Crisis Precipitates ChangeJul 12, 2021
“I wish I could just blink and not exist anymore.”
I was familiar with the thought pattern.
It was before sunrise as I walked through the fluorescently lit and eerily empty hallway of the hospital. The customary time to arrive for my intensive care unit (ICU) rotation, I needed to review all of the overnight labs and come up with a plan for the patients I was assigned before morning rounds, then we’d round on the patients, review mid-morning labs and round again in the afternoon. Each day was approximately twelve hours long and the rotation ran six days a week. Inevitably, the plan was do whatever is necessary to stave off death, for the patients and myself. On the days it was bad, my mind would fantasize an additional step: I could see the syringe plunger full of drugs entering my arm and, at that point, the pain would stop and freedom would begin.
I was so tired and worn down.
The first patient I was assigned in the rotation, Mr. A, was in his eighties and didn’t have family or friends to visit or help make medical decisions for him. He’d been admitted for a fall and hip fracture, although quickly developed a hospital acquired pneumonia and delirium requiring his ICU stay. I remember watching him, comatose or confused, buckled in, and being turned like a rotisserie chicken in a ‘rotobed’ in hopes of helping his lungs clear. Around three weeks into his stay we had a lengthy discussion about whether he needed prophylactic or full-dose anticoagulation as he had arguable indications for both and a delicate coagulability profile given the rounds of surgeries, antibiotics, critical illness, and shell of a body he had left. It was decided to go with a full-dose and within 48 hours he had a massive brain bleed and died.
I felt like I’d tortured an old man for the last weeks of his life while sticking the taxpayer with a bill in the hundreds of thousands of dollars rather than helping anyone.
This is not to say I didn’t witness success, even miracles, in the ICU. Young people in tragic car accidents sometimes made incredible survivals. Others got stuck there. One patient had been in the ICU for years, withering away on life support, stuck in the purgatory of conflicts possible between medical ethics and family will. This wasn’t why I got into pharmacy or medicine. I wanted to see the vitality of people boosted, their zest for life restored, their ability to function and feel-well improved. Instead, my patients were almost lifeless, sedated, and decisions made based upon vital sign parameters and electrolyte concentrations rather than treatment preferences.
I needed a new path.
I’d been working hard in graduate studies for years at this point, championed a number of extracurricular leadership positions, and generally accelerated in my studies. In almost all ways I was a model student, securing a first-year post-graduate residency at a prestigious tertiary care hospital with a reputation for high-quality training. I had been at this hospital completing residency for several months, yet still had several months to go. In some ways I knew there was light at the end of the tunnel, although there was still too far to go to be able to ‘feel it’. My hard-headed and achievement-driven persona never understood quitting the program was an option that I could have allowed for myself.
In the depths of that darkness a dear friend gave me a 5 x 5 square of high-quality LSD blotter.
Waking up one Sunday I had off, my body felt it had been hit by a truck, my mind sluggish, low, and irritated without the usual pot of coffee needed to boot it into action. I managed to pack a day bag and head to the beach. Precisely once per month for 3 months I sat on the beach all day with 1-2 tabs of LSD directing my thoughts, feelings, and life energy. The first trip got me out of the critically low place that I could barely recognize at the time. The second trip made me realize just how lonely my life was. The third trip left my cup overflowing and ready to make the changes I saw I needed to make to have a life I could feel was worth living.
I was inspired to take a psychedelic path for my health and career.
I began interviewing for second year residency programs in psychiatric pharmacy. I figured that I needed to be an expert in traditional psychiatric medications as well as a variety of mental health struggles (beyond my own) if I was going to have an impact. I set my sights on an entry level academic position that would protect time to work on scholarly projects relating to psychedelics. I began seeking out opportunities to volunteer at psychedelic harm-reduction booths at music and art festivals. For my 30th birthday I bought myself a ticket to a plant medicine conference called ‘Visionary Convergence’ where I met my love and now wife of five years. I became Board Certified in Psychiatric Pharmacy and went to work as an academician.
Academician was initially a dream-job. It afforded me many great opportunities and resources to conduct psychedelic research, synthesize psychedelic literature, and provide continuing education about psychedelics to other professionals. Each day, a new rabbit hole to investigate in PubMed, I began to accumulate understanding of how a variety of psychedelics interacted with psychotropic medications. It also strengthened my knowledge of curricular design, pedagogy, and how to be an effective teacher and mentor for students and trainees. However, eventually my ‘yes man’ attitude left me encumbered with responsibilities and duties that were not exciting to me and burnout came visiting once more. This time it woke me between midnight and 3am with physical pain so bad that I had to take a hot shower to loosen my diaphragm enough to take a deep breath. Luckily, I had loving support, deeper self-knowledge, and tools this time around. My passion project - Spiritpharmacist - had also slowly taken over half my (over-extended and unsustainable) working hours.
Set on my purpose and path of educating persons about and bringer psychedelics to the world so they may be used for therapeutic purposes, religious or sacramental worship, and as agents of self-improvement I decided to resign from my academic position. In some ways it was hard to relinquish an identity that I'd built for myself with so much hard work over so long. There are times I still mourn the professor. In other ways the transition felt natural, needed, and the next step in my personal evolution and quest to do what I love and live life fully.
I’m finding new life, passion, and a sense of responsibility in the forging of my own curriculum for anyone to take in psychedelic medicines. There's also such a special joy in being able to authentically share stories like these with you. I expanded my psychopharmacology consulting practice dedicated to psychedelics and continue to publish my work in peer reviewed medical journals. I continue to strive for balance in my professional and personal life, which is rich with a family now.
Why recount this?
Burnout, depression, and suicide are higher among graduate healthcare students, trainees, and medical professionals than just about any other segment of the general population. I witnessed within myself a journey of descent, from the bright-eyed pharmacy student of the year with an insatiable thirst for knowledge to jaded and barely living within five years of professional training and on life support once more after five years in academia. We are the persons’ our system is expecting to care for everyone else for the rest of their lives. If we cannot even keep ourselves well in the process, how will we improve the health of others?
If you are reading this and identifying with any of the story, please know there is help, hope, and light at the end of the tunnel, for yourself and your career.
I help patients, students, providers, and organizations with finding themselves and/or following their passion to help persons use psychedelic medicines safety and optimally. I’ve rolled my knowledge, experience, and services together to create a psychedelic pharmacy resource and support membership. The transformation within myself and within countless others I’ve witnessed with the aid of psychedelics is nothing short of remarkable. It’s precisely the intensely humanistic, helpful, and life-restoring work that I envisioned myself doing when I began my educational journey toward a pharmacy career.
I’m inviting you to join me.
Kind regards & blessings,
Ben Malcolm, PharmD, MPH, BCPP
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