When Sparks Fly — Or How Birding Beat My Burnout

Abstract

A physician takes up birding and finds that identifying a rare bird presents challenges not unlike those of deriving a diagnosis from a puzzling set of medical findings. Its rewards prove an effective treatment for what may have been a subclinical form of burnout.

A little more than a year ago, I took up birding as a hobby. As a child and into my 20s, I built model airplanes, shot rifles (don’t ask), and chased the planets. Since that time, I have not had a bona fide hobby. I have read about the tragic disappearance of hobbies from young people’s lives, though given that I’m approaching 60, my adoption of a new hobby won’t really move the needle for the young. Nevertheless, I thought maybe it would preserve my cognition and stave off other erosions by a few more years. What I’ve discovered is that a tiny part of me that long reveled in making a “great diagnosis” was burning out, and birding has helped me have some fun again.

Many birders can recall a particularly beautiful “spark bird” that materialized out of the sky and inspired them to take up the binoculars. My spark bird appeared across a shimmering blue bay one fine Sunday morning last July. I was biking in Sandy Hook, New Jersey, eager to get in my requisite miles, when I passed a turn-off that I’d passed many times before. I noticed a wood platform projecting into Spermaceti Cove near parking lot E. An older man with a spotting scope was gazing out toward a sandbar. He offered me a peek, following Rule 4a of the American Birding Society Code of Ethics: “Freely share your knowledge and experience.…Be especially helpful to beginning birders.” If you’ve never seen an American oystercatcher (Haematopus palliates), I can tell you that its graceful red beak and fiery orange-yellow eyes throw its black and brown feathers into eye-catching relief (see photo). In the 1800s, the species had been hunted to near-extinction for its plumage and for sport, but now there are nearly 50,000 along the U.S. Eastern Seaboard alone.

Intriguingly, I’ve found that identifying a rare bird presents challenges not unlike those of deriving a diagnosis from a puzzling set of medical findings. Birds have “field marks” such as wing bars, eye rings, and plumage changes, as well as distinct habitats such as the salt marshes favored by oystercatchers or the tip-tops of trees chosen by glittering American goldfinches. These features, along with behaviors such as pumping their tail up and down (palm warblers and phoebes) or dashing off a tree limb to snag a tasty fly (great crested flycatchers and eastern wood-pewees), are akin to signs and symptoms such as pallor, dyspnea, rusty sputum, and fatigue. Throw in the countless songs of the songbirds — the rales and murmurs of the avian world — and you have yourself a set of clues worthy of a tricky CPC case.

The birder, author, and artist David Sibley has said that the trick to identifying a baffling bird is not finding the traits it has in common with another similar bird, but discerning with a sensitive eye and ear the differences between them. The least sandpiper and the semipalmated sandpiper are almost identical “peeps,” but for the slightly richer, chocolatey brown back on the former and the darker legs on the latter. Similarly, distinguishing two closely related vasculitides, such as Behçet’s and Buerger’s diseases, depends on the caliber of the blood vessel that’s inflamed. Making such fine distinctions is what birders and diagnosticians have in common. More telling may be the ways in which the two diverge.

In 1984, during a neurosurgical rotation in my fourth year of medical school, a few classmates and I met a young woman with a headache who had the subtlest indications of frontal release. That she ended up in this particular clinic meant that someone had suspected a neurologic condition, but the attending physician had us speak with and examine her before committing to a diagnosis; we settled on a frontal lobe tumor. When the CT scan confirmed that there was a meningioma in the anterior of her brain, my fellow students and I had to stifle our reflexive grins. Though we genuinely felt compassion for the woman (who did well after resection of the tumor), the awkwardness of that moment helped crystallize for me that what may have been a great day for me in terms of my budding ability was possibly the worst day for the patient.

With all our years of training to “get it right,” is it a failing to celebrate making a correct rare diagnosis? Imagine the oncologist for the first time piecing the clues together to diagnose a newly reported rare cancer. Does the physician’s repeated repression of so many feel-good moments contribute in even a tiny way to burnout in medicine? Has it resulted in too much gallows humor, too many dehumanizing moments of “us versus them”? The real challenge, of course, is to align your wonder as a medical scientist with your compassion as a fellow human and so ally with your patient in fighting the disease. Perhaps birding has enabled me to enjoy the diagnostic thrills of medicine that I once so appreciated but that I often quashed in an effort to be “professional” and compassionate.

A colleague tells me that to diagnose occult depression, he sometimes asks a patient “When was the last time you had fun?” Ask yourself the same about your medical life. We know that ours is a solemn occupation, and we have committed under oath to be serious and sober practitioners. But there is a zero-sum feature to the way I sometimes seem to practice medicine, as if my pleasure in my craft subtracts from the emotions of the patient in front of me. I’m now good at hiding that pleasure, but too much concealment can hurt. Osler called pneumonia the “captain of the men of death,” and as someone who cares for the frail elderly, I know exactly what he meant — but would I dare toss off such a characterization to a patient or her family?

So maybe birding has saved me from zero-sum and landed me in win–win. When I nail a tricky identification by distinguishing between the common tern and the Forster’s tern using only my eyes and ears, I feel the joy of a differential diagnosis well played. I immerse myself in the majestic migrations of fall and spring, the trace of a bird on the wing bringing the loveliness of a common yellowthroat and its soft song. As the new joy of diagnosing bird species suffuses my life, perhaps my binoculars substitute for the microscopes whose H&E-stained images and Gram stains I once gazed at with awe. Birding even includes in its code of ethics a directive to be kind to the novice, much like medical training’s well-intentioned “see one, do one, teach one.”

I have prided myself on avoiding frank, diagnosable burnout, but maybe there was a subclinical form that needed treatment. Others with more talent can stave off burnout with sculpting or music or marathoning. Though I strive to be a sober and sensitive physician, some days I miss the joy of making a tough diagnosis and singing it from the treetops. Birding helps me beat the burnout.

Disclosure forms provided by the author are available at NEJM.org.