Wednesday, January 26, 2011

Bitter? Well, a little....

For those of you who read my posts, such as my rant about how much it sucks to work weekends and how the bright light at the end of the tunnel is a big fat lie, probably think I'm incredibly bitter and unhappy. That I'm some kind of cranky old doctor who sits on my porch confiscating the wayward baseballs of little children. Some of you have suggested that I switch fields.

Well, really, you don't need to worry so much about Fizzy. The truth is, I kind of like my job. It's not perfect. You're not going to catch me and my job alone in a closet doing unspeakable things (I worry about some of you, really), but I'm quite satisfied. For starters, I don't work weekends. I sometimes really help people. I have a lot of flexibility. I can eat lunch or go to the bathroom any time I want. (I'm not joking. This is huge.) There's a lot of room for career growth and research. If someone told me I'd still be working at the same place 20 years from now, I'd be pretty happy. Like they say in Office Space, it would be nice to have that kind of job security.

So your next question is undoubtedly, "But Fizzy, you're always whining and moaning. If you're happy, why don't you just shut the hell up already?"

Well, that's a good question, although quite rudely phrased. It's sort of like this: say you spent the whole day cleaning your giant house. It sucks but then when it's done, maybe you can finally relax. Except you can't relax because you pulled a muscle in your back and have excruciating pain for the next several weeks. It's sort of like that.

I wish I could say that my training sucked and now it's over, thank god. Except it's not so simple.

All right, my pre-clinical years were not great. My school had a failure rate of something like 10%, which meant that 10% of the class actually had to repeat an entire year. That puts a lot of pressure on you, especially when you're in the midst of a bad break-up and some family medical issues. But I was used to studying hard, so while it was bad, it wasn't that bad. The clinical years were when I started to fall apart. Some people simply don't like waking up at 4AM and working 27 days of the month. Some people start to physically deteriorate. I was in the latter category. I've always had a pretty low energy level (which would explain my impending obesity) and I really struggled with the physical demands of clinical work (e.g. sleep deprivation, standing in place for eight hours, etc.). It was pretty bad, but I got through it.

It was intern year that really got me though. It changed my conception of myself, and not in a particularly positive way.

For starters, my first resident as an intern was a cruel bitch who tore me down on my first day and continued to bat me down every time I tried to recover. (You can read more about her cruelty here.) People like her over the course of my training really brought down my confidence in myself. But it wasn't just that.

I'm a typical oldest child in that I always feel this compulsive need to be responsible. I'm not Type A, but when you ask me to get something done, you can bet it will get done and at least a day early. In school during group projects, I was always the one who quietly did everyone else's work while they slacked off. I am extremely reliable and organized and always have been. Except I discovered during my intern year that after 2AM on a call night, I wasn't particularly reliable. I'm not going to elaborate further, except to say that I'm not proud of my behavior on some of my call nights. (I will at least say that absolutely no harm whatsoever came to any patients.)

That was part of why I switched residencies, in order to have a more regular schedule. Leaving my residency was the most drastic thing I'd ever done in my life, very unlike me, but I was horrified that I couldn't trust myself during call-heavy ward months. I don't think of myself as prone to depression, but I became desperately miserable that year. I was recently reading a journal I kept during intern year, and I wrote one very serious-sounding entry where I said that I wished a car would run me down on my walk to work the next day.

So that's my story. Years later, I still have negative thoughts about myself due to those early years of training. I have trouble thinking of myself as the old reliable person I always was, despite three extremely successful subsequent years of residency. And some of the physical ailments I developed under the extreme stress of my early training still haunt me. But I guess in some ways, I got off easy. One of my colleagues attempted suicide during intern year.

Some of you have applauded me for my honesty and this about as honest as I can get. I don't know how common my experience was, but I've learned it's more common than I thought. I was, after all, a very average intern, as my shocked program director told me when I informed him I couldn't take anymore. I suspect there are people reading this now who feel the same way I did, have in the past, or will in the future.

20 comments:

  1. Fizzy, I thank you for your honesty. I really loathe the culture of medical training sometimes. I am hoping work hour rules will do something to help, but it won't get rid of those really awful residents.

    Here's to the light at the end of your tunnel. I can almost see...wait, no, I can't see mine yet.

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  2. The Industrial Supply Company From Hell (where I worked for 3 years prior to medical school) was a lot like this. I am desperately afraid that residency will be a repeat. On the other hand, at least as a resident they won't make me clean under the conveyor belt when orders get slow. For a year.

    I am someone that really does better with a normal amount of sleep as well.

    And for the record, the whole wanting to get hit by a car thing? Felt that way during 90% of my Ob/Gyn rotation, for the sole reason that the residents were 90% psycho bitches. That's right: MEAN BITCHES (take that Candace). And that's the least offensive term I could come up with.

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  3. I love your post, Fizzy. Please keep writing!!! <3

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  4. Fizzy - thank you for your honesty, Medical training is cruel. I was on call with guy intern who cried every call night.. I feel bad I could not comfort him as I had to do work for the two of us while he was crying. He later developed retinal detachment, took 2 weeks off and was ruthlessly critisized by his intern peers for having 2 week "vacation" on their expense. I cried on average once a year in my residency training, form physical emotional exhaustion since I had to work 36 hour shifts without any sleep and could not push myself physically or mentally anymore. Suicide rates among women doctors are the highest in the country. Because you will more often than not end up in bad environment after your training, plus family, plus rasing kids, or spouse, or parents issues. I thank you for your posts about bad MD jobs, I had 2 bad ones and on my 3rd and happy. My last job I witnessed a woman collegue rash out of the exam room, down the hallway exclaiming on top of her lungs "Damn this place, they do not respect doctors here" only this was a stronger expression. We doctors work harder than most, have less and less respect from our patients, more and more abuse from our bosses/practice owners/institution leaders and yet we are expected to say ... we love our jobs...thats where people break down, because they do not feel they can "love" this life. I am in a happy environment now and like you hope for another 20 years. So lets breathe a sigh of relief.

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  5. Fizzy - Your post reminds me of this particularly horrible rotation I had as an intern. The fellow was mean and wouldn't help me when I asked for help with a patient and the admit orders, as well as the plan of care. The fellows on service complained that I couldn't stay awake for the 30 hour shifts, and my program director even suggested that I get my thyroid function checked because I couldn't stay up for 30 hours!!!! I subsequently discovered how indispensable coffee is for keeping awake starting from 2am onwards during on call days. That was the only way I survived calls. (When I was breastfeeding I would pump bags that were labeled "Lots of caffeine!")

    Thank goodness it's all over. I really did not like residency. I don't see why it's a necessary rite of passage to have such ridiculous hours and such a demeaning hierachy in order to learn to be a doctor. So I do approve of all these recent changes and IOM recommendations. But that's a topic of discussion for another day.

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  6. Thanks again for your honesty Fizzy. I really enjoy your "controversial" posts and appreciate your ability to say the things that so many of us are thinking.

    Your comments about responsibility really stuck a cord with me. I too have a compulsive need to be responsible and found that when extremely stressed and sleep deprived my reliability dropped off. Luckily I've found that out in medical school and will choose my specialty accordingly!

    Keep writing and keep up your cartoons, you have a real talent!

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  7. I think we all have these stories. I came into med school thinking surgery but my horrible rotation put that out of my mind quickly. I guess I came out less traumatized because the rest of the rotations were great and I left with my self esteem intact. I think that is critical. I had horrible hours but never felt demeaned in residency. But I guess I was really lucky. Glad you are recovering. I hope you get increasing enjoyment from it and recover.

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  8. Everyone is so supportive... I have nobody to argue with! :P

    It's really amazing that people don't crack more often under the combination of abuse and long hours. Worse, I think we all tend to hide it from each other, and pretend we're all fine.

    And even worse, when someone really does crack under the pressure, such as that guy Anon mentioned with the retinal detachment, all their colleagues criticize them as being "weak." But I can't even throw stones because it's hard not to get angry at someone who causes you to have even more work when you're already overworked.

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  9. I've always been surprised by the people who give you such a hard time about being honest about the fact that medical training is terrible. I spent several months of intern year hoping I would get hit by a train, not bad enough to die, but to end up on a vent in the ICU, because surely that would be better than the emotional beat down I was getting every day. While those feelings are now resolved, I can't help feeling that I lost something very valuable to me: my optimism, my idealism, and my good opinion of people in general. I understand that medical training is hard for a reason, but does it need to be so hard to take all that away from us?

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  10. Maybe the goal *is* to make us crack... at least, to make people who are vulnerable break down early, before they're in a position of power to do more damage. After all, as attending doctors, we get abused by patients and the hours can also be pretty brutal.

    What bothers me is that I always heard medical training was hard, but I really just didn't *get* it until I actually experienced it.

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  11. I can relate in a way. When I was in the Army, my training was draining physically, mentally and emotionally. I remember running at 0500 wanting to cry so bad cause I was so exhausted, but you never let them see you cry. Every time I saw a car drive by during our morning physical training I wanted it to hit me so bad cause I knew that was about the only reason I could stop.
    Blah Blah Blah, life is hard when your doing you best and people are still yelling at you and treating you like dirt and all you can think about is having to go pee.
    Been there sister.

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  12. Anon: I actually felt like I was in the army. Except the big difference is that I think people expect to physically push themselves when they join the army. I would never have joined the army for that reason. It was more of a surprise in medicine.

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  13. Yes, people don't get the physical demands of medicine. That said some people thrive on it. I get a feeling of accomplishment at the end of the day. Fizzy, you ave every right to be honest about the work and the pain and sacrifice. Just remember there are a few crazies like me who enjoy it.

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  14. My best friend cracked during surgery rotation. She had the meanest "witch" of a resident in the whole very malignant program. I mean, this resident is still legendary - and not in a good way. Instead of the school being supportive they ended up kicking her out. So... not everyone makes it or has a rainbow at the end of the training tunnel. She's got a ton of loans to pay back and many productive years lost.

    One resident from my program tried to kill his kid and himself - luckily he was not successful.

    I have high expectations of my interns, and I am ALWAYS complaining about something. "I didn't get any sleep last night because I was taking care of my kid." "My intern forgot to order..." "My attending wants to meet for hours to discuss..." It is my way of coping - and maybe it is your way too.

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  15. The internal medicine residency at my medical school was so toxic that nobody from my class matched or wanted to match there, except for one person. Rumor had it that she got "locked in" by the department heads who deliberately gave her poor recommendations so she wouldn't match anywhere else. Don't know if it's true, but based on what I'd seen in that place it was certainly believable. The residents there were some of the most unhappy people I've ever encountered. My FP residency (which was elsewhere) was comparativley benign, even though most of it was on no sleep--every 3rd night with OB call which meant deliveries all night long. It's too bad that post graduate training remains so toxic after all this time.

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  16. Fizzy,

    You must be my sista from anotha mista! I am new to this blogsite but Thank God for it. It is impossible to be prepared for the physical, mental, emotional demands of medical school and especially residency. I am ten years out and still have those years stored in a tiny corner of my brain that shouts "Do not open!!!" whenever my mind wanders there. How would we survive without denial and reaction formation as awesome defense mechanisms right? Some moments of my day are joyful and i honsetly feel that i'm doing what I'm supposed to do but those are fleeting and the overall crush of all the responsibility and hassle most of the time makes me wish that I could enjoy my life and my family the way I feel like I was meant to. Wish I had opened a flower store or something instead. Thanks Fizzy for putting it out there...

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  17. Kellie (General Surgeon)January 28, 2011 at 4:37 PM

    I did both army basic training (regular not officer) and surgery residency. Both were difficult but in very different ways. I think my most difficult rotation was in medical school and was pediatrics. It was an ER intern doing her pediatrics rotation that I didn't get along with at all. She was a bitch.

    I still think the first 3-4 weeks of my maternity leave was WORSE. I think it was worse because I knew that it was for real and not going away anytime soon. Being a mother now is the BEST :)

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  18. Yeah, while residency sucked in a number of ways maternity leave topped it. Being up all night every 3rd night pales beside being up all night with a screaming newborn who bloomed into a colicky infant. I literally remember the first time the kid was awake and not screaming or eating because it didn't happen until she was several weeks old. The trauma remains, even though said kid is now almost 30 years old.

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  19. Yeah, maternity leave was rough. I think I may have even written a post comparing maternity leave with internship (or at least, I composed it in my head). The part that was worse was that you never get a night or a day off. But in general, I think it was way better because I actually felt happy when I watched my daughter feed in the middle of the night, whereas I'm pretty sure I derived no joy from anything I did in the middle of the night on call. Then again, I might have felt differently with a colicky baby.

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  20. I was actually happy to go back on call after my maternity leave, I think I got a little more sleep on call than with my newborn.

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