“Residency is perfect for my physical, mental, and emotional health,” said no intern doctor anywhere…ever (if you find one, I’d love to meet this unicorn). Intern year has been a disturbingly chaotic mix of the good, the bad, and the downright ugly. The good is that I am one year more capable of taking good care of my patients and one year closer to achieving my dreams as a doctor, and I have three years left to work alongside some truly amazing co-workers who inspire me. The bad is that getting here has meant sacrificing significantly more of my time, energy, and health than I even realized would be possible. The downright ugly is that, while I have never personally had suicidal thoughts, I finally understand firsthand how the demands on medical trainees can continue to lead to the physician suicide crisis if left unchecked.
My grandma warned me that life’s storms would come, and residency thus far has been the biggest storm of all. This storm leaves an unacceptably small reserve of time and energy to deal with life outside of residency, which continues to have storms of its own. Of course, I knew that residency hours would be long and the work would be tough. However, despite years of preparation, I was unprepared for the level of extreme fatigue on all fronts. I am fatigued by the fact that my body seems less and less capable every day to keep up with what my training is requiring. I am fatigued from having to repeatedly choose between less sleep to produce more results in a given day or more sleep to better function to fight through the next day. I am fatigued by the number of times I intentionally come to work with a positive attitude only to end up expending energy dealing with the all-too-often negative attitudes of certain others. I am fatigued by the many misconceptions that other well-educated healthcare workers have for patients who look like me or come from backgrounds similar to mine. I am too fatigued to even begin to truly unpack the microaggressions I personally experience as a black female doctor any given week. I am an unbreakably strong, highly capable, and unrelentlessly optimistic person, yet here I am in a cycle of constant fatigue that doesn’t even allow me the time or mental space to fully process the emotional high’s and low’s of what it means to truly be a women’s health doctor in the American healthcare system.
“This cannot be life,” or at least that’s what I tell myself when in disbelief of how miserable things can be as a resident, especially if you focus on them for too long. I have had countless venting sessions with my own co-residents and residents in different training programs across the country, so I know that I am not alone in my sentiments. What I tell myself is completely right. This is NOT life. This is just residency. Ultimately, this 4-year experience of residency is only a small period of time in the grand scheme of life, and as powerless as I may feel at times, I have the power to determine how much it impacts my life moving forward. Sure, I want to be a physician and surgeon with excellent clinical skills. However, I refuse to do so at the cost of losing my context as a whole person, because I believe that this entire context of my being is what makes me unique and keeps me connected to greater things in this world.
How can I flip the script and take back my power? How can I care for my body in such a way that it becomes healthier and stronger on the other end of this challenge? How can I use my love for my patients and co-workers to inspire us all through the tough times? How can I transform the negative experiences I have as a resident into lessons for how to better advocate for myself, my patients, and the world around us? Despite all of the challenges, how can I STILL live my HAPPIest life?
I am ending intern year with tons of questions, but not nearly enough answers. Honestly, I am an intern, a “baby doctor”, so there’s a great deal that I simply do not yet know about Medicine. However, I have learned from thirty years of rich life experience, and I know a thing or two about finding my way through challenging times. I won’t pretend to have all of the answers or that I ever will, but I have some “golden rules” from my intern year that are helping me to find my way.
Golden Rule #1: Be kind and respectful to EVERYONE.
I’ve said it before, and I’ll likely say it again: my mother raised me to treat everyone with the same basic human level of kindness and respect, regardless of their title or lack thereof. Yes, I treat the drug-addicted patient, life-saving nurse, the hard-working janitor, the all-knowing front desk manager, and the world-renowned doctor all with the same level of kindness and respect. We each have a role to play not only in the hospital, but also in the world, and we are better collectively as a whole when we recognize the value that every individual brings. In healthcare, emotions can run high, but as an intern, I will go on record to say that no colleague or patient of mine will be able to say that I snapped at or mistreated them. My mama raised me better than that! There are so many things that you will inevitably get wrong and ultimately learn from as an intern, but with a little effort, KINDNESS IS ONE THING THAT EVERY INTERN CAN GET RIGHT.
Golden Rule #2: Do your best to show up…on time.
My motto for residency was initially going to be, “Show up and shout out!” The dream was getting to residency, giving everything my all, and seeing things fall perfectly into place. Well, that crashed and burned shortly into intern year. I couldn’t “show up and show out” every day, because the fatigue set in, and often, showing up was all that I could muster. Sometimes, I honestly didn’t have my all to give, because the prior week stole it from me. There will be so many deadlines that so many different people will impose on you, and you will have to figure out for yourself how to balance meeting their demands and keeping yourself sane. When I had my all to give, I did my best to give it, even sometimes against my better judgment. Every day, even when I couldn’t show up and show out, I could certainly do my best to show up on time. This meant taking my commitment to my patients and colleagues seriously, not allowing my extended commute time to be an excuse, and sticking to a schedule whenever possible. Humans are imperfect, so you will likely miss the mark a few times, as I did. As a general rule, do your best to show up on time, and the effort you consistently put in will show.
Golden Rule #3: Listen and learn.
Because of the extreme fatigue I felt as an intern, I stopped wasting energy trying to impress people, or as a matter of fact, doing anything that did not feel 100% authentic. I have a VERY strong policy against the “fake it until you make it” mentality (more details on that to come in a later blog post). Instead, I practice what I refer to as “authentic silence”. It has been SUCH an impeccable relief. Essentially, authentic silence has meant that I free myself from speaking up just to fit in with others or any other scenario that I did not feel was completely authentic or desirable for me in any given moment. There’s so much small talk that occurs in a workplace, but very little of it is actually ultimately meaningful, and NONE of it is worth engaging in conversation when you do not feel naturally driven to do so. The practice of authentic silence also saves you from engaging in the inevitable workplace drama that will do its best to find you. In my case, it has also promoted the peace and calm I have needed to better check in with myself and grow my connection with God. As an intern, I spoke up if I felt something was harming me or others, if it was needed for patient care or team collaboration, or if I genuinely felt I had something that I desired to say. Otherwise, I aimed to predominately listen and learn. I was amazed by what you can learn about the system you are in and the people within that system, if you stop talking and just listen. As you learn people and find “your” people, you’ll naturally have more to say within the sacred authentic, safe space that you will have created for yourself. Moreover, as an intern, you can better embrace your role as a sponge if you soak up all of the knowledge around you rather than always trying to prove your own. In the words of DJ Khaled, “Listennn!”
Golden Rule #4: Seek and be receptive and responsive to feedback.
“Seek feedback early and often” was some of the best advice I received as a medical student, and I put that into practice as an intern. As a medical student, I always felt like I knew exactly where I stood and could map out a way to address my deficits based on the very direct feedback I received. As an intern, I have often felt a lack of clear, honest, and actionable feedback. I have theories about how the differences in institutional or regional cultures may play a role in this, but ultimately, it does not matter. I have learned to be more proactive about charting my own course for growth as a resident doctor. I now go out of my way to essentially try to let my preceptors know, “I just want to learn. I have no ego in this. Please, critique me so I can learn!” This helps in many cases, whether someone did not give initial feedback meaningful thought or felt uncomfortable giving constructive feedback. Additionally, I am learning to identify key mentors in specific areas of weaknesses who can help me improve my target areas. Also, don’t forget to ask for feedback from not only those above you, but also those who you lead or teach. It’s true that you don’t know what you don’t know, and you’ll never be able to take your career to the next level without soliciting and responding to the feedback you need.
Golden Rule #5: Cut yourself some slack.
Love thy self! THAT is the other thing that every intern can get right. Have self-compassion and cut yourself some slack. Residency is hard, and intern year is most likely to be the hardest. Make time to care for yourself and do things that you love. It may seem like you do not have enough time or energy. However, you may find, as I have, that engaging in self-care, time with loved ones, and quality “me time” can make you more productive, give you a new source of energy, and ultimately replenish your reserves for inspiration. This blog is a major part of my own self-care mandate, because it allows me time to reflect, embrace my love for writing, and prioritize the pursuit of my HAPPIest life with or without residency. Find some people and some things you love, and embrace them like your life depends on it!
Not only did my grandma say that storms would come, but she also told me, “And God will carry you safely through each one”. That was the truth, because the power of prayer and God’s grace has seen me through so much more this intern year and every year than I ever knew I could bear! Here I am, heading into my second-year of residency, and encouraging any student, intern, or underdog out there…
YOU. CAN. DO. THIS.
With Love and HAPPIness,
The HAPPIest MD
P.S. Here are some relevant links you may find helpful:
- If you are dealing with suicidal thoughts, depression, or any mental health issues, please know that you are not alone and know that there are several resources available to you. I provide a few tips for such resources below:
- Most universities or academic programs have in-house support staff that can provide confidential counseling and refer you to additional care as needed
- Engage with your program or university’s student or physician wellness program, if available
- Reach out to your dean or program director to make them aware that you are in need of additional support
- Despite the stigma that you may feel, in my experience, deans and program directors are typically grateful for you proactively dealing with your health, which helps to prevent later crisis
- If you are having suicidal thoughts, please speak with someone.
- Once you feel that you have the immediate support that you need, please feel free to reach out as needed to let me know how I can create additional content or opportunities to support your journey. You deserve peace and HAPPIness, and I want to ultimately see you living your HAPPIest life!