I don't know about you all, but 6 months into intern year I found myself a little pooped. It's not the “4 a.m. on my first nightshift back—hospital coffee isn't cutting it—I need whatever the guy in bed 7 is on” variety of exhaustion that was getting to me. That unique cocktail of terror, adrenaline, and excitement that carried me through the first few months was long spent, and the thrill of finally being a “real doctor” was replaced by the burden of expectations it carries with it. It's a dull fatigue. I began to think back to July 1.
At the beginning of residency, our program director gave us a wonderful and inspiring talk. He told us how centering his practice of medicine around love for the patient has enabled him to escape the burnout that seems to claw at most EM physicians in some aspect. It may sound cheesy, but if you met him you would realize he really lives it and believes it. It was inspiring. That is how I wanted to practice medicine. Engaged, and actively living out loud the values that made me want to be a doctor.
During the first 6 months, something changed. I don't know if it was the DOMA that broke the camel's back or what, but something definitely went wrong. I believe there is a poison combination of apathy and cynicism that lingers in all EDs like an evil humor, and I fell victim to it. I became jaded. I found myself easily frustrated with patients. I felt the candle burning at both ends, yet life still seemed very dim. As if self-loathing wasn't enough, compassion was hard to come by, with constant reminders from attendings that “Back at County we worked 24-hour shifts every 24 hours, in the snow and up-hill” while the medicine residents scoffed at “45-hour” work weeks. There seemed no way out.
To add to my anxiety, I felt my skills and knowledge falling behind those of my co-interns. I didn't have the energy to care I was falling behind on reading; I started every shift hoping the hours would pass quickly so I could go back home.
Realizing I needed some help, I turned to a co-intern I highly respect – the one who is genuinely all smiles and no complaints, has a knowledge base big enough you think his last name was “Tintinalli-Rosen-Weingart” and who is so damn nice you can't even hate him for it. We went to a local watering hole. It was a good vent, spewing all the pent-up anxiety and self-loathing onto a pub floor. His response was unexpected.
“Dude, I feel the exact same way.”
It's kind of refreshing that no matter how unique we all fancy ourselves to be, we are probably sharing the same hidden doubts, insecurities, and fears as everyone else. Go ahead and ask a co-intern if you are in the same boat. We are all in a unique time of temporary imbalance. It's really hard, and sometimes we only have each other. Sooner or later, we are all going to fall off the wagon. Take that deep breath, talk it out with a friend, and get back to where you want to be.