Show Notes
Burnout gets tossed around as a workplace buzzword, but its clinical reality can be completely destructive, even to people at the absolute peak of their profession.
This episode is different from the usual Dr Kumar Discovery deep dive. There is no new micronutrient or technology here. Instead, Dr. Ravi Kumar steps out from behind the microscope and tells his own story. Recorded on stage as part of psychologist Dr. Trey Tippens’ “Trey Talks” series at First Health, it is an open, vulnerable conversation about the burnout Dr. Kumar hit shortly after finishing his neurosurgical residency, and the long road he took to come out the other side still in love with his life and his work.
Dr. Kumar walks through how seven years of 80 to 100 hour weeks, powered by raw adrenaline, quietly drained the resilience he had been spending like money out of a bank account. He describes how the crash did not announce itself as stress in his mind but showed up in his body as chronic headaches, stomach pain, no energy, and eventually depression, even after moving to paradise in Hawaii. He tracks the corporate hospital trap that locked him into a cycle of financial strain and the moment a single minus sign on a paycheck pushed him to quit neurosurgery altogether.
Then comes the reset. Dr. Kumar and his wife sold everything they owned, packed two suitcases each and a dog, and moved their family of four children to the top of the Western Ghats in Southern India. Operating barefoot in a hundred-year-old stone mission hospital, using autoclaved discards from around the world and formaldehyde-fumigated operating rooms, he stripped medicine back to its essentials and rediscovered something he had lost: gratitude, purpose, and joy. This is the story of how he found his way back to neurosurgery, this time owning his career instead of letting it own him.
Episode Resources
In this episode, you will discover:
- The real academic definition of burnout: The three clinical pillars of emotional exhaustion, depersonalization, and loss of personal accomplishment, and why it is more than just being tired
- The danger of adrenaline banking: How high achievers run their bodies on borrowed resilience capital until they hit a sudden, physical collapse
- Why burnout can be silent: How it often bypasses conscious mental stress and presents directly as physical illness, from chronic headaches to unexplained stomach pain
- The illusion of the finish line: Why crossing into paradise or a lighter schedule will not heal burnout if the underlying toxicity and pattern remain
- The sunk cost trap in a career: What it takes to walk away from a 15 year training investment when the path is quietly destroying you
- The barefoot medicine paradigm: What a resource-constrained Indian mission hospital taught Dr. Kumar about sterility, focus, and human connection, including a year without a single surgical infection
- Gratitude as an antidote: How taking money out of the equation and practicing purely for the mission naturally sparked joy and healing
- The practical pivot: How Dr. Kumar restructured his life to keep doing the neurosurgery he loves while protecting time for family, hobbies, and inspiration, so his career no longer owns him
Key Takeaways
- Burnout is not simply exhaustion. Clinically it is three things at once: emotional exhaustion, depersonalization (seeing patients as objects instead of people), and a loss of the sense that your work matters
- High performers often run on adrenaline and resilience capital they cannot see draining. The crash frequently comes not during the grind, but the moment they finally stop
- For some people, including Dr. Kumar, burnout shows up first in the body. He felt physically sick with headaches and stomach pain for years before recognizing it as burnout rather than an infection
- Changing your location or lowering your workload will not fix burnout on its own. Dr. Kumar carried it from a brutal residency to paradise in Hawaii to a sleepy elective practice, because the pattern and the toxic environments followed him
- Sometimes the only way out of a deep rut is a dramatic move. Selling everything and moving to India was the reset that jolted Dr. Kumar out of the pattern and gave him a new path
- An environment rooted in gratitude and mission, with money taken out of the center, restored his joy in medicine. When he decoupled his skill from financial incentive, the meaning came flooding back
- The lasting fix was structural, not geographic. Dr. Kumar came back to the States on his own terms, working less than full time, starting a podcast, and building a life where he owns his career rather than being defined by it
- His advice for anyone in the crucible: if you are unhappy, do not just steer slightly within the rut. Figure out what truly inspires you, make it a real part of your life, and be willing to do something dramatic to get there
Transcript
[00:00 –> 01:10] Dr. Ravi Kumar: Welcome to the Dr Kumar Discovery. So today is gonna be a little different. We’re not gonna dig into some new technology or a micronutrient or some underappreciated corner of your health. Today, you’re gonna learn about me. Specifically about the burnout I hit in my neurosurgical career not long after I finished my residency. Here’s how this came about. I sat down with Dr. Trey Tippens, who’s a psychologist at the hospital where I work, and he interviewed me on stage for his talk series called The Trey Talks. We went through the whole story, how I burned out, how we sold everything and moved to India, how I found my purpose over there again, and then came back and more or less started my career over from scratch. So if you like a good story, or if you’ve ever wondered how a person walks through burnout and comes out the other side still in love with their life and their work, or you wonder how you find meaning in life? Or how you keep your career from becoming the whole of who you are? Then that’s what this episode is. I think there’s something in here for a lot of you. So I decided to put it out as an episode. And I hope you enjoy it. Okay. Let’s get into it.
[01:10 –> 01:44] Dr. Ravi Kumar: My name is Dr. Ravi Kumar. I’m a neurosurgeon in search of the causes of human illness and the solutions that help us heal and thrive. I want you to join me on a journey of discovery as I turn over every stone in search of the roots of disease and the mysteries of our resilience. The human body is a mysterious and miraculous machine with an amazing ability to self heal. Let us question everything and discover our true potentials. Welcome to the Dr Kumar Discovery.
[01:44 –> 03:12] Dr. Trey Tippens: So first of all, I wanna thank you all for for for making the time to have a conversation like this. This isn’t something that that medical staff, um, you know, some of you guys know my experience. I’m I’m a former army psychologist. This isn’t something that high stress, high delivery professionals talk about openly and vulnerably in such an open forum. But I think it’s an incredibly powerful and meaningful conversation because not talking about it does not mean that it’s not occurring. Right? And recognizing the leadership of of our local, um, surgeons, providers to talk about their experience is gonna normalize. The hope is that it normalizes these conversations so that if you should ever experience burnout in whatever field that you’re in, that you know that you’re not alone. Right? Ultimately, at the end of the day, what we end up feeling is alone as though we’re going through something that’s unique to us, uh, and we’re often afraid to speak about it, which gives it even more power. So I wanna thank all of you for being here to to be a part of this, and also I’d like to thank doctor Kumar for having the courage to come and speak openly and vulnerably to such a wide audience. Um, so I’ll do a quick, just brief intro, and then I’ll ask you just to give us some some background on on who you are and how you got here to First Health. Um, so this is Dr. Ravi Kumar. He’s a neurosurgeon here at First Health. Tell us a little bit about your background and how you ended up here in the medicine.
[03:12 –> 04:15] Dr. Ravi Kumar: I thought I just wanted to fish and surface, so I went into marine biology and, uh, discovered the biological sciences. I thought it was fascinating. It was just, you know, learning about science, learning how life and the world works. But I quickly discovered after I got my degree in marine biology that I wasn’t going to have the impact on the world that I really wanted to have. So I went into medicine. And it’s the perfect combination of science and philanthropy, and bringing technology and curiosity and discovery to into this realm of helping people. And I know a lot of you guys are in medicine, and this is why we went into it, because it combines these two aspects. And that’s what drove me into medicine. I ended up, you know, going to medical school and falling in love with the central nervous system, so I became a neurosurgeon because I thought, hey, you know, if I can physically change someone’s body to help them with pain or suffering, uh, especially through the nerves which are fascinating little organs, then I would make it have a huge impact. And and that drove me into this field of neurosurgery.
[04:15 –> 04:33] Dr. Trey Tippens: Wow. Um, so you had you came in with internal motivation. You came in with all the right reasons. You wanted to help. You wanted to to be a force of good in the world. Um, and then you went to residency. What was residency like for you?
[04:33 –> 05:58] Dr. Ravi Kumar: So residency is is brutal. Any specialty, it’s brutal. That’s just how it is. There’s so much you gotta learn to be able to be safe and to be knowledgeable and be skillful in dealing with people who have this sacred biology that if you mess up or you make the wrong decision, you take them in the opposite direction of where you’re trying to go. Your your first, uh, goal is first do no harm, right? And so, residency is that deluge of information and skill and all these things that you’re learning to try to become that safe, skillful, uh, healthcare provider. Neural surgery specifically is very intense. It was seven years and it was 80 to 100 hour weeks for the full seven years. It was unbelievably stressful. But you know, I was I was fairly resilient. I was young, uh, I could deal with not getting sleep. I could deal with having to be focused pretty much all day. Uh, and, uh, it went well. And I thought, you know, this is I picked the right field, and and I was very happy with it. And I know this is what we’re talking about, and I’ll give you a little premonition here. Until I finished residency, things started to fall apart for me, and and it it would took me a long time to realize why.
[05:58 –> 07:35] Dr. Trey Tippens: So, I know we talk about burnout a lot. It it’s kind of a buzzword that we use across a lot of different fields. There isn’t actually an actual academic definition of burnout. Let me give that to you. This will be the only academic thing we talk about today. Uh, so the definition of burnout is three things. It’s emotional exhaustion, it’s depersonalization, and it’s loss of personal accomplishment. So emotional exhaustion is getting up every day, doing the same thing, grinding it out, having nothing left when you get home, and then getting up the next day and doing it all over again. Depersonalization is buffering yourself from other people by depersonalizing them. You don’t see them as people, you see them as objects. You stop seeing them as as individuals with a a, you know, cluster of of, uh, family and and the empathy that goes along with that. You start to see them as a cluster of symptoms, and you start to see them as as an object to be to be fixed, not to be engaged with. So you start creating a barrier between yourself and the patients that you’re working with for medical, specifically, and a personal accomplishment. If you don’t feel like the things that you’re doing matter, um, the lower your personal accomplishment gets, the less likely you’re going to want to continue in that doing that work. Right? So if you’re high in emotional exhaustion, if every day is a grind for you, if you’re high in depersonalization, you stop engaging at a human level with other people, and you don’t feel like the things that you do matter, that’s burnout. Right? That’s what burnout is from an academic perspective. Do any of those, uh, resonate with you and your experience in in residency?
[07:35 –> 08:44] Dr. Ravi Kumar: Yeah. Well, you know, residency, I feel like for me at least was this constant adrenaline run. I was high on adrenaline the whole time. It was like I was running my body on resilience that was coming out of a bank account. And I think I was quickly exhausting it. I didn’t know it at the time because, you know, you felt like you could just do it all. You could work a hundred hours a week. You could, uh, do it day after day after day, and when you didn’t crash, you thought, well, I can just keep doing this. And, you know, I it wasn’t until you and I know a lot of people, uh, relate to this. It’s not until you actually stop for a second that it all just comes crumbling down because you’ve essentially, I didn’t know it at the time, but I had essentially exhausted all of my resilience. And I was still a young, a fairly young man, but even then, you you just don’t have the ability to go full bore for so long without paying a price.
[08:44 –> 09:02] Dr. Trey Tippens: So looking back at that time, um, with with the, you know, the luxury of 2020 vision, Could you identify some maybe some examples along the way that maybe were, uh, could have identified you a little bit earlier that you could identify that cell that experience for yourself?
[09:02 –> 10:09] Dr. Ravi Kumar: Yeah. I mean, sleep is a big one. Right? The fact that I just wasn’t sleeping for for so long, you know, sleeping for you know, getting home at 11PM, it’s after it’s after dark, everyone’s asleep, and then waking up at 04:30 the next day, day after day after day. I mean, you can just imagine that’s not compatible with human biology. And and I think those physiological stresses like poor sleep, poor nutrition, uh, no access to sunlight. I mean, especially if you work in the OR, there’s no windows, you know. You’re under, you know, halogen lights all day. And so, um, those could have been signs that I looked out for, but that’s not what we did. I mean, if you showed any weakness in residency, it was or showed any slowing down or any kinks. It was like weakness. It was like you were failing your job, especially in neurosurgery. And so, we were all doing it. It wasn’t just me. It was there were 21 residents in that program and we were all doing the same thing, just working to exhaustion and and spending our our capital, our resilience capital.
[10:09 –> 10:16] Dr. Trey Tippens: So, were you doing anything at that time to take care of yourself or to manage that in any way?
[10:16 –> 11:10] Dr. Ravi Kumar: No. I mean and that’s the thing, you know, you you didn’t have a hobby. You didn’t have money to have a hobby. You know, you didn’t have, uh, you didn’t have, you didn’t own your life. Um, it when you’re working so hard. Your your job completely owned you, and that was okay because there was an endpoint. There is this you were gonna hit a point where you would reclaim your life, and hopefully have a very satisfactory life, you know, where you made a decent amount of money, you had a decent amount of time, and you could invest in the things you love, like your family, your nutrition, your hobbies, your enjoyment. And that was that was the trade off. That was in our minds. That was what we were trading these ungodly hours for. Is that this future point where it would all come come together?
[11:10 –> 11:17] Dr. Trey Tippens: So then you got to that point. Mhmm. And what was it like when you when you cross that finish line?
[11:17 –> 14:07] Dr. Ravi Kumar: Yeah. So for me, you know, everyone’s different. Right? Um, and I’ve learned more about myself after going through this whole burnout journey, but, for me it’s it’s basically somatization. I I get sick, like physically sick. And even though I don’t feel stressed out, you know? And when I finished residency, started my job, we moved to Hawaii because I just want I still just want to surf, you know. And so we moved to Hawaii. And it’s paradise, right? I got a job as a neurosurgeon there. And I became immediately sick. I was having headaches, like horrible stomach pain. I had never had stomach pain. I never had headaches. Uh, no energy. Just the ability to go out there and paddle. You know, surfing’s very intensive. You have to spend so much energy just paddling against the ocean so you can get out and catch a wave. And I could barely do it. I just had nothing in the tank anymore. And, um, I felt like I had hit this point where I was ready to take back ownership of my life, and I still didn’t have it. My career was extraordinarily stressful. You know, we were out, uh, in the middle of the Pacific Ocean, so there’s no place, other place people could go. There are no referral centers. And so, you take everything that comes to you and it’s always an emergency in neurosurgery, unfortunately. And so, I’m dealing with that. I’m getting through the first year jitters. When you get out of residency, your first year is is learning a lot I mean you spent seven years learning about neurosurgery or whatever your specialty is or even like you know nursing or whatever your role is in healthcare that first year is a deluge of information And you’re and the buck stops with you, because you’re making the decisions. You’re making the clinical decisions that affect people’s lives. And if you make the wrong decision, people get hurt. And so that first year is very stressful trying to juggle that. So I’m sick, I’m getting to this first year. I’m I feel isolated. I can’t do any of the things I I want to do still. And it kind of like this illusion that I had that I’d finish residency and the good life would come wasn’t coming. Mhmm. I got so sad. I got I got depressed, and I didn’t realize it was burnout. And I didn’t realize that my body wasn’t working properly because of maybe stress or burnout or whatever it is. My wife, Chosen, who’s in the front row here, she’s like, Ravi, maybe it’s stress. And I was like, no. I’m a doctor. I know this stuff. Trust me. I’m sick. I’ve got like some infection or something. But that infection went on for years. And it wasn’t getting better. And, uh, that’s when we finally, uh, figured maybe this is burnout. Yeah.
[14:07 –> 14:23] Dr. Trey Tippens: So so you landed on burnout. Right? Kind of identified what was the catalyst for some of these experiences. So now you had, you know, maybe what it is, but what do we do about it? What did you do about
[14:23 –> 22:59] Dr. Ravi Kumar: it? Right. So, you know, our our thought well, so at the time, you know, this is right when the pandemic hits. I had been in practice two years, pandemic hits, and, um, you know, the first thing that the hospital does is furlough you, right? Because they’re not sure if they’re going to have the money to pay for you, but furlough doesn’t mean you stop working as you guys all know. I mean, you’re still working and for some reason during the pandemic people weren’t just coming in with COVID. They were getting way way more sick with a bunch of other things that you didn’t see before at a higher frequency. And, uh, so now you’re working twice as hard You know, you’re you’re coming back for partial pay and, um, you know, the burn it just accelerated my burnout It it was it was crazy. The pandemic, like for a lot of people in this world, was a huge catalyst in ours. So after two years of, you know, we’re coming to the end of the the most crucial part of the pandemic, uh, Chosen and I are like, well, I think we need to make a change. Because just staying there and doing the whole thing didn’t make sense. And there was a lot of pressures to not change because I was, we were living in Hawaii. It’s paradise, right? Uh, my brother was in practice with me. My brother’s a neurosurgeon. And we were, I was able to practice with my brother. The hospital was a nice place. It it there was all these things that said, why would you be silly and give this up? And I’m just thinking, God, I’m so unhappy. I don’t even know if I want to be a neurosurgeon anymore. And I certainly if I stay keep doing what I’m doing right now, I won’t be, and there’s no chance that I will be because I’m I feel like I’m dying. That I mean, that sounds hyperbolic, but that’s what I felt like. Mhmm. So we decide to to look for another job. And that’s when something came up in Washington and we I gave my notice and we we moved out to Washington so what was it like in Washington well we look for something very different in Hawaii I was doing everything from pediatrics to skull based tumors to vascular to I mean, I was everything was coming to me. And I I had to take care of it because these people had nothing else in it. And it there was some satisfaction in that. But I I was stressed. I was so I was at the end of my wick and in Washington, it was a small community hospital Mhmm. With referral centers around it and no trauma call. And I thought, gosh, maybe this is it. Maybe just doing a sleepy elective practice with no trauma, that’s what I need. And so we moved to Washington, uh, we buy a a little farm, we, um, I start working at this place, and everything’s going pretty good. I mean, the the change alone was like was healing in a way, and I started feeling better right away. But within like a month, all the things that you don’t see when you interview at a place, those start to come out. And I realized that the hospital was treating the doctors really badly. They weren’t supporting them. Uh, they are treating the nurses badly. And then people were treating each other badly. And it just became this vicious cycle that basically creates a toxic environment. And that’s why they couldn’t keep people there. Uh, and that quickly trickles into your practice in your life. So, as soon as that started happening, I immediately started becoming less happy. Again, you know, I felt like I had made this great change, and things just start toppling down again. And when I first got there, my body started feeling better. I felt like I was healing. And finally, I was like, gosh, maybe this is it. I just couldn’t be in Hawaii. But all those sick feelings started coming back, and it reinforced the fact that, you know, this mind body connection was completely controlling me. And I started thinking, well, maybe I can’t be a neurosurgeon, actually. Maybe that’s just not in the cards for me. So, um, right about that time the Department of Justice announces the largest claim or settlement with a hospital in the history of the Northwest for inappropriate surgeon surgeries done by neurosurgeons that had been there before me. And this this is released nationally, and it’s huge news, and locally. And at this hospital, I wasn’t salaried. I was working on production. And overnight, there were no patients anymore. And they they don’t want to come to this little hospital where neurosurgeons are performing inappropriate surgeries, right? And so, the the practice dries up essentially. And I, you know, I’m like, oh, this is bad, you know, it’s toxic. Now, I’m just in this environment that’s likely very litigious and there’s bad press and I’m not people are not coming to me anymore. And so, I get my next paycheck, you know, and it looks it looks normal like it looks like a normal paycheck that I normally get. I was like, oh, okay. And then I look and there’s one line in there and it I’m like, what is this? It was a minus. And it was the amount of money I owed the hospital. I had no idea. I’m so naive. I, you know, I didn’t understand the pay structure that I was in. So I go to the hospital and I said, what is this? And they’re all, that’s how much you owe us. I said, why? And they said, well, you’re not doing surgery, so we kept your paycheck the same, but we’re lending you the money. And I said, well, how do I pay it back? And they said, well, cash, or or you can work it off. And I was like, what? And so, I realized that they had me in this like, were locking me into this indentured cycle of servitude. Basically, the practice had dried up from their, like, inappropriate, they were I mean, they were pushing these neurosurgeons before me to do massive spine fusions at large numbers. And then it the Department of Justice came in and said it was inappropriate. And now the practice had dried up and they had me there covering call and doing all this stuff and paying them to do it. So, I said, okay, no, stop doing that, stop uh, lending me money. Here’s your $10,000. That’s what we owed him. And I quit. And that was, I mean, that was just over the line. And I quit neurosurgery. I’m not going to be in neurosurgery anymore. I’m done. Gotta figure something out. Maybe I’ll substitute teach. I had done that before I went to medical school. I didn’t know, you know? Um, but at the same time, I was like, you know what? We I can’t just I need to do something radically different. Because I still had this feeling like I didn’t want to give up on the training I had put into this. I mean, I loved neurosurgery at one point. I really did. And so I said maybe I maybe there’s a chance so I said chosen let’s do something let’s sell everything we own and move to Southern India. A wild idea right I’m I’m half Indian My father’s from, uh, Tamil Nadu, which is a country in Southern India. And, uh, I hadn’t really had much connection with my cultural heritage, you know? It was half of what I am, and I didn’t know it. Didn’t know anything about it. Our kids are quarter Indian and so and they had no connection. And so it wasn’t like out of nowhere, but, you know, my wife looked at me and she said, Sure, let’s do it. And so, like that, we sold our house furnished. Everything we owned, the kitchen stuff, the furniture, air, the beds, everything, the sheets, you know, towels, furnished. We sold it furnished. We got rid of, you know, I had a bunch of tractors doing stuff on the farm, got rid of all our farm animals, we sold our cars, and we had two suitcases each. There’s we have four children. Two suitcases each and a dog. And we got on an airplane and we flew to Southern India. And that was basically me saying I don’t know what the future uh, has for me, but I need to hit some kind of big reset button, or else there’s a good chance I’m not gonna be a neurosurgeon anymore. It was us reshuffling the deck and seeing how the car our hands would be Yeah. On the next next round.
[22:59 –> 23:26] Dr. Trey Tippens: I mean, part of what I hear you saying is the way that you thought things were going to go. Obviously did not go that way and, and that you needed for yourself to reconnect with the meaning behind what it is that you’re doing. Right? Yeah. So, so when you got to India and you started, um, kind of reformulating and recalibrating for yourself what it was that you were trying to, to create out of this life. Um, what did you find yourself doing?
[23:26 –> 30:26] Dr. Ravi Kumar: Yeah. I mean, I didn’t know what I wanted to do, honestly. So but India was the the time to find out. It was a journey of discovery for us. And so we we go to Southern India and my grandfather who was actually, uh, he’s from the Caucasian side of my heritage, he was born and raised in Southern India. My father who’s Tamilian, he was born and raised there. But my grandfather had been a missionary’s child and they sent the missionary’s kids up to the the top of this mountain range in southern Indian called Southern India called the Western Ghats. And there’s a little town up there called Kodaikanal where there’s an international school that was built to educate these missionary kids back in the day. And so I thought, that would be very fitting, you know? If we moved to Southern India, we went up to the top of the Western Ghats, put our kids in this international school, rented a house, and figured things out. And that’s exactly what we did. Um, Um, it was totally wild. I mean, India, if you anyone’s ever been there, is like a different planet. It’s so culturally different and so beautiful and chaotic and just all these things that we don’t see around here, it’s there every day all around you. The smells, the the colors, the the the the light from the just coming in through the sky is just different, you know? And so it was a it was totally new for us. I was just gonna take a sabbatical year. I was just gonna be, like, decompressing for a year, thinking, figuring out what I wanted to do. And we started making friends right away. I mean, people were so friendly there and they and one of my friends said, Hey Ravi, I want to come introduce I want to take you and introduce you to one of the doctors at the Mission Hospital. And this little town, Kodaikanal, it’s at the top of this mountain range. It’s above the clouds, so they call it an island in the sky, because it’s literally if you look from the air it’s just this island sitting in clouds. And there’s constantly moisture coming in off the Indian Ocean, so it’s it’s constantly draped in clouds. And to get down to the plains where the hospitals were, it was an hour and a half to two hours drive through windy jungle roads. And people were basically if you got hurt up there, it was you had an island, you were on an island. There was getting out and surviving was very low chance. So they had this little mission hospital up up there and my friend takes me to it and it’s this, you know, hundreds of years old, this little building built out of stones, like literal stones that they stack on top of each other and cement together with mud and cement. And they build built kind of this hospital structure out of it. And we walk in, it’s open air hallways, open air windows and there’s this, um, like little kind of rickety desk under a squeaky, you know, ceiling fan and there’s a doctor sitting there and there’s a line of patients just waiting to see him He’s seeing each patient charting, you know, manually on paper uh, listening to their hearts, checking them out and and they’re and they’re just all looking very grateful for this service that he’s given to them. Well, we walk up to him and my friend introduces me and says, Hey, this is Dr. Kumar. He’s a neurosurgeon. And Dr. Sendhal, who was the doctor I was meeting, he’s like, Oh, really? Can you do some neurosurgery here? And I look around, you know, I mean, we’re like in a hundreds of year old stone building, uh, and I was like, I don’t know if you could do neurosurgery here, honestly. Because I’m used to like, you know, we’re in the OR with navigation and ultrasonic aspirators and operative microscopes and high powered drills and all this technology, right? Neural constant neural monitoring from the brain all the way down the spinal cord. And this place barely has electricity. And I’m like, I don’t know if we could do neurosurgery here. And he goes, I think you could. And if you did, people would be very grateful. And so I said, okay, uh, I’ll if if something comes up, someone’s in great need, call me and and we’ll figure it out. And he and he says, oh, great. And I said, but first things I need to know, how do I get a medical license here? And he goes, oh, you don’t need one. And I said, what? Start tomorrow. He goes, You can operate under my license. And he was an orthopedic surgeon by trade. And there, you know, if you’re a general surgeon, you do everything. If you’re an orthopedic surgeon, you do everything. Uh, and so he could do a little bit of spine surgery, but he really wanted my help to like basically do the complex things that he wasn’t able to do. And, um, he goes, you can operate under my license. So I was like, okay, well, what about liability insurance? Where do I get that? And he goes, what’s that? Uh, you know, if someone sues you, it covers the settlement. And he goes, what would they sue you for? And I said, well, you know, like malpractice claims. And he goes, uh, no, we don’t have that here. And so I was like, so you’re saying that no one has malpractice insurance? And he goes, no. I’ve never heard of that before. Uh, maybe someone has it, but none of us do. And so I was like, okay. That that’s very different right away, right? So I agreed to the help, and they’re gonna call me if they need me. And in the meantime, um, I’m just gonna go back and live live my best life and figure my life out. Right? Well, like the next week they call me and someone’s fallen off a terrace wall. So we’re on these up in the mountains so all the hillsides are steep and so at the farm they have to terrace the hillsides. And you know, these guys are are working hard all day. And this guy fell off a terrace wall and he and he broke his back. And it’s an unstable fracture and he’s got some neurological injury. And so there’s no MRI scanner or anything. The government hospital, which is also up there that doesn’t have ORs, it has a like very rudimentary CT scan which gives us some gives us some basic imaging. So, I agree to meet Dr. Sendhal at the hospital and we go to the OR and I take a peek in And it’s this small room and this is like, it’s stone walls, but there’s, you know, cracked window windows, like, I mean it’s the obviously outside air is coming in. There’s a drop tile ceiling that’s completely stained and got fungus growing on it definitely. And I’m thinking, oh my God, this is like a guaranteed infection. And I said, well, how how do you not get infections? He’s like, don’t worry. We fumigate the room with formaldehyde before every case. So they they fumigate the whole OR with formaldehyde in between every case. So, I’m like, okay, let’s do it. So, I get my scrubs on, and I walk in the room, and when I walk into the room, everyone looks at me in horror. I’m like, what?
[30:26 –> 30:26] Dr. Trey Tippens: What did
[30:26 –> 33:25] Dr. Ravi Kumar: I do? Did I forget to put on a mask? No, I got my mask on. My hat’s on, you know? And they look down, and I’ve got my shoes on. And and I realize that everyone is barefoot in the OR. And their shoes are the dirtiest thing you can bring in the OR. Why would anyone do it? Are you sure you’re a doctor? That’s how they were looking at me because obviously, you know you can’t wear shoes in the OR. So, we’re operating barefoot. They eventually bought me some little galoshes that were had to stay there right outside the OR. They were white, so they looked clean. And I would wear those because I felt so odd operating in my bare feet. But yeah, you operate barefoot. The patient had been intubated by the anesthesiologist, and the anesthesiologist was squeezing the bag. There was no ventilator. So, the whole case, the anesthesiologist would sit there and squeeze the bag rhythmically, sometimes hours, while I was operating. He did have an assistant, but, uh, who would help him with that. But it was it was the amount of attention the anesthesiologist had to give to their patients. And they didn’t have fancy monitors looking at end tidal gases. You know, they had they blew up bladders with anesthesia gas to give them. And so, it was it was a totally different world, and they were amazing at their jobs with the rudimentary tools they have. So we opened this patient’s back and they, and they bring out this tray of screws for implanting in the spine. And they were odd screws. Like, I don’t think there was a screw from the same company in that whole thing. There was a handful of screwdrivers, you know, screws from that had been donated through charity. Basically discards from around the world, ended up in a charity pan, somehow ended up on the top of a mountain in India. And so that’s what we were placing So we’re drilling little holes and finding a screwdriver that fit a screw and running it down and connecting and and we fixed this guy’s back And that was the same thing I did dozens of times there you know, using these, the leftovers from the rest of the world to take someone from a horrible situation into a salvation that they wouldn’t have had otherwise. And it was the same for all the other equipment. The towels had holes in them. The Bovies were cracked. I mean, because they were reused hundreds of times. In the ORs here, when we use something, it goes in the trash. At least half of what we use goes in the trash. And we’re a disposable OR here. There, it was, they didn’t have that luxury. And for that year I was there, I never saw one infection, guys. Not one. I mean, we were using, you know, autoclaved, reused disposable items, uh, formaldehyde, fumigated ORs, and never was there an infection. Yeah. It was it was a totally extraordinary experience.
[33:25 –> 34:00] Dr. Trey Tippens: Yeah. So just listening to your to your story up to this point, um, your experience in in India is the first time that I heard joy in your voice as you were talking about your experience of becoming a doctor and a neurosurgeon and reconnecting. What, what was it about that that was different from what you had experienced? Because it wasn’t the science. It wasn’t the, it wasn’t the equipment. What was it that that reconnected you with the joy of doing medicine?
[34:00 –> 37:21] Dr. Ravi Kumar: Yeah. I mean, when I think back to that that hospital, it was an environment of gratitude. Honestly, the patients were so grateful. I mean, you were there for them in their worst moments, when they had no other alternatives. And, you know, those surgeries I did there, if I hadn’t been there, those many of those patients would have been paralyzed or dead. And and they those patients knew that. And they were so grateful. The doctors were grateful to the nurses. The nurses were grateful to the doctors. It was really the purest form of, uh, gratitude that I’ve ever seen. And it gave, and everyone had this mission there. I mean, and I know that we have missions here. We all do in our lives, we work to fulfill some principle that we think is important in this world. There, the doctors were paid about $1,000 a month. $1,000 a month, and they lived on the hospital grounds. We complain we complain when we’re q3 or q4. Right? Like every third or fourth night on call. They’re there on call. They’re there on call 24/7, living on the hospital grounds. They’re true residents, but they’re attending physicians. And not one time did I ever hear a complaint. The nurses worked for about $200 a month, and they if if they were at the top of the pay scale. And they would come in, uh, from surrounding areas, they’d bus in, they’d walk into the hospital, they’d take off their shoes, and they’d work for 12 to 14 hours. Never a complaint. Always, basically, so thankful to be there to serve patients and have a job. It it truly was that gratitude that really makes you happy. I mean, you know, I I was obviously volunteering, but the when you take money out of anything, when you do something purely for the mission, for the the embodiment of What you thought medicine would be about or whatever you’re doing is about it it creates joy. It’s like automatic And so, that that was amazing. I could have practiced there for my whole career. I really could have, you know, and I and during that time, I I mean, I went there thinking, I’m not gonna be a neurosurgeon anymore. But after that year, after that time there, I I fell back in love with medicine. I fell back in love with neurosurgery. And I realized that, uh, you just have to approach what you do in life with a greater sense of mission. And if you take money out of it, I know we all need money, we can’t work for free, But if you take money out of it mentally and think about it from that perspective and go about what you’re doing with those goals, that mission, happiness follows. And I discovered that there.
[37:21 –> 37:49] Dr. Trey Tippens: You know, one of the things that, as you were talking about your, your journey, a lot of people, I think it’s stuck into a sunk cost fallacy where they feel like I’ve already put so much time. I I already put my family through so much of of this. I’ve I’ve already spent so much money. My only option is to keep going forward, uh, is to keep pushing through, is to keep slogging through. Um, why do you think that you approached it from a different what
[37:49 –> 39:42] Dr. Ravi Kumar: why do you feel like you Yeah. I felt that sunk cost phenomena for sure. I mean, I think we all have. Right? I mean, I had trained 15 years to become a neurosurgeon. And and to to drop it all and move to India and say, maybe I don’t wanna be a neurosurgeon, there was a huge sunk cost fear there. In fact, fear ruled every decision we were trying to make back then. The the fear that I had spent all this time and I wasn’t gonna fulfill the the the destiny that I thought I was supposed to fulfill, the the cost of falling or the fear of falling behind financially, that’s a big one. Right? I mean, we sold everything we have. We’re gonna have to buy it back, we’re gonna have to find another home, we’re gonna lose a year of income, uh, we’re gonna spend savings. Those those were real fears, you know? The fear of, um, losing social connections, the fear of moving your children across the world, the fear of figuring out how to get through the bureaucratic nightmare of getting a dog to India and then back. You know what I mean? Because we really took our dog there. And so, I mean, there was so much fear around everything. All the materials we had in this world that were anchoring us into this pattern of living that was making me so unhappy. The fear, there was even fear of getting rid of that stuff, even though it was a thorn in our foot. And so, how did I get past that? Well, we just, you know, kind of closed our eyes and and left. And jumped. Yeah. And it was the right thing. I mean, I truly think that sometimes to get out of a rut, you have to take a big leap. And, that leap might cost you and the time, but in the long run, it it pays you back, and it it certainly has for us.
[39:42 –> 40:03] Dr. Trey Tippens: Um, and then the other thing, you know, as you were just talking is reminds me of a quote, you know, the things you own start owning you. Right? And they start becoming a part of the way that you make decisions in the way of the thing. So you said you could have worked there for a career. We’re not in India right now. No. Um, you’re here. So how did you come back to to reconnect with the The States?
[40:03 –> 42:17] Dr. Ravi Kumar: Yeah. So, you know, we we did talk about staying, But we had had this goal and we had had this agreement with our children, which are who are teenagers going to college now and all this getting ready to go to college now. So we had said we will go for one year. We’ll reconnect and reassess. And that’s what we’ll do. And that was a commitment that we had made. So, even though at the end of that first year we had found significant joy and fulfillment in being in India, it was time to come back. Our kids wanted to go to college. Um, my wife wanted to be close to her family. And we we couldn’t imagine sending them off to college in The US while still being in India halfway across the planet so we had to end our time there at least for for now, you know, I mean it keeps circulating back in our mind about going back and doing the same thing maybe on a cyclic basis or maybe even, uh, permanently. So, we came back, but we weren’t just going to come back and jump right back into the same rut. That was that was what I knew. I wanted to be a neurosurgeon again. I mean, that that had reconnected with that. But I knew that I had to do it differently. One, that I wasn’t gonna chase, uh, financial gain. I mean, I wanted to be paid for my job, but I didn’t want to make financial incentive the main incentive to my career. And two, I didn’t want my career to own me. I wanted to own my career. I wanted to own my life. And I wanted to do something else that gave me great inspiration. And so when we came back, that was the goal. That was to structure our life so that I could be a neurosurgeon, I could be inspired, we could have a, uh, happy, thriving family life, and I would not get burnout again. So
[42:17 –> 42:38] Dr. Trey Tippens: what I hear you say is you, um, became more than just simply a neurosurgeon. Like, you had reconnected with other parts of of what make you as a person who you are, recognizing that we are more than than just the things that we do. There are other areas of our life that are important. What are some of those areas for you?
[42:38 –> 43:34] Dr. Ravi Kumar: Yeah. So, I mean, I love to explore and learn and teach. And, um, so I I had been talking to my wife about this for a while, and I said, well, why don’t I just learn about things and then teach them to the rest of the world? So I started a podcast. That was the first thing I did. And then I said, well, okay, so that’s one thing. The other thing is I need time. I can’t have all my time, all my time devoted to the career my career. It has to be there has to be some symbiosis between my life and the things that give me great inspiration and my career. And if there is that symbiosis, then maybe I’ll be also a hold into it or, you know, unhappy in it. So, I knew that I had to work less too. You know, I couldn’t be a full time neurosurgeon.
[43:34 –> 43:37] Dr. Trey Tippens: So how has that transition been for you? Have you been successful in
[43:37 –> 44:41] Dr. Ravi Kumar: Yeah. I mean, it’s it’s always a process. Right? I mean, you’re I’m learning still how to how to how to structure my our life, but, yeah, I’m not a full time neurosurgeon. I’m 0.75. I’m probably actually even going down to 0.5 this summer. I love my job here at First Health. I love, um, doing neurosurgery still. But doing it full time, I know would send me even though this is a very, like, nice environment to practice in, I know if I went full time, I would run back into that rut of unhappiness. I I know. And that’s just me. Right? That doesn’t that’s not everyone, but that’s how I am. On in the other parts, uh, in the rest of my time, I’m doing things that I enjoy. I’m working on my podcast. I’m, you know, planting fruit trees and spending time with my family, and and that gives you this feeling of ownership of your own life and not and that I’m not defined also, that I’m not defined by my career. I am a neurosurgeon, but that’s not all I I am.
[44:41 –> 44:56] Dr. Trey Tippens: So not everybody has those options. Right? Um, so what would you encourage people to to reflect on or think about in terms of their own meaning making and their own approach to the way that they engage with medicine?
[44:56 –> 46:29] Dr. Ravi Kumar: So, you know, everyone’s different. I have many friends that I went to residency through with who are still working like one point fives, you know. I mean, they’re just working non stop and they don’t show any signs of slowing down. I’m obviously not built like them. I’d and and I often ask them, are you happy? And they’re like, well, I’m I like neurosurgery. And I said, but is that I mean, you’re this takes your whole life. Does that make you happy? And there’s never a definite answer on that. Right? Because there’s this fear that if you don’t do what you’re expected to do, you’re not fulfilling your mission in life. And so, you put happiness aside and you just you just go after it. Right? Well, I think it’s very important to figure out what inspires you in this world. It could be something different. It could be art. It could be, you know, food. It could be travel. It could be mission work. It could be a number of things. And making sure that that occupies a significant amount of your effort in this world. We have to go to work, we have to make money, and we can apply that mission in our jobs and outside our jobs. And I think that is, at least, I’m still learning, I’m still trying to figure out figure it out, but I think that’s the way that you stay inspired in this world. And if you’re inspired, you don’t get burnt out.
[46:29 –> 46:31] Dr. Trey Tippens: Right. Man’s search for meaning.
[46:31 –> 46:32] Dr. Ravi Kumar: Right? Yeah.
[46:32 –> 46:47] Dr. Trey Tippens: Um, so are there any any final kind of thoughts, anything that you would like to share, any lessons learned about your own experience of burnout that maybe you didn’t touch on earlier, how you could have identified it earlier, how do you identify it now?
[46:47 –> 49:18] Dr. Ravi Kumar: Yeah. So, I mean and that that’s really hard to identify it by it. I mean, you gave the criteria. Right? And people can hear those criteria and say, well, I’m not burnt out. But this is what I I say, if you’re unhappy. And, you know, not everyone’s unhappy. There’s a lot of happy people in here working very hard, and and that’s fantastic, you know? If you but if you’re unhappy, you have to you have to reassess how you structure your life, uh, I think. Because life can create ruts, you know? I I think a rut is a perfect analogy. You get in this rut, and you can’t get out. You might steer a little bit this way, or steer a little bit that way, but you’re still falling into this rut. And the only way to get out of that rut is to do something dramatic. And I’m not saying you gotta move to India. That’s what we did. And we got rid of everything we owned, we moved to India, and it jumped us out of that rut. Right? It created a new path. And so, it’s scary, and it’s hard, and it seems like it shouldn’t be what you should do, but sometimes reshuffling your deck, hitting that reset button, doing something extraordinary can create that new path for you that leads you to a life that you’re more satisfied with, that you’re more inspired by. You’ll get pushback for that, guys. When my wife and I told us we’re, uh, when my wife and I told our family that we were moving to India, they were like, what is wrong with you guys? I mean, there was even anger because we were doing how how could you throw away a career? You have a nice house. You have all this stuff. Why would you do that and go live in a stone house on the top of a mountain with intermittent electricity and intermittent water. Because we literally had the truck and water and, you know, I mean, it was it was a totally different life. Why would you give up what you have now? And they won’t understand. Right? And they might get angry with you, and you might get financially hurt, or you might lose friends. But if you’re doing it for what you think is right, for what you think will inspire you, fulfill you, then it’s worth it. And in the end, it’ll all be okay. Yeah.
[49:18 –> 49:24] Dr. Trey Tippens: So, again, I’d like to thank you for for sharing your story and and and the courage that it takes to be open and vulnerable about these.
[49:24 –> 49:26] Dr. Ravi Kumar: You guys are awesome. Thanks for being here.
[49:26 –> 49:27] Dr. Trey Tippens: Thank you guys.
[49:27 –> 50:05] Dr. Ravi Kumar: Okay. I hope you enjoyed that one, and I hope you got a really good look at who I am, how I work, and some of what I’ve walked through to get here. And more than anything, I hope there is something in there that you can carry into whatever crucible you might happen to be in right now. Because we all get handed hard things at some point in life. And honestly, how we choose to respond to them is what shapes the road ahead. So cheers folks, and I’ll see you next time.