Do not become a doctor. This was the piece of advice my parents gave me when I initially shared my desire to do so.
No, neither parent is in the medical field. As I’m finishing medical training today, I fear this will be the advice I will give my daughter one day. Once wide-eyed, I now look in the mirror and barely recognize myself. Seven years into post-medical school training, I see unkempt gray hair, wrinkles, and eyes duller than a doll’s. Where did the time go? What happened to me?
Once upon a time, I enjoyed dancing. I liked going to concerts and plays, staying awake to watch the sunrise, putting on mascara, flirting with boys, and eating at restaurants I could not afford. I maintained my sense of self in medical school and the first years of training. But by year seven, the person I once knew was gone.
Everyone makes an adjustment from youth to adulthood regardless of career choice. The difference for us in medicine is that every choice — for ourselves and patients — is an enormous, sometimes life-altering decision. We are left to find ourselves in a hectic, arguably abusive, lengthy apprenticeship where we shatter at a less-than-perfect review from people who did not bother to learn our names.
During these training years, I felt incredible loss, bore witness to death, and cried with happiness as I brought my own daughter home from the intensive care unit. Like others in training, I missed most birthdays, weddings, and holidays.
In pediatric critical care fellowship, I asked an attending what she did during training. Did she miss life’s milestones? She blankly responded, “We all missed out.” There’s a whispered, if not unspoken, expectation that surrendering to medicine is part of training. And, despite our growth into adulthood, we continue to be infantilized because this is how it has always been done.
The guilt associated with catering to our personhood while in training is stifling. In pediatric palliative care fellowship — year seven — I apologized every three hours when I excused myself to pump breast milk for 20 minutes. Despite the warning that I might make others feel uncomfortable, I pumped at my cubicle. I felt like I would miss too much of the day if I took the extra 10 minutes to walk to another part of the hospital to pump in private. I apologized for asking to step away to use the bathroom or attend my own health care check-ups. When I was actively having a pre-syncopal event, I lay on the ground, feet above my head, as I calculated one last methadone conversion. This, quite frankly, absurd behavior is likely a combination of both my inherent nature and medicine’s nurture.
Brené Brown’s writings on authenticity were concepts — among many — that we explored in our multidisciplinary leadership class. I could not help but think, “Bullshit.” From what I have seen over these past seven years, the importance of authenticity in the workplace does not apply to medical trainees. We are groomed to be a variation of the same person. Only now are we raising awareness for diversity, equity, and inclusion. Authenticity is not celebrated, and those who speak up in support of their own truth are frowned upon for doing so. They become labeled as “outspoken,” “difficult,” or are gaslit into thinking they are the problem — not the static health care system. “My Fellow” and “My Resident” — we are nameless, transient, interchangeable belongings to answer pages and speak when spoken to.
We are mid-30s subordinates to survivors of a broken system who continue to work within a broken system that I once idolized.
Training during the pandemic is harder than before it began. We are now threatened by staffing shortages, COVID exposures, and hiring freezes leading to job insecurity in a field that historically yielded security. Superiors became more obviously burnt out, as evidenced by shortened patience, unapproachable body language, and defensive tone, while we trainees struggled to understand their medical decision-making. Homelife became overturned by a transition to remote learning for school-aged children, and partners experienced lay-offs or transitioned to remote working. In this, trainee education became an afterthought resulting in virtual lectures with body-less heads speaking into a void of black boxes.
The educational banter we previously overheard between attendings at in-person lectures nearly vanished. A shared mental model is at stake.
The COVID-19 pandemic left me feeling like a burden to an overly burdened medical system. When it had the potential to bring us closer together as suffering individuals, the pandemic only strengthened the existing medical hierarchy.
There has been a fundamental lack of appreciation that trainees also have their own families about which to worry. We fear bringing COVID home to our loved ones. We have lives outside the hospital confines that are also overturned. Like in years past, the Match has moved some of us to new cities where we know no one and have no network upon which we can rely for assistance. If we are now living in isolation and working in isolation, is the passion for our patients and the field enough to carry us through?
Years from now, when my daughter can say more than “puppy,” I imagine what will bring her joy. I hope to introduce her to art, music, literature, and science. I want her to travel and immerse herself in different cultures. As I look into her open future, I also dread the day she asks my opinion on becoming a doctor.
I have hope that the field will evolve into a more welcoming, supportive environment. This includes providing adequate parental leave with accommodating return-to-work policies and child support. It requires administrators who understand the importance of attending our own medical appointments and loved ones’ birthdays, anniversaries, weddings, and funerals without passive — or overt — aggression. It upholds the importance of putting on our own oxygen masks first before helping others. I worry it will take painful labor and years of remodeling to renovate the cracking stone upon which medical training is built.
Lauren Rissman is a pediatric palliative care fellow.
Image credit: Shutterstock.com
