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!).
Subscribe to Posts
17 comments
Oh wow. I am totally with you. I know we talk about this all the time, but it’s really amazing how similar the lives of residents are, no matter which hosptial/part of the country you are in. You could have been describing my night. The calloused feeling is really unsettling, and can take your breath away sometimes when you realize what it is that you have just said or thought about a patient or a family. And to think I went into medicine because I love the complexity of being an Internist, talking to families, troubleshooting complicated medical problems, and figuring out diagnostic dilemmas that come through the ER. Now, my blood pressure goes through the roof when I see the phone # of the ER on my pager, I immediately become antagonistic and argumentative when the ER resident is trying to tell me why Mr. or Mrs. X needs to be admitted, and I get angry at the families of Hospice patients who bring them in, repeatedly, when they are supposed to be DNR. I also find myself looking at the clock in most Code Blue situations, waiting on all the rounds of ACLS drugs to be given, so that I can call the code and let this poor person just freakin’ die like nature intended.
I mean, there are still times when you get that rush of an elusive diagnosis, like when I thought to order a volatile acid screen on a patient with chronic nausea and vomiting and a mild acidosis, and it turned out that she had subclinical methanol poisoning. But then there are the other times, like when we admit a woman in renal failure because her idea of a suicide attempt is to deprive herself of water, and with a baseline renal insufficiency, she pushes herself into acute renal failure _ and this was the 3rd TIME this year she had done this. Just let her kill off her dang kidneys, what do I care?! Or when a crazy guy with syphilis and schizophrenia gets brought in by the police because he threatened to throw himself in front of a truck if someone didn’ t give him his narcotic pain meds. After initally laughing at the ridiculousness of it, I looked at his medical record and see “history of multi-trauma after throwing self in front of truck in suicide attempt.” And I feel no sense of empathy, only anger at how this jacka** is going to keep me up all night as I try to sedate him with haldol and ativan because he’s flying off the handle b/c I won’t give him narcotics for his non-existent pain. Or when I lit into the ortho resident who calls for a medicine consult at 2am on a hip fracture patient whose only past medical history was hypothyroidism. Last time I checked, they have an M.D. after their name, too, I mean - UM continue the synthroid and go fix her f***ign hip?!!? Seriously. At 2am. There went my 2 hrs of naptime. Or when I am on phone call for the clinic at night and someone calls at 3am saying how they are nauseaus and can’t sleep. I am all like, well you are MAKING me nauseaus and I can’t sleep either because you are calling me at 3AM!!!! Or when I am looking at the abdomen/pelvis CT of a woman with chronic abdominal pain, and realize it’s the 14th CT she’s had in the past 8 months for the SAME COMPLAINT. It’ s like you can’t even imagine the time when we DIDN’T practice defensive medicine.
And don’t even get me started on how I am missing my kids’ childhood for all this bullsh*t, and how I have never felt more distant from my husband of 9 years, or how filthy the house is, or the fact that my dogs haven’t been walked in the last 2 1/2 years. UGH. I feel ya - only 3 more months, and I am counting the days. Thanks for the opportunity to rant. I love my life, I really do……just keep telling yourself that…….
I walked into the back door at home today post-call, and see my little girl walking. I had missed her first steps while I was gone.
Well it’s definitely not an episode of Greys Anatomy eh? Still I admire you for even taking this on, and am constantly amazed by how despite everything you don’t give up, no matter what. That’s saying something!
I know it’s tough to do, but if you can find a positive pocket of people, latch on to them. As a teacher, it is easy to fall into some of the same stuff you’re talking about-dreading parent calls, annoyed when kids show up for something as you’re packing your bag, p’d when for six months no one has contacted you and now they’re contacting you for the first time with cc’s to every administrator on the planet blasting you for their kid’s grade-of course, the kid who does no work at all and talks all through class but now whines that it’s the teacher’s fault-she doesn’t like me. Then there are the administrators who come through a revolving door but have to make a mark while they’re there-that means change for the sake of change. You get the picture. Anyway, after a while you learn who to avoid and what places to stay away from, and what things drain your time unnecessarily. The best way to deal with all of it is to accept that this is not temporary. This is your life, this is your career, and you plan to do it for the rest of your life. That means that what you do today is what you do forever. If you are in bitch fests today, you will probably join in on bitch fests for the rest of your career. Everyone needs to let that pressure valve go, so there’s nothing wrong with that. Caring jobs drain you physically, mentally, and emotionally, and the last is the hardest to cope with. Just don’t let angry, negative people make it worse for you than it needs to be. Sorry, do I sound like a Mom here, or what? Keep up the good fight!
PS-I know that this stage is temporary. The first few years in my profession are 90-100 hour weeks. It passes. I just meant that you start habits in your profession early so if you can find a positive place to let that release valve blow, stick with it.
It’s not only medicine, although I imagine that most people would actually feel more compassion about the number of hours doctors work.
I’m a social worker/case manager for a non-profit. I work in foster care with children with severe mental health/behavioral problems due to severe abuse and/or neglect. I work way more than 40 hours a week, I get paid crap, and I get to hang out in homes that would make some of the houses on hoarders look nice. And too often I make a recommendation or testify in court about a child’s future, and the Judge ignores what I and others have to say and a child is returned home to a abusive or neglectful household.
My husband is a teacher, and typically works at least 12 hours a day. He and others in his profession are presently the enemy in the eyes of the public despite the fact that he works his ass off and really cares about the kids he works with. And two weeks ago, because of budget cuts, he found out he’s losing his job for next year, a loss compounded by the 2 year old and 10 week old depending on us.
And yet, every so often something does make sense. Sometimes I get to watch kids be adopted by their foster families or to see their parents really work hard to get their lives straightened out. And sometimes my husband runs into a parent who tells him that their kid wishes they could bring him from grade to grade.
There ARE things that make these kinds of jobs worth it. You’ll find it in medicine too.
(sorry so long, I rarely comment).
I don’t have much to contribute, as I am not in the medical field and right now at home on bedrest because of early contractions. But I still just want to say: You are doing so great, and the hospital and patients are lucky to have you! It is amazing how you juggle work and your family and find time to blog. You are really amazing. A minute ago I was whining to my husband that I have to be lying around all day for another five weeks, but reading your blog made me feel sorry about that. No more whining here, I will just remind myself what you have to do! Thank you for those posts, its the mixture from those happy things about the kids and the serious things that makes your blog so interesting to read and my favorite one.
Laurie
You have such strength and courage. I work in mental health and am have chosen to work part-time. I always say that I would not be able to do it full time for all the reasons you have pointed out. This is the balance that works for me. I admire how hard you are working.
Hang in there. You’re in the home stretch. I know it sucks most days, but I know you can do it. I don’t think you sound depressed. You sound tired, and like you need to unload some of the crap that’s handed to you daily. Hey, that’s what we’re here for! tee-hee:)
It’s hard to imagine you losing your compassion. Maybe if you did this field for the rest of your life . . . . I hope time passes as quickly as possible so you can start the next chapter-DERM! I was at my doc’s the other day and in the elevator we were commenting on how derm was on the very top floor. I was all-of course it is! Derm gets the cushy penthouse suite! I always think of that GA episode where they hung out, drinking the water on the couch watching the beautiful derm residents . . .;)
I love the disclaimer at the end. Many times after a rant on my blog I get the calls, comments, and emails checking in and I really AM ok, just needed to get it out. All that being said, my heart goes out to you! I never once have doubted that you, your marriage, and your family would survive this, or that you are an amazing doctor, or that you hate your job. But the reality is it is still hard. And it sucks! I can’t do much for you, but know you have my thoughts, prayers, and love. (and if you lived closer to me, you’d have my business too….) I am very excited to see how all of this plays out in your life - I know at some point you will look back and admit again how much it sucked, but also that it has made your life that much better (even if its just a “i don’t want to ever do anything like that again” lesson). Keep pushing and if you ever need anything, please let me know.
Oh - and so you know…. i have a totally different perspective on doctors now, in a good way. Thank you Laurie!
It’s good to let it out. I cried all through my internship–even as an RD we see patients dying, children abused, things we cannot help or control, and BIG TIME idiots that we’d like to smack
You do it all because you are a caring person–even when you are exhausted and don’t feel like you have anything left to give. Just remember that what you do is important and worth it in the end. hugs!
I haven’t been to your blog in a while since I figured you’d be really busy. How in the world do you find time to be a resident (as awful as it gets sometimes), be a mommy, be a wife AND keep up your blog? I really enjoyed seeing all the pics. Grif is so darling! I’m glad Fin is feeling better. I’m sorry to hear how down you’re feeling. This too shall pass. I think you’re amazing and I know I’m but one of many! Hang in there!
Laurie,
I think you did the right thing by tell the druggie the truth. Don’t be discouraged. Good luck with the next 3 months and keep posting about your kids. Really great set of kids you have.
Kim
I-I’m so glad that you have your blog to vent! There’s no way that a person can hold onto all of that and not just lose it! You are doing an amazing job!! Your’e almost there! Yahoo!! I am an ICU nurse and I make damn sure that if I have to call ‘you’ at 2am, it better be a really, really good reason (like my acute renal failure pt. the other night with a critical Cr+ of 18!!!!), but otherwise, we do our best to handle it and we really do respect our interns and do not envy them for one second. Heck, 7 of our 9 patients on Tues. nite were not icu worthy and at times it is hard to keep your patience, but there is usually something every day that makes me glad I came to work!! Good luck and be well!!
You are going to look back on this time in your life and wonder how you did it.
Pho for Six?
my adorable laur.i am so very proud of u and all the shit u have to put up with,but when i hear ur wonderful laugh when u play with griffie ans the kids.i know all will be well and i keep counting the months left on my fingers and it is not too bad,kisses,gia
Having read your ranting, I would like to tell you of my own limited experience with similar patient problems at the nursing home. The freebies are at least 10 times more demanding & greater problems than the paying residents. Keep smiling & let me know when your Republican conversion is complete. Love, Grandpa
Leave a Comment