Residency is not forever.
That is the mantra we repeat. We say it to our co-residents who work and struggle alongside us, and we say it to our loved ones who express concern about what is objectively an abnormal lifestyle. We repeat it to ourselves when we’re met with a particularly challenging situation, and we remember it when we put on our white coat, don our scrubs and return for another day of work.
Here, I’ll share one of my hardest moments in residency, why the experience was challenging and how I moved forward, with hope that transparency in regard to my journey will help you navigate yours.
My Worst Day in Residency
One month ago, I woke up at 4:30 a.m. to get ready for a 28-hour shift in the pediatrics intensive care unit. I’ll be candid: I’m not meant to be an intensivist.
This particular shift was following my first day off in a 13-day stretch, a day off I had enjoyed to the fullest: I went to a boxing class, I had high tea with a dear friend and I took a walk through the city that I love.
On principle, I avoid the use of the electronic medical record at home in an attempt to separate my personal life from my role as a resident. But I had an eerie sense of guilt as I navigated my day off. My panel of patients in the PICU included unwell patients who were in varying stages of death. There was one patient, the newest of my panel and my youngest, who had a favorable prognosis. As a team we had identified her as the patient who was most likely to be able to resume her previous life after she had recovered from her procedure.
I walked into my shift and went to find the overnight coverage in order to receive sign-out. I logged into the computer and saw a myriad of new studies for that patient — the patient I sang to when I examined her, the patient whose parents I spent hours reassuring after her procedure. The patient who had become my favorite. I was overwhelmed when overnight coverage shared that my patient had cardiac arrested twice, required over an hour of CPR and was on ECMO.
I had never managed a patient on ECMO before, and to be frank, I hope I never manage another patient on ECMO.
I was in tears when I examined her. I hugged her parents, and we cried together. I was struck by her father’s words: “When you were last here, she was normal and now … now she’s nothing at all.”
I still hear his words when I think back to that day.
I cried on rounds as I skirted around discussion about her prognosis, I cried in the still between admissions and I cried at the end of my 28-hour shift when I started my walk home.
I was blindsided. I hurt for the family, and I hurt for myself. I wished I had had time earlier to decompress, and I resented that I hadn’t had a legitimate amount of time over the course of my shift to process what I had seen.
The Challenges of Residency
Few would say that a career in medicine in easy, and many would identify residency as one of the more challenging points of the journey, thanks to the schedule, the steep learning curve and the culture of training.
We entered the field to become healers. We spend a great portion of medical school learning medical management and pharmacotherapy, yet the curriculum in medical school glosses over death and the culture around it, so we enter residency ill-equipped to process our patients’ deaths and even to discuss poor prognoses and outcomes with their families.
As residents, we feel autonomous for the first time. Although many of us had patients pass away in medical school, we didn’t feel culpable. Now, however, I struggled with the loss of my patient on both a personal and professional level, rehashing every aspect of the care we delivered.
We often intellectualize patient loss, and with good reason: We want to take every measure to ensure such an outcome does not occur in the future. Yet we rarely have the time and space to decompress and to process the loss on a human level.
Taking Steps Forward
I didn’t think I was going to make it through that 28-hour shift. Somehow I did, but even now, months after that patient passed, I still grieve her. I still think of her family.
I know I am not alone in this. There are days when I tell myself that I will leave residency, and there are days when I dread my return to work. There are days when that very mantra “Residency is not forever” doesn’t seem sufficient to get me through. Yet here I am, still dedicated to my career and with a love for medicine.
At different points of hardship, I’ve come up with strategies that have helped me to move past my darkest of moments. I hope some of these may be helpful for you.
- Remind yourself that the situation is temporary.
- Give yourself the grace to process the experience. Often, we have to process outside of work, but it’s imperative for you to be able to express your grief, preferably before you return.
- Acknowledge what aspects you can change and those you cannot.
The nature of our role as residents brings us into close proximity with traumatic circumstances such as loss, yet it can also stand in the way of us properly processing these events. These moments strengthen our clinical acumen and make us better physicians, and they can help us to develop our empathy, strengthening our connection with patients and families.
Ultimately, our pain is proof of our humanity, and it’s important to remember that humanity is a beautiful thing.