Is residency an exercise in futility?


It was Saturday. My first day off in the last 14, which included three 26-hour calls. My wife was left home alone for these stretches to care for our 2-week-old son. I’m sitting on the couch, reading a book to my little man, enjoying a much-needed breather, and making up for lost time in seeing him grow into a person.

And the phone rings. Concurrent emergent cardiac surgeries: the only way that I could be imprisoned by those four walls once more. I call my wife, who had just left the house to go the gym for the first time in 4 months, and with my tail between my legs, tell her she needs to come home. I begrudgingly hop on my bike, and my wheel tacos on the ride in.

By the time I arrive, spirits are certainly low. I’ll be captive for an indefinite amount of time, possibly overnight, far away from my family, and ever-so-distant from much-needed rest.

At this point, a choice presents itself. What countenance do I wear? What foot do I put forward on arrival? Do I wear the “screw-this” face? The “how could you have the audacity to get sick and need surgery when I don’t want to be here” face? Do I complain about my plight to co-workers? Or do I put all that behind me, and give my lung transplant recipient top-notch care with a smile?

Every day we are faced with choices like this. As a resident, it can often seem like a greater power is purposefully stacking the cards against you. We face incessant duty hours, sleep deprivation, a postponement of “real life,” tremendous stress, and all of this at a babysitter’s hourly rate.

The thing to remember is that when it comes to how tired and overworked you are, nobody at the hospital cares. There are two reasons for this: a) this is the life you chose; and, b) those who you would lament to are working just as hard or even harder than you. Throw in the collective belief that “you are a doctor and you’re going to be rich,” and sympathy will be hard to come by.

Is it all doom and gloom? Is residency an exercise in futility?

Absolutely not. The blessings that come from this line of work are immutable. Who is learning more on a day-to-day basis than you? Whose career is getting more enriched through the pursuit of academic knowledge and procedural skill than a resident’s? As residents, we are in a unique position. We know enough in order to safely practice medicine, but our relative paucity of skills and knowledge necessitates further training. It’s a wonderful paradigm that has us always (safely) pushing the limits of our knowledge and skills. Combine this with the fact that our duty is to improve someone’s health and quality of life, the very foundation of their being, and you realize why this cannot be a 9 to 5 Monday-to-Friday gig.

How can we sublimate the fact that telling co-workers how hard you work is an exercise in futility? Let’s revisit that choice we mentioned earlier. In your 20th hour, are you going to let your guard down, put less effort into your notes, and let your patient’s blood pressure ride a little low because you don’t feel like changing their orders? Are you going to blindly throw narcotics and anti-nausea medications at your post-operative patient because the call room bed is cozier than a trip across the building? Are you going to do a substandard job, and a total disservice to the patient who is depending on you to get them through a much more difficult time than you are having?

Absolutely not. You dig down, you find the strength, and you take the high road to rise above the voice in your head that tells you that 80 percent is OK. You don’t complain to those around you — it will get you nowhere. You do the best job you can in spite of everything. That is your daily duty, and it’s what you’ve promised to do.

Let me say that we don’t have to border on militancy in the hospital. Sure, you have incredible demands that must be met, and in some respects, failure is not an option. You have to buck up and do what it takes to deliver excellent patient care, even when running on fumes.

All that being said, you must ask for help of any kind when you need it. Whether it is someone to lean on for your own mental health, an extra set of hands or minds for clinical assistance, or a personal day to recover from fatigue that stands in your way of caring for patients, never be afraid to ask for help. To say that “nobody cares” is an overstatement. While colleagues at the hospital don’t want to hear about poor you and how difficult your life must be, there are other loved ones outside of work that care very much about your well-being and personal feelings.

Save your emotional toil for them.

Brian Radvansky is an anesthesiology and critical care resident, works with Med School Tutors, and blogs at the Med School Tutors’ blog.

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