A friend of mine who finished her residency in June just took a job in a non-medical field. I talked to her over the phone last weekend. She is so happy in her new position, she said, so happy.
Sure, I said, who wouldn't love a 9-to-5 job after what you've just finished?
You know, it's not even the hours, she said. It's the respect.
See, apparently, when you're not a resident, people sometimes appreciate the time you spend at work. People consider your feelings when they respond to your ideas. When you do something well in the real world, sometimes you even get praise. Praise!
Apparently, there are people out there who occasionally own their own time; who feel entitled to ask for support; who, when they are treated like children, can turn their backs and leave.
I used to live in that world. I had lots of weekends then, and what felt like options.
I don't live there any more. My job stinks. The hours stink. The way it isolates me socially stinks. The havoc it has wreaked on my relationship with my family and my perception of myself stinks. I used to be creative, and I used to have energy and faith in people. But where I am now, every day seems full of special punishments created by the cosmos just to fuck with me. Those punishments--only the most recent of which involved missing most of the ScienceBloggers' meet-up in NYC--stink.
I went to a noon conference the other day on Mindful Medical Practice. ("Mandatory," said the reminder page at 11 a.m. "Attendance will be taken.") As we sat in front of our plastic plates of iceberg salad and semi-congealed ziti, a little man with glasses and bushy hair sat in front of the room and demonstrated a meditation exercise. I wanted to reach out and take him by the throat; ask him, sincerely, whether he had any recollection of what it was like to be a resident; and then squeeze.
The thing is, I am mindful. I identify my emotions as they come up, often without immediately reacting. I appreciate physical sensations in the moment: the wind in my face, the coffee in my hair, the sun in my eyes, and occasionally, pleasant things, too. But those things are crowded out by the other things I'm mindful of, and the mental attention required to cope with those things.
I'm mindful, for example, of how much the medical profession has taken away from me. If it weren't for this goddamn residency, I'd be living somewhere that pleased me with a heap more freedom than I have right now. I am qualified and capable at doing a million jobs that involve no pager, no condescending attendings, and no needy patients. For the love of all that is sacred, why did I choose this one?
I usually have some kind of great answer for that question, often in the form of a story. But I haven't had a great story in months. They're still happening, but I am no longer a part of them: I am watching from the outside as people experience my care--able to give them what I ought to, but no longer able to take much away.
P.S. Many thanks to the kind support in the form of comments and private emails. I'm not sure why you're all so warm and lovely and nice, but you are, and I'm so grateful.
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Wow, hang in there, girl. Reading your blog makes me glad I never wanted to go to medical school. Although, it must eventually get better, right? Maybe you should e-mail Orac from Respectful Insolence for some support.
Hey, Mermaid! I think it's funny, in a sick sort of way, that the institution that seems to be doing everything in its power to make you dissociative would require you to attend a lecture on mindfulness. Maybe They should be required to attend a lecture on making life bearable for the people it otherwise seems to be chewing up. I certainly hope that you used that time (after the fantasy-choking) to think about what you might want to be FOR HALLOWEEN!
Being in a powerless position stinks. I hated it when I was going through it (and still do as a junior professor). All I can say is that once this is over and you have your credentials, it gets better.
I wish that I could be there to give a big hug (if you want a warm place to vacation you can always come visit).
Your frustrations echo loudly in my ears and resonate in my heart. Any resident knows how the training system is set up to fail us (its learners) and the healthcare system is set up to fail us as well (its providers and patients). I too have felt this frustration. Now as a third-year resident, I am looking to new ones on the horizon.
However, it's not all in the dumps. I am at a program where the patients are complex and often demanding, but none of my attendings are condescending. There seems to be an every-so-tiny niche in medicine for reasonable, caring, considerate training and I have found some part of it. If only everyone was a warm, progressive, and political family physician (at least for me).
I hope you find your niche. The system is broken and we need to continue working to change it.
My past month M4 rotation has put me in a lot of community meetings with child protective services and a lot of county social programs. When I tell people in these organizations I'm a med student, I expect to be dismissed, treated like I'm an idiot, and generally excluded from whatever is going on. Instead, people smile, think it's sorta neat that I want to be a child psychiatrist and care about a lot of the things they care about, and go to the bathroom when they need to relieve themselves instead of just pissing on me.
It's so weird to not have to apologize for existing. I doubt that changes when you're a resident much, either.
As awful as this sounds, it does me little heart good to know that residency training hasn't changed much since the 1980s (I did mine at Barnes Hospital, which at the time was a blend of San Quentin Prison and a circus side-show).
What I find interesting, if not amusing, is that twenty years later instead of everyone considering me to be a low-life no-nothing scut monkey, they all gaze at me with fear and hope, expecting me to cure them of the horrifying illnesses they harbor. The pressure to deliver perfect care sometimes makes one long for the good old days when nobody gave a damn if a patient dropped dead - in fact such tragedies were a key component of the cathartic dialogue between residents that I believe is correctly labeled "black humor." Hah!
For short-term help I suggest reading The House of God, by Samuel Shem, and hang tough. It will get better - as long as you still want a career as a physician.
> Mindful Medical Practice. ("Mandatory," said the
> reminder page at 11 a.m. "Attendance will be taken.")
I hate, hate, HATE those lectures! Meditation... meditate on THIS
I usually spend that hour thinking of all of the things I *could* be doing with that time - running to the bank, picking up my dry cleaning, going to the post-office to return that pair of shoes that I bought online 2 months ago that are way too big, getting my oil changed in my car, getting my car inspected... shall I go on? All things that can only be done during normal business hours. And, since I'm posting a comment @ 12:47am while on call, I don't think my hours fall in to that category!
It makes my blood boil to sit and be lectured about meditation, et al, when really all I need is that hour OFF!
I always leave those lectures hypertensive. And with a long "To Do" list!
BTW - what residency did above-mentioned friend finish, and what is the new job?
PS - sorry you missed the meet-up in NYC. How was the pre-meet up clothes shopping?
One day you will no longer be a resident, but you will still be a physician.
Thank you for doing what you do
God bless you
Residency sucks. And I think that's the thing that sucks the most about it.. you have all of the responsibility in the world, but limited authority and no control over your own time (as limited as it is). It's wearing and frustrating after a while. I don't have any great solution, but I've been promised that it ends.
Keep on fighting the good fight!
Signout,
It breaks my heart to see you, with such rich interpersonal skills (as evidenced by your patient stories), be treated in such a fashion that you feel unwanted and unwelcome in the profession. We NEED people like you in medicine! Indeed, keep fighting the good fight. As many before me have said, residency does end. Your career, on the other hand, is just beginning. Maybe they make it so bad so the lows in the rest of your career seem high. :)
Have a great day today. Please do something special to get you out of the blues. We miss you.
Signout - your feelings are totally normal. And the irony of the mandatory mindfulness lecture is hilarious - the mindfulness lecturer demonstrates his own lack of awareness by not allowing you to do something more helpful like sleep for an extra hour. One day you'll look back and laugh. I promise. :)
Last week, I almost took a job in a non-medical field, one that would utilize my experience and knowledge in medicine, would pay better and give me more vacation time BUT would exclude all patient care.
I agonized over the decision, but after reading and re-reading Tal Ben-Shahar's book, "Happier", I decided to stick with clinical practice and I do feel happy over my decision. I plan to blog about this later, but I'll give you the short version:
I find meaning and purpose in caring for people, making them better, having long-term relationships with my patients and staff. I know that if I left practice, it would be a loss to my colleagues and my community, but if I wasn't happy doing it anymore, I would leave too.
Yes, residency stinks, but afterwards you can find a job in medicine which is not as stressful and where you can be reasonably happy.
I could have had the cushy job in finance or advertising, but my heart wouldn't have been in it. Maybe a few years from now, if my personal circumstances change, I might feel differently. So, hang in there, it's too early to take a different road just yet.
I had a similar experience with a teaching program for high school biology. I ended up not enjoying it at all and have migrated over to my hobby of computer programming. It's been a wonderful move, which much less stress, people who appreciate me, and greatly increased pay.
Since I work in the healthcare industry, I see a lot of ex-physians moving into administration, trying to get out of the patient care business. It's tremendously hard work, and I have the greatest respect for people who stick with it. Best of luck to you.
Thanks all around for the words of support and the willingness to overestimate my interpersonal skills. Am plowing through.
I appreciate the offers of vacation spots. I may well take you up on these eventually--it would be wonderful to see so many folks I haven't seen in so long!
To answer EGM's question, the above-mentioned resident was in peds, and her post-residency job is working for a company that makes educational software for doctors. She does some graphic designey/copywriting-type stuff.
I think people differ greatly on this issue. For example, if it were completely unidentifiable as my own, I would have no problem with a picture of my naked ass being posted on the Internet. Others would be absolutely horrified by the prospect.
What I find interesting, if not amusing, is that twenty years later instead of everyone considering me to be a low-life no-nothing scut monkey, they all gaze at me with fear and hope, expecting me to cure them of the horrifying illnesses they harbor. The pressure to deliver perfect care sometimes makes one long for the good old days when nobody gave a damn if a patient dropped dead - in fact such tragedies were a key component of the cathartic dialogue between residents that I believe is correctly labeled "black humor." Hah!
And the irony of the mandatory mindfulness lecture is hilarious - the mindfulness lecturer demonstrates his own lack of awareness by not allowing you to do something more helpful like sleep for an extra hour. One day you'll look back and laugh. I promise. :)
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Thank you for doing what you do :)
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