Burned Out and Drowning

It was his second time heading out that Wednesday in November 2017. The weather wasn't ideal: overcast, unsure winds, a chill in the air suggesting a nearby storm.

Typically a dozen surfers could be spotted in the water along this stretch of San Francisco's Ocean Beach, but on that evening, just a few dotted the horizon. One was from Australia, another an interventional pain specialist trying to get a last run in before flying off to a medical conference in the morning.

Matthew Wetschler, MD, MPH, paddled out into the water with his friend Mark Goldberg. Having already been out that morning, Wetschler elected for a more casual bodysurf this evening, grabbing a pair of flippers and a hand plane in lieu of the surfboard.

Working in emergency medicine, traveling, he had been in a different time zone a week ago, on call around the clock. Home on alternate weeks, his schedule wrecked his internal body rhythm, but he enjoyed it, the time it allowed for life outside medicine. When he was off, he was at the beach at first light every day. The tradeoff, perhaps, was losing the long-standing relationships doctors in other specialties got to develop with patients.

Here in the water, other surfers slowly gravitated toward each other. The current pulled sharply -- it was one of those days you'd rather have others around, even strangers. Though most were used to it, Ocean Beach was formidable, unwelcoming, even dangerous. Reports of swimmers drowning were not uncommon, and with 15- to 18-foot swells in the winter, experienced surfers had drowned too.

Wetschler didn't mind the rough waves. For him, extreme sports were more than just a way to decompress, it was about navigating his boundaries -- finding his edge. In his early 20s, he had moved to Jackson Hole, Wyoming, to become a ski instructor, with dreams of pursuing the sport professionally. A blown knee intervened.

He no longer saw the other surfers now and assumed they had paddled farther out. Goldberg had drifted off too. Floating a couple dozen yards from the shore, Wetschler was enjoying the emptiness. He stopped paddling and began to tread water. Aside from the sound of the wind churning the waves around him, it was quiet.

Ryan Mattie, MD, the local pain physician, opted to head back to shore. He hadn't really wanted to surf, but with the conference in Seattle in the morning he figured it was his only chance until the following week. Something -- the waves, the pulling current, intuition -- sparked in him and told him to call it a day.

As the sun sank beneath the horizon, Wetschler turned to catch a glimpse, and as he did so an undercurrent dragged him down from the surface of the water, sent him tumbling through the depths of the sea. Spinning, falling, out of control, he landed face-first, hard, in a shallow patch of sand. The momentum shot his legs up behind his head like a scorpion, hyperextending his neck to a near-snapping point and stretching his spinal cord like a rubber band.

The next thing he knew, he was face down in the water, disoriented -- numb. He couldn't move his arms or legs. He needed to breathe but couldn't. The entire sequence must have lasted less than a minute, but Wetschler knew he was about to drown and there was no chance of rescue. He sent an agonized scream to the depths of the ocean, filling his lungs with seawater before it all went black.

Back on the surface, Sebastian Joll, the Aussie surfer, had decided to call it a day and was paddling back when he saw something bobbing in the water maybe 25 or 30 yards out. Was it a seal? A garbage bag? As he moved closer, he realized the mass was a floating body in a dark wet suit. Without thinking, Joll started paddling toward it and looped his arms through Wetschler's. Fighting against the current, Joll screamed to the shore for help.

On the beach, Mattie was walking out of the water, heading back toward his apartment. He glanced back up shore and saw a surfer in the water, struggling to reach land, dragging in something heavy. Mattie started back toward the sight and sprinted when he saw Joll flop a body down onto the sand.

With no pulse, icy-gray skin, and water pouring out of his orifices, Joll thought maybe Wetschler had been dead in the water for days. The scene attracted others -- a local nurse, a distraught Goldberg. It didn't look good, and no one understood what was going on. Someone called 911.

While the nurse tried to keep his airway clear, Mattie began chest compressions, but mentally he had declared Wetschler dead. At some point Wetschler regurgitated some sea foam, but without much else to go on they continued CPR.

Exhausted from bringing Wetschler to shore, Joll could only look on.

Surf rescue and the fire department arrived in under 5 minutes, dragged Wetschler up the beach to drier sand to prep the defibrillator, and cut open his wet suit.

But before they delivered a shock, Mattie checked Wetschler's wrist for a pulse: faint radial beat, normal rhythm. The paramedics bagged him and then Wetschler started breathing on his own, enough to transport him. Moving quickly, the crew loaded him into the ambulance.

He was alive, for now, but Mattie had bigger concerns. If Wetschler had experienced an anoxic brain injury, he may never wake up again. Even if the hospital was able to stabilize him, Mattie didn't know what "alive" would mean.

Stunned, the surfers gathered in the parking lot near the beach. Goldberg called Wetschler's family. After he got off the phone, he took email addresses to update Joll, Mattie, and the others on Wetschler's condition. They drove home, alone and shaken.

For the next few days, Joll checked his email frequently for news from Goldberg, but didn't receive anything. Assuming the radio silence meant the worst and that Wetschler's family was grieving his death, Joll fell to recounting the experience in his head, going through his own grieving process.

To him, it had been a failed rescue.

But then Joll got a call the following Sunday. It was Wetschler's brother.

"Matthew is alive," Dane said. "And he wants to meet you."

Wetschler was born in 1980 and raised in the suburbs of Pittsburgh. Quiet and slightly reserved as a child, he channeled his energy into playing sports with his brother, Dane, who was 6 years his junior, and took art lessons when he wasn't attending boarding school outside the city. He was raised by his mother, a former interior designer, and father, an internist in private practice.

A studio art major in college, he spent upwards of 40 to 50 hours a week working on his assignments. During rehab for his ski injury he turned back toward art, a passion lit from the same flame as the extreme sports. It had always been a part of his identity -- angst-riddled poetry in middle school, sketches of anatomical structures in med school.

The canvas, a defined, restricted dimension, physically limited him. Painting was an exercise in navigating a space, making it his own, and then sending it out into the world.

Although his father exposed him to the medical field early on, Wetschler initially took a different path: art school, ski bumming, and a volunteer gig in the slums of India. The latter experience pushed him toward medicine. In 2008, he began med school at the University of North Carolina at Chapel Hill, proceeding in 2013 to an emergency medicine residency at Stanford University.

But residency proved difficult. In his final year, he stopped painting completely for the first time since childhood. Working 80 hours a week and grappling with the trials of residency left him feeling lost and burned out, finding it hard to to remember why he thought medicine was ever a good idea. He took a leave of absence in 2016 to repair what had come undone in the last few years of clinical training.

It took months to regain the emotional stamina to return to practice. He had nearly forgotten the simple but powerful idea that initially drew him to the profession, namely that he was one person in front of another using his knowledge to help them. At an emotional low, he rented an art studio and started to paint again, putting in long hours like he did in art school.

Art quickly revived him, and after returning to and completing his residency, Wetschler moved to San Francisco to begin practice and also began giving lectures about his burnout experience. He found that when he spoke candidly and vulnerably about his experience, it resonated more deeply among residents than the flashy burnout messages so often delivered in disembodied bullet points. His lectures went beyond advising students to do more yoga or get enough sleep, explaining ways to find recuperative techniques within the workplace and neutralize the maddening trials of medicine.

In his talks, he spoke about finding peace and solace in a space where most doctors felt out of control -- about translating the feeling he found in the Wyoming mountains or the Pacific Ocean waves to a sustainable calm in the chaos of an emergency room.

After being revived on the beach, Wetschler had been driven to Zuckerberg San Francisco General Hospital and rushed to emergency surgery. Some people with his type of paralyzing spinal chord injury would simply be stabilized at this point, but his physician pushed for a more aggressive intervention. Within 6 hours of the injury, Wetschler underwent a laminectomy and fusion, where his surgeon removed the cap of bone from the top of his spine to relieve pressure.

While the procedure is traditionally performed by slightly elevating the blood pressure in the spinal cord and measuring blood levels through an arterial line in the arm, Wetschler received an additional catheter in his spinal column, so that his caregivers could more precisely measure changes in blood pressure, and more accurately and aggressively adjust his medication to optimize the amount of blood flowing to his spine.

When he awoke from surgery, the doctors told Wetschler his rehabilitation would be a slow process, but that he would eventually be able to walk again. As he was young, athletic, and had a favorable injury, perhaps he would transition from a walker to a cane in about 8 months.

Several days after his surgery, Wetschler was transferred to Santa Clara Valley Medical Center in San Jose. There, nurses fed him, changed his diapers, dressed him, bathed him. His initial goals were of the most basic kind: lifting a finger, wiggling a toe, feeling the warmth of human touch on his palm. Once he could move all his fingers, he transitioned to more ambitious tasks: sitting up, making a fist, putting on pants.

Each day he said to himself, what can my body do today?

Joll visited Wetschler at Santa Clara, and when Mattie returned from the medical conference in Seattle, he immediately visited too. Mattie had been a resident at Santa Clara as part of the Stanford University program, and after working with patients with spinal cord injuries for years there, he knew all too well how devastating they could be.

Throughout Wetschler's rehabilitation process, it was the idea of being in the water, in nature that he chased. But this was something he kept within himself -- an almost laughable dream he feared expressing in the sterile, fluorescent confines of his hospital room. What he sent out instead, to maintain some form of control when his body did not grant him the privilege of swimming, running, or even lifting a book, was art.

As soon as his fingers could palm a brush, Wetschler was painting. And when he could get into a wheelchair, he transformed his hospital room into a studio, covering canvases his family had brought him and bedecking the walls to create his own small gallery.

About a month after the accident and surgery, Mattie returned for another visit. Wetschler had completed about a dozen paintings and even produced a series using hospital equipment found in his room -- iodine, syringes, and tubes. And he was smiling, making jokes.

A year before, Wetschler had been finishing his residency at Stanford -- grueling, but arguably the pinnacle of achievement. His parents were happy, society was happy. He knew he should have been satisfied, doing a job caring for other people at a well-regarded institution, but in truth it was an emotional nadir.

Now, a year later, he had awoken paralyzed in a bed following a near-drowning experience and everything he'd taken for granted was put into question -- but he felt happier than he'd ever been. How, he wondered, could he hold those two experiences next to each other and not question what one needs to be satisfied in life?

Faced with the same situation, Joll said, he might have gone to a dark place, but he saw Wetschler react to his circumstances with calm and focus, maximizing the opportunities that came his way.

Wetschler's rehabilitation physician at Santa Clara, James Crew, MD, said it was fairly miraculous that Wetschler didn't have more neurological damage from the start. He presented with an incomplete spinal cord injury, a case that can be unpredictable in terms of recovery.

While his physical therapy -- everything from taking a couple of steps on parallel bars to learning to walk again using a zero-gravity machine -- exhausted his body, painting was therapeutic for his mind, said Crew. It was a way to keep him centered on improving and seeing what was possible, instead of focusing on how his body was limited. This, Crew explained, is the mindset he and his staff try to instill in every patient.

For Wetschler, it wasn't just the painting itself, but an insistence that he was still a whole person and could still have a voice in the world. Being stuck in a hospital where everything from the rooms, doctors, and even patients seemed sterile and uniform, he felt that to paint and be covered in paint was almost a countercultural statement, a refusal to be homogenized. Painting reflected a refusal to have his narrative -- of who he was prior to his injury, and who he would be after he left the hospital -- severed.

In 6 weeks, Wetschler had completed his therapy and returned home from the hospital, walking out on crutches months ahead of schedule.

Back at home, he continued working on his physical therapy. After a few weeks, he could walk without crutches for short periods around his house. Joll, who it turned out lived a few blocks away, came over often to play complex board games or cards with Wetschler, who took the opportunity to retrain the finer motor skills in his fingers.

Wetschler and I met one afternoon last November at a coffee shop a few blocks from Ocean Beach. It had been a year since his accident. He carried a slight limp and on colder days, he said, his right side still gave him trouble.

The street where we sat was lined with palm trees and there was a board repair shop next door where surfers sporadically trickled in, clad in wet suits. Not many though -- it was November in Northern California and would soon be getting dark.

Still, these were perfect conditions for the serious surfers, many of whom had moved to this neighborhood to be close to the beach. It has a reputation and you have to master tamer waves before securing your spot here, Wetschler told me.

Wetschler's gaze was fixed on a dangerously full latte as he made his way to the table. His hands trembled slightly, trying not to spill it. He had been painting, clearly, his palms and fingers spotted with white paint he no longer bothered to wash off. At 6-foot 4-inches, he dominated the small cafe, which was basically just a hallway. His movements measured and patient, he successfully slid the drink onto the table along with a slice of toast, sticky with jam. He smiled easily, made jokes about his efforts.

When Wetschler woke up in the hospital after the accident, he was paralyzed from the shoulders down. Although his memories from that day are clouded, he remembers realizing his body was irrevocably altered and that his life would never be the same. But in the back of his mind, he knew one thing would anchor him through whatever the future held: his art.

He finished his toast and wiped his hands before pulling out his phone, opening his Instagram, and scrolling through his pieces. Each one, he told me, involved a form of resistance that tested his recovering body.

The pieces themselves are stripped and austere, just a dry brush carving through thick white paint that's almost like plaster. There are no colors.

For one piece, he tied a 2.5-pound weight to his right wrist, which had been giving him trouble, and challenged himself to hold a brush at one point on a canvas covered in acrylic paint. But as his strength gave out, the brush sank lower on the canvas, carving deeper into the frame. When he could no longer maintain his strength, he rested, then moved on to an adjacent point on the canvas and began the process again.

In the end, there are nearly a dozen crescendoing strokes that resemble elongated keys on a piano, or a growing tide. Effort is detectable in the brushwork, and it gives the viewer a sense of strength -- of moving forward.

Each piece is ultimately about his physical body, which remains partially disabled, interacting with the canvas.

"The art is about struggle and resistance and perseverance, and I think that's something that everyone can relate to, whether or not the aesthetic of the work really speaks to them," he said. "The work is unadorned like the story is unadorned, and the story is in the work."

I visited the shore where Wetschler had been pulled from the water. The air temperature was in the low 70s with barely any wind. The beach was clear with just a few surfers straddling their boards along the horizon. It was hard to imagine the cutting breeze the day of his accident a year ago. A sign spiked in the sand along the shore read, "DANGER! RIPS!"

Wetschler first re-entered the waters of Ocean Beach after his injury in summer 2018 to create his most involved painting to date. Using his entire body as a brush to a 48-by-96-inch canvas covered in gesso acrylic paint, he performed the piece on the stretch of sand where Joll had laid him just a few months before.

The canvas lay on the shore, on one side of a 200-foot circle, with the surf on the other. It was dusk, a brisk 60 degrees and dropping. A few of Wetschler's family and friends, including Joll, gathered to watch the ceremony. Eight months into his recovery, Wetschler walked slowly along the perimeter of the circle.

He steadily trod through the ocean on one end, gathering sand as he emerged from the sea and continued in a circular motion, before leaving his body's imprint on the canvas, standing up, and repeating the entire process again. And again. And again.

By the time he finished, he had circled the beach more than a dozen times. He was shivering with cold, but was surprisingly energized. He had relearned how to move with the water again, instead of in its opposition. Finally providing himself the space to realize just how close to dying he had come, he was struck by a moment of catharsis. He wept.

He calls the piece "Reentry."

Today, it hangs at Winston Wächter Fine Art in Seattle, along with nearly a dozen of his other pieces. As Wetschler continues to paint, he has also been traveling around the country, delivering lectures to businesses and young professionals about his experience. He has been supporting himself through art sales and his public speaking gigs, and delivered the keynote address earlier this year at the American Academy of Emergency Medicine meeting in Las Vegas.

He hasn't returned to clinical medicine just yet. He told me he was hesitant, but curious, to do so, and probably will soon. His latest entrepreneurship, Mariposa Health, kicked off earlier this month to provide gender-affirming care for patients in Colorado through a virtual medicine clinic.

Despite his concerns that returning to a clinical environment might become all-consuming, he said the other aspects of his life have enough momentum to sustain themselves when he returns to practice. Besides, he is always up for a challenge, and sees returning to medicine as yet another opportunity for growth.

"It was one and a half years ago when I was thinking I'd like to be practicing medicine part time, traveling around the country and lecturing, maybe selling an art piece here or there," he said. "And I'm traveling around the country, selling an art piece here and there, and about to start practicing medicine part-time. I definitely did not predict this route, but it's a hell of a way to realize an ideal life."

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