Throughout my life until more recently, I used to evaluate success based on external measures, such as how much money I make, the impact factor of journals I published in, how many articles I produced in a year, etc etc. As I started achieving some of those “successes”, I started realizing quite rapidly that not all of them brought me happiness and feelings of accomplishment that I imagined they would. Even if they would bring a brief spark of joy, it would rarely last longer than a day or two. It did not contribute positively to my self-esteem either. Eventually, these “successes” just became forgettable aspects of my life that added little to my day to day joy, if at all.
The realization of WHY this was came when I was doing a guided meditation on manifesting. During this meditation exercise, the guide asks you to clearly envision what success looks like to you, and pushes you to imagine every small detail of your successful dream life. In this guided meditation, when I was only with myself, with no one to prove anything to, I realized that my vision of success was nothing like what I had defined success to be. Success was having a thriving garden, it was holding hands with my husband and watching the sunset, it was having the time to feel the breeze on my skin on a beach, it was having the luxury of booking travels with my husband, it was being in a home that gave me peace and serenity. These things of course, require some money to achieve, but by no means was money the only part of it. Fame and prestige? Well, it didn’t include those at all.
Law of attraction states that we attract things in our lives that we are in alignment with. Therefore, to manifest, we need to align ourselves with the values and outcomes we wish to attract. With my definition of success having been shifted (or perhaps realized) from what society defines as success to what I believe constitutes a successful life, now I can fine tune myself to attract what I need to achieve this dream.
So tell me again – what is your definition of success?
Culture of incompetence is a phrase that us, as resident doctors, came up to describe certain hospitals that have a culture that encourages a passive form of incompetence by discouraging productive change.
This does not mean that they encourage residents to make mistakes or to be incompetent in a general sense. Rather, it means that we are encouraged, either directly or indirectly, to abide by unspoken rules that are prohibitive of increased efficiency or innovative approaches to patient care. To give an example that I had mentioned in my previous posts, I had once worked in a hospital where working fast to speed up patient care was seen as putting pressure on the team and being a bad learner. Other residents had similar experiences in this hospital, where they were asked to adjust to the team’s pace, even when it was clear that there were areas of improvement needed to make the team more efficient. The hospital had set up an unspoken rule that it was happy with the status quo, despite the fact that it was no longer serving the giant and ever growing population of patients, resulting in months or even year long backlogs of patients to see, and patients waiting in the emergency department for days just waiting for a bed to become available in one of the inpatient units.
How does a culture of incompetence form? I believe that it starts from a seed of “leaders” that believe that what they are doing is near perfect, if not perfect, and that there is no room for improvement. Any attempts at productive change is seen as stirring up trouble or even being a bad learner. This kind of culture in turn produces an environment where those who agree with this worldview are the ones who decide to stay after their mandatory rotation ends, and the saga continues.
This kind of workplace culture can cause traumatic moral injury in young and motivated learners, possibly making them lose that spark that keeps them wanting to innovate and improve. Perhaps the reason why healthcare has seen so few innovative changes in the past many years is because this culture is pervasive in medicine. As residents, we get placed in a lottery system that inevitably lands us at a hospital with such a culture at some point during our training. While I wish I could say that most of us come out of the experience with our eagerness and dreams of a better future intact, it often marks the beginnings of becoming a bitter and burnt out physician.
I noticed this change in myself more recently when I pulled out a garnet bracelet from my jewelry drawer for work today. One of my daily rituals as a witch includes picking out a gemstone to support me at work and to set intentions for the day. Garnet, besides from being a protective stone, also encourages vitality, leadership, and positive growth. Since being burned by this culture of incompetence and many months afterwards, I was afraid to wear this to work in case it would push me to stand out more than a resident “should”, attracting negative attention and criticism. Today, for the first time in almost a year, I took out this bracelet for me to wear to work, feeling finally ready to return to my old self again.
If you feel that a productive and growth-oriented behavior that is appreciated by patients or clients is being met with resistance and even animosity in a new environment, I implore you to take a pause and to evaluate the environment before changing yourself. If you could find a way to hold onto that spark inside of you to ignite torches of positive change, a day will come when you are free to light up the world as you are meant to do.
Stay strong, my friends. Better days are just around the corner.
No, this blog post is not about Lady Gaga’s timeless song, “Til it happens to you”, although I would encourage any soul to check it out.
I feel that we, as humans, are motivated by our survival instincts to engage in victim blaming. Aligning or identifying with the victim feels like admitting our own vulnerability, because if the victim was “victimized”, and we are like the victim, then we are also vulnerable to being victimized.
To cope with this fear, one points out the victim’s flaws, whether it be regarding the victim’s character or behavior, trying to make the victim as unappealing of a human being as possible, one who we can’t possibly be similar to. In short, we dehumanize the victim so that we can feel safe.
I have certainly been guilty of this myself. I did not come from money or anything special, really, and my academic achievements used to be the only thing that made me stand out from the herd and gave me a sense of belonging and identity. Because of this, I had absolute faith in my ability to tolerate whatever hardship my research or academic career otherwise would throw at me. Unconsciously, I was TERRIFIED of ever admitting that I could face a situation that I couldn’t tolerate in academia. Therefore, when I heard about other trainees leave their abusive supervisors, I used to immediately go into victim blaming mode for my own survival, thinking that the abused student/ trainee was “weak”, “useless”, and probably deserved the bad treatment anyway.
If you read my previous blogs, you will know that the goddess eventually decided to teach me a lesson and gave me an obstacle that I could not overcome. I, for once, could not tolerate the abuse that was thrown at me and had to leave that position, the learning opportunities that came with it, and the possibility of a good evaluation in that rotation. When I shared this story with my colleagues, some were sympathetic and offered me words of support and advice. Others however, looked at me with judgmental eyes veiled by fear, almost wanting to scream at me “You deserved what happened to you, that would NEVER happen to a normal resident”. They interrogated me to find out what I had done wrong to deserve this outcome, so that they could be reassured that it was my fault, and that it would never happen to them. It did not escape me that I had also felt the same urge to judge when other colleagues would confide their struggles to me – I was being taught an important lesson that would stay with me forever.
My work in providing compassionate care to my patients as a physician DEPENDS on my ability to identify with them. If a patient with an extensive substance use history walks in the door with yet another overdose – I cannot hope to provide empathy and support that the patient needs in that moment unless I feel a kinship with them. The patient was likely living in highly marginalized conditions with multiple social stressors – the substance use was a way of coping when they had no other resources. I have also been at the end of my rope at the mercy of strangers for my next meal or a roof over my head. This person could be my brother, sister, mother, father, or even me.
What do I do though, when that survival instinct to feel safe is so deeply engrained into my biology? This is when I dig into my identity as a witch and ask for the help of my goddesses and spirit guides – to allow me to transcend beyond my human nature to recognize that we are all children of mother Gaia. Spiritual leaders in witchcraft and other paths often come from dark pasts – I deeply believe that this is no mistake. I believe that these individuals are angels sent to earth to learn a lesson, so that they can alchemize their suffering into healing light.
At the end, brothers and sisters, we are ALL human. We are ALL vulnerable to the same misfortunes and follies, to the same depths of sorrow and loss. This was one of the many lessons the goddess had planned for me when I came to this earth, and I hope to share it with you today.
Have a blessed new moon, child of Gaia. I embrace you.
Working in a hospital as a doctor is an interesting experience because while you are working on a team, you are often the only doctor on the floor, especially if it is overnight and you are on call.
The responsibility of being the only doctor feels HUGE the first few nights any resident does call by themselves, and it never really goes away as staff physicians often tell me. Once in awhile, a physician from a different specialty will work on the floor with you as a part of a “buddy system” to be an extra pair of hands on the floor, which is always greatly appreciated. The downside of being that “off specialty” doc is that they are often othered by the team, seen as less competent, and treated as such as well.
I was having yet another overnight shift at the ED where my staff happened to be this off specialty doc. However, he had been working as a ED physician for many years and considered himself (perhaps accurately) a specialist in the area. Unfortunately, the night went very poorly for him. Several resuscitation cases came in that he could not manage on his own – he had to call the help of another ED doc but alas, it was not enough to save the patients. I was not involved in those cases so I did not know of the details of what happened in that resuscitation room.
The rest of the night marched on with a heavy mood. I could hear whispers from all corners of the hospital talking about how these cases did not go as they should have, that another physician would have been able to save them. It was hard to control myself from not thinking what they were thinking. Would the outcomes have been different had it been a different doctor? Someone who was trained in ED from residency?
When it came time to review some of the patients with this physician, I could see the worn and defeated look on his face. As soon as I started presenting, he abruptly cut me off and without giving me a chance to finish, he started to ask basic questions, insinuating that I basically did not know what I was doing. When I showed him my documentation proving that the information was all there, he LOUDLY told me that residents are not to be trusted and that because of this, I must follow a way of presenting as per his preferred style to demonstrate that I “am not making stuff up”. I was dumbfounded by this experience. Immediately my mind went to what I was going to put on this supervisor’s evaluation for treating his residents this way. Then, the goddess whispered in my ear, “no, Embrace the Other”.
He was alone in this entire ED, managing a highly acute floor by himself in a truly difficult night. He was further othered by the staff here due to the failed resuscitation cases. I imagined what I would have felt in his shoes, and my heart immediately broke for him. The thing is many resuscitation cases are not “salvageable” when they come into the hospital. Patients often have the wrong idea of what a resuscitation is like from TV shows – miraculous recovery is extremely rare. Even if a person’s heart is to start beating again, the chance of them regaining much of their baseline level of functioning is even smaller. With his years of experience working at the ED, I am sure he knew this too, and so did the rest of the ED team who were judging him. However, amidst all this background information, his identity as the “other” is what shifted their view into judgement and criticism instead of understanding and empathy. His harsh criticism of my work, increasing his voice so that everyone else could hear, was probably an unconscious effort on his part to re-exert his power and sense of control on this floor. Yes, it came at my expense, but what I had to endure was far less than his suffering.
Gritting my teeth and controlling my breath, I told him “Thank you so much for teaching me this, it is very helpful.” He nodded and sent me on my way to see more patients. At the end of the night, when he was doing my evaluation, he said “I was so glad you were here, it would have been a rotten night without you”. It was in this moment when the teaching of the goddess became apparent. Had I not shown understanding and patience in that moment, I would have pushed him further into the darkness. In choosing to set my ego aside to embrace the Other when nobody would, I accompanied another physician, another human being, in his journey from darkness back to the world of light.
It was the first one of my series of night shifts at the Emergency Department – I was excited to work in the ED again (one of my favorite places to work at) and was looking forward to having a productive and rewarding night.
Unfortunately, not quite having adjusted to the night schedule, my brain was foggy and my body was exhausted. I still tried my best to be chipper with the team and present for my patients, reminding myself of my goal to be a good team player and a healing light. Despite my efforts, I made two consecutive mistakes within the first 3 hours of my shift – both small mistakes not affecting patient care, but still quite a deviation from my usual performance. I tried to not think about it and move on, telling myself that I need to be more careful tonight as I am having an “off day”.
After suturing a patient at 3AM in the morning who had decided to do laundry in the dark in the wee hours of the morning, my staff and I had a disagreement over the type of sutures I chose to use. I decided to go with patient preference in the choice of sutures, and he wished that I had used a different suture which has evidence for causing less scarring. It was a matter of opinion and practice, and he did not hold this against me in any way. He just provided me education and made it clear what his preference would be if we were to suture another patient that night. Normally, I appreciate this kind of straight forwarded communication because it allows for a smooth shift and running of the team. That night though, I found myself getting extremely angry over this, thinking to myself “HOW DARE he decide to make an issue of this on a very busy overnight shift”.
Recognizing that my anger was completely out of proportion and irrational, I took a small break and sat in the lounge area where I could take off my mask and breathe. I went over my shift and my experience working with him so far. He was a great supervisor – he had clear communication, let me know right away what he likes and what he doesn’t like, and allowed me a good amount of independence. Why then, was I so upset with him over this small disagreement?
In situations like this, psychiatrists recommend that patients go back to the time before the argument had even started, to check in with their emotional states that may have influenced their reactions to the argument or discussion. In that moment, it became crystal clear to me that I was already very upset at MYSELF for making those small mistakes in the earlier hours of the shift. Despite my best efforts to suppress these thoughts, my mind was already on edge by disparaging thoughts targeted at myself. Specifically, I was telling myself that I was a failure and a bad doctor because I had made those mistakes.
Everybody has off days. Doctors and nurses are human, and therefore, are vulnerable to making human error. The mistakes that I made had not harmed anyone, although they did cause minor inconveniences. I took a deep breath and meditated. I looked at the sigils I wrote on my badge – protection, peace and patience. I thought of my goddesses and asked for their guidance. I then thought of what I often tell my patients – What would you have told your friend if they made these mistakes? This made it clear what the issue was. I had no compassion or patience for myself and immediately jumped into a judgmental mindset – an attitude I would have NEVER taken towards any of my colleagues. The consequent feelings of being a failure was so painful to sit with, that I had displaced my anger towards myself to my supervisor as soon as there was opportunity for such transference.
Displacement, according to Freudian principles, is one of the maladaptive defense mechanisms where one unconsciously transfers/ displaces their inner conflict, usually stemming from earlier life experiences, to a situation or a person that is not a part of that inner conflict.
I was grateful for the guidance of my goddesses for giving me the space and calm to realize that self-compassion, or lack there of, was at the root of this issue. I inwardly expressed my gratitude to my goddesses and allowed myself to feel the feelings of shame and disappointment at myself for the mistakes I had made. I then told myself “I forgive you – I forgive you for these mistakes and for being harsh on yourself. I honor that your desire for perfection came from a place of wanting to be a healing light. I embrace you and I love you”. Immediately, I felt a sense of relief come over me.
I was able to return to my shift and had a great night – we helped many people and my supervisor and I made a fantastic team through a very busy ED shift. While this shift had not gone exactly as I had planned, I was grateful it happened. It was a wonderful reminder of the importance of self-compassion and forgiveness. I was also reminded that when all else fails, I will always have my spirit guides and higher self to show me the way.
Lately, I have been noticing that “Shadow Work”, a concept originating from psychoanalytic theory, has been appearing more than ever in mainstream media. I often hear it in the context of Wicca, a modern religion combining witchcraft practices and psychological principles, as well as many other spiritual paths.
In psychology, the Shadow is an analytic principle that identifies the part of one self that has been split from one’s conscious identity. While it is hidden from one’s conscious mind, this Shadow forms a significant part of one’s personality and how they relate to the world. While different branches of psychoanalysis calls the Shadow by different names, they generally agree that identifying the shadow is an important part of psychotherapy as it brings into awareness one’s behavioral patterns, in particular in relationships with others, that has been hidden from their conscious mind. For example, imagine a girl who has been raised by an unpredictable mother who would swing from being verbally and physically abusive to the most loving creature in the world within a split second. A belief forms in her that adults, or authority figures in general, are dangerous and not trust worthy, and that she is not worthy of receiving unconditional love and care. This belief, this way of seeing the world is so painful for her that she represses it deep into her unconsciousness – it becomes her shadow. As an adult, she has recurring issues in her life resulting from rejection of authority figures and accepting love or care from others, particularly from those that remind her of her mother. Unconsciously, she projects her belief that authority figures cannot be trusted and that she is unworthy of love and support whenever she meets a person or a situation that triggers this shadow to reappear, lifting her away from reality and making her see the world through the veil of her shadow.
Shadow work as a Wiccan principle centers around identifying one’s shadows and bringing them into consciousness, so that one can ask for help from spirits, gods and goddesses of the highest good to integrate the shadow into one’s true self. Working through one’s shadow is thought to allow for the emergence of a more whole, and integrated self, which makes them more aligned with the Universe and their magick more powerful.
The concept of the shadow has existed far before modern psychology and Wicca. Many spiritual paths dating back thousands of years and religious teachings have identified the role of the unconscious mind in how we see the world. Many meditation practices, in particular, focuses on making room for one’s shadows to appear into the conscious mind so that they can perceive the world as it is without the cover of the shadow. In Buddhism, it is said that when Buddha was born, he looked up at the sky, down at the earth, and said “Between the earth and the sky, only I exist”. There are a number of different interpretations for this saying. My favorite one is that Buddha understood that he himself, was most responsible for how he sees and relates to the world; that he understood that only himself is the true builder of his Universe.
What can we do then, once we become aware of this shadow? Freudian psychoanalytic theory states that bringing the shadow into one’s awareness, also known as “insight” is enough of a treatment in itself to alleviate the impact of one’s unconscious influences in their psychopathology. Internal family systems talk about making space for the shadow in one’s mind by accepting it and allowing it to co-exist peacefully with the other parts of one’s identity, so that they can be integrated into a more mature and resourced part of themselves. Dialectic behavioral therapy, which incorporates a significant amount of its techniques from Zen principles, suggests that one should mindfully notice, without judgment, one’s shadows as they emerge, accept and honor them, AND at the same time, make an active effort to see the world without the influence of their shadow. In Gabrielle Berstein’s “Universe has your back”, she shares a mantra/ prayer where she beautifully demonstrates this principle of honoring one’s shadow while a making a commitment to see the world without it.
In ancient witchcraft or paganism, the influece of the Shadow or the unconscious was at times descirbed as being “posessed” by the evil spirits and energies from one’s past. For example, exorcims or banishing spells were often targeted at expelling the evil spirits hunting a person’s mind that originated from a traumatic event(s) from their past, such as war or rape, producing anxiety, depression, and even psychosis.
As a physician and a practicing witch, I find myself adopting both approaches. As you have probably already guessed, the above example of the abused and neglected girl is my own story, my own shadow. Using the psychoanalytic theory, I recognize that unconscious beliefs originating from my childhood trauma influences how I relate to others and the world. I try to keep this in mind when I find myself suddenly spiraling into fear-based decisions and judgements of others so that my world is not always covered by my shadows. I embrace my younger self and tell her, Of course you had to guard yourself from trusting authority figures, because trusting them was not SAFE. I understand and honor you, and I also recognize that we are at a safer place now where we are surrounded by wonderful mentors and have the resources to defend ourselves. I also recognize that I am still hunted by the evil spirits of my past, the spirits that hunted my mother, and hunted her mother. I ask for strength from my goddesses and higher spirits to help me see the world in its truth, and to shine light in my path to banish the evil spirits of my past. I used to struggle with consolidating magick and medicine especially with matters of the mind, seated in the brain which we understand so little about. Now, I understand that they are in fact two slightly different paths that ultimately aim to get us to one shared destination – moving us closer to peace and love.
My love of crafting is one of my regular reminders that there is something magical inside of me.
Not just crafting, I love anything where I am engaged in creating something that has not existed before. I love building things out of clay, painting, western and Chinese calligraphy art, making music, and creating digital art. This translates into research as well – my favorite part about doing a research project is at the very beginning, where I am coming up with a research question and designing a particular technique or optimizing a protocol.
Most of the time, if not all, I do not have any clue as to what the final product is going to look like. I am just captivated by the joy of creation. I put my hand on the equipment, smile, and let my intuition guide my work. I know that as long as I am having fun, the outcome will ultimately be a reflection of that joy.
This is a little statue of the goddess I made. It is of course not perfect – far from it, in fact, if you want to consider the technical aspect of it. However, when I look at it, it brings a smile on my face, and I feel the joy that I felt while creating my little goddess. It is amazing how energy translates as well – when I showed my little figurine to my husband, he immediately smiled and gave her a loving pat on the head.
As witches, we co-create our destiny and the world that we live in. The Universe becomes a product of the beautiful harmony between our intentions and the spirit. Lately, I started to wonder why then, do I not approach co-creation with the joyful wonder and curiosity that I have when I am crafting. Instead, often, I find myself approaching new situations with apprehension, and at times, even outright assumption that the outcome would be horrific.
Thinking outside of magic, self-fulfilling prophecy is a well-known and studied concept in psychology. It applies to situations as well as people. If one believes that the outcome of a situation will be horrible, and therefore there is no point in trying, the lack of effort and negative behaviors that this person exhibits as a result of these beliefs will ultimately result in a bad outcome – thereby confirming this person’s “prophecy”. Another well-studied concept in psychology is Confirmation Bias. Confirmation bias is one’s tendency to look for evidence that is confirmatory to the person’s ideas/ beliefs/ opinions, adding additional evidence that the belief was correct. For example, if I approach a new rotation with the preconceived idea that it would be a bad rotation, my mind would unconsciously look for signs that it is a bad rotation, focusing on negative incidences and remembering them instead of positive experiences that also occurred with the same or even greater frequency. Overtime, these negative experiences will be much more salient and accessible in my memory than the positive ones, making me CONFIRM my BIAS that the rotation was in fact, bad.
As a witch, I believe that the Universe returns the energy that I put out. This is a Universal notion that is echoed in many different cultures – I strongly believe that ideas that resonate and persist in multiple cultures speak to the Universal truth. Therefore, if I approach a new situation with negative energies, the future that I co-create with the Universe will reflect this negative energy, ultimately leading to a negative outcome.
Crafting and co-creation are both acts of creation. I can tell myself that I approach crafting with much more joy than I do towards entering novel situations in REAL LIFE because I have complete control over what I craft while I have very little control over my reality. However, believing this is a CHOICE that I made. In crafting, I do not have control over the weather conditions that my air dry clay is exposed to while on the balcony. I have no control over the hairs falling out of my dollar store brushes, and I certainly have very little, if not ZERO control over my tempéramental computer and its constant struggle to run my lengthy codes. What is different is that in crafting and even in research, I have unconsciously made a decision that whatever is produced at the end of it is worthy of love. This allows me the freedom to approach crafting with wonderous curiosity and without fear of the outcome.
I am very well aware that many situations in real life are not enjoyable and even painful. I will not lie to myself and say that all parts of life are joyful, even if I make significant efforts to believe that they are. However, I can make the choice that no matter what, at the beginning, end, and in every step of that journey, I will love myself and trust that I am worthy of love of the Universe. Co-creation is working with the Universe to shape my reality. The product of co-creation, therefore, is my future self.
This blog therefore is a declaration to myself and you, my brothers and sisters, that I make a commitment to believe that no matter how circumstances outside of my control tear me apart, I am, even if I am in pieces, worthy of the love of the Universe. I trust that no matter what, I work with the Universe to co-create my reality where the outcome will always be of love.
Spring is here! Oestara was more than a week ago but today it officially feels like spring, with the temperature finally reaching above coat weather. I adorned myself in goddess jewelry, put on a flowery dress, grabbed my husband by the hand and ventured into a nearby park.
What a beautiful time it was! We found a fairy creek (with non-native plants, critters with an offering surely placed by a fellow sister/brother witch). We saw many battle scars from mother nature’s brave fight with yet another harsh winter. How glorious it was to be out in the sun, smell the fresh grass, and admire the new baby greens on the birches!
My first three posts have been particularly dark. I sensed a change coming though, perhaps for about a week or so now, feeling the spring goddess wake up inside me and my world filling up with light again as the days got longer. My astrological charts have been showing a lot of Sun energy in the tenth house, indicating a renewal of passion, hope, and spirit in my professional life and other passions.
While wandering the street market after our visit to the park, we ran into a street vendor selling crystals. A blindingly bright crystal point caught my eye almost immediately – a sunstone tower. What’s more? It was on sale! I took it as a sign that the Universe has intentionally put this crystal in my path, and brought it home. Sunstone is linked to good fortune, clearing all chakras and allowing one’s true self to re-emerge. It is quite literally spring cleaning delivered in crystal form.
If that was not sign enough – my paper was finally accepted for publication and my algorithm – yes, the one that has been running for the past 4 days – finally finished, delivering promising findings. What relief! I was so overwhelmed with gratitude I could almost cry. My dog, my familiar, is lovingly accompanying me as I am basking in the grace of the goddess and Universe while writing this blog.
I thank my goddesses, gods, spirits and angels of the highest good for always guiding me to the right path. I thank them for giving me the strength to emerge from the long, dark winter. I thank them for the immense happiness I feel as I embrace the elements surrounding me.
I thank the Universe for blessing me with all the opportunities that have come my way, and for always guiding me back to love. As Gabrielle Bernstein has brilliantly put, “The Universe has your back”.
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.