By: Richard Gunderman, MD, PhD
IU School of Medicine 

Stories play a more formative role in physician wellness than we commonly suppose. If the stories we tell ourselves about our work, patients, and lives are defective in some way, they are likely to take a toll on us. On the other hand, if we tell ourselves accurate, rich, engaging, and inspiring stories, then the outlook for good work and a good life brightens considerably. 

But where to look for good stories?

In this holiday season, one of the best examples of the difference stories can make is one of the best-known and most beloved of all Christmas stories, Charles Dickens’ 1843 “A Christmas Carol.” Written when Dickens was only 31, it tells the story of Ebenezer Scrooge, a man who has been laboring under the burden of a defective narrative for many years, whose life is transformed by a new and better story.

We first meet Scrooge as a “squeezing, wrenching, grasping, scraping, clutching, covetous old sinner.”  When his cheerful nephew wishes him a merry Christmas, Scrooge replies, “Bah! Humbug!” When charity workers arrive to request a donation to assist the poor and report that the poor would rather die than go to workhouses, Scrooge responds that they should do so and “decrease the surplus population.”

Scrooge can be seen as the representative of a certain spirit very much alive in contemporary health care, one that puts self-interest before the interests of patients and communities and prizes profits over people. He is both a miser and a misanthrope, depriving his office clerk Bob Cratchit of all but a lump of coal to keep warm and ridiculing him for attempting to keep a family on a salary of only 15 shillings.

Yet even Scrooge is not beyond redemption, for the pathetic story he has been telling himself these many years – that money is the only thing that matters and that the more money he manages to accumulate, the better his life – can still be replaced by a far better one. Such a transformation requires the supremely materialistic Scrooge to undergo a spiritual visitation, beginning with his long-deceased business partner, Jacob Marley.

Marley’s ghost appears dragging chains, “the chains I forged in life,” he says. Marley laments, "No space of regret can make amends for one’s life’s opportunities misused.” Yet, Scrooge says, “You were always such a good man of business, Jacob.” “Business!” thunders the ghost. “Mankind was my business. The common welfare was my business. Charity, mercy, forbearance, and benevolence were all my business.”

Marley’s ghost tells Scrooge that his only hope lies in the successive visits of three spirits over the following nights, each upon the tolling of the clock bell. Scrooge may not know it, but he need not ask for whom the bell is tolling. In typical businesslike fashion, Scrooge suggests it might be more efficient if all three spirits visited simultaneously. He does not realize that transforming a life is emphatically not a matter of efficiency.

The first spirit, the Ghost of Christmas Past, takes Scrooge to an early time in his life, marked by a happy relationship with his sister (his nephew’s long-deceased mother) and a holiday party hosted by a generous employer who treated him as a son. Scrooge also sees his betrothed Belle rejecting him, believing he is becoming a man who could never love her as much as money.  Then, years later, we see Belle with her own large, happy family.

The second spirit, the Ghost of Christmas Present, takes Scrooge to scenes of busy markets, dinner celebrations, and a joyous holiday spirit that even reaches ships at sea and lonely lighthouses. Scrooge also visits the home of the Cratchits, whose obvious poverty does not ruin their gaiety. Scrooge is drawn to Tiny Tim, Bob’s seriously ill son. The ghost informs him that Tiny Tim will soon die unless things change.
  
The Ghost of Christmas Yet to Come is mute and takes an unwilling Scrooge to scenes involving an unloved and recently deceased man, where he sees mean-spirited people bartering over his stolen property. Scrooge asks to see people touched by death, but the spirit only shows him the Cratchits grieving over Tiny Tim. Finally, the spirit takes Scrooge to an unkempt, desolate grave, where he reads “Ebenezer Scrooge.”

As a result of these encounters, a new story finds Scrooge, providing him with a new lease on life. He attends his nephew’s Christmas party. He makes a large donation to charity workers. He sends a preposterously large turkey to the home of the Cratchits. Having seen the course of his miserable life up close and personal, Scrooge encounters a different narrative characterized by compassion and generosity.
  
If any human being could be accurately characterized as burned out, it would be Scrooge. He has fallen victim to many of the forces underlying burnout in medicine: the sense that nothing really makes sense, that it does not matter how we lead our lives, that other people are mere tools for our own profit, and that he who dies with the largest pile of money wins. Yet just as there is hope even for Scrooge, there is hope for us this holiday season.

Of course, the Christmas spirit need not be confined to the holiday season. On the contrary, compassion and generosity are called for every day of the year, and those who answer this call are invited to deepen and enrich their own lives by contributing to the lives of others. Just as Scrooge learned to keep the Christmas spirit well, so too, in Dickens’ words, “May that truly be said of each of us, and all of us!”     

Richard Gunderman, MD, PhD, is the chair of the ISMA Wellness Steering Committee.