Friday, February 24, 2017

PGY 3 on the horizon

It's been a while since I've written. I've been on call so frequently and so exhausted. I think I've been better at managing my anxiety and burnout but I still feel like those are present in my life every day.  I miss my loved ones a lot and constantly feel like I'm away on a mission. 

The good thing I that I've been come clinically better.  I'm a better physician than I was starting out.  I'm just so tired physically and spiritually.  This blog is still my avenue to obtain fresh air so to speak, by writing and expression.  Everyone says residency gets better and it gives me some hope, but I still don't feel like things are getting better yet.  I'm still waiting to see that.  

Hoping I can rest spirit some and just clear my mind sometime. 

Monday, February 6, 2017

Express Yourself

I'm working post call.  Just another day.   I got to talk to a senior resident about what I'm going through and he said he went through the same thing as me!  It made me feel so much better that I'm not alone.  I've known the resident for a long time and they told me they've noticed I have changed.

Residency is hard.  People drop out. People switch specialties even 2 years into residency.  If you don't have a support structure, build one!  It's so important. If you're not comfortable talking to people in your residency, make friends in other fields at your hospital and talk, even ancillary staff.  

People in the medical world work very hard, down to the techs and people who clean the operating rooms.  I just live in a constant state of exhaustion, hunger, and thirst.  I am careful about how much water and caffeine I take in because I don't want to be stuck with having to go to the bathroom when there's so much to do or I'm in a case.  

Another aspect of residency is working with people in other fields and building my reputation as someone knowledgeable and trustworthy.  So far it's been good. I can't emphasize how important it is to introduce yourself to the people you work with, even if it's just one call shift for a few minutes. 

Going to make it through this week for some hard earned rest. 

Thursday, February 2, 2017

Resident Check In

Just checking in with everyone, wanted to let you all know I'm doing okay.   I'm just so exhausted.

A lot of my colleagues in my year are feeling symptoms of "burnout," or just feeling exhausted emotionally, physically, and psychologically.  I think it's acting synergistically with my own negative feelings.  At least some people appreciate my sense of humor in this exhausting, stressful, anxiety-inducing time.  Sort of makes me feel a little better.

Residency is so much more tiring than college and medical school.  Sometimes you'll be lucky if you don't work two weeks straight.  Taking a sick day because you actually are ill requires calling and e-mailing a lot of people at once and your absence is pretty disruptive to a service, especially if you work somewhere with a high patient census all the time.  And people might even be mad or upset with you or be disappointed in you.  It's a very strange system.

This blog has really been helping me maintain my mental health.  You can't really understand what residency is like until you do it, and it affects a lot of people differently.  

We don't work 40 hours a week.  There's no overtime.  There's no 5 day work weeks.  You might work 80+ hours a week for a year and there's no bonus, no special compensation except for maybe a $5 meal voucher when you're on 30+ hour call.  Even when it's shift change and there's an emergency, you do your duty and you stay the extra 1-2 hours to keep someone stable and save their life.

We stay late after starting our days at 430AM and spend inordinate amounts of time on the phone to make sure that patient gets seen by neurology in time, or beg to get our patient seen urgently because they have a new diagnosis of a serious problem and there's no room in the clinic for 3 months.

Everything about medicine is so tiring.  The administrative things, the legal aspects, how physically demanding it is to not eat, drink, or use the bathroom for hours at a time when you're already sleep deprived and being pulled in 27 directions at once.

I guess I'm in the process of getting stronger.  I just need some rest.

Monday, January 23, 2017

Rough day

 I guess a good way to describe residency is a series of highs and lows, even in the same day.  I had a rough day and feel pretty bad.  I didn't hurt a patient or cause a delay in care.  It was just rough for some dumb reasons.

I used to think I was the only one having a bad day sometimes, but we all do as residents.
Once, one of my friends and co residents said he was made to feel so bad he questioned his career decision.

People should know we don't get much respect as residents.  Medicine is better than in the past when surgeons would throw scalpels and syringes.  One surgeon I heard of cut an intern with a scalpel because he "kept getting in the way.".   I've witnessed hazing of surgery residents and fellows and swearing in the OR directed at trainees. I've also seen demeaning insults casually thrown at residents during patient conferences.

I wonder how everyone gets through the discouragement sometimes.  

Sunday, January 22, 2017

Developing as a young doctor

It's been a couple of weeks since my last post and I have to say things have been getting better.  Which is something that doesn't usually happen.

Work is usually hard, fast-paced, tiring, sometimes stressful.  These past 2 weeks, however, have been "okay."  They've been better than last month, though.

There've been some hang ups getting used to the new system but I've dealt with them pretty well and have been functioning well there.  It's a lot like rock climbing, it takes time to find your footing, but after that, you keep climbing.  

I guess I get pretty anxious about new situations and the constant adaptation process, but those just come with residency.  I really want to be stronger and more resilient.  

I feel like better times might be over the horizon, and I think I might have caught glimpses of it.  I hope I will eventually be less in "survival mode," and thrive more.

On another note, my work-life balance has been good.  It will only last for another week or two, though.  I'm proud to say I've finally been exercising more and feel like I've been making some progress in improving my overall health.

This is the rare sunny day during residency, and I'm fully embracing it.  Good days do come to us.

Monday, January 2, 2017

Anxiety in Medical Training & My Thanks

I've been having a lot of anxiety with the new year, for some reason.  I think it's because I'm starting a new rotation and have to learn a whole new system and whole new faculty and way of medicine all over again.  It's almost paralyzing, it's definitely troubling me.  I had a stress dream just last night and I wonder if I'll be able to sleep tonight.

I'm still trying to figure out why I'm so anxious.  I think I'm just so petrified by my anxiety that I can't analyze myself.  I read a quote earlier that said something to the effect that "men aren't scared by things, but by their view of them."  I think that quote is helping me cope with my anxiety a little.

I have trouble believing in myself, when I actually am a good resident and people have praise for me. When I get praise, I attribute it to something else like luck or someone else's help.  I just don't have the ego.  I have this weird possible delusion that I think people around me don't think I'm good or smart and I'm always dreading some kind of hurtful criticism that will further erode my self esteem.  I have too many days where I think "Another day to disappoint people.." and other days where I pick myself up and think "This is a new day, a new chance to do great."

We start learning about stress and anxiety and wellness when we begin medical school, and we hear about "impostor syndrome" and "mindfulness" early on.  Anxiety and stress hit a lot harder in residency for a lot of reasons, and everyone handles it differently.  I'm trying hard to cope.

I'm just so affected by my anxiety and stress, especially recently that I've thought about seeking help. I don't know how much anxiety and stress is "normal" in residency, but I know I don't feel well.  I'm trying hard to be calm and brave and believe in myself, but it's taking some time.

So many readers have been leaving me kind comments of support and it means so much to me.  I feel like you are another source of strength for me.  Thank you so much.

Tuesday, December 27, 2016

The psychology of medicine and medical school: Confidence

A lot of my time is spent feeling uncomfortable when I'm on a rough rotation.  Most of the time, residency is pretty bearable, but there are times I spend entire days for a week in dread of how people will treat me and feeling like I'm not good enough.

A couple of months ago I was walking back from a shift and saw a medical student crying in a public area some students sit and study, being comforted and talked to by a professor.  

I kept walking past to give the student their privacy and I thought a lot about how I had my own nervous episodes as a basic sciences student in my own home by myself.  Medical school is overwhelming in its own way.  Of course, residency involves a lot more responsibility and patients can be harmed, but when the stage of the medical student is stressful in its own way and with its own consequences for not performing as expected.  

I used to look forward to weekends during medical school because it was my time to "catch up" with the immense amount of information we had to memorize and understand and apply for our exams.  I would wake up at 430AM Saturday and Sunday to study.  I knew material well enough for my exams to do well, on everything from the first medical school exam to Step 3.

I only was as prepared as I was because of really hard work and pushing myself past what I thought were my limits.   Being prepared enough to know things off of the top of your head is where you should be everyday in medicine and before your exams as a med student.  The exams will still be hard and unfair and surprise you, but you'll feel more confident and be might be less likely to panic.

I think back to a lot of times I was on rotations as a student and resident where my self-confidence was torn down and I was made to feel worthless and dumb because I didn't know some minutiae not relevant to patient care.  

My biggest struggle in residency so far has been putting up with difficult personalities, people who aren't very kind or patient to learners, and they're like that with everyone.  I don't want special snowflake treatment, I would just like to be talked to like a colleague and not like the dirt on someone's soles.  

But you get through things like that, a day at a time.  You remain hopeful and remember residency is temporary and that you'll move onto better things and be happier.  For some of us, residency is a true, magical adventure, but for many, it's an exercise in endurance and maintaining your hope.  That might sound a bit dramatic, but residency is long hours, erratic schedules, and people's lives are in your hands as you try to survive and thrive in an unkind hierarchy.

All in all, I want to say that knowing more and studying hard is what will help make you more confident as a medical student and a resident.  It'll contribute to you being more resilient in its own way.