My intern gazed blankly at her notes from the day.
“You OK?” I asked.
Her face was quivering with restrained tears as she turned to me, “I don’t think I helped anyone today.” This was not the first time, nor would it be the last time, that I had heard those words from a resident physician.
Medical training is no joy ride. How could it be? First, there is the intellectual challenge of cramming knowledge into one’s brain and tempering it with good reasoning. Next, there is the physical toll of long hours in the hospital. Most challenging of all is the inescapable spiritual and moral distress in the land of the sick and dying.
Physician burnout has become an oft-repeated phrase in the medical community. A PubMed search of medical literature reveals that there were only seven references to “physician burnout” in 1986. In 2016, there were 243. Of these, 34 articles directly referenced burnout amongst resident physicians. These numbers don’t include the hundreds of articles that reference burnout in non-academic publications, blogs and the mainstream media.
I am happy that the conversation about burnout has spurred wellness initiatives such as self-care workshops, wellness days and more tolerable schedules in residencies across the country. However, well-intentioned conversations on burnout can also enshroud us in billows of despair and cloud our view of our profession, our lives. Sifting through articles on burnout in the early days of my residency, I felt trapped. Why on earth had I become a doctor?
More than 31,000 residents started their residency training this July. For their sake, I want to steer this gloomy conversation towards a more ambitious, more coruscant path. I want to talk about finding joy in residency.
Every resident has felt a tiny shiver of delight after nailing a challenging procedure for the first time.
Every resident has felt uplifted after seeing colleagues do something altruistic for their patients.
Every resident has felt a mini jolt of bliss after hearing a sincere: “Thank you, doctor.”
And yet, the misery of residency often blinds us to a sweeping spectrum of joy. Joy that can be ours. Joy that should be ours! Becoming attuned to moments of joy — big or small — and soaking them in builds resilience. It could be anything: encountering the secret splendors of the human body, seeing our students gaining skills and knowledge or witnessing the courage and decency of our patients. Buttressed by a stash of joyful memories, we can better endure the inevitable difficulties of residency.
Of course, simply appreciating these moments of joy will not eliminate suffering. There is no denying that our work sometimes depletes us. A positive attitude won’t neutralize all unpleasant experiences. There will still be unstoppable deaths, long days and prickly colleagues. Moreover, there is no substitute for professional mental health services for the many residents who silently suffer mental illness. There is also no substitute for fundamental programmatic changes to decrease structural violence against resident wellness. Indeed, leaders like Dr. Christine Sinsky exhort physicians to audaciously pursue joy in practice through implementable changes in the way we structure our practice of medicine.
But I do believe that learning to savor the glimmers of joy in our work will dispel some of the gray haze that can ensnare trainees in residency.
Finding nuggets of happiness in the daily grind of residency need not be complicated. Everyone has a way. Some practice appreciative inquiry by being curious about the people around them and being prompt with their praise: “That’s a cool tattoo. Tell me about it!” or “Did you see how artfully Dr. Wu explained the plan to the patient?” Others may opt for mindfulness, journaling, or poetry. Really, the method is less important than the desire, nay determination to find joy. And oftentimes, we need someone to point us in the right direction.
Conforming to the statistics on burnout, I too felt disengaged, disgruntled and dysfunctional in my first year of residency. Just before the pernicious plumes of burnout engulfed me completely, I began noticing a few anomalous colleagues and professors. They seemed happy. They even seemed to enjoy what they were doing —
what a notion! I gravitated towards these beacons of delight and began to see my profession anew through their eyes. Some of them looked past the daily drudgery to appreciate the beauty and humanity at the heart of medicine. Others glowed with geeky giddiness as they pieced together clues to make diagnoses. From such marvelous individuals, I learned to look for joy in the everyday experience of residency.
And I found it! I found joy when I listened in awe to my patient’s stories about the Battle of the Bulge. I found joy when I stumbled upon an elusive diagnosis of Anaplasmosis under the lens of a microscope. I found joy also when I watched my intern tenderly hold a patient’s hands in hers and pray with him as his spirit left his body. The joys were multihued and some were tiny, but I carried them with me as a reminder of why I chose this profession.
With experience, I learned to point others towards joy — like my aforementioned intern.
Taking the notes from my intern’s hands, I sat down next to her.
“Look,” I said, “you gave this young woman the right antibiotics for her kidney infection, and she feels better now.”
I started flipping through the notes of all her patients one by one.
“You sent this man back home to his wife and kids who missed him. You reassured this boy’s parents that he’s going to be fine. You spared elderly lady confusion and unnecessary suffering by helping her understand that her time is coming.”
I looked up from the notes to look at her and said, “Today, you played an important role in all their lives.”
The tears refused to be choked back any further, but they were accompanied by a little smile. “Yeah, I guess I did.”
Despite reports of burnout and depression, thousands of residents provide excellent care to millions of people every year. Academic medical centers would grind to a halt without them. If residents do all this in an emotionally attenuated state, just imagine the wonders we could perform if we felt happy and fulfilled.
Pranay Sinha is an internal medicine resident.
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