I remember the day I decided to quit residency.
It was January in my intern year and I was on one of my internal medicine rotations, which always were my least favourite. I felt like my life consisted only of long hours and a surfeit of other people's suffering. That morning, after four hours of rounding alone on my patients, I was about fifteen minutes late for morning group rounds, and mid-month evaluations were being held. During my evaluation, I was told by my chief resident that I did not do a good enough job of being on time. She was clear that my job was not to be right, it was to be punctual. She was there to help with the rest, she said. Then at rounds I got some questions wrong and was told by an attending I needed to review some topics and make sure I knew my patients better. We also concluded two of my patients were terminal.
Cut to twelve or thirteen hours later when I was finishing up my evening call. I was in the middle of checking out the patient list to the nighttime senior - a fast-paced, highly regimented process in my program since our patient lists tended to be long and medically complex - when the other chief resident breezed into the room. He had seen some of my notes on my patients, he told me. They were lacking in depth. I needed to take more time and make sure I was being appropriately thorough. He breezed back out of the room and, after a pause, I completed my checkout.
A short time later, sitting in my car in the parking garage, I went to turn my car on and couldn't even initiate the movement. Instead I sat there in the cold as the sum of the day became clear. A profound heaviness took up residence in my chest. Had I accomplished anything that day? I got criticized for taking too long and not taking long enough. Likewise, I didn't know enough but wasn't meant to know more. And I couldn't help many of my patients anyway, since many of them were dying.
What the hell was I doing this to myself for? I had no answer. Yeah, I'm done, I thought, and turned the key in the ignition.
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Obviously I'm writing this as a licensed, board-certified physician who works full time in clinical medicine, so we know how the story ended. But I will never forget that moment, sitting there in the chill darkness, quietly listening to my last big dream break apart. I cannot describe the pain of that to you, especially because I know that I am a creature that was made for hard work. Why did this happen? Because I couldn't hack it? Not tough enough, or in the modern burnout parlance, not resilient enough? I pondered that for a while and almost accepted it as true. But now that I've had a little time to gain perspective, I reject that.
I'm a low maintenance, mentally tough woman with deep emotional resources and the personal grit necessary to grind out hard work over months and years. My childhood dreams always involved work and adventure, not the more domestic goals many of my friends had. I'm a career woman at heart and I'm comfortable knowing God made me that way. But residency broke me (twice, actually, but that's a different story).
There are a lot of articles out there discussing how horribly residents get treated, whether it be through overwork (you try staying awake and doing hard mental and sometimes physical work for 24-48 hours continuously), emotional fatigue without time to process, or genuine personal abuse. There's also a lot out there about burnout in medicine, although not as much on treating burnout in residents. I obsessively read what little there was my second year of residency, looking and looking for solutions, but they're few and far between for those still in training. The truth about treating burnout is one that is directly addressed in discussions of burnout in attendings: it doesn't usually get better unless/ until your circumstances change. The articles discussing burnout in residents try to dance around this fact, which is disingenuous of them. There are mitigating measures you can take, of course, but those are a wound dressing on the infection, not an antibiotic.
In the end, I didn't quit. I started some crappy counselling where she mostly told me I needed to sleep more, sometimes with tears in her eyes. I started gardening a bit and I took up knitting, so that no matter how many people I saw who I couldn't help, I would have something tangibly positive to pursue. I cried every evening about going into work the next day. I started Zoloft. I was on that for six months. I knitted more. I made all my loved ones ugly scarves. My herbs died, but at least I got outside in the sun a bit. Mostly, I moved on to second year, which in my program isn't quite so horrible, and I was able to upgrade from misery to numbness and a simmering anger that lasted until graduation. Since getting out of training I've been tentatively exploring happiness again, and it is fresh, beautiful territory. I'm grateful but I'm not used to it yet.
I'm doing fine now, but it's the end of another long, dark winter, and I'm sure there are residents suffering and questioning themselves and their commitment. If you're one of those residents, I feel deeply for you. I can't tell you whether to stay in or leave the field. But I can tell you that it's probably not your fault that you're having a hard time. Medicine is difficult at the best of times; it's the nature of the beast. And the current setup for training is draining, demoralizing, and at times outright abusive. It's normal to struggle with a burden like the one you are handed during residency. You're not imagining it. Other people don't have to go through this. You're not being overly sensitive.
So get some of your own crappy counselling if you can. Maybe you need some Zoloft. I highly recommend something positive and physical and low-maintenance like growing some plants or knitting. Read The Resilient Practitioner, which hopefully will help you as much as it helped me. Email me if you can't afford it and I will buy it for you. And please believe me when I say that it can get better.
