Saturday, September 22, 2018

Intern Year: That Time I Cried in a Stairwell

Over the past four years of medical school, I’ve learned to strongly believe in the power of vulnerability. It’s a concept that I’ve embraced – though not without difficulty – and I try my best to not only incorporate it into my personal life but also my professional life.

(Though something I’ve discovered is that those two lives bleed into each more often than most of us have the courage to admit). 

With that being said, and rather ironically, I’ve always had a terribly hard time crying in front of others in the context of one of my weaknesses or insecurities being put in the spotlight, especially when done in a sudden and unceremonious fashion. Crying as a result of anger and frustration never - for whatever reason - leaves me feeling as bothered.

Perhaps it’s because I subconsciously feel that crying from the latter emotions is a sign of passion or strong opinion whereas crying from the former is a sign of personal failing. 

So when I found myself in tears in a hallway on the Friday morning on my first week of residency, literally unable to hold them back after barely succeeding in doing so for the prior hour, the first thing I felt was shame and embarrassment. 

I have a bad habit of bottling my negative emotions and stress. Usually, I can keep the bottle plugged and hidden until I’m able to sneak away and empty it out when no one is watching. There’s only a small handful of people that I would every willingly engage in a conversation where I know it will make me cry.

But sometimes the bottle gets filled too much, with so much pressure that just builds and builds and builds until it shatters. 

The first week of residency, being on call twice in one week, and having a relatively high amount of complicated patients (for my level, at least) was the perfect recipe for it to happen. I was disorganized and flustered on rounds on Friday in a way that I have never been before (literally), and the results of that were not pretty. 

My chief resident caught me as I was trying to hold a conversation with him a bit later, the dam holding everything at bay starting to crack more and more with each passing sentence. 

“Are you crying?” he asked me. 


“Yeah,” I answered. 

He stood up. “All right, come on,” he replied, guiding me in my dazed trance into a nearby stairwell. 

“It’s okay that you’re crying…it’s normal,” he stated calmly, “But one of the rules of residency is that if you’re going to cry…always have your moment in a stairwell.” 

I laughed at that, immediately grateful for the genuinely empathetic way in which he handled the situation.

Noted, I thought.

“I just have too much botox around my eyes to cry anymore,” he also added. 

Pro life tips of an awesome senior resident. 

I felt better the next morning, but the main thing that lingered after was the embarrassment I felt in losing my composure in front of a person I barely knew. I felt exposed, transparent in a way that made me squirm. I still wince thinking about it. And that in and of itself made everything even worse.

Why is that?

Probably pride. Maybe a little bit of ego. Two concepts that have been stripped down, torn apart, and reset already in the few months that I’ve been a general surgery resident. 

I consider it to be a good thing. 

I’ve always thought that pride and ego is a double-edged sword for a surgeon – we need to have a certain amount to be able to do what we do (can I even include myself in ‘we’ at this point?), but on the other hand it can quickly become our biggest downfall. It’s a balancing act. For me, vulnerability has always been a way to maintain that balance. And perhaps embracing my weaknesses in a new way was one of the first necessary growing pains in figuring out residency.

“Be gentle with yourself” are words I often say to other people.

Perhaps I need to start listening to my own advice more.

That first rotation already seems a long time ago – even though it was really only two months ago. 

I started on a GI surgical oncology service where there was no shortage of patients with complicated medical, surgical, and personal histories. It was humbling to start my journey of being a doctor on a service where patients are often grappling with some of life’s hardest questions and curveballs regarding terminal illnesses, dire situations, and end-of-life care. And many of them did so with a light and hope and warmth that was incredibly authentic inspiring.

That rotation was followed by a month of nights – a crash course in surprises and everything under the sun. It felt like the wild west of surgical care. Overnight, another intern, a third year, and myself covered five services, about 60-70 patients, and new acute care consults (gallbladders galore!). It was, oddly enough, a very enjoyable month. Amidst the chaos that can occur at night, there was a certain peace to walking the empty halls of the hospital at night. 

Getting adjusted to the rigor and intensity of residency has also been an adjustment in and of itself, filled with moments where I was tired, up for more than 28 hours, and my brain function felt nonexistent in situations where it was desperately needed. 

Thankfully my capacity to think while being exhausted has continued to improve. And now when it feels like I’m learning about 50 new things in the span of five minutes, approximately 27 of them stick in my brain as opposed to the measly 10 at the beginning of July. 

Progress, people.

During night float, I started to see how easy it could be to become callous and robotic – how empathy and patience can be some of the first emotions to be put toward the wayside. In moments where I’m trying to do an admission, am getting new consults, still have 5 postop checks to do (yay Vascular!), have a patient unexpectedly start to decompensate, and am getting hammer paged seven times within five minutes, it would be so so easy to just snap at somebody. Especially since I’m still trying to figure out how to respond to, do, and handle all of those things (yet another growing pain) without asking someone or without being slow.

At least I know where the food, coffee, and bathrooms are. 

During the past few months, I’ve learned how to make empathy more of an active process rather than to just let it be a subconscious, passive driver like I have in the past.  The simple, cliché statement of “putting yourself in other people’s shoes” really does hold true. 

If I’m being paged, it’s because someone is concerned, they’re trying to help their patient, or they’re trying to make their own lives easier (all things that I can empathize with, even the last one). If someone is snapping at me or being hard on me, perhaps they’re having a bad day, someone had just got done yelling at them, or that’s how they were, unfortunately, trained. Or perhaps that’s what they strongly feel will make me learn the best.

It’s all an interwoven, never-ending cycle. And I’d like to think that most people are trying to do their best in a complicated, difficult system that never sleeps and rarely lets up. 

I’ve also learned that stopping – both physically and mentally - in the midst of the chaos and just taking a deep breath can help immensely. I can’t control the things going on around me about 90% of the time but I sure as hell can control my own actions and thoughts. 

Be present.

My patients help with that. When I walk into a room, I do my best to ignore the list of things that still need to be done so that I can just simply focus and be in that moment. 

Most of the time I succeed in that endeavor. Other times I unfortunately don’t. I have a feeling that will continue to be a perpetual struggle for the rest of my time as a healthcare provider.

The residents, midlevel providers, and nurses that I work with also tremendously help. They’re a wonderful group of people and I feel very blessed to be in the residency that I am in. It’s a comforting feeling to know that you feel safe to ask questions, be vulnerable, and learn in front of a group of people. And to have fun, enjoyable times along the way as you do so. 

As I near the end of my third rotation (Colorectal Surgery!), I look back and am in awe at how quickly the past few months have flown by and how much I’ve grown in just the few short months I’ve been an intern. I can only imagine what the next three months will hold and where I will be then. 

I haven’t had any other moments of crying in a stairwell since that day (okay okay okay, I did cry one more time post overnight call in my car a couple of weeks after), but there most certainly may be more.  

And that’s okay.

But for now…one day  - and experience - at a time.  

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