Ceremonyheals blog

…and continue to make ceremony.

For over twenty years of my adult life, I led a rich and full existence, practicing as a conventional family physician. Then, in March of 2005, I crashed and burned. In an episode of deep despair (totally predictable to anyone astute enough to notice all of the signs and portents, but a complete surprise to most of my friends and colleagues) I made a suicide attempt.

Which was, thank goodness, unsuccessful.

What makes my story important and worth sharing is that you will not hear stories from women like me very often. Sadly, most doctors who attempt suicide succeed. More disquieting, most doctors who suffer any mental health/ spiritual health crises will be shamed, blamed, humiliated, and harassed into keeping their mouths shut. If they want to be accepted back into the fold, prodigal sons and daughters must repent, and agree to walk in lock step with the conventional values and attitudes of their brethren.

The religious overtone in the choice of words that I am using is deliberate. I was inspired to write this essay after reading “Leaving the Saints: How I Lost the Mormons and Found my Faith” by Martha Beck. Some of the parallels in Ms. Beck‘s life with respect to her personal journey of awakening, and her church authority’s response to that awakening are frighteningly similar to my own experiences with my state medical board.

Three official groups offered me support in getting back on my feet after my emotional crisis: the state’s medical benevolent society, an organization called Physician Health Services, and my state medical board. These three groups have very different histories and motives. These three groups have very different levels of awareness of their effect on a fragile trauma survivor.

Historically, physicians in trouble have been able to go to their local medical societies for support.  The most common support was financial support offered to widows of doctors.  With urban mythology giving an average life expectancy for physicians of fifty-eight, I saw a certain irony here. I applied for financial assistance from my state Benevolent Society when my short-term disability benefits ran out. As I completed the paperwork for the grant, I thought to myself, “Well, I guess I am a widow to myself! Here I am, a woman doctor in deep financial crisis and in emotional trouble, but I am alive”. I was granted funds twice by this organization, and these funds were all that kept me going financially in that first year of waiting for clearance to return to the practice of medicine.

Physician Health Services is a corporation contracted by my state medical society to offer free services to troubled physicians I was happy to accept these services. This organization has become a gold standard for excellence in the management of impaired physicians. I signed on for a two years of behavioral health monitoring; accepting a standard contract which involved agreeing to an ongoing relationship with a therapist, a psychiatrist, a peer monitor, and with the regional director of the PHS organization.

Early on in my contract with PHS, two things happened that I now see as little tinkling warning bells. First, in June of 2005 an article appeared in the New England Journal of Medicine (“Taking their own lives—the high rate of physician suicide” Eve Shernhammer, M.D., Dr.P.H, NEJM, Volume 352:2473-2476, June 16, 2005). This article calculated a risk of suicide for women physicians as one-hundred and thirty percent higher than age-matched peers.

In a meeting that I had with the national director of PHS (a step in beginning my two year contract), I asked him what he thought of that statistic in Dr. Shernhammer’s article.

“I don’t believe it” he responded.

That made me a little uncomfortable.

Second, there was that comment made by my regional director at PHS. My first question once we had settled into our initial meeting was, “Have you worked with many suicide survivors?” The physician, a man who appeared slightly younger than me and a lot closer in looks to a James Brolin than to a Robert Young, leaned back in his chair, pondering my question. “No suicide attempts” he responded thoughtfully, but I have worked with a couple of doctors that the Board may have driven to suicide”.

What kind of comment was that?

I was deeply disturbed that this man (in a role I assumed was care-taking) said that; to me, a suicide survivor, in the first year of recovery! In retrospect, I see that it definitely helped me gird my loins for interactions with my third official support group: my state Board of Registration in Medicine.

I soon understood that Dr. James Brolin-look-alike was not care-taking me. He was my parole officer.

My Medical Board began their support with an official evaluation by a forensic psychiatrist to assess my competency to return to the practice of medicine. My state Board continued their “support” by shifting their polite and concerned inquiry regarding my competency to return to the practice of medicine to other areas. Their “support” became a formal complaint, charging me with violating boundaries of a patient (sexual!), practicing medicine while mentally impaired, and undermining the public confidence in the profession of medicine.

The details of how a psychiatric evaluation for professional competency (and I was assessed as competent) became an official complaint of sexual boundary violations of a patient would take too much time and has too many bizarre twists and turns to easily describe in this article. A little more on this topic, later.

Sanctuary trauma is a term used to describe the experience of a trauma survivor going to seek sanctuary in a community thought to be safe, and experiencing further trauma at the hands of that community. That would be a good description of what happened to me, in the hands of my Medical Board. At a time in my life when I was extremely vulnerable and struggling mightily to get back to shore from this deep water crisis in my emotional and professional life, my Medical Board held out what looked like a helping hand, and then proceeded to push my head underwater, and hold it there.

I went from being helped to being persecuted quite suddenly and unexpectedly. It became my responsibility to find my way through this ordeal and maintain my sanity.

Enter ceremony, as the operative phrase in my life. I found a way through my professional nightmare by creating ceremony. Rebecca Well, author of “The Ya-Ya Sisterhood” speaks of little altars, everywhere. I created little ceremonies, everywhere.

My personal spirituality centers around earth based traditions (neo-paganism), and has for over twenty years. Ceremony, as defined on-line at wikopedia, means “an activity, infused with ritual significance, performed on a special occasion”.

I made ceremony at a pagan retreat center in July of 2005, using my five days in retreat space there to think about my professional life, my personal stressors, and the consequences of my desperate March actions. I sang, and drummed, and danced. I cried, and laughed, and experienced many epiphanies. I noticed coincidences, and watched for signs and portents. I promised myself that I would come down from the mountain (yes, the retreat really took place at a mountaintop) and continue to use ceremony to heal myself, and to help others, when I could.

As I opened myself to more and more possibilities of letting my spiritual connections inform and guide my day-to-day interactions, many strange things happened. Here are a few examples, from my two-year journey:

Twilight Zone, Episode One

My lawyer frantically chased me (electronically, through a cell phone) up the mountain, as I was on my way to my spiritual retreat. He had an urgent message, with an agreement from the Medical Board that I needed to sign right away. It was a legally binding statement that I “voluntarily” suspended my practice of medicine. The frenzy and frenetic communications over a three-hour period as my attorney faxed papers back and forth between his office, the Board’s office, and the sluggish fax machine in the main office at the Sufi retreat center at the bottom of the mountain were hysterically funny. A friend from New York City was carpooling to the retreat with me. She watched these goings on with increasing incredulity and amazement. She was my guardian angel of objectivity, as she waited in a garden across from the office while the fax machine whirled and hummed. She encouraged me to come and sit with her while we waited, enjoying the humming of bees and watching butterflies lighting on flowers rather than standing over a machine and waiting for something (anything!) to happen at the other end.

There were many urgent deadlines given by my Medical Board on ridiculously short notice in the months that followed. I made frequent trips to Federal Express offices miles from my country home; my attorney and the Medical Board never did quite seem to comprehend of a person who really lived miles away from any fax machines or corporate business supports. Each trip, I created a small ceremony in honor of that first time at the foot of the mountain, and my choice of remaining calm rather than choosing a panic and adrenalin rush response as my professional chain was yanked.

Twilight Zone Episode Two

The interview with the forensic psychiatrist went beyond weird, into the realm of The Outer Limits. First, there was the moment of clear disconnect and hostility, as he (a white man in a position of power) asked me (an African American woman with my professional life in his hands) about the topic of my college thesis. While I wasn’t exactly clear on the relevance of this twenty-seven year old project to my competency to practice medicine, I shared that I had written about the relationship between black women as patients, and the white male doctors who often were their caretakers.

“And what, exactly was your point? He asked, fingers poised to record my answer on the laptop he pecked away at throughout our conversation.

I remember answering as politely as I could, just as his computer crashed. His computer crashed in an unfixable way. His computer crashed in an unfixable way at that exact moment, and he was unable to flex into pencil and paper mode, and had to re-schedule me for another day.

This experience—hysterically funny, like Twilight Zone episode number one—inspired me to create ceremony for every encounter with potentially hostile interviewers and evaluators.

I had many experiences in interviews and evaluations where I got through using ceremony. My favorite involved a three-day remedial ethics program in New Jersey. This program called Pro-Be (I kid you not; it is pronounced PROBE and I was mildly rebuked when I pronounced it incorrectly) fulfilled state requirements for me, as an “ethically impaired” physician. We were all doctors with Medical Boards that had judged us to be in need of ethical education. I agreed with the Medical Board judgments regarding some (e.g. a Christian doctor from a Midwestern state, tangled in a web of sexual dalliances involving several patients, and staff); I did not agree with the Medical Board judgments regarding others (e.g. a Jewish doctor from the Northeast whose termination letter to a patient led to a revenge driven complaint of absolutely no substance). I created sacred space within the constraints of the seminar by writing a prayer of support for each of the twelve other doctors on a piece of origami paper that I brought with me, and folding it into a paper crane. After the seminar was over, I took the cranes and created a mobile. It hangs in my living room today.

Twilight Zone Episode, Three

Dr. Forensics of the crashed computer couldn’t seem to figure me out. He spent three months gathering sufficient data, and needed to interview not three, but five of my peers to assess my medical competence. He had me meet with a psychologist for more testing. She flashed lots of pretty, multicolored ink blots at me, and asked me to tell her what I saw. I remember I asked her how many answers she wanted, and she said, “Oh keep going as long as you see different images”. About 20 minutes into this test she scrutinized me carefully. “Are you an artist?” she asked. I did not respond, “Isn’t everybody? As I wanted to, but said, “Are you asking me if I draw? Yes, I draw…” She looked triumphant, and jotted something down. I think I just got placed in an acceptable box.

Twilight Zone Episode, Four

This example is “the clincher” for me, regarding my relationship to the Board of Registration of Medicine. It represents “irretrievable breakdown” and “irreconcilable differences”. It represents the moment when you know your marriage cannot be saved.

In late June of 2005, I invited friends to a public event in the Boston community where I had practiced medicine for the previous twelve years. In 2004 I had moved a ninety minute drive away to a rural location in the Western Massachusetts, but continued doctoring in that Boston office up to my March crisis. The public event was a dance. It was a dance in a church, in a drug-free, alcohol-free environment. Included in the invited guests were several former patients. It was in this environment that I was judged to have violated the sexual boundaries of a female former patient. I was reported to have performed an erotic dance (my attorney got the language of the Board’s complaint changed to “provocative” from “erotic”) in front of her.

It sounds as if I must have performed a strip tease or at least a pole dance in front of a bound and gagged woman, unable to flee the pornography before her. What I actually did was I performed a ceremony. At this weekly Friday night dance space, community members take turns providing some alternative entertainment during the twenty minutes of a formal break, halfway through the evening. It was my turn that week. In fact, that was one of the reasons I had invited friends to come to this space to say “goodbye” to me; because I would be doing a ceremony of closure with my Boston community. My ceremony during these twenty minutes involved the singing of a Sufi chant (“We are Opening Up In Sweet Surrender to the Luminous Love Light of the One”), holding hands, walking into a spiral circle and out again, ending with the tone “ohmmm”

Erotic dance?

A violation of sexual boundaries?

What must that unfortunate woman have seen, to have even mentioned that dance at her next visit to her current doctor? She was reported to have described the dance as making her “uncomfortable”, and asked her current doctor (my replacement at that Boston office) how I was doing, because I “seemed kind of manic” at the community dance, and had mentioned my suicide attempt to her.

By the time the telephone game had replayed the scene from the dance, through the former patient, to the replacement doctor, then Dr. Forensics, then a medical director, and finally a Medical Board prosecuting attorney, I was a figure who had Undermined The Public Confidence in the Profession of Medicine.

When a formal complaint was filed against me in June, 2006 not by the former patient, but by the Medical Board on behalf of the former patient, I woke up to my real crimes. If I was confused at all when charges of professional ethics violations started being waved around, I became clear as more and more psychological testing was ordered for me. The same psychologist who labeled me “artist” informed me that my mid-Western way of running my practice was in and of itself in conflict with the stricter, Banned in Boston standards of professional medical distance. Boston doctors do not have friends who are patients, or patients who are friends. They do not make house calls. They should, in an ideal world, not run into their patients at all on the weekend in the local grocery store. If such an unfathomable thing as shopping in the same store as your patient should accidentally occur, the appropriate response for a Boston Doctor is to go down another aisle, before you are seen.

I loved my patients. I had done well by my patients for fifteen years of work in the Boston area. I had never in my career been sued for malpractice. I came through my mental health crisis and spoke and acted as my authentic self (which apparently looked “manic” to a former patient). I showed my clay feet through a suicide attempt, and dared to speak about it. These were the behaviors my Medical Bard claimed undermined the public’s confidence in the medical profession.

I am guilty.

I practiced medicine while mentally impaired. Damn straight, I did. I commuted eight- six miles each way four days a week (including Saturday) to eight-hour work days. I did this for over a year, after moving to a more rural community to get my teenage son away from drug influences. I did this while looking for position as a doctor in my rural community. I did this while becoming more and more discouraged with the managed care/ corporate medical scene that I would have to embrace, for my livelihood. Funny how my medical practice’s management did not seem to be concerned about this crazy lifestyle as long as I was keeping up with the number of patients I was assigned to see each day.

I am guilty of having been crazy enough to allow myself to have an untenable work schedule That Shernhammer statistic about female doctor suicides had shocked me, but I had an epiphany when I read it. Yes, I was crazy, with my workaholic (and culturally sanctioned) lifestyle and behaviors. But in my moment of despair and my suicide attempt, I had succumbed to an occupational hazard, not to a basic character flaw. And from all I could see, the level of toxicity in the culture of medicine was going up, not down. Medical care-takers were being asked to do more and more schizophrenogenic behaviors, in the name of Managed Care. My experience with my Medical Board left me deeply disgusted with the current practice of conventional medicine in my state.

Two years and three months into this ordeal, I Just Said No.

I stopped looking for a medical practice with monitoring criteria that would satisfy my Medical Board.

Because I care about my emotional health, I completed two years of official monitoring through PHS, then terminated my contract. Because I care about the lies that were perpetuated about me and my “unethical conduct”, I took a course in ethics, and had myself “certified” as ethically sound.

And where does this adventure leave me?

Taking inventory on what is left of my work as a healer, I see myself evolving into a space beyond the conventional medical practice that taught me how to diagnose physical illness, think through the options for treatment taught to me in medical school, and prescribe treatments (mainly pharmaceutical) for these illnesses. My medical Board has forbidden me to give advice or use these pieces of my education to support clients. How appropriate; I see my talents have progressed to providing education and support regarding spiritual health issues, and I am becoming an expert in this rich and rewarding way of healing. All of those coping skills that I was forced to use to keep myself sane through my ordeal are gifts that I now bring to others.

Physician, heal thyself, was the starting point. Now, I offer with confidence healing for the soul and spirit of clients. I help people create space in their lives to remember the sacred. I help create ceremonies of spiritual healing, using the right-brained “artist” pieces of who I am.

I am deeply satisfied that these “healing artist/ ceremonialist” pieces of me not only survived my confrontation with my conventional medical colleagues, but have actually been polished into gems of creativity that will allow me to serve clients with compassion and caring.