Dark Times for an Intern
It’s end of March. I’m ~3 months from the end. There’s almost light. But these are dark times for an intern. Most interns this time of year have what we call “compassion burnout,” a terrible, but real, condition that happens to even those of us who would’ve considered ourselves as deeply compassionate previously. But there’s only so many times you can deliver the “C” word before you stop feeling that stabbing pain when you tell a patient they have cancer. And only so many times you can sit and sympathetically listen to a people’s illogical reasons for wanting a family member to remain “full code,” when you know it’d just be torture (for them and the medical team) if they were to require intubation or chest compressions. You start despising family members who insist their loved ones are “fighters, and would want to fight ‘til the end,” when you realize your patient wants nothing more than to be allowed to die peacefully but continues permitting aggressive medical care to appease others. You start resenting the patients that ask anything of you, as their doctor, in the afternoons because it only means you’ll have to stay later…knowing if it were your family member, you’d be asking the same of their medical team to make sure they were getting top care. You loathe the patients who become anxious at 3am or start having non-cardiac chest pain because any chance you may have had at closing your eyes was just taken from you. You become intensely irritated when asked to fill out the 50 page stack of FMLA paperwork your patient hands you, even though you once considered yourself a patient advocate.
I am sometimes ashamed that I find it therapeutic to be part of a group of interns that convenes in the wee hours of the mornings in the computer area of the doctor’s lounge. It’s there that we sit facing our computers, collecting patient vital signs, labs, test results, with our backs to each other, just venting. We spew venomous, horribly uncompassionate words, talk about how much we hate our jobs, our patients, our attendings, and then leave feeling lighter to start our dreaded days. I guess it’s healthier than carrying all that negativity around all day?! At any rate, I feel bad about it with what little energy I have at the end of the day. I don’t hate my patients, and I
pity admire my attendings who have to do this daily until retirement. But I do hate my job most days.
It’s funny. I always wondered why / how doctors could have higher rates of alcoholism, suicide, and divorce than the general population. It’s no mystery anymore. This job shaves years off a person’s life. Intern year alone probably stole 10 years from me, left my kids in a place that’ll require more healing, threw my marriage into stress it’s never seen, and turned my body into a recycling bin of redbull, diet coke, wine, and vodka. I’m gonna make it, and so are my kids and my marriage. But as my mom pointed out, there’s no glory in medicine these days. It’s a daily sacrifice in exchange for very little respect or reward.
These are not the Marcus Welby days. Rather, these are the days of shift work, litigation, and overworked for constantly threatened pay. I had a debt collector show up at my house last week, informing my nanny I have $120,000 in collections (that was the portion of my loans for which I apparently didn’t get forebearance granted). As for the personal reward? Even that’s debatable. I cross-covered on a patient during an overnight call (30hr shift) the other night who came in critically ill from injecting drugs. I got paged at 2am saying he was going to leave AMA (against medical advice). I raced to the scene (it’s the interns’ shit job to try and talk patients out of leaving AMA) and tried to figure out why he was agitated and wanting to leave. He cursed me out, told me I sucked at life and my job, and that our hospital wasn’t doing $hit for him. Mind you, this is a patient without insurance, who my hospital treats at a loss. He threatened me and talked to me in a way that was so appalling. Normally, I’d have just taken it. But that night I was exhausted and I’d had it. So I said “I’m sorry you’re unhappy with your care here. But I’m not going to BEG you to allow us to treat an infection that will otherwise kill you. I don’t think I should have to care more about your health than you do. If you’d like to leave, that’s your choice and your right, so go ahead, though I think that’s a poor choice.” I walked out and was paged about 10 minutes later by an attending telling me to get my ass back in there, apologize to the patient, and convince him to stay. That’s the reality of medicine as a profession. It really is a crappy job a lot of the time and the patients who deserve our attention and time don’t get it because it’s taken up by the ones who don’t want to help themselves or just want to whine about stuff. Damn, that sounded unintentionally republican! For the record, I have not converted to the dark side! I’m just jaded and disgruntled.
Please know that I’m not depressed. No one should be concerned about me, I’m just using this space to vent! I’m actually doing very well and my resident and co-intern are always telling me they can’t stand how upbeat, enthusiastic, and energetic I always seem, even post-call. You’d probably only know how much I dislike going to work if you’re aware of how much I love being at home (or if you know me, read my blog, etc;). And despite the dread that surrounds my work life, I do take good care of my patients and I’m
anal thorough in a way that compels me to check in on them from home. Part of why I don’t like internal medicine is because it’s stressful and hard for me to let things go, even when I’m not technically “at work.” I’m a worrier. I really do love my life, just not my job on a daily basis. So don’t worry about me after reading this (Yiayia!).