Wellness, residency, and the witch

I still have flashbacks of sitting in the room in a zoom meeting with one of my previous supervisors, a couple of weeks after the death of my grandmother. She knew about this, but it didn’t stop her from calling me “lazy” for asking if we might be able to order bloodwork for a patient through her family physician instead of ordering it myself. Ordering it myself would take half an hour of administrative work due to a system issue far larger than myself. This would be on top of 16+ hours of work that I had to do that day. I remember freezing in that moment. Was it SO wrong to ask for some decrease in my administrative burden at a time when I am barely holding on and trying to cut out any corner of time to take care of my wellness? Yes, asking the patient to get her bloodwork through the family physician’s office would have taken her another trip to the lab to get it rather than getting it done at our hospital. However, this was not out of common procedure – as the consultant, it was rare, if ever, for us to order the bloodwork directly from our office. This is why the system was set up so that there were many administrative barriers for us to order it – because it was not common procedure. Thirty minutes of my time that I could dedicate to properly grieving for the loss of my grandmother vs. saving a patient a trip to the lab. The supervisor could have offered to order it herself – with her hospital privileges, it would have taken her half the time to order the bloodwork than me. However, she did not. Instead, she chose to call me “lazy”.

I later found out that this was in fact, resident abuse, only after I had disclosed this incident to a resident wellness advisor. I was happy to get a different and wonderful supervisor, who is now one of my mentors, after parting ways with her and believed that this was a one-off incident.

I was wrong.

I worked in an inpatient unit that I mentioned in a previous post. Generally, the inpatient team consists of a staff physician, a resident and a medical student. These 3 individuals, in addition to the nurses and other allied health professionals, dedicate their entire day to seeing about 6 patients. Surprising – I know. Frustrating? Absolutely. I accepted that this was just the way it is, that it is normal to spend 1.5 – 2 hours per patient per day doing daily extensive interviews, of which very few of the information went into treatment planning or administering evidence-based treatment. However, in the middle of my inpatient rotation, I met a wonderful supervisor who showed me that this was in fact, NOT good patient care. She taught me how to perform efficient patient interviews that focused on gathering pertinent information to inform treatment planning. Patients were informed of the nature of the inpatient admission – that they were in an acute care setting and our goal was to return them to a place where they can return to outpatient care. From day 1, we focused on disposition planning. We were clear of our role as physicians in the team, where the focus was to obtain enough diagnostic and past medical information to figure out which medication was going to be most suitable to treat the patients. Anything outside of that was delegated to allied health professionals. There were clear drawing of boundaries between us and the patients and us and the other teams within the inpatient unit.

I thrived in this environment. I enjoyed watching patients return to their baseline much more rapidly than I had seen before. There was regular patient turn over. Every time I had emergency shifts, the nurses would tell me how happy they were that there are enough inpatient beds available to send the patients instead of turning them away simply because there were no beds. On top of that, both my supervisor, myself, and my medical student were able to go home before 5PM. We were able to spend quality time with our families, take care of ourselves, and have energy left over to devote to our passions outside of the inpatient unit. I went to work full of purpose, with a clear goal in my head – return the patients to baseline, have them reintegrated into the community, clear the beds so we can treat more patients in need.

Unfortunately, this did not last. Two new supervisors came along who were very triggered by my rapid assessments, in my redirecting of patients, and focusing only on the information that would directly inform evidence-based treatment planning. After one day of working with me, one of them sat me down to tell me that I need to spend longer with the patients and in the inpatient unit in general. She felt that I was rushing the patients and rushing the allied health professionals – to her credit I am sure some of them did feel rushed by my methods. However, what she said in that meeting still hunts me to this day. “I am sure you will have good work life balance with the way you do things. BUT you are not doing good patient care – you will get complaints.” She was sending a CLEAR message that, my work life balance, MY WELLBEING was in direct conflict with being a good doctor. Mind you, this very supervisor walked out on a patient crying in her room the next day when I wasn’t present. The other supervisor who agreed with her managed to agitate a patient one day when I wasn’t there – the same patient that I was able to maintain healthy rapport and boundaries by keeping the focus on clinically relevant information only. That didn’t help though. I spent countless hours talking to my mentors, trapped in the room by myself, staying awake from sleep, running that conversation over and over again in my head asking myself: can I truly NOT be a good doctor if I value work life balance? Does taking care of my wellness, wanting to be efficient, wanting 8-10 hour work days make me a bad doctor?

During that time, I went to work everyday and wished I was dead – and I am sure this was evident in my face, in my defeated demeanor… purposelessly and meaninglessly nodding my head feeling that I was trapped here, perhaps forever, until I just wasted away and didn’t exist anymore. I felt lost. I will just touch on resident suicide here, a whole different topic that I will discuss at another time. During this time, for the first time in my residency, I truly regretted going into medicine. I truly believed that there was no way out of this – that I was not meant to be a doctor because my wellness was important to me, and not being able to tend to my wellness at a time when so many things in my life were falling apart must mean that I am just not cut out to be a doctor.

It was only after I finally had the time to tend to myself, seek the guidance of my goddesses, gods, angels, and spirits that I was able to see how flawed this was. A very wise physician who once supervised me said “The best thing we have to offer to this world is our energy. Sometimes, the only thing we can offer the world is our energy.” Pushing me to work extra hours without clinical indication (I never minded spending extra time in the hospital if it was going to affect measurable outcomes) to the point where my spirit was broken from not having the time and strength to return to myself, perhaps not shockingly, made me resent my patients. Being ridden by anxieties that arise from blurring my boundaries only resulted in a toxic accumulation of negative energies inside of me until I dissolved into that dark, dark void. During this time, my patients did not get better. We went from having regular patient turnover to having no movement in the unit at all. Nurses at ED asked me what was going on, why are there no beds available. I shrugged my shoulders and turned away, trying to hide my tears from falling out. I was not well enough to provide good care to my patients at this time. I went from happily spending Sundays going over my patient list before I start working on Monday to feeling nauseous when I saw the hospital building while going to work. I had no energy to offer to this world or my patients.

It took me weeks to recover from working with this supervisor, which happened when I was transferred to a different rotation where efficiency was a requirement, not an option. Why? Because it was shift work – everyone is capped to 7-8 hours of work in 24 hours. That gave me 8 hours to sleep, and 8 hours to work on my research, to tend to my spirituality, and to return to myself again. My energy brightened, I started looking forward to seeing patients again – and they sure felt it. This was one of those times where I truly believed that I would be lost without my spirituality, my spirit guides. To have something to hold on to in the spirit realm when my physical realm fell apart – incantations, crystals, and eventually, to my goddesses – saved me.

Many residents are not as lucky. When their life in the hospital falls apart – their entire world falls apart. They have nothing left on this world to hold on to. Our institution tells us that they will build up our resilience, so that we can “cope” when the unavoidable crap hits the fan. What they don’t understand is that there is only so much resilience one person can have, especially when we are not given the time to recover it while constantly having it chipped away bit by bit. They constantly send messages that wellness is incompatible with being a good doctor, that we must put our patients ahead of our own well being, even if it means to the detriment of ourselves.

The dark void is behind me now. Now, I once again have patients that tell me how “shocked” they are at how happy I am to see them, often telling me how they never had this experience with a doctor before. I used to be surprised to hear this – but not anymore.