Saturday, June 28, 2014

I See You

My first year of residency is winding down and I've been in my last rotation, internal medicine. 

I've been taking care of a patient who has given me a glimpse into how horrifically a human can hurt another, humiliate another, destroy another. I've had forms to fill out, phone calls to make, family members to meet with. All of this has provided enough busy work to keep my mind from drifting into actually processing the things I see in front of me. It has kept me from considering, for more than a fleeting moment, what my patient might possibly be going through...what the family might be going through. I feel borderline selfish even, getting upset over it, shaking my head over it, because it seems I am making it about me and not my patient. We're all drained, we all want to look away.

I come home, I want to talk about it yet I don't want to say a word.

The manager of the ICU sat beside me yesterday at the nursing station and said, "you are obviously passionate about your job, you obviously chose the right profession". I took it as one of the highest compliments I've received, but as she said it I nearly burst into tears. I thought about how much I hate this job sometimes and the things it shows us, about ourselves and about others. I feel weak when my work upsets me, and I feel jaded when it doesn't.

As I drove home today I felt angry about this job, I thought about what an awful line of work it can be. I watched the bobcat driver roll up and down our front yard, the heat beating down on the metal roof. Back and forth, spreading the dirt out.

My dad used to do work like that, he worked construction and road crews. As I got older I felt sorry for him, that this was his job. I continued to watch the methodical work out my front window and couldn't tell if what I felt was pity or envy.


PGYx said...

Sometimes I wonder if we should do a better job sharing this perspective with those who pursue medical training. I just finished residency, and while I got fantastic training in my program, most of the ideals taught in medical school and even residency are just not possible in the real world of medical practice and insane overhead costs.

It is really hard for a thinking and caring person to maintain any degree of optimism about healthcare. I don't know if I would do it again unless I really couldn't find something else to do. I think as a pre-med student I might have viewed burnout in medicine as a personal failing, but I now see there are great reasons why so many doctors and nurses have had it with this field.

That said, I sincerely hope any dissatisfaction you may have subsides as you progress through residency. Congratulations for being nearly done with internship! My how time flies…

Kays said...

Being accepted into a Canadian medical school this past May was literally a dream come true for me. But as the initial excitement wore off, and people kept asking me if I was excited to start medical school, I started to realize what actually lies ahead. It's not just more exams, sleepless nights and stressful days, but it is a whole life time of dealing with systems that are broken and patients who will need me to always be their rock. It's scary, and my honest and truthful response that I say when I am asked that question, is that I am honestly scared for what lies ahead.

PGYx said...

@KP: I don't want to squash your dreams, but if you have any inkling that you'd be happy doing something else then you might consider it before you invest in the degree. A doctor told me exactly that while I was studying for the MCAT, but I didn't believe her words could apply to me. :-) Is Canadian medical school free or low cost or will you graduate with a ton of debt? In the U.S. it's tough to change career directions after medical school with $200K+ of debt. That said, I loved medical school, am so grateful I learned so much in school & residency (even as hard as the latter often was), and truly feel like this is my calling. But a part of me wishes I had other work skills to offer.

Liana said...

"We're all drained, we all want to look away."

I think there is not enough emphasis through our training about self-care. A lot of our work is traumatizing and we don't take good care of ourselves, and we end up burnt out.

Albinoblackbear said...

PGYx: I wonder if there would be a way to possibly convey to (mostly very young adults) this aspect of the job (likely a futile endeavor!) Getting into medical school is like winning the academic olympics, I mean, who in their right mind would turn down the gold medal - even if they were told the mixed blessing it came with?

I went into medical school after being a nurse for 5 years and so had some preparation for what lay ahead, but like anyone who works in health care I get broadsided some days by what is expected of us and by my experiences at work.

I agree with you too about the burnout factor - it does look like failure on balance. Maybe it is a failure in some ways - a failure to find ways to deal with what happens at work, or a failure to establish support networks and strategies, adaptive coping skills! :)

I don't really see how I felt a few days ago as dissatisfaction, more as an emotionally trying time.

I'm like you - I feel that medicine is my calling but there are certainly days when I miss my more multidimensional self which I believe has been somewhat traded in for a much more medicine-oriented person (unavoidable in residency?!) I hope to get some of myself back when this is over. 1/2 way finished my family medicine training now, which means only 2 more years of residency (since I'm doing the extra training in surgery). Much shorter road than when I decided to head down this crazy path! And yes... time does indeed fly!!! :D

KP: Fear is a healthy emotion, I think. Fear is what has always kept me safe as both a nurse and a physician.

I think the people who have the toughest time are those who went into medicine simply because they were smart and it seemed to be the right thing to do. Or those who went in it for status, cash, because their parent's told them to, etc.

Liana: Yes, I couldn't agree more. The pathetic attempts at addressing these issues usually occurred in painful seminars about a week before exams were on, often led by flaky women wearing loose fitting clothes and jungle jewelry. :) So yeah, it's no wonder we're all walking around in varyingly wounded states.

Liana said...

I read Dan Harris' 10% Happier book and he makes the very valid point that things like mindfulness based stress reduction and meditation have a serious PR problem: "Until recently, I thought of meditation as the exclusive province of bearded swamis, unwashed hippies, and fans of John Tesh music".

Yogi said...

Just wanted to point out that "a PR problem" is the same thing most MDs have: the appearance of caring more about salary and other financial matters than the patient in front of them.

Maybe we should all think a little harder about substance over form. "Normally Dressed" people have been teaching MBSD for 20 years and meditation for 30-40 years; they weren't hard to find, except in the minds of those who had made up their minds that MBSR and TM etc were part of the hippies and great unwashed.

I know and treasure my PCP: a PhD/MD, who loves working with patients. But he's the first in more than 30 years. I try to resist tagging all MDs with the "golfing on Wednesday" tag or the "Surgeons have no bedside manner" tag. But it is very hard to do when you are confronted with a reality of "I wish I weren't here."

And don't get me started on casual snide attacks like the John Tesh thing. Who cares what music people listen too, unless you think they aren't good enough unless they listen to what you think is the Right Stuff.

BrainiaxMD said...

"I continued to watch the methodical work out my front window and couldn't tell if what I felt was pity or envy."

This line really hit the nail on the head. I felt that way the first year after the board exams, when I opted out of pre-residency to take the year off.. Fast-forward a few years to fellowship and I still find myself thinking the same things...

Has it all been worth it? Now that I'm already at the verge of knowing, I'm actually afraid to find out...

Albinoblackbear said...


Yeah, I am looking at 2 months left of training now and I completely agree with you. Afraid to find out...

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