I think that your life is making you tired


Summary: In the absence of disease, a busy life lacking personal replenishment is detrimental to your health and future
Take home message: Reverse engineer the type of life that you desire, cut out the distractions, live intentionally and replenish yourself daily
Key beneficiaries: Anyone who lives in this busy, distracted and in this connected world!
Time to read: 8 minutes (Get a cup of tea, coffee, but not vodka)

The question

Her eyes were expectant and body poised to receive the results of her recent blood tests.

Jane was 36 years old and a busy woman. Next to running her household, she managed her own home-business and was involved in her children’s many extra-curricular activities. I’d seen her before and I knew that she didn’t have much time for herself.

“I can feel that something just isn’t right with me Jonathan” she quickened, as my eyes scanned the screen of blood tests ordered by my colleague.

“Jane, Dr Morgan has done a pretty exhaustive battery of tests and I can understand why she’s done so. She’s written that you haven’t felt like yourself in a few months, that you’ve been having trouble sleeping and had a general lack of energy”I summarised.

“Yep, it really feels like i’ve been hit with a ton of bricks. Sleep isn’t refreshing and i’m spending my days tired but still rushing around after the kids, hubby and the business”, Jane replied.

I prepared myself, as I’ve done many times before, to deliver unexpected news. I usually calm my breathing, face the person and draw eye contact.

“Jane all your blood tests were fine. We looked for general abnormalities and those specific for fatigue, and they are all normal”. In particular your iron studies, thyroid level, blood count, urine sample and blood glucose are all within limits.

“But I don’t understand”, Jane countered. And then she asked a question that I’ve been asked a several of times before in this situation a GP, “Then why am I so tired?”.



The answer


Let me point out that there are serious medical conditions which present with fatigue and also less acute medical problems which contribute to fatigue.

The red flags that must be investigated together with fatigue are: unintentional weight loss, unexplained fever, abnormal bleeding, new masses and lumps and unremitting pain.

Common conditions contributing to fatigue: iron deficiency anaemia, undiagnosed diabetes/uncontrolled diabetes, low thyroid hormone and the continuum of burnout, anxiety and depression.

In Jane’s case there were no red flags in her history nor did we uncover any common conditions through our investigations.

But one aspect of her spoke louder than words. Her busy lifestyle.

When I’d met her before, she was always in a hurry and seemed preoccupied. She’d hinted that she was a little anxious at times but always covered it with having so much to do. She wasn’t overweight nor was she athletic and she definitely didn’t have any bad habits such as excessive drinking or smoking cigarettes.

But she was overrun with activities daily and carried the weight of worry about her family, business, marriage and her slow fatiguing body.

Calmly, I collected my thoughts and said “I think your life is making you tired”.

The truth

Her eyes became glassy, a tendency that I tend to evoke in my patients and people.

I knew that my words had hit a nerve. I could tell though, that this was not new information, but this time it had come with biochemical and physiological proof, delivered with authority from a trusted source.

“Jane, the reason that you are feeling so tired is that you are doing way too much and your energy output just isn’t being replenished adequately” I said, breaking the silence.

“But it can’t just be my lifestyle, I mean most of the mums that I know in my situation, are just fine. There has to be something else?”, she countered adamantly.

I’m not sure whether my sigh was audible but I felt it inside of me.

The sad truth is that most people will not be able to accept this advice, mainly I believe because it isn’t physical and measurable and the interventions are also not prescriptive medical therapies

Furthermore they see that their hands are tied as it relates to their life and commitments and any adjunctive explanation and therapies appease their disquiet.

The reason for Jane’s fatigue appeared simple in the face of serious medical conditions such as a bowel cancer or Addison’s syndrome or even less acute explanations such as low iron due to menorrhagia (heavy periods — the most common cause in women).

But changing your lifestyle isn’t a quick fix, it doesn’t involve taking medication, nor does it involve any elaborate interventions.

For this reason, it seems insurmountable sometimes and too difficult to know where to start, what to do and how to do it.



The way forward

As I counselled Jane through a few simple steps of how to proceed, I sensed understanding in her posture and through the questions she was asking.

“What do you mean by replenishing activities?” Jane asked, her eyes squarely fixed on a piece of paper that I was writing on for her.

“Jane, there are so many activities in your life which require a great deal of your mental, physical and emotional energies that at the end of day or even week, if you aren’t filling up your tank with replenishing activities, you are effectively running on empty”.

“You may eat well, go to sleep early and even try to do some exercise but at this stage, your life is imbalanced in favour of activities which are taking your best energy, leaving little for yourself”, I summarised but continued on.

“Replenishing activities are entirely personal actions that you undertake every day, week, month and year that help to fill your mind, body and soul with carefully curated sustenance. They revitalise and refresh you and help to protect your body through the stress, distraction and pace that you encounter everyday”.

“For example your second daily aerobics class keeps you active, strong and helps to release neurotransmitters in your brain which helps to boost your mood. Then book club with your friends every Thursday night is a chance for you to let your hair down, laugh and enjoy some replenishing relationships”.

The tone of my voice softened and became serious, “Jane, you’ve got look at everything that you are doing and decide whether or not you need to give something up, say no or obtain help to keep going, because you if you play this scenario forward a few years, you are going to be in a much bigger hole than you are right now”, I warmly warned her.

“You don’t need hours for yourself right now, that is impractical with school aged children, but I would sit down with your husband and ask him to help if he can and earnestly carve out time in your schedule to replenish yourself. Most importantly I would schedule time for you to do something that you love and rewards you enormously, that will help to significantly fill up your tank”.

As Jane left my room that afternoon, I was optimistic and hopeful she would heed my advice. Our encounter had not only left me running thirty minutes late but more confident in my belief that our busy and distracted lives are leaving more and more people sick, tired and depressed.

Practitioner and preacher

Jane might have wondered why I spoke passionately and with authority around the area of lifestyle change, it is because I am a recovering burnout doctor.

On two occasions I have successfully burnt myself out with volumes of work, study and commitments with a lack of personal replenishment. With so many lessons in my life, I had to learn this one twice.

At the end of July it will be three year since I made phone calls to work, my parents and my two mentors and told them that I couldn’t go any further.

With my wife sitting next to me, I sobbed as I talked to my parents about how I was feeling,beside myself with anguish about the future.

I’d run out of energy. I was sad, profoundly tired and intensely clouded in my thinking.

As I have written about before, hitting bottom was what sent me looking for ways to restore balance into my life and to erect safety nets to prevent it from happening again.

But since then, life has become busier, as there have been days that I’ve been up all night in theatre, long stretches of continual work and anaesthetic lists, several key career exams (one which I failed by 0.3% and had to sit again), a diploma of dermatology, I’ve organised events, was asked to sit on the church board and not to mention the birth of our third son last year.

But in all of this, I haven’t stepped far away from the lifestyle playbook which I started to write in September 2013, as I begun to reverse engineer my life and started to live my life intentionally.

Reverse engineering your life is working out your why from working back from your last day on earth. What did you want to achieve? What type of person did you want to be? Where did you want to go? These are some of important questions for you answer and respond to, or sadly they will be answered for you as you react your way through life.

Living intentionally is doing small but significant things each day which take you closer to the person whom you want to be on your last day.


The lifestyle playbook

The playbook has evolved with work and our growing family, into a series of activities that I try to religiously adhere to daily, weekly, monthly and yearly.

By doing so this helps to ensure that I stay on track with respect to key priorities in my life.

The examples here are intensely personal to me, my faith and the type of relationship I desire with my wife and sons.

Whilst the content may will not appeal to everyone, the key act of ensuring that you are intentional about preserving your energy, living to your potential and enjoying the best health of your life is universal.

Since writing my article on”Rest, replenishment and the art of saying no”, I’ve realised that life swings constantly in imbalance.

I’ve also concluded that if my future is to start an online medical business, this will increase my work, hustle time and inadvertently affect my rest and replenishment.

But like all strong foundations, the daily habits of replenishment will continue because I’ve noticed explosive growth in my creativity, energy and passion since instituting these slowly nearly three years ago.

(Take a peak inside my Playbook of replenishing activities)

Your future

A busy life is not productive.

Busyness represents a person who is reacting to life rather than thoughtfully responding.

Busy is also insidiously distracting to the mind, detrimental to our body and eternally destructive to our soul.

As a GP my driving desire is to help anyone caught in the same place I was. I am very optimistic about the future and know that writing about my story will help those who feel that the busyness of their lives may be affecting their health and wellbeing.

My encouragement to you is not to step away from hard work but to remember to continuously replenish yourself as a sure foundation for the great things you want to achieve and the person you desire to be on your last day.

Live intentionally

Love relentlessly

Enjoy your health and make memories with your loved ones

Dr. Jonathan Ramachenderan

6 comments on “I think that your life is making you tired”

  1. Such an excellent message Jonathan – for everyone. We deplete our energy sources without really looking at what we need to replenish us. Thank you for sharing such a thoughtful, insightful post!


    1. Thank you Sara and especially for what you and Colin are leading and doing in the doctor’s health space, it is very helpful. Replenishment is one of the joys of life!


    1. Dear Sami, thank you for your encouragement, it means a great deal to me, especially coming from a medical school friend! The real inspiration are those people living this out each day and getting it right. And I think as GP’s we are actually in the lifestyle and habit changing business!


  2. Jon, you have articulated and expressed this so well. I can learn so much from what you have written to help my patients too. I too am learning (some days are better than others) to be aware of the internal stress and tension that slowly creeps up when the major in our lives involves doing, giving, helping, serving & we don’t rest or replenish ourselves, learning to say it’s ok and it is not selfish to be kind to myself! Thanks for the message.


    1. Dear Lara, thank you for taking the time to read and comment. You are correct, it is absolutely required to be kind to yourself. Tension does creep up on you and it is really about having a sabbath. God has hard wired us to work hard and rest and replenish ourselves intensely. And what better way to replenish your energies by doing something that you LOVE and absolutely CRAVE, this adds to your tank in ways that nothing else can. I think selfish is what the world says. God never intended for us to busy all the time but productive in living out our purpose, salty, bright and well replenished.


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