Tuesday, November 23, 2010

Cry baby

In a previous post, I make a comment about how I sometimes (frequently) feel tearful when I'm on call. At the risk of putting myself out there, I'll admit I've definitely cried on call before. A few of the events that have pushed me over the edge:

--My senior resident telling me at the end of my 30 hour call that even though I was off duty, she expected me to go watch my patient get a colonoscopy. ("It might be painful, but you better go because it's worth it for your education!")

--Spending 14 straight hours rounding on 70 patients on a Saturday and finally getting home, only to immediately get called back to the hospital for chest pain the patient had been having all day and decided not to tell me about.

--After an entire afternoon of coding a patient multiple times and finally agreeing it was hopeless, when the nurse said, "The patient's daughter wants to hold his hand as he goes."

After a while, I got a little better at holding it in till I got to my car, where I'd really let loose.

When I mentioned my frequent tears in a previous post, I think a few people may have called me "emotionally unstable" in the comments or something along those lines. All I have to say to that if that's the case, there are a hell of a lot of emotionally unstable med students and residents out there.

Of the residents and med students I've worked with, I've gotten to see a lot of them cry. In my intern year ICU rotation, I saw practically every female resident working there cry at some point. My senior resident cried when she realized the next morning that she missed a pneumothorax (wouldn't have mattered). She also cried when the coroner yelled at her post-call for incorrectly declaring a patient. I even saw the "badass" senior resident on the team crying one afternoon.

In med school... wow, it happened a lot. After exams, before exams, just randomly in the locker room. I remember during my surgery clerkship, we were having a workshop on tying knots, and one student was having trouble with her knots and burst into tears. I still remember what she said: "I don't even feel that sad. I'm just SO TIRED."

I guess my point is that you shouldn't be made to feel like an emotionally screwed up freak if you cry at some point (or multiple points) in your medical training (or beyond). Unless, of course, you're a man and you cry. Then you're weird.

(I have never once seen a male resident or med student cry before. I wonder why that is. Do they just not feel it or are they better at holding it in?)

66 comments:

  1. I'm 4 months into MS1 and against all odds, haven't cried yet. I fully expect to, since I've cried at such devastating undergrad events as:
    - cannot find parking space
    - professor being a jerk
    - long day
    - washing away the final product instead of the supernatant in an ochem lab that took 4 weeks.

    ... I guess the last one was justified. But I feel really on edge about the idea of going into the clinical years, knowing that I'm probably going to set new records for a) failing to hold back tears, and b) having attendings look down on me for it.

    ... it's gonna suck. If any of you wiser folks know a way to kill the tears, I'd love to hear it.

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  2. I've only cried once during med school so far, and that was on my Ob/Gyn rotation during nightfloat. I'm sure tiredness had something to do with it, but those ladies were mean!

    I have no doubt that more tears will be forthcoming when I return to clinics and go on to residency.

    I've never seen a man-doctor cry either though. What's up with that?

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  3. Fizzy

    Reading the old blog, I think people were not saying never cry about stressful, horrible occurences but you commented about feeling tearful about simply being on call on the weekend. Perhaps this is a rare occurrence for you but for many physicians this is part of the routine. Would you expect them to be crying continuously? Have I ever cried at work? Yes, with the mom of a 24 year old dying from cancer and its therapy and with the 28 year old mom trying to survive until her baby's first birthday. Would I cry about the obvious inconveniences of a job I chose? No.

    If crying helps you tolerate your job fine, but it does leave you open to questions about why you chose the profession.If the rewards are worth the tears, more power to you.

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  4. HAHAHAHAHAHAHA!!!!!!


    Obviously a pre-med.

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  5. AP: I didn't even mention college crying. I saw every single one of my five freshman roommates have a crying meltdown at one point.

    OMDG: I don't know what's up with men and crying. I've never seen my dad cry, but I've seen my mother cry 100s of times.

    Anon: Part of my point is that people *don't* just cry on the job when they see some horribly sad death-related thing. For many people, being tired and frustrated is enough to bring on tears. Maybe not for you, but I don't think you should judge people as not fit for the profession if they're more prone to tears than others.

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  6. I agree with the poster above--crying is a totally healthy response to some very upsetting situations in medicine.

    Crying as a habitual response to the job you do every day--that's different.

    As above, hopefully the rewards outweigh the tears.

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  7. Dr. Katie: I hope I wasn't in any way implying that I cry or feel like crying every day at work. If that were the case, I would probably look for a new job.

    Even in my last post, I talked about feeling tearful during weekend calls, which even at the worst point in my PM&R residency, only occurred 6-7 times a year. During internship, when I was extremely overworked and exhausted, I cried much more often. But I doubt there are many people out there who can say they were truly happy during internship.

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  8. Fizzy

    Just to clarify, you yourself have claimed to be quite judgemental. But that aside, I am not questioning your choice but simply saying that if every day events frustrate you to tears others may question your choices. There are many things that make for a long healthy career in medicine-not the least the fortitude to deal with the many vicissitudes of our job. If the tears help you do that great. I do not find it helps me except in that rare overwhelming circumstance.

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  9. Women seem to cry more than men, in medicine or not. Ask a woman last time she cried--she can probably remember and it probably wasn't long ago. Ask a man--he may not even remember.

    This doesn't mean men don't get as upset or frustrated, or that women are overreacting by crying. It only means the different sexes handle their emotions differently.

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  10. Anon at 7:21: When on earth did I claim to be "quite judgmental"? I said that we are ALL judgmental, to the point where calling someone "judgmental" is sort of meaningless. Actually, when everyone was accusing me of that on another post, my husband laughed and said that I was probably the least judgmental person he knows.

    I also never claimed every day events have this kind of impact on me, only weekend call, which I take rarely to never. I'm not sure where people are getting this from...

    My point is that a lot of people cry on call or at other points during their medical training, and I don't think it means they're weak or not suited for medicine. I actually remember the chief resident (a guy!) told us during a residency interview that he cried during every call during his intern year.

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  11. Perhaps it is a self selection issue. You have colleagues who cry after call. I don't--and they are 50% women.

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  12. i'd be interested in knowing "anonymous's" profession.... medicine or not? and if medicine, what speciality? and if medicine, MD, DO or what?

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  13. MD 15 years into subspecialty practice. Definitely not PM&R.

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  14. Self-selection?

    Are you saying that people who cry gravitate to certain residency programs? Or maybe I just really like being around people who cry? :)

    Anon, I have no idea what field you're in, what phase of training, or even what to call you, so it's hard to respond. I might also suggest that some people may cry in the bathroom without you knowing about it. I'd guess 90% of cryings are private. That's why I think it's so frequent, based on the number of times I've actually SEEN people crying.

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  15. "MD 15 years into subspecialty practice"

    I'd guess at that point, people have figured out their lives enough. You realize the post was about med school and residency, right?

    "Definitely not PM&R."

    Ouch.
    DEFINITELY not? Are you sure you're not slightly PM&R?

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  16. Look- not trying to create a battle here. In every study is an element of selection bias. I am telling you from my experience which is clearly different than yours, the tears are in frequent even among the women. I perhaps trained in a different era with different expectations. If we cried about long or frequent calls or weekend hours, we would be crying a LOT. Again, if the tears help you vent or get through the tough times for you, great. But I hope for you the good outweighs the bad.

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  17. I guess I'm just trying to say that tears ARE very frequent these days and I don't want women who cry to feel weak.... because it really is common. They should know that they're not alone... I would have felt better if I knew that.

    I'm not trying to create a battle either.... actually, I'm mostly just trying to procrastinate because I ought to be packing :P

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  18. " Definitely not PM&R"-

    I won't claim to know how difficult or easy your call days are.

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  19. Yes, medicine is changing. Yet, I am quite involved in medical education and have not seen the same extent of tears.

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  20. "I am quite involved in medical education and have not seen the same extent of tears."

    I've never cried in front of an attending. I would take great pains to avoid that. Maybe you were my attending at some point and I'm one of the examples you're using of med students who don't cry :)

    Just because you don't personally see something, doesn't mean it isn't happening. I was shocked when I later found out the large percentage of my med school class who were seeing therapists and on antidepressants.

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  21. Also, I have no idea if I'm replying a bunch of Anonymouses or just one. If you can at least make up a name for yourself as I have done here, that would be incredibly helpful in fostering argum... er, *discussion* ;)

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  22. Logging in as a resident who has cried at work on several occasions. Including in front of attendings. (Oops.) Most of my med school/residency friends who are women have cried at/about work as well.

    Of note, we're not crying *about* "long or frequent calls or weekend hours" - we're crying about difficult situations that occur in that context (poor patient outcomes, etc.), which generally involves inadequate sleep, relative isolation, and stressful interpersonal interactions (with consultants, patients, nurses, etc.).

    It's interesting how little residency programs (mine, at least) do to acknowledge or address these stressors.

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  23. One of my colleagues who's studied a fair bit of Women's Studies told me once that women often cry as a response to anger; it's like we know we can't usually express anger to those who most anger us, or in most situations, but we're allowed to cry, so we do. Exhaustion adds in. Men maybe have an easier time expressing anger as anger. That's the theory, I guess.

    I've cried at work, as have a number of my colleagues (including men) and I keep tissues in my office for when students cry, because it's not that unusual. A lot of times it's tiredness and frustration, seems to me.

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  24. I agree that medicine's a hard field to be in and that medical training is rough on most people.

    But Fizzy--I disagree with your conflation above of people who cry out of exhaustion, frustration or just seeing sad things and people with clinical depression (presumably your classmates on antidepressants and in psychotherapy).

    As you yourself have maintained several times, crying in the face of frustration or exhaustion is NOT the same as depression.

    Depression is NOT the same as emotional frailty, either, but that's a discussion for another day.

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  25. Janet: Conflation.... SAT word! (Had to look that one up :) I totally agree that crying from frustration doesn't equal depression... like you said, that was the whole point of my post. I mostly brought up my depresssed co med students to point out that people can have emotions going on beneath the surface (depression, anger, dissatisfaction, frustration, etc) that attendings or coworkers might not be aware of. It's fairly easy to hide these things from casual work aquaintenances. So just because she says she never sees med students crying, doesn't mean it never happens.

    Depression is a whole other issue, that I'm not going to touch right here.

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  26. Wow, Fizzy, you are becoming the Don Imus of our blog - not that I'm accusing you of making racial statements against women's basketball teams, of course - but man! The controversy.

    I like the theory about men express anger easier and for us it just goes to sadness. I certainly don't express anger much on the job - and see men do it more often inappropriately - unless to co-workers venting about something to a partner behind closed doors. There are more male doctors around, so maybe this isn't a gender thing, but certainly an observation.

    I haven't cried in practice (except my first weekend on call when I was by myself and had a ridiculous amount of work I did not feel trained to do well enough- but managed), but did in training a handful of times. In privacy, of course. A couple seem silly in retrospect - I was being badgered by an attending over and over during a conference (I was presenting - I was very preggo) about how there was blood all over the organs in my autopsy pics - they weren't clean enough, an aesthetic mess. Another manic-depressive attending kept putting me between him and another attending and I lost it over his anger (also preggo).

    I completely fell apart one afternoon at the crime lab - I think there were way too many kids/babies one day and I left after lunch and drove around in tears.

    No, I don't consider myself emotionally unstable either. Just human.

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  27. Giz: I'm beginning to feel like I could write about my kid's poop and it will start a controversy. Maybe I should do it just to see what happens :)

    Now that I think about it, I actually don't think I've cried at work since residency ended. Never during fellowship and never in practice (yet). In internship, I was just out of control with the tears, but I think I had very good reasons for each time I cried during residency. (Mostly getting accused of bad things I didn't do.)

    I think unless you are the kind of person who very rarely cries, you're going to cry during training. And probably over something dumb too.

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  28. My worst med school tear-fest?
    Into my mask for most of hour fourteen of a whipple, 10 weeks pregnant, no zofran in sight, when asked by the attending to "draw a Rouex-en-Y on this guy's drape while I go eat a sandwich and the senior resident holds this retractor"

    I'm prone to tears, both happy and sad, and I love my job.

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  29. We'll have to start calling you Fizzy the Firestarter. LOL.

    I'm just a wee little premed, but I'm sure there will be times I cry during training. I can tough it out through sad things usually, but I can imagine that exhaustion/frustration will cause tears at some point (which will make me angry, so I'll cry more). I hate crying, especially in front of other people.

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  30. I try hard as heck not to express anger and frustration at work. My only problem with that is my poor non-medical husband gets the brunt in my venting at home.lol.Sunni

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  31. Fizzy, I think there's nothing wrong with crying. It allows us to get out emotions that might otherwise simmer and cause worse stress. I think it's healthy, for men and women.

    For the record, I have cried numerous times over the years. Mostly it was due to being hurt or to being angry beyond any other form of expression. I have also been openly just plain angry on numerous occasions. I don't have any regrets about either.

    The crying episode that most impressed me occurred in med school on my surgery rotation. The chief of pediatric surgery (an old, crusty guy) was in the OR with the OB's to deliver a high risk baby with a large teratoma of the neck. They knew this would be an airway problem ahead of time, so the delivery was scheduled in the OR. All their efforts to establish an airway failed, and the baby died there in the OR with the mom (who survived) on the table. I was watching from the hall through the window.

    When it was over, the surgeon came out of the room, sat down on the floor outside the door, and sobbed.

    It happens to everybody. No shame, no "weakness."

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  32. I think it is healthy to cry. I think the main issue is context: every day? Every week? With extreme stress? I have cried but generally when there is no other outlet or the situation is beyond the control of my emotions. I can count those situations on my hand. Am I abnormal to not cry after a long call or at the thought of weekend work? Or maybe I am at the other end of the bell curve( we are all on a continuum). Does not make me stronger just different.Just a thought.

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  33. Just got home from SICU call ... where I cried in the unit supply closet and then again in my car on the way home.

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  34. I cried often my intern year, usually after call and often "for no good reason" (once it was because I lost my bus pass and had to pay an extra dollar to get home). The real cause? Sleep deprivation- it's just not normal to go 24+ hours without sleep on a regular basis, and for me that leaves me with minimal emotional reserve. Now that I'm out of training and am able to make adequate sleep a priority, crying is rare.

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  35. Fizzy,

    I don't think you should let some of these comments get to you. I'm only a pre-med, and I've cried occasionally when I've had things to do at night after being at school all day away from my family. I cry because I miss them and would love to be at home cuddled with them, at it's really hard to be away from them so much. It gets to you at times. I can't imagine how hard it would be to be already working long hours in residency and to be gone all weekend from your family.

    I've also always really enjoyed your posts. I don't understand why people find them so controversial, it seems like their just nitpicking.

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  36. I love Gizabeth's Don Imus comment. I am totally going to start calling you that.

    "I don't even feel that sad. I'm just SO TIRED."

    Holy crap, if crying for that reason makes you unstable or unfit or in the wrong profession... than none of us should have been moms. Unless you know a mom who's NEVER cried for a reason like this. In which case, she is as weird as a guy who DOES cry when he's tired.

    I think they don't feel it as much.

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  37. Nope, there are guys who cry at the drop of a hat and women for whom crying is an anathema. Our profession is too hard to nitpick about your methods of coping. But just because people do not cry does not mean they do not feel. They just express it differently. I like a few minutes of running or a long shower to restore equilibrium. Sunni

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  38. I just cried reading gcs's post. Come to think of it, I usually cry about her posts!
    I'm an m1, and I cried alot when I started this school year bc I have a nine month old who I'd stayed home with for six months, and I thought leaving him might very well kill me. Currently, the thought of overnight call makes me want to burst into tears, but I'm praying by the time I get to that point, i'll be ready (and he'll be older).
    I was a pediatric or nurse for four years before med school and motherhood, and I have cried numerous times at work. The main two reasons were anger at coworkers (never cried in front of a doctor who was yelling at me though) and cruelty to patients. I'd go into angry rages with tears and all when I saw someone being unkind to a patient.
    I'm hoping I can keep it together in the future. Now that I'm a mom though, i've teared up at several case studies involving children. So I'm probably gonna be worse.

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  39. wow, anon 15 years into subspecialist practice--- clearly there is a hierarchy there huh. Too ashamed of your subspecialty to even mention it? Or just assuming that it doesn't need mentioning since you define PM&R as clearly at the bottom? Are you even a woman? And if a woman, are you a mother in medicine?

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  40. I'm only pre-med, a mother and a wife who works full time at a psychiatry practice as an MA. However I have cried both from school and from situations I have witnessed at work. I fortunately haven't yet cried in front of a professor or my bosses. However there have been days where I cried simply because everything was overwhelming...

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  41. Another one who had tears well up reading gcs's post.

    I cried a very few times at work during medical school (Obs rotation for me too... high 5, OldMDgirl) and very many times at home. Physical or emotional Exhaustion is usually there hand-in-hand for me.

    Saw my first child welfare seizure last week. The cries for "mommy" from that child still haunt me. And... here come the tears.

    Better get to bed.

    -A very tired resident, mother to a toddler, and spouse to an MD/PhD

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  42. The crying episode that most impressed me occurred in med school on my surgery rotation.

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  43. It is really affirming for me and probably for all women who have hid in the bathroom crying during a rough day at work that so many people are coming forward and saying that it happens to them too. One of the worst things about medical training is feeling alone in your misery.

    What's really annoying is how often the thing that pushes you over the edge is something really dumb. Like you will just be so exhausted and frustrated that you will, say, drop your can of soda on the floor and that will be the thing that makes you cry. Then you feel like such a loser because you're crying over something a 5 year old would cry over, but that's what happens when you have zero reserve.

    Amazingly, I never cried during my OB rotation! Granted, I hated it and I was unhappy and my residents were horrible to me, but it was my last rotation of 3rd year, and by that point, I was just so relieved to be done and I was able to recognize that the residents were just a group of miserable bitches.... whenever they would say something awful, we med students would just go off and make fun of how ridiculous they were. (Plus they had gotten reamed earlier in the year for being cruel to students, so we had a lot of power.)

    Anyway, I think that some people are quick to judge me, mainly because as moms and doctors, that's kind of what we do. We are always telling our kids what to do and our patients what to do, so it makes sense that people would read my post and try to tell me to reevaluate my career just because they feel obligated to offer (unwanted) advice, even when I'm writing about things that happened to me years ago.

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  44. Ashley: from 15 yrs subspecialty: I am quite proud of being an oncologist thank you. As I specified in a later post, I could not claim to know what a call night for a PM&R involves. I just wanted to express that not every woman cries after every call and in my experience through 120 hour weeks and every other night call was not a lot of tears. It is okay to cry if that is how you vent, but have the decency to concede that not everyone cries. People do have other methods. Some of them may be beneficial as an outlet for someone who cries a lot. You do not have to attack me to make a point. Onc15

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  45. And I am a mother of three including a toddler. Onc15

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  46. Onc15: When someone asked you what you did, why didn't you say you were an oncologist then? Seems like the logical thing to say. Why was your response "definitely not PM&R"? It was because you were clearly showing some contempt for me. It's okay, just own up to it and don't act so innocent. I was being bitchy too, I admit it. :)

    Nobody says you have to cry either! I never suggested that. The point of my post was to say that people who DO cry feel chastised and your suggesting that anyone who cries is ill-suited for medicine is an example of why we feel so uncomfortable about crying. Look at how many women 'fessed up to secretly crying! I think it's good that you were reading this because maybe you learned something from it.

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  47. Onc15: actually no, while I learned about the subset reading and writing here, I still think it is that. There was really no contempt. I clearly specified that I was not your specialty to 1) indicate that I did not know what your call schedule or work involves and 2) not to make any judgements about onc. That is not important to the discussion. Every field has its bad days. I also clearly stated that there is no problem with crying, just evaluate for yourself if crying about your schedule says something about your field or about you. If you think that is bitchy then I can understand why comments from your chief or a patient or a situation would bring tears. I rely on PM&R every day to help my patients so I have great respect for the field. Good luck in it.

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  48. Come on, onc15. Just own up. You're an intelligent person and I refuse to believe you honestly can't see why some of your replies sounded kind of condescending and obnoxious. You said that you don't cry, that if you cry at work you should question your choice of profession, that none of your colleagues ever cry, and that none of the students you work with ever cry (extremely unlikely to be true). Then when someone asked you what you did, you didn't tell us and just said emphatically "definitely not PM&R" without any kind of explanation till later. You really don't understand why any of that would seem bitchy to a large number of women who admit to crying at work and at least one who works in PM&R? I'm not saying you're a bitch.... I'm sure you're a nice person, but you can see how that sounded, can't you? I'm a nice person and I know I can turn into a raging bitch online sometimes when people piss me off. And of course, we doctors can be incredibly condescending without meaning to be. But I admit it! Just admit it! :P

    And I'm glad you have respect for my field and you seem like someone who truly cares about your patients. I do have respect for people who are better at handling more grueling call schedules without breaking down, because I can't do it. I don't think it makes me a worse doctor or a worse person, but it limited the jobs I was able to take because I didn't want to be in a job where the schedule alone made me very prone to tears. (I'm not currently in such a job.)

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  49. Onc15: if you want to think I was being a bitch,there is little to say. I repeatedly said crying was not a sin and that I did not question your choices. You did not ask me what I did but someone else who had nothing else to add other than insults. I clarified within 2 comments so if my "definitely not PM&R stung, I apologize--not my intent. You can also be quite biting(see I did not say bitchy) when something hits the mark with you. The oncology bit has little to do with crying--every job has its trials and tribulations, so I did not think it pertinent. I have plenty of sad stories and frustrations. Crying is not part of my makeup and perhaps the people I work with and I form our own little subset.

    PS: my own episode of crying: young woman with lymphoma I treated through pregnancy delivered a healthy baby girl. She relapsed when her baby was 6 months and I was pregnant with my second. We pushed and pushed but that awful tumor kept coming back. The day I went into labor, she had me paged. She was intubated and barely cognizant. She wanted my permission to stop. I cried all the way through delivery. She was gone a few minutes before my little one arrived and a week before her baby's first birthday.

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  50. I have NEVER commented on a post anywhere, but I feel the need to express some fizzy support. I'm a surgery resident and I applaud that you want people to feel that they are not alone if exhaustion can bring someone to tears - add a husband or child to the mix and exhaustion and guilt and questioning can lead to even more tears. Also, sometimes the tears in the midst of exhaustion are also a function of the things we see every day whether we realize them or not. I consider myself a non-crier. I previously worked in a very high powered field and cried only once when I was blantantly sexually harrassed. However in medicine I have cried many times. Last year I cried every day for a month and each day the trigger could be anything. I never cried in public so no attending, fellow resident or even my husband knew, but it happened. I eventually realized it all stemmed from one tragic patient death and after a while I got it under control. But, this experience is one of the ones that affirms my career choice. Yes, my response may have been dysfunctional but if something can reach you so deeply there must be meaning. Medicine is hard, we see people die a lot. We live in ICUs, we code babies, people disrespect us daily and all with little emotional support as residents and NO sleep. So if you need to cry then cry dang it. I may cry but I'm still a G.

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  51. Thanks for telling your story, Anon Surgery Resident. It's truly hard being a resident and I do wish there were more counseling available for residents, considering everything we go through. It ought to be mandatory, so there isn't any stigma attached to it. You shouldn't have to be clinically depressed before you get to talk about your frustrations.

    Onc15: How very sad. Exactly why I couldn't be an oncologist, but I'm grateful there are people like you.

    And I don't mind if you tell me I'm being a little bitchy. Sometimes I read my own comments and think "wow, that was bitchy." And I usually feel bad because in real life I am your typical laid back physiatrist who never argues with anyone and just tries to make everyone happy. Very Type B. But then again, sometimes saying things online anonymously are the most honest we'll ever be.

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  52. Totally different anonymous here---another PM&R doc x 15 years. I've cried, for a number of different reasons.

    I don't care what kind of doctor you are--we all work long hours, do stressful work, miss precious time with our family and friends. It's a wonderful, fascinating, humbling profession. It can be quite isolating, too. It's right up there with motherhood--one of the best, and the hardest, things I have ever done.

    I prefer to cry rather than become hostile. The suggestion that someone who cries in response to work demands on occasion should not be doing the job at all is ridiculous.

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  53. I'm a crier ... I've cried when I failed a test and I've cried when I've gotten an A in the same class. I've cried at not being able to find a parking spot when its raining. I've cried because I'm tired and can't sleep. I've cried because my patients have been crying. I've cried because my patients weren't crying. I've cried because patients had no one crying for them. Basically, I'm a crier.

    However, this week, when I should be crying as my sister is in the hospital with shingles and kidney failure, and my mom has the flu and is scheduled for knee surgery next week, and I'm struggling life with driving my granpa to radiation since my mom can't and trying to find time to visit my sister, I'm not crying.

    However, when everyone wanted to watch miracle on 34th street yesterday, I firmly nixed it in the bud because I'm pretty sure that when the tears do start this time, they'll be hard to stop.

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  54. Onc15
    I take exception to some of your inferences as well
    I am a mother, I am a doctor
    I want to see a lot of my kids and I want to work part time. I have had many people tell me that perhaps medicine was not the right career choice. My career
    I also find the pressures involved in being a doctor in training and a parent often bring me to tears. Non of this makes me any less of a person, any less of a doctor or a mum. Its just my way. I never yell at people, I never get cranky...sometimes I wish i did.

    And another thought... I have never cried in front of doctors who scare me, often the ones who trigger the tears... perhaps your coping mechanisms make you a little less approachable and the tears you claim you've never seen have just fallen out of your sight?

    Just because you find something difficult sometimes doesn't mean you shouldn't do it. that would be a boring life. Climbing mountains is hard, running marathons is hard...and because its difficult its uber rewarding...just like doctoring, and mothering!

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  55. Onc15: maybe I am a terrible writer. We all have situations when tears are unavoidable. Again, everyone cries sometime. I am amazed at the level of ire I have induced by saying that there maybe a range of behaviors. For me as a non crier--to say I am going to cry because I am tired or do not want to work the weekend away from my family would trivialize what is a rare event. But, if that is how you cope on a daily, weekly or whatever occurrence, look back to my very first post:"I hope the rewards outweigh the tears." The presence of women and especially mothers is a humanizing one. We have made major improvements in training schedules and hours spent in training. But no one can easily take away the pressures of the job. Since I love my job and really would not trade it for anything(even more time with my 3 girls), I stick with it. If I were driven to tears (even in private) frequently, I would reconsider my calculation. But that is me--perhaps it is my type which is rare.

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  56. Onc15: actually Bekkles, as a core faculty mem ber in my training program, I have the open door. The residents come to ask how to talk to patients, how to coordinate with a spouse's career, how to negotiate the world od academic medicine. I have a box of tissues handy for the resident worried about applying for fellowship since she is pregnant, for my(male) fellow who is really afraid he will miss his wife's delivery because of the call schedule, for my fellow attending who hates her assigned mentor. Usually we come up with solutions and leave the room laughing. Do you think they are uncomfortable? My goodness, aren't you taking some giant leaps? Again, please use tears if that helps you-I prefer humor, exercise and chocolate(usually why I exercise).

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  57. I was taking giant leaps,
    similar to yours when you suggested since you never see people cry after call shifts, it mustn't happen!
    I have seen many a junior doctor dissolve into tears, almost always on cover(call) shifts.

    I guess there is so much of language that is lost in the written word,
    I also exercise for stress relief and spend a large proportion of my days smiling and laughing...you see this is the issue...you seem to be making assumptions that those of us who admit to tears or tiredness or frustration are blubbering messes without any functional coping skills which I find slightly offensive. I do hope that this is not the case, and I realise that a "comments" discussion is potted and missing a lot of filling.

    Just wanted you to know that there are others, many of them I would suggest, that shed tears and love their job. Even if they don't shed them in your presence.

    But finding a fellow doctor in tears would never make me think they should rethink their career choice initially. It would make me think they needed a meal break, a tissue and a shoulder and before long they'd be back on the job.

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  58. Very well said, Bekkles. I'm someone who cries (or at least gets teary eyed) fairly easily. Just yesterday I was reading a book and desperately wiping my eyes so my husband wouldn't make fun of me that some chick lit was making me tear up. I've always been the kind of person who cries in movies, etc. So for me, tears are a fast response to frustration, especially if I'm already in a situation that doesn't make me terribly happy (Saturday afternoon, being away from family).

    If I saw someone in tears, my first thought would be that the person was having a rough day. If I saw it on a much more frequent basis, I would probably be concerned that the colleague was depressed. I don't know if I would EVER suggest to a person who has trained hard for nearly a decade and amassed a huge debt that the career they're in might not be appropriate and to consider something else. If someone said that to me, I would not only cry, but I would probably really dislike the person.

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  59. Onc15: sorry. Had to go to piano lessons and Tai Kwon Do. What did I miss? Oh yes, just a reiteration of what I have been trying to say. Of course everyone has an individual bad day and helping a colleague through that is a must. Fizzy realized that her first residency was making her miserable- may I venture producing more tears? She found a specialty that let's her do her job without tears. Great. That was what I suggested. Balance the tears with the joy or at least contentment of your job. I have trained a lot of residents, and if they are breaking down every day, I find out why and if there are solutions: time off, switching tracks, perhaps a research elective. There are many ways to do medicine without torture. Perhaps we are not equating tears the same way. But if you are losing your equilibrium about a schedule that is a fact of your training, do you cry every day or do something to change it? I am not talking about crying at the movies.

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  60. This post came at an opportune moment for me - I'm in the middle of a NICU rotation (which I HATE with a passion), and my grandfather (who has been sick for some time) died the morning of one of my 30 hour calls. I suffered through it, claiming that I was "fine if I worked," but at 3am, after admitting my third premature infant that had to intubated, everything came crashing down on me. One of the very astute nurses pulled me aside and told me to take 5 minutes; this woman was my godsend that night.

    Thank you for your honest post about emotions - so often, we forget, or try to deny, that we are human beings capable of feeling.

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  61. 6 months into my intern year and I've been on call in one of the largest NICU every 4th (sometimes 3rd) night, which means nearly 30 hours with no sleep. So far, internship is turning into a real cryfest, thanks to exhaustion.
    I still love peds though.

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  62. Kellie (General Surgeon)November 28, 2010 at 11:08 AM

    I am a general surgeon 13 years past residency and fellowship (critical care). I cried once during residency when an attending made me so mad I couldn't do anything else. He didn't know I was crying (I did it outside of the room). A few weeks later, he had a patient die on the table and he cried. Never would have thought he'd do that.

    Only saw one resident who cried frequently. She would cry for seemingly no reason.

    Since then? Cried a few times with patients. Usually someone I've just diagnosed with cancer (usually breast).

    I actually think I was too tired to cry during residency. Did mine well before the hours restrictions, at a place where it was well known you would work hours much beyond what is humane.

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  63. I'm a second year med student and though there hasn't been much crying to date in med school, I think it will happen.


    Whoever said up there that women cry out of anger, that is me.

    When I was working full-time I got so angry at my boss I wanted to punch her (accused me of doing something horrible that I wasn't guilty of). Instead I just broke down crying. It was horribly embarrassing....then I remembered she was a jerk and it didn't matter.

    If crying is how you keep from punching someone, then so be it.

    If crying is how you keep from going crazy, cry your heart out.

    Why are people so judgemental about this??

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  64. I really think the comments pro and con are talking at cross purposes. One group says that crying is a vent for frustration, fatigue, etc. The other is saying that Frequent tears are a sign that self reflection may be helpful. If you know yourself and the tears help you, self reflection really should not be a problem. Mountains out of molehills, people. Neither side is being supportive of the other, which is the topic for another blog.

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  65. If crying helps you tolerate your job fine, but it does leave you open to questions about why you chose the profession.If the rewards are worth the tears, more power to you.Thank you for your honest post about emotions.

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  66. Everyone cries sometimes. I've seen guys cry this year. Not as much as I've seen women cry, but it does happen. Or they vent in different ways (as we all do). I've cried this year. I'm sure I will again.
    What I take out of it is I don't want to be the one making people cry.

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