Halfway through intern year

Here are a few things I’ve done so far:

– felt cynical

– been humbled

– felt guilt

– went by someone else’s opinion instead of my own, and was burned

– cried at family meetings

– cried on the drive home

– hid in a bathroom and cried some more

– yelled at a patient

– felt disrespected/intimidated/supported/appreciated by other healthcare staff

– felt bad about myself for not knowing a fact

– treated someone rudely because i had just been rudely treated by someone else

– pronounced people dead

– broke it to an old lady that she had syphilis

– watched families watch their loved ones be coded

– felt like I should have been able to do more for someone

– felt like there was nothing else I could do for someone

– fetched drinks for patients

– gagged while examining someone

– woke up with anxiety cramps

– seriously questioned being a doctor

After 6 months of excitement, self-doubt, and growing pains, my morale had hit an all time low. I felt alone, isolated, and stuck. I thought it was maybe the weather, or maybe just me. I’ve wondered why I’m doing what I’m doing and why did I want this so badly – was I totally wrong? Is this what my life is going to be like forever?

It was a rough few weeks.

I’m not sure when things started to shift. Maybe it was from hearing so many co-interns mention something about feeling tired, feeling burnt out, feeling like they didn’t know why they were doing this. There was that time a 3rd year overheard us talking and sat with us for an extra hour after night clinic had finished, to tell us that he understood how we felt, that he was sorry, but that it’d be ok. He drew that graph someone had drawn for him, telling us that it’s half way through the year, the days are dark, and everyone at every level is feeling low. It’s expected and it’s ok. The more I confided in others, the more they confided in me that they too had been feeling dark and down, questioning themselves and where they are, lonely yet reclusive. In groups we wanted to appear confident and capable, but one-on-one we were openly vulnerable, anxious and insecure. One day while driving, it occurred to me how ridiculous it was to feel I was a bad person for not knowing something. Then you named this perspective and put this conflict into words.

A friend, a co-intern, told me of waking up devastated and guilty for not remembering what he had read the night before. Another told me of feeling it was time to quit. Another told me of anger over not being trusted, or fear of being thought of as not performing. And another told me how alone he felt. We all wanted so badly to show what we are capable of, to be told we are capable, to feel capable. We were falling apart.

It’s halfway through the year, and it’s some long dark days. But I’m feeling new. Newer than before when I felt like I was all untapped potential; vast and mysterious, awaiting the dramatic reveal. Now I feel like a sprout; little and very green. But earnest. Nothing more, nothing less.

The enemy

“The chronic pain patient who wants more and more pain meds isn’t the enemy. The pain meds are the enemy.”

First day

Tomorrow is my first day as a resident. Orientation finished last Friday.

I’m nervous and feeling like a big odd ball of emotions: relief, terror, gratitude, awe, and incompetence are the first few that come to mind. How do people ever become “real” doctors, anyway? In med school, being a “real” doctor meant being an MD. Now it feels like you should know what you’re doing before you can call yourself that. When I see “Physician” on my nametag, or hear people refer to me as doctor, I want to correct them, “Oh, but I’m not a REAL doctor yet.” I hope I don’t cry when I see my first patient, haha  

Really though, I’m so happy in my program so far. I was skeptical when I finished the interview day here, wondering if they were just saying all the right things to sell us the program. But I have a good feeling about it all. Their emphasis on communication, their attitude and approach, so patient-centered and wholly supportive of everyone. I was looking for a family-feeling, a new team, a new home, and I may have found it. I’m buying into it all and I feel the other interns are too.

Anyway I’m terrified, nbd. Wish me luck.

With a growing …

With a growing avalanche of new knowledge and skills bearing down on them, they feel increasingly overwhelmed by what they do not know. They soon discover that, instead of expanding their capacity to make a difference in the lives of others, the rigors of medical school have constricted their field of view to their own survival.

Burnout at its deepest level is not the result of some train wreck of examinations, long call shifts, or poor clinical evaluations. It is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice. When a great ship steams across the ocean, even tiny ripples can accumulate over time, precipitating a dramatic shift in course. There are many Tertius Lydgates, male and female, inhabiting the lecture halls, laboratories, and clinics of today’s medical schools. Like latter-day Lydgates, many of them eventually find themselves expressing amazement and disgust at how far they have veered from their primary purpose.

Quote from The Atlantic article by Richard Gunderman, “For the Young Doctor About to Burn Out.”

Feedback

When I was swimming, I loved getting feedback on my strokes. It meant I was getting attention and on my way to perfecting my technique. The more the better!

Now in clinicals, when I learn a mistake I made or get a question wrong or it turns out I overlooked something, I feel bad. At the end of the day I’m sighing and trying to relax about it all.

How come I’d be so happy to hear what i was doing wrong when it came to swimming, but not when it comes to smarts? With every comment or lesson, I felt like I was getting better, but in medicine I have to remind myself it doesn’t mean I’m a poor student or going to be an incompetent doctor.

 

Home again

I’m back at my alma mater for a rotation.

It’s been really interesting to see how it’s done in Canada. I’m at a new hospital, at an academic center, with slightly less sick patients, so it is a biased look, but hearing the great talks and hallway lectures from the attendings about research and studies, and questions still unanswered, has reminded me of how fun and exciting it is to do research, and to have a project that you really own and shape.

I was pretty sad this week, as I thought seriously about whether to go back to Canada or the US for residency. Even though I’m back “home” where I lived for 6 years, being away from NYC, which has been home for the last year and a half, has me feeling a bit lonely as I get used to my new placement. I felt sad thinking I might feel lonely the next years, through residency and potential fellowship, as I keep moving place to place, and still don’t know where I want to and where I can or where I will settle and make my home.

But I just got to keep reminding myself that things change, and to enjoy this moment.

It’s snowy outside, and pretty cold, but life is good.

Halfway through sub-i

Well I’m halfway. Last week I worked every day of the week. A patient coded while myself and my co subi were alone on the floor. Backup came, of course, but it was terrifying nonetheless. Next time we’ll know what we can do, instead of just auscultating while the patient is struggling to breathe.

I’m getting into the flow of things. Said bye to some patients I’ve grown fond of. One patient has her adult daughter by her side almost every moment day and night. Her daughter feeds her, changes her diaper, and keeps her company all through the night. I felt happy and sad to see them go. Will I get to ever know what happens to them? That’s goodbye for real?

I feel like a job is done when patients leave, but really its just that my part is done. They are rarely completely healed, just stable and safe to go home.
It feels good to feel myself becoming more efficient, less afraid, growing. But I also feel myself hardening a bit. Like things don’t affect me as much. It partly comes with experience I guess but mostly just helps to work faster. There are limitations to hospital care and as much as I love the pace and intense patient care, and I love the interdisciplinary work, but I also feel sometimes like just a pit stop or a bandaid. Are the changes I make going to impact their health down the road? Will their primary care doctor make any changes? Will they follow up? Are they any more healthy?

Two Mondays to go.

First day of sub I

Disagreements between when a patient was ready to go led to the patient being discharged late in the day, at the family’s insistence. Pts family is frustrated that discharge took so long. I overhear the son say “you’d think its the first time they’d ever done a discharge!” And it was! Haha!

I got scolded today by a private attending for stuff done by someone else, and had lots of frustration taken out at me but really it was such an awesome day! It feels so good to take care of people.

Family medicine

Family docs are the nicest! Specializing is overrated.

Psych tidbit

Interesting thing I learned from my psych rotation: both when people sink into depression, and when people come out of depression, the person is the last person to feel the change in their mood.

I have a patient who is a 100% example of this. I really like working with him. He has gone from total catatonic to talking and expressing his feelings, his worries and even sometimes thinking he might be getting better. Today we did a crossword puzzle about fruits together. He laughed for the first time in months ( not while doing the crossword, but later when I was testing his memory and asked him to repeat something I had told him a while earlier. Because he knew he wouldn’t be able to do it) I feel really fondly toward this patient, really rooting for him. I feel sad that I will be finishing my rotation soon and won’t see him again most likely. I hope the next med student treats him well.