Signing out

aka Oops, I rambled away from my intended topic

In my last two weeks of residency, I was a senior resident for the new interns—some of them in their first two weeks on an inpatient floor. It was so interesting to close this chapter as they opened it for themselves. There was fulfillment—the diagnoses that they caught, the parents who trusted them, the smiles from our patients. There was frustration—a day-long struggle to get a medication covered before discharge, a sudden reversal of a patient’s clinical status, a social emergency and a code happening two doors apart. Everything, Everywhere, All At Once™.

I can’t stop thinking about the show Severance. It’s not my usual show. My usual show is awkward comedy and satire that is ultimately wholesome—think The Office, Parks & Recreation, New Girl, Schitt’s Creek, etc. I don’t like to be scared. Severance is, well, kind of scary. It’s a dystopian thriller and dark satire of American work culture. It’s about a company that allows you to “sever” your work persona from your outside life persona, so that each version of you has no knowledge or memory of the other. That means that when you are at home, or out with friends, you have no recollection of what you did at work, and when you are at work, you have no recollection of your family, your friends, your interests outside of work; even your last name. Something about this forced division, the idea that we can separate from ourselves in order to achieve productivity and efficiency, reminded me of medical culture. Drinking less water so you don’t have to go to the bathroom as much; holding off on family plans until the optimal year of medical training or attending job; missing weddings and family events because your schedule is pre-set 1 year ahead. A lot of what people fear about medical training is this loss of self, loss of connection with the outside world, loss of agency. A 28-hour shift, often in windowless spaces, disconnects you from the outside world for that length of time. To be able to walk outside, you have to ask someone to cover your phone. Rest is never built-in. Even when you go home, you feel dissociated. When so much happens at work, even in the span of rounds, it’s hard to go home and convey that to a loved one.

I thought about my interns, showing up to work energetic balloons slowly deflated by the onslaught of chat messages, calls, EMR clicks, demands from their senior residents, attendings, pharmacists, nurses, patients. Showing up with such high performance expectations and realizing that there is so much left to learn. Seeing them, I wished I had been kinder to myself as an intern. I wish I was kinder to myself now! It’s not just mindset, though. The workload that doctors-in-training face is immense; they’ll routinely have more than ten to-do’s for each of 5-6 patients, even just starting out the year. In the new chat system that replaced beepers, while you take the time to respond to one chat, you often get 3 more. Everything is a Hydra. You want to walk patient room to patient room in the afternoon but instead you’re stuck responding to notification after notification, call after call, alert after alert, all the noises constantly activating your stress response.

Despite the varied motivations for a career, I think we all seek fulfillment in our work, and human connection is a deep part of that fulfillment. I think patients seek that element as well when they are seeking care. Part of human connection is being able to process and react to things as they are happening, and have the time to debrief and reflect. But when things are chaotic and unrelenting—as they so often are—it’s really hard to find that. And the problem is, when you become more efficient and potentially gain that time—the workload just increases.

I started this reflection to reflect on how much I have indeed learned over three years, but that will have to wait for another post, since it ended up a commentary on the medical environment that inducts newly minted MDs. The environment results from a complex interplay of our healthcare system, insurance companies, academia, professional organizations, governing bodies, and medical tradition. Every time you pull at a thread, its much longer than you were prepared to deal with.

No spoilers, but in Severance, it only takes one person questioning the system in their workplace to chip away at the premise of the whole operation. Now, in medical communities, people are questioning the culture, the hours, the “wellness.” Can a waffle party cure burnout?

The pursuit of self-worth and self-agency is spreading amongst the medical community, at every level. Ultimately, in seeing the interns, part of me is sad that this system is so hard to work in. Part of me is hopeful, though. Many things have changed, and many things will change. They have incredible strength and willpower, and kind hearts and souls. Our patients are in good hands.