We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing

Book Title: We Are All Perfectly Fine: A Memoir of Love, Medicine and Healing

Author: Jillian Horton, MD

Publication Details: HarperCollins, 2021, 304 pp., $18.99, paperback

Our medical colleagues are burning out at record rates. Ninety-one percent of US physicians have felt burned out at some point in their career. ¹ The pressures of quality improvement, electronic health records, 15-minute appointments, and waning connections with colleagues all contribute to the morass. Where do we turn to find relief and solace?

Jillian Horton, a Canadian internist, reached the limits of her capacity as associate dean of students and clinician at the University of Toronto. The demands of teaching and caring for hospitalized patients became like a yoke. She found herself completely burdened by emails from students, paperwork for patient care, “and wishing everyone else would leave me the f*#k alone!” (p. 13). At that point, she boarded a plane to Rochester, New York, to attend a retreat at the Chapin Mill Retreat Center for doctors suffering from burnout with founders and program directors Ron Epstein and Mick Krasner of the Mindful Practice in Medicine program at the University of Rochester. The book chronicles the journey of her rise and fall in academic medicine.

We learn about her childhood, specifically the illnesses of siblings, which led her to pursue a career in medicine. We discover how these early experiences in life drive us to become doctors but also can haunt us. Readers will find themselves doing their own self-discovery as they experience the ups and downs of the author’s journey. Clinician readers will relate when Dr Horton describes her difficultly absorbing the transference of patients and their families’ anger at their diagnoses and at the medical system. We all experience this emotion, however it exacts a toll on our psyche. She writes about not being able to complain to colleagues because they seem to be in the same situation. No wonder we burn out, she muses. We work even when we are sick and strive to never be unkind to our patients even as we lack kindness for ourselves.

Dr Horton is a gifted storyteller. She artfully uses the other doctors at the retreat (ie, a pediatrician, a surgeon, and an emergency medicine and family medicine doctor) to make her point. Her attention to detail in her writing makes the characters and their tales powerful. When a chief resident describes a serious error, we are there with her; the guilt and lack of self-forgiveness feels like déjà vu. In her case, even when a family is ready to move on, she is not. For all physicians, these are the life-changing experiences that eat away at our soul and leave us unable to carry on. Her inclusion of dialogue in group sessions shows the reader how others process these situations. We are voyeurs as the leaders teach attendees how to notice and not make assumptions or jump to conclusions. The author challenges us to criticize the system, take back our lives, and get help when needed. She describes how the group does writing exercises with prompts, embraces silence, and uses techniques to arrive at acceptance.

At times, admittedly, the author’s sarcasm becomes wearisome. Inclusion of this humor is her defense mechanism but is still a little much. Otherwise, the book is impactful and useful for any professional at any stage in their career. For medical students and residents, Dr Horton’s cautionary tale offers strategies to avoid getting overwhelmed—although the book could come across as a depressing foreshadowing. For midcareer and late-career physicians, the book offers a chance for readers to pull back from the abyss, if approaching it, and to reset to make the rest of their career joyful and meaningful. Women who are trying to balance an academic and clinical career alongside personal and family obligations may find this book particularly relatable.

Dr Horton gave up a potential vocation as a writer to become a doctor; this book proves she never abandoned the innate skills she possesses to craft words into lessons and entertainment. Perhaps her writing also is the medicine she has been looking for—another lesson for us all. This book may be a wake-up call to prompt readers to get help; that may be all readers need to right their ship.