Residency blues. Again.

I'm lucky enough to not have lost any colleagues to suicide...yet. In the US, physicians are the profession with the highest rate of suicide. Pamela Wible has described three scenarios that I know have at least flitted past my consciousness. The idea that we are supposed to take on as much responsibility as we do and not be allowed to address our own distress is appalling. We shouldn't be afraid to ask for help for fear of losing malpractice insurance.

I know I've blathered on about the stress associated with residency, but honestly feel that I just can't do it enough justice. The words to describe the emotional roller coaster just don't exist. Instead, I'll give you a list of events that I have experienced, usually many in the same day.

Received lab results back that confirm invasive breast cancer in my neighbour.
Been so overwhelmed at work I haven't cleaned my poor kitty's box in well over a week.
Delivered a beautiful baby girl to a mom and dad who couldn't stop kissing each other or the baby to let me congratulate them.
Delivered a beautiful baby boy to a mom who because of her own brain injury will not be allowed to keep him.
Revive a patient during a code blue and have him go on to living a healthy happy life.
Help a young woman suffering from a painful cancer sleep away her last week of life. And then help her parents cope with their daughter's decision.
Lost track of so many emails and Facebook messages from friends I'm surprised they still answer me when I do send a note.
Been told that I'm an incompetent physician who needs to do at least 6 months of remedial training.
Been told I'm a brilliant physician and that my preceptor is excited to have me as a future colleague.
Had patients hug me for telling them about their cancer, their lack of cancer, that I'm leaving a practice, that their mom just died.
Newborn baby exams. Smelling newborn babies.
Helping moms learn to breast feed when they've given up hope.
Missed my nephews special events for work.
Finding my own worrisome lumps.
Had my vacation time continually denied until I just gave up and have weeks of vacation at the end of each residency year left over.

The ups and downs never end. It can be absolutely exhausting. My blog has provided me with some outlet for what I'm doing. I also have a fabulous partner who is extra supportive and a BFF who is going through the same crap. But even with all of the help, residency is incredibly isolating.

This doesn't make sense to me.

Residency is supposed to be preparing us for practice. We should be learning the coping mechanisms now that will keep us from planning a 03:00 dive off a bridge.

Which I suppose leads to the question, what prevents us from becoming hopeless? How do we keep our light shining when we barely have the energy to wash our hair?

Zakari Tatasuggests monthly counselling sessions for residents to address the extra stress that residency incurs. She also says "The idea is not to find a perfect solution but to openly discuss and accept that physicians are vulnerable. The current culture that presents physicians as always being in control of their psychological health should be discarded."

I know an attempt was made in my med school to encourage self care, but it wasn't given as much attention as the importance of knowing how to write a clinical note or avoiding embarrassing the school. Lip service from the chosen few lovey dovey types that isn't also reflected in regular practice is soon lost.

Next week is resident wellness day at my institute. Events will be held in a city I try to visit and will include a speech and yoga. One day a year doing something I could do at home by watching a Ted talk while stretching.

As with most other behaviours, I argue that we need to learn and be taught by example. After breaking bad news, do a debrief and check in on one another. A preceptor who is willing to admit to difficulty dealing with everything on their plate and going through the options of dealing with said overflowing plate teaches a valuable lesson. We are trained to recognize depression and anxiety in our patients but rarely ask our colleagues about it. I've seen a doc whom all his colleagues stated was burned out but none were willing to talk to him or ask how to help him slow down and recharge. The lesson I learned is that my own mental health doesn't matter in my profession.

That can't be right.



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My partner isn't immune

My partner is incredibly supportive. Like ridiculously supportive. To the point that he is also having exam nightmares.

What a good fellow.


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How do they do it?

I forgot how painful a surgical rotation is. I'm expected to be at the hospital and up on all current cases before 7. AM!!!!

My partner was a huge help this morning in making the transition from a 9:00 start. He brought me coffee in bed, changed the temperature in the room to make it more appealing to leave the covers, and bugged me q5 minutes to get my lazy bones out of bed.

I have no idea how residents without partners survive. Though truth be told I'm too spoiled to even be able to think about any other way o life.


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Residency Blues

Starting around 4-6 months into residency, almost universally, residents everywhere get hit with the blues. It is soul sucking and demoralizing to work every day, for what feels like millions of hours, at something that you are never really that good at.

We rotate through different specialities and disciplines every few weeks to every month or two. Our advisers change daily or weekly. Just when we think we're starting to get the hang of how this guy likes to see his notes written, or how she will think about making orders, we're thrown into a brand new situation.

Actual mastery of any domain is difficult to achieve because Family Medicine residents are meant to be exposed to as much as is possible so we get little time to hone our skills before moving on.

I'm in a community based program. This means that I'm in a small hospital which is great for being the only resident on and getting more chance for exposure to cases as they come through the door. It also means I'm the only resident who understands what I'm going through. Even though there are technically 4 of us in the hospital right now, we never see each other because we are never on service together. When we do see each other in the halls there is a flood of conversation, sympathetic smiles, and general advice from our experiences with the rotation before we need to move on.

I came from a large, very close class in med school. I miss them like crazy. We would frequently run into each other in the halls of the hospital while on clinical rotation and give each other pep talks before running on. We had small groups where we could all commiserate and hug and eat chocolate. We didn't feel alone. I knew that more than 140 other med students had my back, and they knew I had theirs.

I feel alone now.

Residency can be very isolating. I love my partner dearly, but he has no idea. He has always been my cheerleader and believes that I'm a rock star no matter how badly I mess up. Other residents get that we do make mistakes and they're horrible and say things like, "Well, you still have a good outcome...", or "No no no. THIS is a terrible mistake." We work through what went wrong and try to learn from it. Residents know how the teams in hospitals work and the questions to ask such as "wasn't there a note in the chart about the patient being diabetic?" This can really help to put things in perspective.

While I love that my partner thinks that no one is smarter than me and that everything will be perfect, it's difficult to believe after being raked over the coals by a preceptor for not knowing the full differential of rash in a 2 year old. It's not that I'm not willing to explain all the ins and outs of the interactions I have at work, but most days when I need to blow up, I just don't have the energy.

The problem with residents though is that they never really have time to chat. It takes forever to set up a good time for us to actually spend time together.

I'm looking for a good solution.

My poor freaked out partner

We talk about stuff I've seen at work all the time. For the survival of my partner's tender sensibilities, I try to avoid topics that will upset him. These usually involve genitals and anything involving poop.

While he was listening to the Unbelievable Truth, a British comedy radio show, he learned some obstetrical facts that interested him.

The first was that newborn babies cry in the key of A.

The second had to do with episiotomy repairs. In particular, fourth degree tears and what outcomes one might expect. A very difficult topic to cover without discussing genitals or poop.


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My Thought Process When I Decided to Apply to Medical School in the First Place

Perspective, like I often say, is a brilliant thing.

I want to remind myself of the gift I've been given by being accepted to medical school in the first place. It's such a gamble to get in; having the right MCAT score for that year, picking people who are able to write a competent letter of reference, the most compassionate interview committee. I'm such a lucky person to have been accepted anywhere given my, err, colourful background.

That I've got to this point in my medical career and haven't been kicked out means to me that I made the right choice. People say that it's hard to be kicked out, but it's not that hard. I've seen it happen several times.

I've whined about not getting my number one choice in residency. Poor poor me. I made it to residency. This is a huge gift.

So, now I want to look at the criteria I set for myself when I applied for med school in 2006. That seems so long ago now. Apparently they were good criteria since I got in with one just the one application.

1. I took a good look at why my marks were so terrible (really terrible, worse than your worst) - it was something I could easily fix and did. Essentially, I needed to stop drinking/partying and learn how to study. I made a plan. I also set up my office so that everywhere I looked I saw things that encouraged me to keep studying.

2. I took a leave for a semester to test myself and see how I could do. Given my past credits, I was able to take a 4th year physio course that is known to be a killer. I told myself if I could get an A, I would let myself continue back to school full time. I got a 92.

3. I talked with EVERYONE I could about their jobs - techs, nurses, docs, surgeons, everyone. If I was going to start over, I wanted it to be worth something at the end and wanted to make sure it was what I thought I was going for. Happily, it was.

4. Rather than just getting enough credits and doing the bare minimum, I did a full second degree in something that I loved and that would lead me to a great plan B career. For me, my plan B was a masters in Health Economics. It was a way I could help Canadians' health if I wasn't a physician.

5. I spent the money on the Princeton Review classes. Not cheap to be sure, but so worth it in the end. Part of my poor marks initially was that I didn't know how to take MC exams and the PR helped me with that. I'm sure any other class would as well, but PR fit my schedule.

6. I looked for EVERY resource available at the school for helping me succeed - how to read papers, math lab help, essay editing, study hints, how to learn - it made me a better learner and set me up for success in med school. While you're never too old to go back to school, it doesn't get any easier.

7. My partner and I realistically discussed each of my intermediate goals and what each meant (graduate from undergrad with poor marks, get into a masters program but not MD, would I try to apply a second time etc.) Having a good idea of what to expect from each other along the way was useful and kept me focused and on my game. For me, I would have applied twice but then called it quits.

8. I really want to practice rural medicine. I kept a painting of a rural scene by my desk in undergrad and during med school to keep me focused on what I'm doing.

9. I kept my social connections tight. Just because you have this brilliant plan for the future doesn't mean you shouldn't be living right now. Balance is key. If you can't balance your life in a way that makes you happy, you're doing something wrong. This has been the plan that worked best for me in my medical studies. So many people, especially med students think that they will be able to start living once med school is over...once residency is over....once they are done with locums...once they have kids and their own practice....whatever. Now is when we live, not later.

10. It feels like there should be a 10 but I can't think of one.

Respect the Jinx!!

It's been a rough year for people I love. I've been refusing to say or think anything that might tempt fate into slapping me in the face. A favourite relative died last night. When I told my partner this morning, he said "so do you think that means it's over for a while?".

Augh!!

You've got to respect the jinx! I try not to be superstitious, but at the same time I'm not taking any chances.

Checking in

After being so worried about my first block exam (and the gong-show of disasters that surrounded it) I ended up doing OK. I had set the bar low, aiming for a 75% but got a 77%. I can live with that! I had 3 weeks of classes for which I barely picked up a book.

When I'm at home, I feel like I should be available to my partner (who is admittedly, quite needy) rather than studying for school. I've been talking to other people in the class who have partners/spouses at home. The common theme seems to be that they really really don't understand how much work there is to do in med school. It's as though they sincerely believe that we're just having fun all the time. When I'm discussing my day, I try to focus on the positive aspects rather than the negative - why would I ruin his day with my crap? That may seem to put a weird spin on things.

Part of the problem is how much I need to censor myself at home.

Talking about neat specialities I can pursue in the future leads him to be 1) depressed that he hasn't got a dream of his own to pursue or 2) point out that I can't do everything. Surprisingly, I do know that I can't do everything but having the idea that I could pursue a speciality keeps me focused and working on whatever subject I'm currently knee deep in.

Nothing gross. Unfortunately the definition of this changes daily. Last night it was extended to include a cleanly broken bone. Seriously. I get no puss or tumour talk, but a broken bone???

Discussing the MD/PhDs in the class is strictly forbidden as they act as a reminder of his unpursued potential. If he really wanted to use his PhD in Biostatistics, I'm sure he could!!

All this censoring makes regular conversation difficult, especially when it comes to the tough topics like money. Argh with the money!! /end rant

I have finally been brave enough to ask for observerships. I don't know how my classmates have been so quick to find them! I felt like I was asking for a favour and that's hard for me to do. It's really exciting to get an opportunity to see what the "real world" of medicine will be like! My first is set up in geriatrics, the next in child psychiatry. I'm 95% sure I'll be a family doc, but I want to check out the specialities too so that I can be confident in that choice and so that I can be the best family doc ever.