There are some patients I saw during my time in residency that truly changed me as a person. I've written about a few, but there are many more. Here is what I have to say about one of them. Names and other personal details are of course altered for privacy.
I took a deep breath, forced the best smile I could, and turned the doorknob. Inside, Rosa sat in her wheelchair like usual; a few months ago we had celebrated her regaining her ability to walk with a cane after her stroke, but she quickly went back to the wheelchair as it was easier for her. Today was our monthly meeting to discuss her chronic conditions. In medicine we call this secondary prevention. Primary prevention is focused on keeping someone from having a serious event like a heart attack or stroke, while secondary prevention tries to minimize the person's risk of another event occurring. We are trying to keep history from repeating itself. Rosa and I had been working together for nearly a year at this point, although perhaps "working together" is a misnomer; our appointments generally consisted of her giving one word answers to my questions, me setting some homework that she would promise to work on over the next 2-4 weeks, and then a short period of silence where I tried to discern something about her true mindset or intentions. No matter my approach, I had never gotten any closer to her. And she had never done a single thing she told me she would do. She never checked her blood sugars. She never drank less soda. She never took her medications. She wouldn't take walks or eat vegetables. And she would never tell me why. She just showed up, timely and polite and unknowable, for every visit.
As I entered, Rosa's aunt and caretaker glared at me silently from the corner - both aunt and glare cornerstones of our appointments.
"Hi! How are you today?" I asked Rosa.
She promptly burst into tears. Her caretaker made no move from her seat across the room.
The deluge lasted at least five minutes. I sat in silence with my arm around her, flabbergasted. Where has this come from? She had never given any sign of sadness before. I handed her a stream of tissues, mute in shock and witness.
When it was over, she sniffled one final time, sat up straight, and said, "I'm fine."
I almost laughed. "Rosa, what do you mean you're fine? You basically cried on my shoulder for the past few minutes."
"I'm fine."
I pressed her but got little in response. She wouldn't tell me why she felt so sad. I asked if she wanted to try counselling and she said no. I asked if she was feeling depressed and she did say yes, so we agreed to start an antidepressant that day. A month later she came back for her check-in. She hadn't taken the antidepressant. When I asked her why, she shrugged and said she felt better, and wouldn't elaborate. And so we fell back into our routine.
One day after maybe two years of this pattern, I walked into the room not with my previous forced enthusiasm but with the sort of calm, professional blankness
that comes with knowing you are about to have another pleasant but
fruitless encounter. In hindsight I can see that the lack of progress had been wearing me down gradually, but at the time it felt like an abrupt change. After our usual exchange of Hi-Rosa-how-are-you-I'm-fine, I simply said:
"What do we need to talk about today?"
"I don't know."
"Well, would you like to talk about your diabetes today?"
"Not really."
I paused. "Okay, then. What would you like to discuss?"
"I don't know."
Always previously, I had pushed past her recalcitrance, prodding her to
some sort of lopsided discussion about her medical conditions,
behaviours, habits, and so on. After all, why
else would she come and see me? I had been determined to help her in some
small way. But that day, hearing her respond so casually - not really, I don't know - I
was suddenly furious. So much effort. So much time spent with her.
So many clinics where I let myself run late to attempt to talk to her.
And for what? So that after years of this, she could flush our agenda
down the toilet as though none of it mattered. Just like
that I was done. If she wanted to waste this time, I was going to
let her.
"Okay... well do you need refills of any of your medicines?"
"I don't think so."
"Anything you need from me today?"
"No, not really."
"...Well, okay then."
The visit was over about a minute later. I never saw her again.
I still struggle with the choice I made that day, born as it was from the cliff's edge of patience. Perhaps I did the right thing externally, but internally I gave up on her, and that alone makes my judgment questionable. Should I have kept pushing, had more compassion and perseverance? Was I serving some vague therapeutic purpose? Did I set us both free from a pointless rut we had been stuck in? Or did I just cut off a source of easy emotional investment that she wanted but didn't want to work for?
The truth is probably buried somewhere in the middle of all of those possibilities. I don't claim to see it clearly. After she stopped coming to see me, I prayed for her and prayed for her, and then I got angry at her again and shouted at God about how ridiculous the whole situation was. And ultimately I trusted Him to redeem it all for good. And this is the nature of medicine and ministry, right? Many times it goes nowhere that we can see. Often in this field there is what psychologists call a complex separation from our patients, one without closure or denouement, and thus also without any kind of satisfaction on the part of the provider. It is stressful but unavoidable. Most of my career I will attempt to take care of someone the best way I know how, and I will never know in this lifetime how it really turned out. And in the midst of that uncertainty, in those stories that seem to stop at failure, I can choose to let my viewpoint be similarly limited or I can look further out and further ahead. I can shout at God and be done with it, or I can choose to trust that He is the author of redemption. He makes all things new and good in His perfect timing.
I'm still coming to terms with that.
Saturday, December 10
Wednesday, November 9
Another step back, or, This is what it looks like to recover from severe burnout
I am in that featureless, dimly lit middle stage on the journey out of burnout. They say with attention to the issue, it gets better and that with time I can be fully invested in my work. Right now it varies day to day. Some days I drag myself out of bed late, reluctant to meet people and be happy. Some days I rise from bed fresh and invigorated; I cherish these days as harbingers of change.
I laugh with coworkers. I bring coffee, help decorate our new clinic. I like the patients I see. I am lavish with my emotional coin since urgent care requires so little of it overall. No one asks me to be their everything here, so there is no emotional abyss of investment to guard against, so I can be generous with myself. I encourage, educate, rebuke, reassure. I remind myself not to get too possessive or protective of these people; these are not my patients. They are just patients. I get to do immensely satisfying things like sew lacerations and fish things out of ears and burr metal flakes out of a man's eye. I puzzle over rashes. I argue about antibiotics. I work twelve to fourteen hours a day, then drive home and smile easily at my husband.
At work, I get a card someone left at the front desk. A card? For me? Yes, says my receptionist. I don't tell her the truth: I don't want a card.
It has my name on the front. I open it and read it aloud to my nurse. It is from a patient I saw a week ago who was in emotional crisis. I remember that we talked for a while and after I determined that she was not in imminent danger, I started her on some medications. I told her she needed a therapist. I remember that I tried to show her kindness but not too much.
The language of the card is effusive. My compassion and flexibility floored her, she writes. My prayers gave her strength. She tells me I saved her. She asks if she can see me again at the urgent care clinic.
I read the letter feeling as though someone has started to press down on my neck. My nurse cries and says she has goosebumps, which is a helpful signal to me to pause for a moment. I just want to run, but a reaction is required here. I mumble something about how touched I am, but really I'm uncomfortably reminded of how much of my shows of compassion are a farce, external signposts that freely promise warm, green destinations but lead instead to cool grey expanses of indifference. I push away the dread and remind myself that navigating a continued doctor-patient relationship with this woman is not my job anymore.
How nice of her, I say. But no, she can't come and see me again. I put down the card and pick up the next chart in the rack.
I laugh with coworkers. I bring coffee, help decorate our new clinic. I like the patients I see. I am lavish with my emotional coin since urgent care requires so little of it overall. No one asks me to be their everything here, so there is no emotional abyss of investment to guard against, so I can be generous with myself. I encourage, educate, rebuke, reassure. I remind myself not to get too possessive or protective of these people; these are not my patients. They are just patients. I get to do immensely satisfying things like sew lacerations and fish things out of ears and burr metal flakes out of a man's eye. I puzzle over rashes. I argue about antibiotics. I work twelve to fourteen hours a day, then drive home and smile easily at my husband.
At work, I get a card someone left at the front desk. A card? For me? Yes, says my receptionist. I don't tell her the truth: I don't want a card.
It has my name on the front. I open it and read it aloud to my nurse. It is from a patient I saw a week ago who was in emotional crisis. I remember that we talked for a while and after I determined that she was not in imminent danger, I started her on some medications. I told her she needed a therapist. I remember that I tried to show her kindness but not too much.
The language of the card is effusive. My compassion and flexibility floored her, she writes. My prayers gave her strength. She tells me I saved her. She asks if she can see me again at the urgent care clinic.
I read the letter feeling as though someone has started to press down on my neck. My nurse cries and says she has goosebumps, which is a helpful signal to me to pause for a moment. I just want to run, but a reaction is required here. I mumble something about how touched I am, but really I'm uncomfortably reminded of how much of my shows of compassion are a farce, external signposts that freely promise warm, green destinations but lead instead to cool grey expanses of indifference. I push away the dread and remind myself that navigating a continued doctor-patient relationship with this woman is not my job anymore.
How nice of her, I say. But no, she can't come and see me again. I put down the card and pick up the next chart in the rack.
Saturday, September 10
Doctors get sick too and this is a good thing
Every time I get sick, it changes my practice just slightly. It doesn't change my medical management, but I can tell that I react to people differently. Here's an account I wrote ages ago, then forgot about, that illustrates this well.
So I have this lump in my breast. No, no, don't freak out; it meets all the criteria for likely being benign:
1. young patient with no medical problems
2. no family history of breast cancer, or really cancer of any kind
3. lump is well-defined
4. freely movable (i.e. doesn't seem attached to the chest wall)
5. tender (super tender.)
6. started suddenly
7. no funny-seeming lymph nodes
8. no other symptoms
All of that put together likely equals a cyst that is infected or blocking a duct or something like that. At worst, it may be a benign tumor, but even that seems like a stretch. All other possibilities are way out there in The Land Of Rare Things. Despite all that, though, I still needed to see a doctor myself. I thought this thing should probably get checked out, and also it was hurting and I wanted it to not hurt anymore.
I'll be honest; it was a good reminder of the patient experience.
It was hard to be perfectly on time. Getting a breast exam was kind of awkward despite how professional and nice my doctor is. I completely forgot something I wanted to tell him and he had to come back in. When he said he thought this was "kind of weird" and that he wanted to get a mammogram "just to be safe," I felt a little chill; we'd just finished talking about low risk I am for cancer, but still! I worried a bit about the cost of all this stuff. I went for some labwork and that needle really hurt, although I was a big girl and didn't swat at the nurse. I'm grateful that I'm on vacation this week so I can go and have these tests without using sick days, but at the same time I really don't want to go and have this tender lump squished about by a mammogram machine.
In the end, I got an ultrasound rather than a mammogram, and they put me on antibiotics for a week, which seemed to take care of it. I still had to see a breast specialist and get several breast exams to make sure the lump was gone, though; at my last visit, he told me I wouldn't need any more extra surveillance. It was just a small infection after all.
I like to think I take good care of my patients in that I not only give good medical treatment, but also do my best to respond to my patients with sensitivity. But the fact is that it's very easy to gloss over the reality of someone else's experience, especially when each individual is just one in a long line of people you have to see that day. When you are a totally healthy person, you simply forget that medical care is awkward and time-consuming and at times nerve-wracking for patients. Sickness, mild or severe, reminds us of all these things.
To put it simply, having my share of normal human suffering allows me to connect with people better, which is the most fulfilling part of my job. So I'm glad that I've had back pain and bronchitis and breast infections. I'm glad that I've been that patient that was so miserable from a cold that I went to my doctor, hoping against hope that it might be bacterial so I could get an antibiotic to feel better (it was viral. I was grumpy and ill for two weeks). Having known the poison of depression lets me pray for those who are depressed with empathy and compassion. Knowing the agony of migraines makes it easy to really care when someone comes in and tells me that his headaches are ruining his life. Experience with grief allows me to offer better comfort to those who are grieving. I know what I'm saying when I tell someone that His grace is sufficient in their weakness. His grace is sufficient in my weakness, too.
So I have this lump in my breast. No, no, don't freak out; it meets all the criteria for likely being benign:
1. young patient with no medical problems
2. no family history of breast cancer, or really cancer of any kind
3. lump is well-defined
4. freely movable (i.e. doesn't seem attached to the chest wall)
5. tender (super tender.)
6. started suddenly
7. no funny-seeming lymph nodes
8. no other symptoms
All of that put together likely equals a cyst that is infected or blocking a duct or something like that. At worst, it may be a benign tumor, but even that seems like a stretch. All other possibilities are way out there in The Land Of Rare Things. Despite all that, though, I still needed to see a doctor myself. I thought this thing should probably get checked out, and also it was hurting and I wanted it to not hurt anymore.
I'll be honest; it was a good reminder of the patient experience.
It was hard to be perfectly on time. Getting a breast exam was kind of awkward despite how professional and nice my doctor is. I completely forgot something I wanted to tell him and he had to come back in. When he said he thought this was "kind of weird" and that he wanted to get a mammogram "just to be safe," I felt a little chill; we'd just finished talking about low risk I am for cancer, but still! I worried a bit about the cost of all this stuff. I went for some labwork and that needle really hurt, although I was a big girl and didn't swat at the nurse. I'm grateful that I'm on vacation this week so I can go and have these tests without using sick days, but at the same time I really don't want to go and have this tender lump squished about by a mammogram machine.
In the end, I got an ultrasound rather than a mammogram, and they put me on antibiotics for a week, which seemed to take care of it. I still had to see a breast specialist and get several breast exams to make sure the lump was gone, though; at my last visit, he told me I wouldn't need any more extra surveillance. It was just a small infection after all.
I like to think I take good care of my patients in that I not only give good medical treatment, but also do my best to respond to my patients with sensitivity. But the fact is that it's very easy to gloss over the reality of someone else's experience, especially when each individual is just one in a long line of people you have to see that day. When you are a totally healthy person, you simply forget that medical care is awkward and time-consuming and at times nerve-wracking for patients. Sickness, mild or severe, reminds us of all these things.
To put it simply, having my share of normal human suffering allows me to connect with people better, which is the most fulfilling part of my job. So I'm glad that I've had back pain and bronchitis and breast infections. I'm glad that I've been that patient that was so miserable from a cold that I went to my doctor, hoping against hope that it might be bacterial so I could get an antibiotic to feel better (it was viral. I was grumpy and ill for two weeks). Having known the poison of depression lets me pray for those who are depressed with empathy and compassion. Knowing the agony of migraines makes it easy to really care when someone comes in and tells me that his headaches are ruining his life. Experience with grief allows me to offer better comfort to those who are grieving. I know what I'm saying when I tell someone that His grace is sufficient in their weakness. His grace is sufficient in my weakness, too.
Tuesday, August 23
The Other Side of Disillusionment
It took a couple of weeks after I graduated residency this summer to finally bring it up.
"You know what?"
My husband looked over at me. "What?"
I looked at him for a moment, and then finally said the thing that had been brewing all day, slowly forming in my mind as a firm conclusion.
"I hated residency."
He half-smiled. "Yeah, we knew that."
"No. I really hated residency. Really, really, really hated it."
His smile dropped away. "I know."
-----
Yeah, I finished residency. I think I'm expected to say something like, "Man, there were a lot of ups and downs! It's an intense period of your life and it's really hard. But it's over now, and I'm soooooo excited to do medicine my way!" But you know what? I hated residency so much it's hard to just get over it. It feels trite to say that, because in medicine it's kind of like saying that water is wet or MIs are deadly. But I learned from watching my fellow residents that "hating residency" can mean many things; some of us just loathe the suck, while others are truly damaged by the process. No one comes out the same as they went in - we all finish somewhat better as physicians but somewhat worse as human beings - but some of us come out in pieces. I hated residency so much that I couldn't even admit it to myself properly during the process because to admit how deep my disillusionment went would be to rob myself of the stoicism necessary to endure through until the end. No wonder empathy takes a record dive among residents. If that was my introduction to real medicine then I wish I could afford to have no part in it.
But why hate residency? you say. It's hard training and hard work, but it's necessary for you to become a doctor. You learned a lot. And it was a job and you got paid. And I don't mean to ignore the good parts of the past few years. I made some good friends who I think will be with me for life. I met a few people who I consider role models. I had some funny mishaps. I found out just how well and how long I survive on minimal sleep (the answer is: a long time, but not that well). But plumbing the depths of exhaustion while learning what this profession is and is not made me question the very premises that led me to medicine in the first place.
1. Medicine is not what I wanted it to be because it is a business, you guys. It's one thing to know that from the outside in a vague sort of way. It's another thing when you have to send a nice old man with dementia to the homeless shelter because no one wants to pay for his hospital stay and his family won't take him back. Or when you realise there's a gaping hole in the safety net for those with mental illness that can only be filled by paying cash to a dubiously trained caretaker. Or when pediatricians or obstetricians or family docs or specialists won't take Medicaid patients because it "doesn't pay enough". Or when you see patients who are begging you for solutions and you have nothing for them despite living in a first-world country because they don't have any money. There were so many times that I cried at the lack of options for someone, all because of money. More money means better medical care in so many ways, in ways that you have probably never thought of. In ways that make me feel ashamed.
2. A doctor's job is not what I wanted it to be, because it's mostly paperwork, or at least it feels that way. This is especially true in primary care. About once a week during residency, my medical assistant would thunk down a thick folder next to my computer. It was full of forms for me to review and fill out or sign. FMLA, disability queries, home health updates, refill requests, Rx prior authorisations... Half the time I had no idea how to even complete the paperwork so I would just do my best and hope it was good enough. You want to know why your doctor's office has started charging for forms to get filled out? Because I would spend literally hours every week on charting and forms and calling around to places for various things. Forms do not get magically filled out by form fairies. Forms get filled out by doctors staying an hour or two late every few days to clear the backlog. I didn't even have what would be considered a full panel of patients for a primary care physician since I was only in clinic about 1/3 of the time. I cannot even imagine how much paperwork a full time family doc has to do.
3. My patients are not who I wanted them to be. I think I am a fixer. I need problems that I can actually solve. But in medicine you meet so many people with things you can't fix, or problems that are not yours to solve. I keep a list in my head - not intentionally - of all the people I met who I just could not help. It's longer than you might expect. I remember a guy who was an alcoholic; he would binge drink and then come in with a horrible flare of pancreatitis, vomiting uncontrollably and in severe pain. And yet he would leave after being treated and then come back a short while later, drunk and sick again. We offered him so many resources for quitting, and he would lie to us, and refuse... it was like we weren't even there. I saw many people like that - people locked in a struggle with their demons, grappling with them as their medical team essentially stood by and watched. There were many others who were just too sick for any medical treatment to offer much. I don't know what I'm meant to do with those people, either in person or as the haunting memories in my head.
4. My colleagues are not who I wanted them to be. Residency doesn't bring out the best in anyone, and we are all flawed to begin with. There were a lot of times when if we hadn't needed each other I think we all might have been at each others' throats, while at the same time there was a lot of irritating pretense that we were all doing okay. There were some minor and major betrayals from attendings, one of which almost cost me a timely graduation.
5. I am not who I wanted to be. Remember when I said residency doesn't bring out the best in you? I don't deal with authority very well, nor do I work particularly well as part of a team unless I am the leader. I am easily demotivated when under stress. I am absolutely certain that I was a grumpy, harsh, lousy person to deal with about half the time (and any time administration wanted me to do something). I am prone to emotionally overinvesting and then I have no way to fill that empty well back up. And I am full of selfish pride. I spent a lot of time in residency not thinking about how best to serve others but instead focused on how best to survive intact. The irony of that is that I didn't survive intact, not really. I finished residency feeling depleted, angry, and afraid of the future. Would I have fared better or even worse if I hadn't been so focused on myself? Who can say? It's hard to imagine how it could have been worse, though. I spent months at a time just getting by.
Residencies are required to do exit counselling as part of staying accredited by the ACGME, the organisation responsible for policing postgraduate training for physicians. My "exit interview" consisted of a 90 minute group SWOT session for my graduating class, a stupid and contrived format that they had clearly settled on as a way to keep people from talking a lot and thus complaining. It meant I didn't get to say any of what I wanted to say. What I wanted to say was, I gave you the last gasp of my idealism and true youth and you gave me back the ashes of dreams and a smaller version of myself. What I wanted to say was, no one told me it would be like this. If they had told me, maybe I would have chosen work that doesn't take so much more than it gives. What I wanted to say was, I have finally learned to hate medicine. You've convinced me to run away.
-----
Of course I don't have the luxury of running away. My husband and I are in the kind of debt that you would not believe thanks to my training; let's just say our monthly student loan payments are six times our mortgage payments. I obviously have to work. For now, I've chosen the next best thing to nothing: urgent care. It feels like I'm letting people down by doing this instead of choosing Work That Will Help People. But at this moment in my life, fresh out of training and counting the cost, I'm not sure what that work is. So I'll treat colds for a while, and we'll see. Maybe residency has just been an extended low point and I'll recharge. Maybe my questions about the practice of medicine have no answer. Maybe I'll learn to be okay with that. Maybe I won't.
"You know what?"
My husband looked over at me. "What?"
I looked at him for a moment, and then finally said the thing that had been brewing all day, slowly forming in my mind as a firm conclusion.
"I hated residency."
He half-smiled. "Yeah, we knew that."
"No. I really hated residency. Really, really, really hated it."
His smile dropped away. "I know."
-----
Yeah, I finished residency. I think I'm expected to say something like, "Man, there were a lot of ups and downs! It's an intense period of your life and it's really hard. But it's over now, and I'm soooooo excited to do medicine my way!" But you know what? I hated residency so much it's hard to just get over it. It feels trite to say that, because in medicine it's kind of like saying that water is wet or MIs are deadly. But I learned from watching my fellow residents that "hating residency" can mean many things; some of us just loathe the suck, while others are truly damaged by the process. No one comes out the same as they went in - we all finish somewhat better as physicians but somewhat worse as human beings - but some of us come out in pieces. I hated residency so much that I couldn't even admit it to myself properly during the process because to admit how deep my disillusionment went would be to rob myself of the stoicism necessary to endure through until the end. No wonder empathy takes a record dive among residents. If that was my introduction to real medicine then I wish I could afford to have no part in it.
But why hate residency? you say. It's hard training and hard work, but it's necessary for you to become a doctor. You learned a lot. And it was a job and you got paid. And I don't mean to ignore the good parts of the past few years. I made some good friends who I think will be with me for life. I met a few people who I consider role models. I had some funny mishaps. I found out just how well and how long I survive on minimal sleep (the answer is: a long time, but not that well). But plumbing the depths of exhaustion while learning what this profession is and is not made me question the very premises that led me to medicine in the first place.
1. Medicine is not what I wanted it to be because it is a business, you guys. It's one thing to know that from the outside in a vague sort of way. It's another thing when you have to send a nice old man with dementia to the homeless shelter because no one wants to pay for his hospital stay and his family won't take him back. Or when you realise there's a gaping hole in the safety net for those with mental illness that can only be filled by paying cash to a dubiously trained caretaker. Or when pediatricians or obstetricians or family docs or specialists won't take Medicaid patients because it "doesn't pay enough". Or when you see patients who are begging you for solutions and you have nothing for them despite living in a first-world country because they don't have any money. There were so many times that I cried at the lack of options for someone, all because of money. More money means better medical care in so many ways, in ways that you have probably never thought of. In ways that make me feel ashamed.
2. A doctor's job is not what I wanted it to be, because it's mostly paperwork, or at least it feels that way. This is especially true in primary care. About once a week during residency, my medical assistant would thunk down a thick folder next to my computer. It was full of forms for me to review and fill out or sign. FMLA, disability queries, home health updates, refill requests, Rx prior authorisations... Half the time I had no idea how to even complete the paperwork so I would just do my best and hope it was good enough. You want to know why your doctor's office has started charging for forms to get filled out? Because I would spend literally hours every week on charting and forms and calling around to places for various things. Forms do not get magically filled out by form fairies. Forms get filled out by doctors staying an hour or two late every few days to clear the backlog. I didn't even have what would be considered a full panel of patients for a primary care physician since I was only in clinic about 1/3 of the time. I cannot even imagine how much paperwork a full time family doc has to do.
3. My patients are not who I wanted them to be. I think I am a fixer. I need problems that I can actually solve. But in medicine you meet so many people with things you can't fix, or problems that are not yours to solve. I keep a list in my head - not intentionally - of all the people I met who I just could not help. It's longer than you might expect. I remember a guy who was an alcoholic; he would binge drink and then come in with a horrible flare of pancreatitis, vomiting uncontrollably and in severe pain. And yet he would leave after being treated and then come back a short while later, drunk and sick again. We offered him so many resources for quitting, and he would lie to us, and refuse... it was like we weren't even there. I saw many people like that - people locked in a struggle with their demons, grappling with them as their medical team essentially stood by and watched. There were many others who were just too sick for any medical treatment to offer much. I don't know what I'm meant to do with those people, either in person or as the haunting memories in my head.
4. My colleagues are not who I wanted them to be. Residency doesn't bring out the best in anyone, and we are all flawed to begin with. There were a lot of times when if we hadn't needed each other I think we all might have been at each others' throats, while at the same time there was a lot of irritating pretense that we were all doing okay. There were some minor and major betrayals from attendings, one of which almost cost me a timely graduation.
5. I am not who I wanted to be. Remember when I said residency doesn't bring out the best in you? I don't deal with authority very well, nor do I work particularly well as part of a team unless I am the leader. I am easily demotivated when under stress. I am absolutely certain that I was a grumpy, harsh, lousy person to deal with about half the time (and any time administration wanted me to do something). I am prone to emotionally overinvesting and then I have no way to fill that empty well back up. And I am full of selfish pride. I spent a lot of time in residency not thinking about how best to serve others but instead focused on how best to survive intact. The irony of that is that I didn't survive intact, not really. I finished residency feeling depleted, angry, and afraid of the future. Would I have fared better or even worse if I hadn't been so focused on myself? Who can say? It's hard to imagine how it could have been worse, though. I spent months at a time just getting by.
Residencies are required to do exit counselling as part of staying accredited by the ACGME, the organisation responsible for policing postgraduate training for physicians. My "exit interview" consisted of a 90 minute group SWOT session for my graduating class, a stupid and contrived format that they had clearly settled on as a way to keep people from talking a lot and thus complaining. It meant I didn't get to say any of what I wanted to say. What I wanted to say was, I gave you the last gasp of my idealism and true youth and you gave me back the ashes of dreams and a smaller version of myself. What I wanted to say was, no one told me it would be like this. If they had told me, maybe I would have chosen work that doesn't take so much more than it gives. What I wanted to say was, I have finally learned to hate medicine. You've convinced me to run away.
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Of course I don't have the luxury of running away. My husband and I are in the kind of debt that you would not believe thanks to my training; let's just say our monthly student loan payments are six times our mortgage payments. I obviously have to work. For now, I've chosen the next best thing to nothing: urgent care. It feels like I'm letting people down by doing this instead of choosing Work That Will Help People. But at this moment in my life, fresh out of training and counting the cost, I'm not sure what that work is. So I'll treat colds for a while, and we'll see. Maybe residency has just been an extended low point and I'll recharge. Maybe my questions about the practice of medicine have no answer. Maybe I'll learn to be okay with that. Maybe I won't.
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