The Undeniable Burden Of Shame

“Shame corrodes the very part of us that believes we are capable of change.” 

—Brené Brown

In her book, I Thought It Was Just Me (But It Isn’t), Brené Brown takes the time to distinguish the difference between guilt and shame.  Guilt is: “I did something bad.” Shame is: “I am bad.” The difference is subtle but powerful.  Before beginning my physician coaching journey, I never gave much thought to the idea of shame.  I was familiar with the term but never thought about how commonly it shows up in life.  If you enjoy reading about other people’s vulnerabilities, stay tuned.  Sh!ts about to get real.

I am about to reveal something that I haven’t told anyone.  Not my wife.  Not my family.  Not my friends.  No one.  Here goes: I was commuting home from work and made a mistake.  I miscalculated and entered an intersection that I couldn’t completely clear.  I thought I would be able to traverse the intersection easily, but once I was there, there was nothing I could do.  Before I could even process what had happened, the light changed.  The driver I was blocking at the intersection began to blare his horn.  I looked at the driver and shrugged.  There wasn’t anywhere to go.  He then began to lurch his car forward toward me.  He flipped me off.  Without thinking, I returned the gesture.  Then, he got out of his car.  He stood momentarily by his open driver’s side door, then bent down and started rummaging through his car’s contents.

The fear surged through my body.  Knowing that I live in a city with so much gun violence, my thoughts began to swirl.  I would like not to be dramatic.  I would prefer not to say that my life flashed before my eyes.  But that is precisely what happened.  I thought about what my family would say.  About how deep down inside, they would know that I had escalated the situation before suffering the consequences of my actions one last time. 

The driver couldn’t find what he was looking for and stood back up.  At that moment, I realized that I was not paying attention.  The light had changed, and the cars in front of me had moved.  The intersection was now clear, and no one was in front of me.  I hit the gas and didn’t look back.  And then, I never told a single person what had happened.  Why?  One word: Shame.  I am bad.  I responded badly.  I always do this.  I never learn.  I have expended all of this time, effort, and energy in my personal development, and I am still letting other people get the best of me.  I am irreparably flawed.  

It turns out that shame is everywhere.  My behavior during my GI fellowship training is one of my most significant sources of shame.  My first year of fellowship was the worst year of my life.  I sat in constant overwhelm and sleep deprivation as the busy 1200-bed hospital assaulted the general GI service with up to 20 new consults per day.  The deluge, however, didn’t end when the consults had all been seen.  The unrelenting beeping of the pager and emergency procedures in the middle of the night prevented any rest before returning to the hospital the following day.  I wore my overwhelm like a badge of honor as I reprimanded, “taught,” and scolded residents and attendings alike for their perceived overuse of the general GI service.  There were four GI fellows every year.  At least one fellow per year was well-known for their poor attitude.  In 2006-2007, that fellow was me.  I blamed my attitude on my New York upbringing and the inability of Midwesterners to comprehend my direct nature.  I had thoughts like, “These people would crumble if they dealt with some of the New York attendings I trained under.” I pushed through it, and I survived.  Just barely.  I completed my training and moved on with my life, or so I thought.  When driving past my alma mater, the memories come flooding back.  The predominant feeling, however, is no longer overwhelm.  Now, the main feeling is shame.  My behavior during fellowship training still stings.  I wince whenever I think about it or hear someone else reference my behavior.  I can’t reconcile that I can be a good person who had a bad year.  I am irreparably flawed.

Another incredible source of shame for physicians is our involvement in medical malpractice claims.  I kept telling myself that I sought physician coaching because “something needed to change, but I wasn’t quite sure of exactly what needed to change.” That sentiment is 100% true.  I didn’t know.  At least, that is what I kept telling myself.  If you asked my wife, though, she knew.  Deep down, I knew too.  It was right there, but I couldn’t see it.  How could a two-and-a-half-year battle in the medicolegal jungle not affect me?  I talked to so many physicians who shared their struggles with similar situations.  I spent two and a half years blaming the system, attorneys, and all of the other things that were out of my control.  I questioned so many things, including a career in medicine.  I started exploring ways out.  And then, one day, it was just over.  I was supposed to return to my life and career like nothing had happened.  I was supposed to accept that this whole process was a money grab and had nothing to do with me.  I was supposed to go back to business as usual and forget everything.  But I couldn’t do it.  I couldn’t forget.  And it led to an immense amount of shame.  Rather than address the shame, I looked for the escape hatch.  I buried everything I was thinking and feeling and placed all of my efforts into escaping my medical career.

And, if I’m being honest, there was probably some shame when I signed up for physician coaching.  Physicians are trained to avoid asking for help.  We are taught to “man up” and get the work done.  Illness happens to patients, not physicians.  Mental and emotional health are not discussed or prioritized.  So, if I need help, doesn’t that mean I am irreparably flawed?

Shame is everywhere.  It lurks in our past and present.  Sometimes, it is obvious, other times, not so much.  When we bury shame and hide it, we give it power.  The shame gets stronger.  For those of you who are old enough to remember, think of shame like a gremlin.  You kill it by shining light on it.  You heal from shame by exposing it and bringing it out into the open.  You eviscerate shame by speaking about it. 

It is important to remember that shame is a normal part of human existence.  It is present within all of us from time to time.  However, it is essential to remember that we can learn so much in moments when everything seems to be going wrong.  When you explore these situations, you grow and become a stronger, more resilient version of yourself.  And when you can speak your shame, the burning cheeks and tight feeling in the pit of your stomach become fleeting manifestations of a mistake that doesn’t define you but empowers you to do better next time.   And when you can see through to the other side, you start to see that you are not irreparably flawed.  You are who you are today because of those experiences.  And, most importantly, you are perfect just the way you are.

How do you experience shame in your life?  Do you let those experiences define who or what you are?  What can you learn from those situations?  Is it possible those events were a gift?

Feeling stuck and trying to figure out “What’s Next?” I invite you to download my FREE GUIDE: The 5 Essential Steps Every Physician Needs To Figure Out “What’s Next?”

This resource offers practical, actionable steps to help you take back control of your career, set clear goals, and make consistent progress toward the life you genuinely want.

PS.  I get a lot of inspiration from music lyrics.  Many people use inspiring quotes (and I do, too), but music really speaks to me.  I hope you find inspiration in the songs, too.

Foo Fighters – Shame Shame