it was the time of his next shift.

His limbs moved automatically, not waiting for a conscious command from his brain which was still busy with the reverie. He got undressed and danced rigidly to the bathroom for a shower. He thoroughly brushed his teeth and washed his body to eliminate all the signs of tobacco abuse. He got out, put on his regular attire, and looked at himself in the mirror. He had done a good job of gentrifying himself. The circles under his eyes blended well with his complexion; he looked overworked but presentable, a perfectly acceptable look in his line of work.

Dr. Sanjeev Kumar, MD, your friendly neighborhood doctor. Tidy and clean, spick and span, at least to your eyes. Dr. Sanjeev Kumar, MD, who might have spent the night in the company of ghosts and recreational drugs to escape what really haunted him, but was still there the next morning to chase your ailments away.

He got out of his apartment and decided to walk to the hospital, a few miles away, in a vain attempt to de-clog his tobacco filled lungs. He unsuspended the night’s woolgathering, but without the cigarettes this time. As he inched closer to the hospital he saw his colleagues, seniors, and subordinates. He waved at them as he passed them, without recognizing who they were or what they meant to him. He knew them and could probably recall their names and personality attributes if he tried hard enough, but that would mean drawing his intellectual power away from the reverie. He could not neglect his own monsters, zombies, heroes, and maidens to make pale small talk with his fellow confrères.

As soon as he walked through the gates of the hospital he snapped out of his daydream, and practiced his opening line repeatedly to himself.

“Hello, I am Dr. Sanjeev Kumar; how may I help you today?” It took him a couple of tries to get the phlegm out of his pharynx until he got the pitch absolutely right. Beaming to himself, he decided to go to the pharmacy first to procure his treasured Ambien before reporting to the OPD. He had a deal with the pharmacist, who gave him his Ambien without a prescription. However, this pharmacist was available only during the morning shifts, and missing him now would mean suffering more sleepless nights.

While on this quest to procure his favorite source of sleep and calm, he passed by the Psych OPD. Many bright posters lit up its corridors, perhaps to offset the hospital’s gloomy environment. One such poster particularly caught his eye. It had a list of questions arranged serially in a column followed by a few sentences of advice.

Are you feeling depleted of your energy?

Are you feeling an increased mental distance from your job?

Are you feeling less efficient in your job?

Are you feeling negative or cynical about your job?

If the answer to these questions is yes,

you might be suffering from burnout!

Contact a therapist and get an appointment today!


The poster made him chuckle. A wave of condescension passed through him.

Burnout! A mere excuse for laziness!

And therapy! A petty refuge for the inadequate!

He looked away, practiced his opening line to himself again, and made his way to the pharmacy.



VARUN RAJ PASSI is a fourth-year medical student from India. When he is not studying, he enjoys writing and reading, his favorite genres being literary fiction and philosophy. He is also fond of music, and is an amateur keyboardist and bassist.


Fall 2021  |  Sections  |  Fiction

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