I haven't been able to fall asleep yet tonight, especially with a week like this.  Tomorrow is another early day.

My mood is a little "better," but I don't know if I'm just numb or neutral.  I know I don't wake up excited or thrilled about every work day.  Often it spills over into my days off where I just lay down waiting for time to pass.  There are things I do still enjoy doing, but I just can't motivate myself.

You'll see I talk a lot about a show called Mr Robot here.  In particular there's a character named Elliot who struggles a lot emotionally.  He talks to himself sometimes and says "What do people do when they get this sad?" and there are times he cries by himself.  He has support from some people, but his relationships become very strained with them, and improve partially, in a cycle. 

I think everyone who has commented on my entries has done something to help me feel less alone.  Before that, I really felt profoundly sad for days that became years, and I was only melancholy at my "happiest."

I couldn't escape by parties or movies, because I would just know I would go back to feeling the same way.  I felt like I was walking through an endless forest at night, with dim starlight and a flickering flashlight. 

I've cried alone by myself, most often when I write on here.  I would cry and my dog would come be by me and set his paw or head on me.  Since he left, I started looking at shelters hoping to find a new friend, someone who I can adopt. 

I had some background on my past dog when I got him.  He had scars, a broken tooth, old cuts on his ears and neck.  He was chained up most of his life in a yard when he wasn't in a shelter.  He was a little damaged by his life but he loved me.  Over a few years he became excited about little chew toys and I'd see him just be playful and funny.  His stubby docked tail would wag back and forth and he would nearly knock you over when you got home.  I felt like the best thing I've ever done in my life was to give him a good home and a good life.  Animals have so little control over their lives and they're so much at the mercy of people, many who are cruel. 

Dogs are smart but I think they might not always understand why they're being treated a certain way.  I think that's one reason why I never was mean or overbearing with my dog. Dogs love to chew on things, and why would I hit or starve my dog because he found a shoe or pillow to play with?   They make toys out of everything or have certain behaviors because they're anxious. 

I felt like we were pretty similar to each other.  Some damaged beings just finding themselves floating in empty darkness.  I will always be close to him and likely other dogs than with people.

Friendship and any relationship is hard to maintain in residency, no one's schedules seem to be compatible and you're left really just doing things post call or on vacation.  Being in medicine means having little opportunity to go to your medical appointments during a typical work day.  I go to my doctors post call even though I just want to sleep and rest.  Any disturbance to sleep post call really messes with me.  I wish there were special medical days you could take, but it'll really be a vacation day or from some other supply of days off that have to be approved by 3 or 4 people in administration.

I don't want to seem dramatic, but in medicine you don't have full control of how good a day you'll have, and it's not about how sick patients are, it's because you might get assigned to team that doesn't function well together, you might get sign out and this patient hasn't even been stabilized, and nursing isn't very competent or doesn't prioritize well so you have an enormous and unwarranted pager burden while managing an already busy service, and the people responsible for training you might hardly train or teach you. 

A lot of teaching in medicine has been "don't do that," or "God damn it," followed by a tool or device being taken from you

When I had my bad asthma attack, I was emailing people during a breathing treatment and basically making a case to take a sick day. Many people were nice but many others asked ".. But you can still come in right? You can still take call right?"

I get that hospitals are busy, everyone is worn down by how busy it is, but there's not much help or many people who can cover for you. And then being a resident you essentially become conditioned to feel guilt that someone has been called in.

Residency is so finite that there isn't much time off. You have to be the best before you graduate and then take full responsibility for patient care.  But then the system leads to so much burnout that you see residents not really study much or put in as much effort as they could. 

I knew a former pediatric surgery fellow who was sick on service and rounded with an IV of fluids running.  I thought that rounding with an IV was a joke, but it actually did happen.  A lot of people in medicine pride themselves in being tough, but not so much in how humane and kind they are.  You hear people being proud of how many cases of a certain type they've done, but not how many people they helped mentored.  Once I did hear an old surgeon say that in the end of your life or career, it doesn't matter how many of a certain case you've done.  Sounds pretty existential or absurdist. 

Sometimes I do really feel that my heart is in medicine. I have strong positive memories of times I cared for patients and times I saved lives.  I just feel so exhausted and shaped by my past experiences in so many ways that I don't always enjoy every day. 

Many commenters are affiliated with other programs and have reached out to me, and others who have reached out talk about how their program takes care of its members.  I thought "Really? There are places like that?  People are actually kind?"

I've also seen a lot of comments from people who describe how emotionally damaging their medical training has been.   Sometimes I feel like a lot of us just feel even worse because of not being treated well on top of having so much control over your life just disappearing. 

I think the people who tell you the stress and struggle state of being a doctor is "Your new reality," or "just life," have left themselves be defeated and making the experience of being trained unsatisfying, and morale-eroding.  

Sometimes I would think being a bird or rat would be a better life.  No loans, no answering to anyone, I could fly or crawl around wherever I wanted, at any hour the day.  Maybe I'd be happy with my little rat or bird family. 

I really am getting exhausted now.   I'm so tired physically but feel like my stress and anxiety makes my room feel a lot smaller than it is.  I also am anxious about becoming more sad again.  But right now I have to sleep and be ready to withstand the waves crashing against me