Exercise. Growing up I competed in multiple sports. The physical enhancement of the human body through movement sparked my interest in human physiology and kinesiology. Consequently, my interest in physiology ultimately led me to medical school. It only felt natural, when medicine became what felt like the bane of my existence, that I’d revert back to this pursuit’s humble beginning. Given the fact that time was a scarce resource during internship, it proved difficult to consistently allocate time for exercise. Nevertheless, I built a gym in my garage and woke up 30 to 60 minutes earlier each morning to workout. I quickly realized that the type of exercise wasn’t important. Movement was crucial. Find what type of exercise sparks your interest, and do it.
Diet. Diet has a huge impact on your mental and physical well-being. It affects your weight, energy level, hormonal balance, sleep physiology, and when abused may lead to significant comorbidities like diabetes and hypertension. I experimented with the ketogenic diet during internship and saw tremendous positive effects from it. I incorporated intermittent fasting into my diet when it was convenient to do so and drastically improved my efficiency in performing tasks throughout the day. The ketogenic diet may not be for everyone. Some people can’t live without a steady carbohydrate intake, and frankly, people of certain ethnic or cultural backgrounds do better on a carbohydrate-based diet. To make diets easy for everyone, it boils down to these concepts: eliminate processed foods; eat protein with each meal; eat healthy fats; don’t overdue carbohydrates. Poor food choices have an adverse effect on our endocrine system, causing addictions, insulin resistance, weight gain, lethargy and so many other negative symptoms. Keep your diet clean and improve your mental and physical health.
Support. It is exceedingly rare to find an individual that is successful, without a single support structure to rely upon. For those who are fortunate enough to have people — parents, siblings, significant others, friends, mentors, etc. — as support structures, use them. There is no shame in confiding in those who understand you and want what’s best for you. Sometimes the response you get wasn’t expected or isn’t what you wanted to hear, but more often than not it is sound advice from an outsider’s perspective. My wife, who is also a resident, is the unwavering pillar I rely on to hold me up when all I want to do is crumble under the pressure. Without her, I would not have achieved my success thus far in life.
Efficiency and prioritization. Being an emergency medicine resident has taught me one invaluable tool: multi-tasking. More often than not, an ED physician is caught between multiple patients and families, multiple procedures, and multiple admissions. It is the most vital trait of an ED doc to tackle many tasks simultaneously without faltering or fatiguing. Often, this seems an impossible task. With time, as a muscle hypertrophies with progressive tension, this skill too develops with repeated practice. Apply this concept of multi-tasking to everyday life. Attempt to be more efficient with daily obligations. Attempt to prioritize your responsibilities on an hourly, daily, weekly, monthly, or yearly basis. Tackle the responsibilities that are most important or require the most time commitment first, when your focus and energy level are at their highest. Save the least important tasks for last. Certain obligations may be done simultaneously, while others will require your full attention. If it’s not important, don’t waste your precious time. If it’s important, get it done.
Medications. There may come a time when despite the inclusion of exercise, proper nutritional habits, endless support from loved ones, and highly organized planning of the daily tasks, you just simply can’t shake the negative feelings associated with your career choice. I reached this point. I exercised regularly. I meditated. Read countless books on stoicism, psychology, neurology, and happiness. Kept detailed exercise and diet journals. Had my wife, mother, sister and countless other relatives to vent my frustrations to. I lived a structured lifestyle, with a consistent morning ritual involving exercise, meal planning, and listening to podcasts or studying. All of these changes significantly improved my quality of life and contributed to my ongoing success at work.
However, despite all of these modifications, I still felt an overwhelming cloud of depression hovering above me. My family and my wife noticed a dip in my energy level. My coworkers commented on my depressed demeanor at work, even on days I felt I had a positive outlook. My focus shifted to the psychiatric evaluation and treatment of depression. The drug database I have grown comfortable with — anti-hypertensives, vasopressors, sedatives, paralytics — as an emergency physician quickly grew to include SSRIs, TCAs, new-generation antipsychotics and various mood stabilizers. These medications are capable of modifying brain chemistry and behavior. Such medications provide yet another avenue to aid in the pursuit of coping with the daily stresses of medical training.
However, the administration and continued use of these medications should be done with the guidance of a qualified physician.
Explore other opportunities. When all else fails, quit. I feel hypocritical writing this, as it is not in my nature to quit anything I’ve started. However, I have thoroughly investigated my options in the event that I decided residency and this career was simply not a good fit for me. There may be significant constraint placed upon you after leaving a steady source of income, availability of health insurance, and responsibilities and reverence as a physician (this may also be a source of burden). Investigate your options. For some, it’s a matter of finding the right specialty or hospital. For others, it’s a new career choice altogether. While I state it is not in my nature to quit, I am willing to accept the fact that it may also not be in my nature to be a physician.
The author is an anonymous physician.
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