Monday, October 26, 2015

Overnight Shift Introspection

Welcome to month 4!
At the end of my first month of residency, I wrote this entry about the daily thoughts of a new intern. #5 of the points I made in that post talked about how medicine is invading my subconscious, and how I kept dreaming about the hospital every night. I hoped that would be a temporary thing. In month #2, I went to the proving ground that is the intensive care unit, where I continued to have nightmares for the first week...but by week 2 or so, they had stopped. I thought I was free, that I had passed that stage. But then I went back to the regular floor medicine for month 3 and the nightmares started up again. I shouldn't say nightmares...not all of them were scary. But I hear nurses' voices and bed alarms in my sleep, and sometimes I dream about patients having certain conditions or illnesses and then when I wake up in the morning, I find myself trying to form a treatment plan in the shower to address a problem that doesn't actually exist. 

I know I'm not alone in this. I've talked to multiple other interns that are in similar situations. One has suffered weekly (if not nightly) insomnia from the pressures of medicine compounding her own (self-admitted) neurotic personality. Another intern finds himself facing a bitter slow-burning rage every time he feels unprepared for something or something goes wrong with a patient (even if it's not his fault). And I myself had to learn how to become less tightly wound - from overreacting to every little thing (and swearing like a sailor while I did it) to responding more often with, "Okay, here's what we can do." I'm still learning that - balancing knee-jerk reactions with careful thought and consideration of the patient's overall condition.

Every year there are new articles around this time about intern depression. Suicide rates are high among new physicians, frustrations with work schedules and work-hour restrictions are consistently present, and burnout seems to come frequently no matter what countermeasures are taken. It's only month 4, so we aren't quite there yet, but it's something we've been seriously warned about. Especially the fact that doctors make the worst patients, and we're terrible about speaking up about or going to see someone for our mental health symptoms. And recently I noticed that some of my fellow residents were having a gripe session (just venting because we needed to) and I noticed some of the medical students looking on, and I could read their expressions. "This sounds terrible. Are we going into the right field?" And I told them this:

Sure, there are times when we get frustrated or look longingly at people with normal jobs. There are days when I would love to wake up and suddenly realize I would rather work a 9-5 job, in some office doing equally important but less demanding work, where I get to clock out and go to a happy hour and have weekends off. But I can't do that.
I freaking love this job. I may not always want to get out of bed, but by the time I get to work, I'm excited to see what my patients are doing and if they are okay, and if not, what I can do for them...even as it frustrates me when they don't get better. I am fascinated, as my fellow interns and residents all are, by the disease processes we see in our patients, and how complicated it sometimes is to find the right treatment regimen. And I know that part is not just a phase, because I see third-years who are getting ready to graduate and have seen quite a bit during their residencies, but when I tell them about an interesting case I saw, their ears perk up and they're just as excited and interested as I am.

I mean, don't get me wrong. We all treasure our days off. We love the days when we get to go out and enjoy the sunlight (or see the sun at all), and go drinking with our friends or apple-picking with our spouses/significant others. I spent a recent Saturday doing utterly mundane things with Fiancee Reptar and it was awesome. And we love the nights where we DON'T dream about the hospital (seriously, one night I had a dream where I saw the face of one of the nurses, and then it melted into the face of one of the patients, and then it did the Raiders of the Lost Ark and turned into the skeleton ghost face thing...that was a wake-up-in-a-cold-sweat night).

Medicine is currently in a time of incredible discovery, even as it faces an unprecedented level of skepticism. We are now being made much more aware of the costliness of our myriad tests and medicines, and forced to really think about if or why we need any particular blood work or imaging. The days of unequivocal respect and obedience to doctors are long over, but now we work hard to form bonds and team up with our patients for their health. And while some patients are better team players than others, it's this way of thinking that helps us to find a balance between patient care and physician-heal-thyself care. I've written before (as have many other more experienced and more entertaining physician writers) about how the acknowledgement over the past decade or two that doctors make mistakes has led to two things: 1) Patient skepticism, and the appropriate but sometimes frustrating questioning of medical decisions, and 2) The urge on all levels of healthcare for doctors to look at ourselves and acknowledge our own health. To do things like take at least one day off a week to catch up on life (laundry day!) amid all the studying; or go play sports, or go out with friends, or write a blog post trying to sort out your subconscious in the hopes that you finally stop having hospital dreams.

So why do we love this field, even as it takes away our peace of mind, our sleep, our eating time, our time in relationships...why? I don't have a good answer. All I know is...I wouldn't have it any other way.

But seriously, no more patients turning into skull ghosts. That was freaky.