216 Being a Doctor After Being a Patient
less about her disease, and hence sustained her mentally. She knew busyness constituted a form of denial, yet persisted. She spoke haltingly, indicating the degree to which these issues remained hard to discuss.
My coping is by denial. That’ s what keeps me alive. I don’ t really think about it. It’ s why I don’ t get depressed. Basically, I work a lot. I’ m a workaholic. I get stressed not over the fact that I’ m sick, but that I have too many things to do.
Workaholism resulted from‘‘ magical thinking’’ as well. David, a psychiatrist, was aware of his use of this mode of coping, but continued nonetheless:
It’ s basically the‘‘ myth of productivity.’’ If I can’ t be sick, then I won’ t be. If I am very busy, and being sick would be a tremendous inconvenience— it just won’ t happen.
Workaholism can reflect, too, a form of bargaining. Neil observed:
I know I was bargaining— if I took on this and that, see how healthy I am? I will prove to the world that I can do all of this, and be Superdoc.... If I’ m really, really good, and help more people, and take on more, and never say no, then I won’ t get sick. I won’ t die. The bargaining was with God or a higher being: if I work really hard... You won’ t let me die.
Neil expressed a folk belief that spirituality can directly improve health. He also felt that his bargaining was effective medically:‘‘ Being so active has been very good for my immune system.’’
Yet ironically, such intensive commitment, while providing personal meaning, can impair health through stress and fatigue. Hard work could precipitate illness through exhaustion. A vicious cycle can ensue. Neil said:
It’ s a Catch-22: the harder you work, the more patients get referred to you, the more people want you, the better you feel about yourself. But I’ m seeing patients on my day off, which isn’ t healthy. It’ s very tough to balance.
Workaholism can also impede one’ s health by decreasing the quality and quantity of care these doctors accessed for themselves. Jessica, the pediatrician with cancer, said:
I had my treatment at the local hospital where I work. Who would go there for cancer treatment? I wouldn’ t; it’ s not a good hospital.