I knew residency was going to be hard. I had anticipated the long hours, weeks in a row without a two-day weekend (which, in an attempt to see the glass as half full, I have come to call vacations), and the mountain of new knowledge I would need to master. None of this came as a surprise and I was braced for them from the day I showed up for orientation. However, I’ve found that residency comes with a whole set of challenges I did not expect. If anyone had told me about them in med school, I guess I wasn’t really listening (or, more likely, was too preoccupied trying to figure out my patient’s acid/base situation by the time we rounded to take much notice). For each of us, these unexpected challenges in residency are likely to be a little different, stemming from our own strengths, weaknesses and pet peeves. Here are some of the difficulties I wasn’t expecting:
1. You can’t keep everyone happy: As we all went into a helping field, many of us are people-pleasers. We want to keep people happy; we want them to like us. In residency, you cannot keep everyone happy, and I’m not just talking about the patients. As a resident, you are constantly trying to meet the needs and expectations of a whole cast of characters – attendings, nurses, medical students, patients, even your co-residents. At times, what they want you to do will be diametrically opposed to each other. Throw on top of that what you want to do in any given situation and it can get messy.
2. Team dynamics can make or break your day (week, month): My best months of residency have been dictated almost entirely by who makes up the team I am on. Even the hardest day is made easier by supportive colleagues who can laugh and cry together. However, sometimes you will have teams that just do not gel. Do what you can to be pro-social: pitch in, support each other. Remember this too shall pass. While most obvious are the co-residents and attendings, ancillary staff from social workers to nursing assistants can color how any given day will go. Never underestimate the importance of establishing and maintaining these relationships. These folks will go out of their way to help you – or won’t.
3. It can be hard to take care of a patient you don’t like (and maybe even harder to admit to yourself you don’t like them): In med school, we are handed patients cherry-picked by our senior resident or attending. We’ve all heard, “Oh this would be a good case for a med student” in reference to the sweet little elderly patient who loves to chat and will benefit from the extra attention. We are often protected from the “challenging” patients, the ones that irritate the nurses, drive away friends and family, and seem unable or unwilling to engage with the team appropriately. Welcome to residency, this is now your patient. It’s the luck of the draw, and you are no longer shielded by higher ups wanting you to have a “good experience” on a rotation. Even if their afflictions are minor, they suck of huge swaths of your time, without apparent recognition or appreciation, leaving you feeling drained and ineffective. Sorry – we’ve all been there. Learning to care for these patients – and dealing with the distress and dysfunction that entails – is undeniably an important skill. And definitely one I have not yet mastered.
4. A lot of it feels unfair and you can’t let it eat you up: I have an incredibly black cloud. When I am on call, weird stuff happens. If I am at a site with the luxury of home call, I will be called in multiple times. When I am on by myself, I don’t have one patient with chest pain, I have two. At the same time. On separate units. With cardiac histories. I have heard of people who actually get a decent night’s sleep on call. I lie down in the call room and the ER pages with another consult. Intern year I worked Thanksgiving, Christmas Eve, Christmas, New Year’s Eve and New Year’s. I am not making that up. However, it seems that residency is unfair to everyone, just in different ways. When I talk to any of my colleagues, they can match my stories tit for tat. So that’s what we do – we listen to each other and swap stories of woe with a sense of humor. And I try not to wallow. I try to remind myself that residency isn’t all about me (actually, in many ways, it’s hardly about me at all) and this is all temporary.
5. Patients die and you have to figure out how to keep going: The death of a patient is something we all experience and yet each time is unique. Each person deals with this grief differently and you have to figure out for yourself how you process the complex emotions that come with this loss. Some attendings or senior residents will recognize the importance of taking time to address the loss of the patient and bring the team together to acknowledge the individual’s passing. But this doesn’t always happen, and even when it does, the feelings you have – about the patient, your own actions and decisions, the apparent capriciousness of life – can take a long time to work through. I’m not sure it’s something you really “get over” nor am I entirely sure it “gets easier.” It is both our privilege and our burden.
Residency has been filled with new experiences, some I expected and many I did not. Although I’ve learned a significant amount of medical science since I graduated from medical school, I have also learned so much more. While none of these challenges particularly felt like opportunities at the time, in retrospect I can see that each has subtly shaped me in some way and helped me grow as a clinician.
Megan Riddle, MS MD Ph.D., is board certified in both adult psychiatry and consult liaison psychiatry. She attended Western Washington University and received a Bachelor of Arts in Spanish with minors in Latin and English before deciding she wanted to pursue a career in medicine and research. She received a Master’s in Biology at Western Washington University with an emphasis in genetics and then went to Weill Cornell Medical College where she earned a medical degree as well as a PhD in neuroscience. She completed her residency training in psychiatry at the University of Washington, where she was chief resident, before completing a fellowship in consult liaison psychiatry, also at the University of Washington. She is currently a Courtesy Clinical Instructor with the University of Washington Department of Psychiatry and Behavioral Sciences and enjoys teaching and supervising residents.