Monday, August 10, 2015

MiM Mail: Lost

Hi, I just started a 3 year residency program, and I'm feeling desperately close to quitting. In fact, if it weren't for the huge financial investment I've made up to this point, I almost certainly would have quit before I even got to this point.

I have a daughter who was born at the beginning of 4th year, and I think 4th year was probably the best year of my life. I loved spending time with her at home (despite being bored and lonely for parts of it). Now that she's older, she's even more wonderful and funny and fascinating, which I didn't think was possible. I dreaded the start of residency, which was, unfortunately, a black cloud over that otherwise wonderful year.

Now that it's here, I don't know whether it's worth it to continue. I don't find the work difficult or all that unenjoyable; I kind of like it and I definitely like the idea of contributing to our family financially. I feel like I could surely handle it all if I didn't have a child. I grieve every single day the lost time with her and the opportunity to watch her grow and be there for her babyhood, which is so fleeting and the part of my own life I want to experience more than anything. Add to this some chronic health problems that I am dealing with, and I feel so depressed. And of course there's no time to seek out treatment or professional help. I really have nobody to talk to about it. I feel like I'm drowning.

I have a supportive non-medical spouse who has a good job, though it would still be a blow of course to give up a future physician income. And I do have some loans, though well below the national average. So...I guess I'm looking for advice. Do I stay or do I go? Or should I approach my PD about some sort of part-time compromise (guessing that's a huge long shot). If I somehow make it though, and don't destroy all relationships in the process, my husband and daughter would probably be better off long term. If I go, I can start to recuperate some sense of sanity and mental and physical health, and I think it's better for me personally. Maybe I could convince myself it's better for my daughter since she'll be in a less stressful environment. I feel lost. -J


  1. Everybody --EVERYBODY-- thinks about quitting residency. Because it sucks. I think about it every single day, fortunately less last week than the week before. You are right at the absolute worst part. Intern year is godawful.

    My advice is to stick it out six months and see how you feel then. Are you still crying every day on the way to work? Or, Are you finding some small reward in your interactions with your patients, or in gaining a level of competence in what you're doing? In your interactions with your coresidents?

    Please do try to take care of yourself. Get as much sleep as you can, and try to see a dr if you need one. Also know that despite what anyone tells you, everyone else is going through the same thing you are.

    You are really very lucky. Many of your cointerns get to go home to an empty apartment and a fridge full of rotting leftover takeout. You get to go home to your daughter.

    It gets so much better. Believe me.

  2. Every single person doubts his/her decision at some point in training. This is normal. Keep in mind that not every rotation during residency will be as busy and demanding of your time. You will probably have some months which are lighter than others. I would second what the above commentor recommended - try to stick it out a few months before making a decision. You may just be going through a rough adjustment, and it sounds like there are other issues at play in your life right now which might be influencing how you feel. You sound somewhat depressed... This is normal and nothing to be ashamed of. Please don't try to face this alone. Talk to someone you trust who can give you objective advice - a doctor, your program director, a mentor. Your health and well being are a necessary part of you being the best mom and doctor you can, so please take care of yourself.

  3. I wanted to quit many many times during intern year (mostly between August and March, the light at the end of the tunnel appeared then). And I was single & had no kids. It gets better. And if it doesn't, then you can revisit the thought.

  4. I agree with everyone above; residency sucks in the beginning (and sometimes in the middle and end), but overall it gets better. Find people inside your program with whom you can talk/vent. Find ways of fitting some joy into your life. And if you are feeling depressed, find a way to talk to a professional about it! Many programs have psychologists/psychiatrists available at no charge to residents. It's absolutely worth it to take action early rather than letting feelings of depression overwhelm you.

  5. Perhaps I’m the exception that proves the rule, though I’m not sure which. I never considered leaving medical school or residency. My first daughter was born the week I would have been attending my medical school graduation. I started residency 5 weeks later with breastpump in hand. It was a challenge. But I found the training and learning in residency complemented what I was desperate to learn as a new mom. I am Family Medicine, so I participated in deliveries and worked with the pediatricians and very ill children. Being a mom meant I brought an intense personal interest to many cases. I researched, examined, and observed the specialists. I spent time with the families to hear their stories and learn. I also made sure to let the moms know how they had done everything as well as they could, were correct in deciding to come in to the hospital, and that they were great parents. I saw myself in their faces and wide eyes above puffy dark circles. I told them how beautiful and full of love they looked and how impressed I was at the clever thing their little one had said or done. I’d get back home and cherish the hours I spent with my healthy child. I think I’m a better doctor and a better parent for those times. I completed Family Medicine residency only a week or two after my classmates after having a 2nd daughter as I started my 3rd year. I went into full time practice soon after. I then had to address my own health and step away from my career for a bit. It’s been good for me, too. I’m getting to participate in the full-time parenting part that is harder for me. Despite all the clean-up and tantrums that come from days with a 2 and 5 year old, I am getting to know them again.
    It sounds to me like the time for your time off is now. It will be ok whatever way you emerge from it. Like another said, programs are often family friendly now. You should expect to be offered 3, 6, or 12 months of time away with no obstacles to returning to residency life when (or if) you are ready. It sounds like starting with some complete time off is the right thing. Part time work should also be an option, but I would consider that more appropriate as an option if you are easing into returning. You may also be offered a “student designed independent study” rotation, where you are at home but working towards a project or presentation. I took some time and revamped some of our clinic’s patient handouts. You could choose to present on the balance of family and doctoring. It’s a topic most of your peers will want to know more about, too.
    With time off, let your mind be free to consider other things. Try other work. Look at applying to a master’s in public health program or something of that sort. Then see how you feel. What do you daydream about? If you still want to do residency, you can. If you want to go a different direction, you should. Your kids can become awesome people with a mom who works long hours as a physician and comes home and loves spending time focused on them. The example you want to provide them is of a strong, smart, brave woman who takes care of herself and lives happily. Plenty of ways to fill that picture.
    Step 1) speak to therapist/psychiatrist promptly. You’re definitely overstressed and possibly depressed. Step 2) Talk to the faculty or program director, whomever you are most comfortable with right now, and let them know. Make plans to form a plan with them. There is a lot of pressure on you but you are not powerless. They should be supportive and facilitate your need to make changes, temporary or long term. They know: you can’t take care of patients until you are taking care of yourself.
    Step 3) Forgive yourself for not being invincible. You’ve found your limit!!! Yeah!! Everyone has them and over-achievers sometimes aren’t very good at recognizing or accepting them. Being aware of your limits and respecting them is an executive function.
    Step 4) Be awesome. Enjoy your awesome family and personal hobbies, abilities, and passions.

  6. What I am hearing is that you feel overwhelmed and you miss your child and don't feel like you can ask for help. I would talk to your chiefs/PD. I would go see a doctor for your depression. Giving you time to go to an appointment is much better than replacing a resident to them. It will get better with time.

  7. What Erin said. Ask for help. Talk to your PD; talk to the EAP at your institution; talk to someone in the GME department. They want you to thrive and succeed and they *will* help you. Most people do indeed think about quitting at some point and first year really does suck. I was depressed during most of my residency - I remember when I finally sought treatment years later and realized that I had been living with anxiety for so long that I thought it was normal until it went away.

    Don't make any decisions about your career right now, and don't feel bad if the "be grateful" advice just makes it worse. You don't have to be grateful. Keep putting one foot in front of the other and talk to someone about getting help. When you have a support system in place at work, you can re-evaluate whether that's enough to keep you in medicine.

    Also realize that stopping now doesn't mean stopping forever. Take care of yourself and leave tomorrow's decisions for tomorrow. It does get better; that doesn't mean you have to live with this much pain right now.

  8. What everyone else said.
    Honestly, making it through intern year sucks, but I would seriously, seriously advise you that intern year, at least, is non-negotiable. You will probably not be able to get into residency ever again if you leave now and if you DO get in, you'll have far fewer choices in specialty and location (because leaving a residency mid-year looks terrible and you do have to declare it on your applications & also because time off between medical school and residency is frowned upon, especially several years.) I know it sucks to hear, but I would advise you to seriously consider if you're okay with never being a practicing physician. Not now, but when your kid(s) are grown?
    So I think really you need to think about two things: how to make it through the next 10 months and then what to do after intern year.
    For the next 10 months, definitely talk to your PD and the chiefs. The very first thing you need is support and it is their job to make sure that you are getting it. If you decide you need mental health services, the chiefs should provide coverage so that you can get them. Honestly, you should have an intern support group -- maybe it hasn't started yet? Feeling overwhelmed and depressed is a common part of intern year, often referred to as "pseudodepression," because its thought to be provoked by the enormity and sadness of the task plus sleep deprivation and isolation, rather than true clinical depression.
    In terms of more concrete things: People do do part-time, although usually it's a block on/block off rather than 40 hours/week. Your program may or may not allow you to do this. You could also ask for some additional leave time that you'll pay back at the end. Also, it goes without saying that if it's not work and it's not your kid, it's not your problem: cleaning the house, cooking, staying late to catch that last admission -- learn to say "no" to all of these things.
    Finally, if this year is just too much, you could ask the program leadership if you can restart next July, but be prepared for them to say anything ranging from "no" to "yes if you reinterview" and if you do that you absolutely need a plan in place to explain to them how next July will be different.

    For future years -- some (most?) programs automatically get easier after intern year. If that's your program great. Otherwise, you can look to switching to a different program in the same specialty -- many programs have lighter hours than others. If your program won't do part time, maybe another local program will. You can also look in to switching specialties to something that has a more reliable schedule. I've had colleagues leave after intern year to do derm, rads and anesthesia. You could also look into path and preventative medicine.

    1. Coming back to add, if you do end up taking time out, its important to look at your state's restrictions for step 3: Most states require enrollment in residency to take it, and some require a certain amount of postgraduate training before eligibility, and you typically must pass within a certain amount of time of taking step 1 or you have to repeat the entire sequence.

  9. You have only two years to go, after which you can work part time, or half time, or do insurance stuff from home, or whatever. You have an extremely powerful and flexible credential in your pocket which with minimal effort on your part you retain for the rest of your life.

    If you decide to quit, you have the title and not much else to show for your 5+ years of work.

    If you feel you can't miss your baby's infancy, I would request medical or personal leave for one year. Part-time doesn't really fit with residency. OTOH, people leave residency for a year or two to do research, get substance abuse treatment, deal with family issues or whatever. It's a known and accepted thing.

    If after a year you still feel like you can't miss a moment of your child's growing up, then quit. You lose nothing. If after a year of full-time motherhood, you remember why it was you wanted to be a doctor, go back to your program and juggle work-life for 2 years. Then you can do anything you want.

    My 2 cents.


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