It’s time to stop treating suffering like a necessary rite of passage

Once, when I was a senior resident covering a busy trauma service at a county hospital, I was on call for nine days in a row while my co-chief had an uncovered vacation. It was July, and we were all — interns, junior residents, and me — new and uncertain in our roles. I left the hospital only twice in those nine days.

When I finally signed over my pager for a day off, I described to another chief resident the nine-day marathon I had just completed. His response?

“When I was the chief on that rotation, I was on call for 12 days straight.”

I’m sure it’s true. Like our more senior attendings who frequently remind us how easy we have it (and how soft we’ve become), as bad as my experience may be, someone else has worked harder, longer, and in a more stressful environment. In fact, this conversational pattern is so common amongst residents (and practicing physicians) that it can be distilled down to its essential elements:

Resident 1: I’m suffering.

Resident 2: I’ve suffered more.

This is not the camaraderie of shared experiences, but a game of one-upping: showing our worth through our ability to endure. I was on call for longer; I had worse consults; I had more demanding patients; etc., etc., etc. I was caught off guard in this instance not only because my co-resident’s response was so unsympathetic, but also because I didn’t know how to respond without falling into the same conventional pattern. My immediate responses all fell in line with the “I’ve suffered more” paradigm. I wanted to tell him why my call was worse than his; why my patients needed more; my traumas were more traumatic; my pain was worth more than his pain. All of this to prove that I was tougher, that I was somehow better because I had suffered more.

This pattern does not help us. Its only purpose is to legitimize and perpetuate suffering. The science fiction classic Dune describes the emergence of an elite warrior race from a brutal prison, where recruits are tortured before being promoted: “The recruits come to believe in time that such a place is justified because it produced them: the elite.” It is the reason that fraternities continue to haze pledges, and it is one reason that abuse so often becomes a cycle of violence. Either we face the fact that we endured unnecessary pain and suffering, or we create a narrative where the pain was essential. We claim to have acquired worth through suffering, making us justified in causing pain to others. And so we transition from victims to persecutors.

But there is an alternative. Consider a new version of an old conversational pattern:

Physician 1: I’m suffering.

Physician 2: I’m sorry. What can I do to help?

Alternatively, if you find yourself playing Physician 1 in this scenario with an unsympathetic Physician 2, consider this:

Physician 1: I’m suffering.

Physician 2: I’ve suffered more.

Physician 1: That’s terrible. How can we make it so this doesn’t happen anymore?

Surgical residency — any residency — will always be difficult. There will always be sleepless nights at patients’ bedsides. There will always be the responsibility of staking another person’s life on your knowledge and ability. There will always be the weight of complications, deaths, and true suffering- not the kind brought about by long hours, but the kind brought about by the metaphysical unfairness of trauma and disease. It is not necessary for our educational system to increase or magnify the difficulties. We can and should seek systems that make our lives easier, not harder. We can and should look for ways to support one another, as well as our patients.

The challenge is to distinguish the necessary hardships of our calling from the self-inflicted (or system-inflicted).  Rather than demanding that we now get to “do unto you as they did unto me,” let’s promise to improve the system. When someone is suffering, let’s promise to honestly ask: How can I make it better? Even if — especially if — no one ever asked you that question.

It’s a question we owe to our patients, and it’s a question we owe to ourselves.

Laura Mazer is a surgeon.

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