Wednesday, January 14, 2015

The Price of Residency

I started this post because in mid-December I was on cross-cover nights on the wards over the weekend.

I was invited to 3 Christmas parties on the same night, and I could not go to any of them because I was working on a Saturday night, because that's the job.

I feel like I should put a disclaimer at the beginning of this post; I should be clear that I'm grateful for my job and having had the opportunity to become a doctor - I think I keep it pretty positive over here. A lot of people have this dream and don't have the privilege of seeing it through, so I don't want this post to seem ungrateful. I'm also absolutely certain that it used to be much worse for residents, as we're now restricted to an average 80 hour workweek.

That said, I think it's important to give both sides of this life.

So the following are just some real life times when I had to remind myself that I wanted to do this.

My first year my parents came to visit in early December because I couldn't travel for the holidays. I didn't see any of my family at Christmas.

On Christmas morning last year I got home at 7:30 AM from my shift, said hello to my husband, and fell asleep until it was time to get up and go back to work.

My sister graduates from college this spring and I'm working straight through - I'm trying to figure it out but it's just about impossible for me to go.

Two of my best friends from college each had weddings this summer that I couldn't go to, because I was working right through the weekend. There are already more I will miss this spring.

There are no sick days in residency. When I have a cold I always go to work. You just wear a mask over the cough. If I did get sick enough that I actually couldn't work, I'd usually have to work an extra weekend or something to cover for the person that fills in for me.

On any given inpatient rotation I spend half the time on days and half the time on nights. I'm never rested, but I am often confused.

There is an expectation, a professional expectation, beyond just showing up for work, that we will do research, apply for grants, participate in quality improvement. It's a different type, but essentially there's still homework even in the practice of medicine. It is also vitally important that we do, in fact, learn the medicine we're there the practice, and reading outside of work is an expected and important reality of the job. The hours don't end when we go home.

I grieve the loss of my hobbies. Our typical schedule is 1 day off per week. We do have electives sometimes, but for most of the rotations with 11-13 hour days, not including our sign out and commute, it is hard to keep up with things I used to love. That one day off usually includes laundry and buying some vegetables.

Some weeks I get to spend most evenings with my husband. Some weeks I see him for 20 minutes a day.

Before residency, I used to exercise. Most days usually. Now I mostly do not. Some residents do, and I admire them. I think I was happier when I did.

Sometimes I find myself choosing between sleeping and eating at the end of the day. Last night, for example, I fell asleep at 630 and woke up starving at 3 AM.

This hasn't happened to me, because I have a cheerful work face, but there is also an expectation of a positive attitude. It's not that there's no support, or we can't have bad days, but if we're really hating a rotation, it may show up in the evaluation if we don't keep that to ourselves.

Several of my colleagues are always well put-together. I, on the other hand, typically go for a "well, my clothes don't have stains on them" aesthetic. Today I painted my nails for the first time in a month. My last haircut was over a year ago. I do brush my teeth, so at least there's that.

I have $245,000 dollars in debt. The majority of it to the government, some of it to family. That's just medical school; I was blessed enough not to have undergraduate debt thanks to my parents. I make enough to live on, but it will take me 20+ years to pay back the cost of this education. And interest accrues all the time.

We see a lot of senseless loss and sadness. Horrible accidents, child abuse, neglect, chronic diseases that leave kids spending months or years in the hospital, cancer, premature babies, parents that care a lot but are dying of terminal illnesses and also parents that can't overcome their own addictions in order to care for their kids. While I think this is one of the most rewarding specialties in the big picture, it's true that it's hard.

I have a lot of nightmares, especially when I've been taking care of really sick kids.

So what's the point of airing all of this?

This is what I always say to people who ask me about getting into medicine now: It's worth it if it's the only thing you could imagine doing. On the other hand, if there's another career that would make you equally happy you should do that instead, because this is life with a cost.

Thanks for reading, see you soon.

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