The Monster Within

When people ask me to describe the most "difficult" horror story I've ever written, my answer is invariably the same. Spider Bite. The tale about burnout. Writing that piece was a strange exercise in empathy and apathy, and I think it's worth exploring the background of the story.

 As a horror writer, you have to be comfortable stepping into the shoes of unlikeable--and often deranged--characters. Zeke Warren definitely fit that mold. Part of Zeke's personality was easy for me to flesh out, since I know exactly what it’s like to be an overworked ER doctor. But the much harder part was imagining the psychosis born from extreme emotional burnout. I needed Zeke to transform from a bitter physician to a bloodthirsty madman, and that meant tapping into a dark place within me.

I wrote Spider Bite as a descent-into-madness story. These are common as far as horror tropes go (and they have always been a favorite niche of mine.) However, the piece also serves as a cautionary tale about burnout. I wanted to hammer home this theme precisely because it is so prevalent and dangerous in medicine.

Here are some sobering facts. My specialty, Emergency Medicine, consistently tops the charts in emotional burnout. According to one large study of 7,228 physicians across specialties, 65% of emergency providers identified as “burned out”—which is approximately three times higher than the average physician [Berger 2013].

So, yes, as an ER doctor, I’m well-aware of the stressors crushing Zeke Warren. They're hardly exaggerated in the story. Emergency providers work in a high-volume, high-stakes environment, where we face a never-ending deluge of patients suffering from an endless list of ailments. Tensions can run high on a busy day. Sometimes our patients channel their frustrations into us. We've been struck by fists, clawed at, spit upon, and screamed at in all manner of derogatory language--and it happens almost every day. When you are on the receiving end of that much abuse, it's natural to want to lash out. That's what burnout does to you.  You lose your sense of empathy. You begin to feel a deep sense of victimization. You project your own anger onto others. And all the while, there's ticking timebomb of impatience deep inside your chest, ready to explore.

If you're conscientious enough, you can recognize these red flags and take steps to put out the fire before it burns you alive. But not everyone has the mindfulness, or the resources, to recognize the danger they're in. For many in the field of medicine, burnout becomes the death of their career. 

I wish I could say that we're moving in a better direction, but I fear it's getting worse out there. The world is not becoming a less stressful place. If you mix in a global pandemic, the corporate take-over of medicine, increasing patient volumes, dwindling primary care services, hospital staffing shortages, and the erosion of public trust, you've got a recipe for some very bitter burnout brew. And we're all drinking it.

There’s one important caveat to all this. Most ER doctors I know are pleasant, sharp, and dedicated folks. They're out there in the trenches doing the bloody work that needs to be done. I'm enormously proud of the work they--and all of us--do for the people in our community.

But there's a darker side to medicine, and that's why I wrote Spider Bite. When you're pushed too far, it's human nature to push back. Unless we can learn how to protect ourselves, and to build the infrastructure needed to sustain this madhouse of emergency medicine, someday Zeke Warren's whispering spider god will come for us all.

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For a deeper dive into trends about emergency physician burnout, check out these articles below:

Berger, Eric. Physician Burnout. Annals of Emergency Medicine, 2013. Link: https://www.annemergmed.com/ar...

Petrino R, Riesgo LG, Yilmaz B. Burnout in emergency medicine professionals after 2 years of the COVID-19 pandemic: a threat to the healthcare system? Eur J Emerg Med. 2022 Aug 1;29(4):279-284. doi: 10.1097/MEJ.0000000000000952. Epub 2022 Jun 22. PMID: 35620812; PMCID: PMC9241557. Link: https://www.ncbi.nlm.nih.gov/p...