Reflections on residency thus far…

To assume that residency can be explained fully to one who has not experienced it in its entirety is naïve. It is almost a living thing – changeable, ravishing. It is a path forged through jungles which holds mystery even after the turns, trials, and tribulations have been fully exposed. As residents, we take photographs along the way to capture moments of progress, anger, fear, frustration – but only in retrospect, and perhaps not even then, it is possible to understand which moments will become significant. Why are there patients whose brief encounters are vivid to me still, while others have simply faded from my memory? How is it that I can paint with certainty the eyelids, the fingers, and the nose structure of my first cadaver from six years ago, but that I can now say so little about the eyelids, fingers, and noses of my patients? I can remember the face, tanned, broad, with graying eyebrows, of the woman whom I first declared dead. But I cannot remember the faces of any of the others who followed. They blur together – a swarm of people whom I have watched depart from this world. Strangers, patients, bodies in stretchers – but not faces.

Steve McCurry, National Geographic

Surviving residency means learning to look away. Or, more precisely, learning to see through the very elements of life – and death – which used to stop us in our tracks. Writing has revealed to me how muddled – and how out of our control – this process is. I have learned to listen clinically – I have learned to listen to the words that will save me time later, that will clinch the diagnosis, so that I might have a minute to steal five minutes of sleep or a slice of sustenance. And, sadly, I have learned to discard all the other pieces of a patient’s story. The details of their personal lives have become meaningless to me – even troublesome for my primary tasks, efficiency and depersonalization.

Medicine practiced in this manner draws me farther away from my writing faculties – and my sensitivities – than I have realized. The process of depersonalization is far more amenable to cartoon drawing or improv comedy than it is to writing – something light, humorous, distant. My art and writing have become vapid. I can observe, but with strict limitations and great distance. I have skillfully walled off the emotions of my patients. In the last two years, in spite of all the tragedy I have faced, I have not shed a single tear for a patient. I wonder why.

There is an unspoken culture in medicine that it is cowardly to break down on the job. It is cowardly, in fact, to personalize the emotions of our patients enough so that it affects our performance. We are expected to rise “above this,” if you will – to be objective, discerning physicians. And I have done exactly this, with raving reviews from my superiors. But it makes me concerned that there is something missing. Perhaps taking care of such sick patients should not be so easy.

This is why illness close to residents – among ourselves, our friends, and our families – hits us so hard. It is not merely the illness itself, but all the implications that come along with it. In spite of our adept skills, it is far more difficult to depersonalize the illness of a loved one than of a stranger. These situations create a dichotomy in our minds – in order to perform our day-to-day tasks, we almost need to believe we are invincible. But when those around us fall, we must accept – even if briefly – the reality that we are not.

I am not sure what the solution is. With the demanding hours of this training, and the way residency – a living, breathing being – devours our lives, takes from us any ounces of energy which we may have remaining, brings us into the void of the hospital in all its intensity – I am not sure how we can open ourselves up to this, emotionally, and survive it. And so, at least for now, we do not.

I watch my fellow residents. We walk around this hospital like zombies, more absent then present. I can only wonder how we will emerge from this – as alienated as we are now, or will we regain some sense of warped humanity after all of this is over… Only time will tell.