August 7, 2023August 7, 2023 monicarose

A Two-Part Reflection on the First Two Years of Residency: Part One

Residency

I’ve been working on what has turned into a two-part post. This is the first part: a candid reflection and vulnerable sharing of some of the difficult moments I’ve experienced in my first two years as an emergency medicine resident. I wrote most of this as I was going through the toughest days. Retrospectively, I’m glad I wrote these things down, but waited until I wasn’t actively going through those difficult days to put them into a blog post. 

These challenges are not unique to me. Some of the stories are ones I’ve heard from others, as I leaned on my co-residents to get through this wonderful but tough journey. 

I do want to open this post with somewhat of a caveat:
Residency is supposed to be difficult. You actually want residency to be as difficult as you can possibly tolerate, so that you end up the strongest attending physician possible. I understand that fully. This isn’t me proposing that there is a way around the challenges, but a reflection on making it through those times. My goal with this is not sympathy, I am not complaining, and I truly love my residency program. I hope that as fellow residents reflect on their own challenging experiences, they come across this post and feel validated, understanding that their struggles are normal and that they are not alone. 
I hope that future-residents reading this are not discouraged, but think of it as a small insight into the resilience they will need to cultivate throughout their own unique journeys. 
I also hope that this can help loved ones of residents outside of medicine have a small glimpse into the days that are just too tough for so many of us to talk about when they happen. 

…

Trying to capture “the hard times” in pictures is almost impossible.

The hard times are sitting with crying family members while you have unspeakably difficult conversations.

The hard times are calling time of death on a patient and sitting in that moment of silence at the end. 

The hard times are the expressions of pure anguish and pain you see on people’s faces, and the torturous cries you hear, sometimes on a daily basis. 

The hard times are standing crying in a supply closet not knowing if you have the strength to go back out to patient care. 

The hard times look like being really sick on your days off, because your body finally registers that it has a second to “rest” from the constant adrenaline. 

You don’t often stop to take pictures of the hard times. These are the times we usually quietly push through without thinking about documenting them. I’ve tried capturing a few of those difficult moments with the foresight of wanting to somehow share them on my blog. The images on this post were from: The day I first saw a child die. Days on the ICU where my cognitive abilities were pushed past their limits for 12 hours straight, and it felt impossible that I could do it again the next day. Heading home from a vacation where I had to constantly try not to let my sickness ruin the entire experience. It feels weird and vulnerable sharing those images, but I had this post in mind when they were taken, and I’m following through with that goal. 

…

The residency journey is extremely difficult on our loved ones. I am so grateful for my husband Dominic, and on so many days truly don’t know how he does it.

Residency, counter-intuitively, feels like an extremely selfish time in our lives. We spend all of our time and energy on the altruistic goal of “helping people”, and yet when we finally get home it can feel like a really selfish career choice we’ve made. We give our best selves to our patients, and when we get home we don’t always have the energy or emotional capacity to keep being that best self at home. I feel guilty for missing family events and milestones, regardless of how my time was otherwise spent. My resident friends with children, in multiple specialties, have shared different versions of their kids automatically going to the other parent for their needs, even when the resident-parent is home. I’m sure that causes heartache on some days.
Mine and Dominic’s first two years of marriage were also the first two years of residency. On our 2nd Wedding Anniversary, he said, “if you don’t count the time we were asleep, we’ve probably spent more time apart than together since we got married”.  Picturing my husband alone, taking care of our home and our dogs while I was at work for most of our first newlywed years, made my heart ache too. He never makes me feel guilty for my time spent at work, but that doesn’t stop the feelings of guilt from coming still. 

Residency truly is a sacrifice for our loved ones as they patiently accept whatever level of energy and time we have to give. 

… 

Dr. Alainya Tomanec, who is also our new program director, shared that processing the emotions that come in response to unique challenges that female physicians face can almost feel like the stages of grief. Some days you’re angry, sad, bargaining and comparing, in denial that this should even be an issue, and eventually you’ll have days where there is mostly acceptance. As soon as she shared this, I felt validated and grateful to have such a mix of emotions normalized. We are entitled to feel however we need to in order to process the variety of challenges we face. 

Beyond getting mad at the handful of people who discouraged me during medical school from pursuing emergency medicine due to it “being a boys club”, I hadn’t really given a lot of thought to how my gender would affect my experience as a doctor before I got to residency. I do wish that someone would have given me the honest warning that being female absolutely will affect your experience as a doctor, and just to be aware of that so you’re not caught off guard later.  I hear, “I haven’t seen the doctor yet” more than my male counterparts; I hear comments on my appearance and my age more often; I am assumed to be a nurse no matter what my name tag says. This is a reality for which I wish I had kind of braced myself to experience before residency. Similar to any underrepresented group in medicine, I know that I am not what the general public would picture when asked to describe an ER doctor. Some days it is empowering to be an exception, but some days it wore me down much more than I expected it would. Some days I internalized the comments made at women physicians’ expense; some days I was convinced that I should not pursue my highest goals and aspirations. My advice for those having one of those days: Sleep on it. Process it, write it down or talk about it, work out the anger in a healthy way, vent to your fellow residents when you need to, and just keep moving forward. The days of internalizing the negativity will gradually become fewer and farther in between.

… 

When I faced hardship in my non-residency life, I found myself struggling to cope. I was more emotional, my sleep quality was significantly affected, and I was just overall struggling more than I thought I should. When I shared this with Dr. Brook Danboise, one of my role models as a senior resident and now one of our faculty, she shared something that I repeat to myself and others all the time. 

“Residency drains all of your reserves” – Dr. Brook Danboise. 

I really can’t think of a better way to describe the challenge of overcoming obstacles, whether they are related to residency or not, when you are already so drained at your baseline. It felt like she was helping me give myself permission to just get through hardships however I needed to, rather than being so hard on myself for not having more energy, more developed coping skills, more reserves. 

Some days the negativity wins. Some days you leave feeling like you struggled so much during your shift, and yet can’t think of what you really learned. Some days you focus more on the misses and what you could have done better. Some days you don’t feel like you have the strength to go back the next day. You are definitely not your best self all the time. Some days you will be convinced that you don’t belong. Some days your reserves are too empty to keep a positive outlook or to remember the “bigger picture”. All of that is normal, all of that is okay. 

These pieces of writing in part one sound very dramatic and emotional, but it is real. With your reserves drained, you will handle things with more emotion at times, you will find yourself reacting and being irritable more than you usually would be. And, let’s be honest, in the emergency department and ICU settings, the patient and family experiences we are a part of truly are more dramatic sometimes. 

Residency asks a lot of you, and we ask even more of ourselves. It is only human to have days where what you expect of yourself and what you realistically have to give just don’t match up. That is where your clinical judgment is challenged and developed, that is where you learn valuable lessons in communication and leadership, and that is where your resilience grows. 

https://monicarose.me/part-two