#pgy4

It's funny though. I see myself as a difficult person. A hard person. Abrasive. Difficult to get to know. Difficult to keep. My standards drive everyone away. Well, except the men I'm dating who refuse to meet those standards. Those men I keep around because apparently collecting red flags is a hobby of mine...

But when shit goes down, I know I'm a good person to have. I'm loyal. I'm good in a crisis. I care about what's right. I will wage war against those who have done wrong. I never learned how to sit by when I see things occurring that I think aren't just.

So I don't get why, when someone working their second day as a psychiatry registrar was irreversibly traumatised, when I told them to go home and I'd cover them and their patient load, people said kind things about me.

Helping others in crisis should be the bare minimum. The very bare fucking minimum that we can do for each other. And yet when I called him to ask if anyone had offered to take the on-call shift he would have to do once his normal day ended, he sounded surprised. Like why would anyone?

When I said to him "it's not okay this is happening to you" he got emotional. Because management hadn't checked in. His consultant hadn't checked in. He thought, on day two, that he was already failing because something that no human should ever have to experience had left him vulnerable. And surely if this went beyond the normal experience in the role someone would check in. Right? RIGHT?!

So I got angry, in that arrogant way that I do, and told him that me working his shift this evening wasn't up for discussion and that if management had a problem with that he was to tell them to call me directly.

I burn bridges. I know that. I know better. But I do it. Because the hospital system is brutal and broken. Because it's not okay to let other humans suffer like that.

The thing though, is that when other registrars messaged me about it, presumably because he'd told them, I didn't reply. I don't want compliments on how "kind" or "sweet" I am. What I want is for all of us to do better. To be better. To demand better. Why did I have to be the one saying he was in no state to work tonight? Where was management when I was having that discussion with him? Some of the members of management are doctors. Fucking career psychiatrists. Where were they when he was being interviewed by the police or talking to patient families on day two in psychiatry and without a senior in the room?

I'm so angry. I'm angry at the system that is broken. I'm angry at the consultant who refused to support his registrar. I'm angry at the management team that refused to do anything that might equate to work. And I'm angry that any human should have to experience what that registrar did without a support network to catch them.

It never ceases to amaze me how this show is too painfully real.

The last few months have been the busiest of my entire residency career and, well, life actually. Maybe I’ve been sheltered so far in my residency but this is the first time I felt, like, this is what is meant by “residency” where you live breathe work residency and reside at the hospital. I think I thought that a few times before but the past few months really blew that out of the water. 100% of my time not sleeping has been devoted to residency. 100%. And the sleeping has been pretty limited. I’ve been on the busiest rotation of my program, and we’ve been the busiest we’ve ever been. On top of that I had to do a lot of work to facilitate graduation for our chiefs and now I am taking over as chief and taking on all of that work. On top of that, I was interviewing for jobs this spring and have finally signed an offer letter because there was a bit of back and forth to make sure they have everything I need to practice the way that I should (yay! but stressful). On top of all that, my co-resident has not been doing well. Actually, she has not been doing well this entire residency. Many people have tried to help her along the way, including me but she is her own worst enemy. And her lack of competence. And her ability to take feedback and improve. And her inability to accept fault ever. And her fucking antagonism. She is the most antagonistic person I’ve ever met. I don’t really believe in personality disorders but hooo boy does she have one. Maybe the most difficult person I have ever dealt with on a prolonged basis. So she is being held back a few months. This is good actually because I was wondering if we were going to graduate an incompetent resident. I’m relieved that our program director does not want to do that. Wish I could go into it more but don’t want to even on an anonymous account. She is going to stir some shit though. Given that I have dedicated so much to my program, which I genuinely feel is giving me great training, I have some feelings about it.

Anyways, been doing all the work plus more.

As someone who is often put in a position to offer advice and as someone who has never shied away from being very open about my own less-than-smooth journey in medicine, I want to share something that happened today with you all. Especially the young ones, who are just starting or have barely started their journey in medicine. 

Let me start by saying that I have never been ‘naturally bright’. Every ounce of ‘intelligence’ I have been praised for having was either through titanic amounts of work and tenacity, seeking tutors and friends to help me. A lot of failing and learning from the failure to rise up and improve. So I’m no stranger to the humility and shame of doing poorly, and the important lessons it teaches. 

That said, I’m still a human being so I still really hate being wrong or failing. And growing up, failure was not met with kindness. It was met with yelling. A lot of yelling. Yelling that extended beyond the grade itself into unnecessary dissection of my personal faults and decision making. For you see, my parents loved to ‘diagnose’ problems. B- on a test? Must have been because we let you get dinner with your friends. That was a mistake. Didn’t make honors? Why are you crying, you weren’t honors material anyways, you like reading comic books too much to be in the honor roll. Stuff like that. That’s the kind of, ha, encouragement, I received. 

So understand that I don’t, at baseline, have a healthy relationship with failure or asking for help. It took me years of therapy, finding good role models, taking to mentors, findings supportive friends and family members to unteach and help me learn better ways to frame the narrative of my failures into stepping stones upon which to build my success. And on the whole, I do pretty well these days. 

But today was very disappointing. Already really down from my grandma’s passing, my program director, who is amazing and meant no harm and was wholly pleasant and kind and supportive about the whole thing, asked me to come to her office. She wanted to arrange a time to meet after my grandmother’s funeral to talk about my abysmal in-training exam score and how we could come up with a study schedule together based on my weak areas from the test. It came to no surprise to me that I had tanked the test. I blew through it, not really interested or focused, because I knew that if I didn’t hurry, Lord knew how many consults would be waiting for me. And I had already gotten into the funk I always do with standardized testing: I’m gonna suck at it anyways, why try harder. I can usually lift myself but I was so stressed out, so nervous. So I knew when I got that score back, I’d hate myself for it. I just didn’t think anyone would care enough to notice or point it out. 

Initially, when my program director brought it up, I felt like my cover had been blown. Not only was my grade, albeit not a real grade that counted for anything except personal pride, not up to snuff, but also an attending I really admire had mentioned in her eval that she loved my enthusiasm and desire to learn but wanted the program to help me shore up my ‘fund of knowledge’. Shit. I had always known. My medicine program never prioritized my education. What I knew, I had to forage for myself. I think it’s fair to say that most of what I learned in residency was self-taught. So of course, I already felt like an imposter, getting into my dream fellowship, a place I never thought would take a scrappy, foulmouthed internist like myself. I actually recall myself physically wincing when I heard that, although I knew no one would strike me. 

Internally, I was a storm of guilt, shame, embarrassment, and self-hate, but also strangely relieved. I felt like a cry for help, no matter how soft, perhaps even one I had been trying to hide for a very long time, had been heard. It was also the first time in a very long time anyone in a position of authority did not ridicule or belittle me for my shortcomings, did not threaten me with the specter of punishment or disappointment, but asked to help me without any trace of pity. She genuinely just wanted to help me do better for myself.