By Dr. Michael Mulick, Guest Writer
One day in 2010, I approached my department chair to give my notice. I was working my first attending job as an anesthesiologist, and I wished to travel the world.
“I’ll stay until the end of the summer and then I’m leaving,” I said. There was a pause. “I understand. Where are you going?” he asked.
I didn’t know. I assured him the job was fine—plentiful vacation and nice people. I tolerated late-night C-sections, and I didn’t mind the commute—a quiet drive through rural New England, though I hit a turkey once. He survived.
But I missed my fellow trainees. They supported me when I was scolded for violating NPO rules—or scolded for not violating them. Above all, I was 35 years old with six figures in debt, and I was rebounding from a long-distance breakup. I saved most of my six-figure salary. Apart from a ski trip and kitesurfing lessons, there was rent, student loans, and peanut butter and jelly sandwiches. It was not my intention to live like a resident. My colleagues had families. I went home to an empty cabin and studied for oral boards.
My savings caught the attention of a bank teller.
“Whoa dude, that’s a lot of money for a checking account. You should be investing,” he said.
I had focused on studying, hadn't started a Roth IRA, and had forgotten all about Public Service Loan Forgiveness. That last bit stings as I actually lobbied for it on Capitol Hill as a medical student. It had not occurred to me that I could take steps toward financial independence; hence, I didn’t attack my student loans. Nevertheless, my savings stash afforded me options.
Conjuring exit plans was my elixir. I answered job posts as far away as New Zealand. Doctors Without Borders—known by its French acronym, MSF (Médecins Sans Frontières)—seemed ludicrous, but I applied anyway and got a phone interview.
“Would you be OK traveling to a war zone?” the interviewer asked. I paused, then said, “Uhh, I’ll go almost anywhere. I’m not sure about a war zone.”
That was sufficient for a second interview. I rode the Metro-North down to New York and entered a hallway adorned with posters of neglected medical emergencies: Biafra, Congo, and Somalia. They interviewed me in French. I flunked.
“Bienvenue, Michael. Je comprends que vous parlez un peu français.”
“Oui, mais maintenant j'ai oublié mon Français,” I said.
Another interviewer asked me: “What do you really want in life?” and “Why do you want to work for MSF?”
I wanted to fall in love, get married, and have a family. But first I wanted to get away—not as far as Baghdad, Mogadishu, or other war zones as requested, but off the grid from rain forest to mountain a few times before settling down.
At that point, I wasn’t even sure I wanted to be an anesthesiologist anymore. I spent a fortune on a decade’s worth of training and couldn’t wait to become an attending. In medical school, I stayed late because I wanted to learn. As an attending, I stayed because I had to. Yet I loved medical missions: Costa Rica, Nicaragua, Honduras, Thailand, Panama, and Nepal. Less industrialized places restored me, an institutionalized physician.
Something to Look Forward to
I passed my boards, and a few weeks later, MSF offered me work in Sri Lanka. I developed a raging case of senioritis, sensing I was on the cusp of an odyssey.
I had no itinerary beyond Sri Lanka despite warnings like “always have a job” and “don’t have gaps on your resume.” The absence of a plan was intoxicating. I was free to go anywhere. My colleagues threw a party, and one day I walked out of that hospital and never went back.
MSF supplied a 401(k), Cigna International, legal advice, and free psychosocial support. I vacated my apartment, moved into my parent's house, and began a peripatetic time in my life. I bought a copy of War and Peace and got rabies shots, and then, human resources called.
“Mike, we need to talk. Can you go to Sudan instead?”
“We don’t have time to get your visa. Sudan, yes or no?”
I had more questions than answers. A mentor from Yale told me, “It must be nice to be young and stupid. Why would you do this? Yuck!” It was time; my heart seemed strong. My parents were aghast. I flew to Paris, and I was briefed on Sudan. I walked along the Seine after splurging on dinner—€35 per glass of wine—and thought, “Why not?” After all, I didn’t know what I was getting myself into.
I was always going to travel. I’ve known this since I was in fifth grade when, as an exchange student, my French “mom” shoved a few francs into my hand and dispatched me, a kid from the north side of Chicago, into the streets of Paris for bread. The urge for adventure never left me.
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I put on the white T-shirt with MSF in red letters and flew from Paris to Kampala, Uganda, to Juba, Sudan. I disembarked, and the most unusual thing happened: nobody noticed me. There were no touts, nobody was selling, and nobody was asking for anything.
The next day, I flew to Wau and finally to my village, Aweil, about a hundred clicks south of Darfur. We landed a sketchy twin prop onto a patch of red dirt. The heat was a kick in the groin, like summer in Phoenix but humid. I sweated buckets and looked around: no airport, just dirt in every direction. I wanted to ask the pilot to take me home, but six flights in as many days were wretched enough. Besides, I didn’t speak Arabic.
A land cruiser with an MSF flag appeared, as if by magic, to fetch me. We drove past fields with straw and mud huts and reached a compound surrounded by stone and barbed wire. I went into a non-ventilated stand-up latrine and dry-heaved. Then, before even setting down a bag, Nancy, the medical director, asked me to go straight to the hospital and do cases.
“Yes, now,” she said.
“I haven’t eaten. I haven’t slept.”
“After lunch, then.”
A few minutes later . . .
“What’s this?” I asked.
“That’s your lunch: lentils, rice, beans.”
I chased it down with chlorinated water, hopped back in the land cruiser, and minutes later arrived at Aweil hospital, an open building with few walls and fewer windows.
“What’s wrong with this baby?” I asked.
“He has tetanus,” Nancy said.
“Tetanus? Clostridium Tetani? I’ve never seen it.”
“Most die without treatment. If we can get them immunoglobulin in time, we might be able to save them,” she said.
“He is breathing so bad. What if it gets worse?” I asked.
“He’ll die. We don’t have ventilators here,” she said matter-of-factly.
The baby squeaked and frothed bubbles from his mouth.
“What else do you see here?” I asked.
“Malaria, meningitis, polio, skin infections, gastroenteritis, lots of burns, cobra bites, hippo bites. There was a bombing the other day.”
Communicating Is Connecting
I went to the operating theatre and was greeted by a cool breeze from the only air conditioner I ever saw in Sudan. Tony, a Canadian nurse, welcomed me into the small room where Niccola, a local nurse anesthetist, sedated a child. Did I want to place an IV? Of course I did. I wanted to show off what a pediatric anesthesiologist could do. My hand was so sweaty that I broke a glove. Then another.
“Hold your hand up to the air conditioner first,” said Santino, a local nurse.
I placed the IV quickly, and Katherine, a local nurse, made a click sound, a palato-alveolar click. Click consonants are only used in Africa. A single click of the tongue off the hard palate was a good thing, as in, “Good job placing that IV, new guy.” I immediately began using the click.
Rupa, an American pediatrician, walked me home while a man rode by on a horse towing a trailer. Some children saw me and yelled “kowacha,” the word for white man or Westerner. They followed, pointed, and laughed, and soon a crowd formed. A few men stopped their miniature clown car called a tuk-tuk and asked to shake my hand. We returned to a collection of mud huts called tukuls, home to a group of Western ex-pats: nurses, administrators, doctors, coordinators, and logisticians. They were either my age or older with adult children.
I couldn’t sleep that first night. There was a malaria epidemic, but prophylaxis was no comfort. I already had Dengue Fever twice, and it was the Aedes agypti (the yellow fever mosquito) with whom I was at war. I slathered on jungle juice (98% DEET) and spent an hour duct-taping holes in the shoddy mosquito net issued to me. Once situated, the power went off abruptly, halting a fan that was cooling me. I laid in bed the whole night, stared at the motionless fan blades, and sweated.
The next day, I performed lumbar punctures revealing meningitis. Tony and I quoted movies. Katherine and Santino taught me Dinka, the local dialect. “En-sho-goop-wa-shoot” means “I’m tired.” “En-a-witch” means “I want.” I started telling jokes in Dinka immediately.
Make New Friends
An ex-pat team was the perfect cure for loneliness. We lived and ate together. Breakfast: baguettes with Nutella or Vegemite. Lunch: rice and lentils. Dinner: sometimes chicken although one of the nurses made pizza once. Occasionally we had beer from Uganda or chocolates from Europe.
We’d play guitar, tell stories, or watch movies. One evening, the Norwegian Refugee Council hosted us for steaks, salads, and electronic music. I started breakdancing, and later that night, I wrote in my journal: “I peed in a toilet!”
About a week and several dozen trips to the latrine later, I was in the theatre caring for a baby when I got tunnel vision and collapsed. They checked my pressure.
“90 over 40. Hypotension,” Niccola said.
Santino popped in an IV and gave me a liter of Ringer’s lactate. The malaria paracheck read negative, warranting a click of the tongue and a photo. I spent the day watching my team bring patients in and out of the theatre as I lay on a gurney, receiving IV fluids.
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Forget About Your Problems
I was officially off duty, and I laid in my tukul. Tony replenished my IV fluids. Nancy brought me Cipro. Rupa brought Crystal Light to make water taste better. “This happened to all of us, and we were never sick again,” they said.
Two days later, I appeared at breakfast. “You’re alive!” shouted the team.
Indeed I was. And I didn’t get sick again.
The heat made sleep hopeless. My strategy: cold shower, position fan, get into bed naked, secure mosquito net, apply DEET, and get to sleep before the power was cut. If I didn’t fall asleep by 11pm, I was screwed. Sometimes I was woken up anyway for C-sections.
One day, our mission chief said we might have to evacuate. There was an imminent referendum to break the country into North and South, possibly inciting civil war with mass casualties. George Clooney was there at that exact moment hoping to catch the world’s attention.
“We were late to the Congo, we were late to Rwanda, we were late to Darfur,” Clooney said.
I was proud of him, a celebrity that used his voice. I wished everyone knew about our work.
Rediscover Love for Medicine
I gradually adjusted. Charts were hand-written on manilla envelopes. We had an Oxford mini-vaporizer, Halothane, Ketamine, and an oxygen concentrator. Prevention trumped improvisation. For instance, how do you deal with open tib-fib fractures from a hippopotamus bite? Answer: best avoid the hippo in the first place.
I didn’t want to go home. I’ll never forget lying in bed one night, sweating as usual, and sleep deprived. Though I had been working 24/7 for two months, I felt extraordinary joy. It was so profound and unusual. Why am I so happy living in these conditions?
My last day was bittersweet. I sang “Sweet Caroline” and hugged my team. They said, “Bon voyage, Chicago boy.” Katherine, Santino, and Niccola said goodbye in Dinka, and we embraced for a photo. As South Sudan prepared to fight for freedom, I began a flight marathon home, initiating a process known as reverse culture shock.
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I forgot all about winter and left my jacket in South Sudan. When I got to Paris, Ali Besnaci from the MSF office gave me his. I still owe him.
I then discovered the most wonderful sights an ex-pat could behold: clean sit-down toilets, faucets that toggled hot and cold potable water, and French food. I heaped butter and jam onto freshly baked baguettes and couldn’t stop smiling.
Back in the US, I took my mom's car for a spin, and I was bewildered by how smooth a paved road felt. I told friends about the hippo, mini-vaporizer, and lentils. I praised America’s clean facilities, new machines, and vaccines. They could hear it in my voice—enthusiasm for practicing medicine. I honestly could not remember what my old problems felt like thanks to chlorinated water, insects, and heat.
I came home from Sudan with a zen-like calm, which is the reason I’m telling this story. If my trip contains any piece of advice, the main lesson was that I gained perspective. Seeing things anew is to enjoy life. My initial frustration, I see, was misguided. Every career has plateaus that precede deeper fulfillment. I know two doctors that committed suicide and thoughts like, “I’ve had enough,” deserve attention, because behind them is a burning desire for hope and new possibilities.
I was in Chicago only a day before visiting a climate-controlled shopping mall. I spent lavishly on one item, a black blazer for my friend’s wedding, and promptly escaped before the siren song entangled me. Being busy and buying were now the exotic diseases.
MSF paid my way from Chicago to Sudan and back, providing a gross monthly salary of $1,500 which conceived my very first 401(k). My stockpile of cash remained intact, but my net worth barely improved. Finance, to me, was like the Krebs cycle is to a concert pianist, a nebulous cloud of pink smoke. It would be years before I’d write my own financial plan—a setback, yes, but how can you put a price on extending a career’s shelf-life? Practicing medicine in that first job seemed like packing my car all wrong for a camping trip. When I unpacked everything, omitted the non-essentials, and tried again, everything fit.
My favorite lesson is a matter of rejuvenation. Vacation is commonly a predetermined chunk of time with expectations that you are renewed by a specific day. Usually, it takes longer; humans need time to rest. MSF told me, “Tell us when you’re ready for another mission.” So, I bought a one-way ticket to Hawaii and stayed on a friend’s couch.
The days passed. I surfed, forgot which day it was, and regained the weight I had lost in Sudan. Couch life was cheap. I dreamed: another mission, climb a mountain, maybe earn a steady income while traveling. I didn’t know what next. But then one day I did. I received an email from a recruiter that read:
“Kia Ora from New Zealand. There is a position available on the North Island. Would you like to apply?”
I sat back in the couch, took a deep breath, and gave a swift click of my tongue.
What do you think? Can traveling around the world on medical missions help cure physician burnout? Could you envision yourself doing a Doctors Without Borders-like program? Would it be worth it, financially and/or spiritually? Comment below!
[Editor's Note: Michael Mulick is a pediatric cardiac anesthesiologist, and he teaches wilderness and survival medicine at the University of Southern California. He lives with his family and writes about his adventures at mikemulick.com. This article was submitted and approved according to our Guest Post Policy.]