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  

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.

Saturday, December 17, 2016

Residency Pearl #2 - The EMR Check and Double Check

EMR makes things somewhat more streamlined.  Medicine today is now a lot of ticking boxes and putting in passwords to sign your orders.

This might seem like a "stupid" pearl to share, but I've seen enough mistakes and wrong orders happen on patients that I feel strongly to write about it.

There's a certain EMR called Epic, and you can open different patients in different "tabs" like the Google Chrome browser or Firefox.  It's great for productivity and also a great way to make mistakes.

This is especially important for new interns who are hurried, rushed, stressed, and upper level residents who are cross-covering and supervising the care of many patients.  It's easy to put in the wrong order for patients.

Examples I've seen range from accidentally ordering a blood test on a wrong patient, to ordering a blood transfusion for someone else.  Sometimes errors aren't caught, and the error gets carried through.  Luckily, the one resident realized they had ordered blood for the wrong patient and they cancelled their order in time.

Usually there are nurses or pharmacists who review and confirm your order, but it might not always happen.

So you might be thinking, "This is such a dumb entry.." but there are endless amounts of real life examples of surgeons operating on the wrong extremity, which is on the extreme end.

Check and double check.  Keep only one EMR tab open on one patient.

Do a mental time out for yourself before you put in orders.  The few seconds saved aren't worth risking your career or someone's life and health.  Much of medicine is multitasking and being pulled in 19 directions at once and being stressed and trying to be efficient but you absolutely have to focus and prevent mistakes.

Spread your vigilance to those around you.

Sunday, December 4, 2016

A doctor's memory of punk rock

I recently started listening to a band called Oslo Ess I found through Spotify.  They're sort of a Norwegian hard rock/punk sounding band.

The energy of their music gripped me instantly and reminded me of all the punk rock I used to listen to growing up.  I listened to the Clash, the Ramones, the Sex Pistols, Cock Sparrer, and a bunch of others like Gang of Four, the Virus, the Casualties, the list goes on.

Similar to going through residency, my teen years were full of angst and I constantly searched for belonging and acceptance.  I wanted to belong.  I constantly tried to find out what really defined "me."

I found an outlet through punk rock in the bands mentioned above because  songs of theirs reflected what I felt personally and also had music relevant to political climate at the time albeit written a bit earlier about different things.

I'm revisiting punk rock again and it feels like the same outlet I had years ago.  I work hard constantly and feel constant burn out.  I'm incredibly disgusted with the way the world is: a world full of war, violence, senseless shootings, economic exploitation, the constant search for more meaning in life.

I think you'd be surprised at the depth of punk rock, especially from the UK.  Most people just paint a picture of punk rock as the music of wild people, destruction, a lack of respect, etc, but you would be surprised at how much of a message the music carries.

Time to study.  Going to bite the bullet an hour at a time every day this week and get through it.  cheers, readers

Thursday, December 1, 2016

Life gets harder

My day was rough.  Rougher than usual.  I have more responsibility, things are more difficult, my patients have more comorbidities and worse health than the patients I've taken care of before, and I have less help.  I can't remember when I had my last day off and I feel like I don't have enough time to truly decompress and recover emotionally and psychologically from work.

I noticed changes in my personality.  I've stopped laughing at jokes and feel more tired and have become more irritable when I've never really been an irritable person.  I skip meals because I'm so anxious and stressed out.  People keep telling me to go eat but I act like I'm too busy or that I'll get to it later.

I'm tired, and really stressed out for work-related and personal reasons.    Difficulty balancing work and life is at an all time high.

At least when I was a med student I had enough time to go to sleep for 30 minutes when I was feeling overwhelmed.

I do good work, I work hard and my hard work is recognized by some faculty.  I'm not a problem resident and I'm not a resident who lives on in stories about their mistakes told by attendings.

I think I have low self-esteem and feel like I don't believe in myself enough or give me myself enough credit, and I don't know how to fix that.

I'm still approaching each new day as an opportunity to really give it my best and impress the people I work with and improve my skills.  I just need more help getting through the hard part of things