Keeping in Perspective During Residency

Despite the fact that many of us fashion ourselves as superhuman or invincible as we plow through the daily grind of residency, generally performing admirably day after day on little sleep, fueled by caffeine and ambition, the long hours and stress of residency eventually gets to everyone.  At some point, we all crack.  The bright-eyed enthusiasm with which we all entered residency fades away and we find ourselves looking in the mirror at someone we hardly recognize.

The changes are both physical and emotional.  Nearly everyone’s weight changes: weight loss due to stress and numerous missed/skipped meals or weight gain due to stress-eating or increased fast food/junk food – sometimes that’s all there is time for or that’s all that’s available at 3am. A full head of thick dark hair turns into some combination of thinning, receding or graying.  Emotionally, we all probably experience some level of depressed mood.  Some definitely suffer major depressive episodes, but most residents find themselves somewhere on the spectrum where we find ourselves emotionally blunted and lacking interest in family/friends and those things which used to provide us joy and happiness.  Many of us also find ourselves jaded and embittered, even to the point of seeing patients as the enemy and other services as saboteurs (this basically explains my ranting about the Emergency Department in my last blog post – generalized disillusionment after three months of home call).

Clearly these changes affect our ability to enjoy our lives, but they also definitely affect our ability to perform and take care of patients.  The effects of lack of sleep are well documented and have resulted in residency work hour restrictions.  Similarly, stress has been shown to impair intellectual judgment and technical skill in surgical residents.  The importance of this is demonstrated by efforts, such as those by Hochberg, et al., to help elucidate the signs of stress and depression and the efficacy of teaching residents to identify these signs.

The question then is what, if anything, can be done to counter these negative influences on our health and well-being. Sleep, as the enemy of productivity, will always be the resident’s ethereal fantasy, especially if you believe the data that it’s not possible to “catch up” on sleep.  It is possible, theoretically, to optimize your time available for sleep by using time away from the hospital efficiently, however, the effort required to do this might end up resulting in just as much if not more mental anguish as losing a little sleep in order to enjoy catching up with a friend, relaxing with a good book or simply just decompressing in a peaceful quiet.  Staving off the inevitable acrimony is more difficult.  It’s the one thing that I struggle with most.  Although I’d like to think my life is well-balanced and that I afford myself with sufficient opportunities to escape work and the hospital, it’s not easy to leave the baggage at the door.

After spending this past week on vacation, I find myself renewed mentally and physically.  I’ve been able to catch up and spend quality time with friends and my wife, and if all goes well, I’ll even be able to slip in a round of golf prior to getting back to work on Monday.  This morning I got a call from a college buddy asking advice about his Lisfranc injury, and I found myself genuinely excited to be able to help give him advice and explain to him the significance of his injury and the likely extended recovery he is facing.  More so than anything, this last week has put things back in perspective and reminded me what it was that got me into medicine and into orthopaedic surgery – the opportunity to help others.  It’s reminded me not to lose sight of the fact that I really do want to become an orthopaedic surgeon and that I will absolutely love spending the rest of my life dedicating my time and talents to this profession.

 

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