Pilgrimage:

Book Title: Pilgrimage: A Doctor’s Healing Journey

Author: Donna Chacko, MD

Publication Information: Eugene, OR, Luminare Press, 2021, 256 pp., $14.99, paperback

This is a tale of burnout and resiliency, of despair and rebirth. Dr Chacko graciously shares her story of plumbing the depths of the abyss as a successful subspecialist (radiation oncologist) and how she found peace in, among other things, family medicine. Don’t worry, for those of us already in the nirvana of the best specialty, there are other lessons in resilience to be gained!

This engaging, self-published memoir is divided into three sections: “The Pit,” “Climbing Out,” and “The Garden.” In the first, she bares her soul, presenting the causes of her personal crisis. Growing up, she felt no sense of unconditional love, and confrontation was studiously avoided. This set the stage for a highly dysfunctional marriage, further complicated by significantly different cultural expectations, which rapidly became noncommunicative. Though professionally successful, her life was summarized as, “I had no support system. My faith was weak. So I did what I always did – I just kept working hard and hoping for the best.” As life spun steadily downward, she sought guidance in a variety of self-help books, including Scott Peck’s The Road Less Traveled.1 Based on this, she did a four-point, pass/fail, self-assessment of: (1) honesty, (2) delayed gratification, (3) accepting personal responsibility, and (4) balance. The conclusion was grim. Along the way, she rediscovered her Catholic faith. Life continued to deal her heartbreaking tragedies, but slowly she found strength. Regarding this point in her life, she recorded, “I was too tired to think of my marriage and what my family had been through. But I would start to notice that life seemed more precious.

The “Climbing Out” section follows the author’s path through loss, grief, memories, healing, and change. As her priorities changed, she felt constrained by her narrow specialty, and a growing burden to care for the underserved: “…to be a real doctor.” She closed her practice, and at age 51, began a family medicine residency. “Some thought I was out of my mind to leave what is considered one of the cushy, high-paying specialties in medicine and enter one of the hardest and lowest paid.” (p. 130). This experience provided additional lessons in humility, transitioning from a knowledgeable subspecialist to a green primary care intern. That teachable spirit persisted, and she demonstrated remarkable insight for someone with the background of a subspecialist, commenting that a major reason for the plateau and even decline in life expectancy in the United States is due in part to the

…health care system [prioritizing] use of medicines, testing, procedures, and operations over primary care and self-care. In family medicine, we were taught to encourage self-care, counseling, and healthy habits, instead of always jumping to medications, injections, CT scans, and specialty referrals. (p. 146)

Following her family medicine residency the author plunged into a second career, caring for the underserved in the inner city. A sense of fulfillment and purpose followed. One might think she lived happily ever after. Alas, that was not to be. As is the experience of many physicians, the imposition of a cumbersome and inefficient electronic health record (EHR) followed by a merger and switch to another EHR took its toll. This left less time for patients—but “Don’t worry,” the vendors say, “you’ll make up for it with higher billing due to better coding”—irrelevant, of course, when caring for disadvantaged populations! With lots of data entered, boxes checked, and information printed, but very little truly meaningful use… burnout was inevitable; it was time for something different.

The final section of the book, “The Garden,” chronicles the author’s finding of what she calls the abundant life: a balance of mind, body, and spirit, based on a meaningful relationship with God. She shares in detail how she found serenity, with the intent of helping others in also achieving it. In fact, she has established an organization to do just that: Serenity and Health.2 There is understandably a touch of promotion of the organization in the closing chapters of the book, but it isn’t commercialized, rather, it is like Kentucky Fried Chicken publishing their secret recipe so that everyone can make it!