Tag Archives: Residency

The Difference of One Day

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The Doctorhood quest is a journey with finite phases.  To reach the next phase you must pass through the hurdles of the previous phase. Like all quests, each phase must end. Now having passed 2 phases, I’ve noticed that the transition between the phases is jarring.

I recently finished my first year of residency, called “intern year.” In the Doctorhood quest, many consider intern year the hardest phase because it’s the time when you begin to practice as a physician and know the least. You are a student one day and then the next day walk into the hospital with your new title of “doctor.” You find yourself with a mountain of responsibilities that you aren’t sure how to manage. It’s a bit of a joke because one day does not make a physician. So, even though you have the “doctor” title starting the first day of intern year, the difference between an intern and a student only begins to emerge as the months drag on. By the end of intern year, you find yourself teaching medical students and realize that you are, in fact, more knowledgeable than you were 12 months prior.

A similar transition exists between intern year and the second year of residency. In my residency program, we even get a new badge declaring us “resident physician” rather than “intern physician.” One day you’re an intern, working under 2-3 layers of senior physicians and the next day you’re a resident with only a very senior physician overseeing your work. As an intern you always have a resident to ask for help. When you’re a resident you’re the one that the interns turn to with questions. Of course, there are people who teach and help you as a resident, but they are more distant and more senior than before. As a resident, you are expected to find answers to many of your questions and you are expected to make many decisions on your own.

On the second day of my second year of residency, a physician who has been teaching residents for years entered the room to lead one of the educational sessions we (residents) have weekly. Before he started his lesson, he acted out strutting down the hall as James Bond does, “Now that you’re all residents you even walk differently. You have that swagger,” he said. We all laughed. A day does not make a physician. A physician is made over years. Today I feel like how I felt during the last days of intern year because the time between today (early on during my second year of residency) and the end of intern year is short. I’ve been questing long enough to trust the process. I know I’ll feel confident as a resident by the end of this year. And, who knows, maybe I do walk the hall a little differently now than I did a year ago. I did, after all, forge intern year and live to tell the tale.

She Must Be Just a Number to You

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“You see so many patients, she must be just a number to you,” the patient’s son said as he watched me perform the official exam declaring his mother dead.

“We care about all our patients and take the best care of them we can. Of course, I haven’t known your mother for as long as you have. You’ve known her your whole life,” I said. I finished my exam. I stated the time of death, gave my condolences, and left the room.

I had pronounced a patient dead almost daily that week. During this patient’s exam my emotions were not the emotions of a son who had just lost his mother without much warning. My emotions as the patient’s physician could not be the same as her son’s. I was sad, of course, but I also knew we had done everything we could for her. As a physician I must balance being emotional and being clear-headed so that I can make objective decisions about how to help patients with their medical challenges.

In medicine we push to the edge of current scientific knowledge, yet we are not capable of magic or miracles. We cannot predict the future and we cannot stop the inevitable. Death is part of life. Since medicine in the science of life it inherently involves death.

As a physician my mission is to prevent and cure disease and reduce suffering. A lot of suffering can happen when a person is gravely ill. Part of my job is to recognize when the fight for life is futile. Once the fight becomes futile, anything we do to prolong life also prolongs suffering. It is at the time of futility that I can offer a path that leads to greater comfort and death with dignity. This path requires a shift from a goal of prolonging life to one of promoting comfort. To stop fighting death is not a decision to take lightly. Further, the decision must be made by the patient or their appointed decision-maker (when the patient is too sick to decide). I can only offer guidance as part of the patient’s care team.

This patient, the mother of this son, had fought for her life. She had maxed out every treatment we could offer. She had failed other treatments. When she was worsening, we called the family to come into the hospital. When everyone who needed to be there was at her side, we turned off the medications and interventions that were keeping her alive. We did this because to keep those medications and interventions going would not save her. She would die regardless. She was suffering. Most importantly, she had made it clear when she was well that she would not have wanted to keep going in these circumstances.

When we turned off the medications and interventions keeping her alive, we gave the patient medications to treat her discomfort. She had pain, shortness of breath, and anxiety. She died shortly after we changed our approach from treatment to comfort. She died peacefully and surrounded by the people most important to her. None of this struggle made her a number. She was a person who had fought bravely and died with dignity. And, sometimes, that is all we can offer in medicine – a place that illuminates a person’s intrinsic bravery and permission to stop struggling.   

I have seen and will see many people die. My role in these circumstances is not a counting role. As a physician I ensure my patients get the best treatment available when there is a fight to have and the most comfort possible when there is no fight left. My role is to adhere to their wishes regarding their life and death as best as I can within the constraints of medicine. These are serious responsibilities that are both rewarding and harrowing. Rewarding because I know my patients receive the best care we can offer and a death as close as possible to what they would want if they had a choice. Harrowing because it is hard to lose someone I cared for and because I feel each patient’s loss, not as a friend or family member, but as a partner in the patient’s battle against death.

Being a physician has made me realize exactly how people aren’t numbers. It is my job to learn my patients’ stories and to partner with my patients to tackle their health goals. What happens to my patients is partially a reflection of how well I did my job and partially a reflection of the complexity of being human. The depth of the patient-physician relationship is part of the reason I chose medicine. My patients’ stories are sometimes tragedies and my relationship with my patients is sometimes difficult, but the opportunity to heal, cure, and reduce suffering is enough to make those challenges worth it. I am grateful for the opportunity to take part in my patients’ lives. Grateful even if we meet under extremely unfortunate circumstances. Grateful even if we meet at the end of their life.

Lost to Follow Up

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Two different cancer screening tests came back positive. The patient needed additional testing to see if they had these cancers, but the threat was real and could be life changing. As the months went on, the referrals I had put in for the follow up tests came back – “unable to reach patient,” “failed scheduling effort,” and finally “referral canceled as unable to reach patient, reorder if still clinically indicated.” The patient missed their follow up appointments with me. I saw, however, the ongoing social work notes in the chart. Half of these notes stated they couldn’t reach the patient and half suggested contact. Perhaps it made sense that this patient wasn’t attending to their cancer diagnosis/rule out follow up appointments. This patient had big fish to fry without cancer. They were struggling with drug addiction, didn’t have secure housing, and weren’t sure where they’d get their next meal. The electronic chart, filled with short notes attempting objectivity written in the same font used in 1980s faxes, told a story. The story was both an epic and a tragedy.

This patient was lost to follow up. Would we ever find out if they had cancer? Did it matter? Would they die before medicine could help them? Was medicine really what they needed? As I watched the story unfold, Maslow’s Hierarchy of Needs surfaced in my mind. This patient’s basic needs weren’t met – food, safety, and a place to stay. Cancer was so high up the pyramid of needs it seemed silly to discuss. Though, was it really that high up the pyramid? I know what cancer can do.

Health is multifactorial. Only one piece of health is access to quality healthcare. This patient was focusing on several nonhealthcare pieces of health – safety and security of the physical body. Perhaps they were also focusing on finding their next meal. Perhaps the recreational drugs they used were treating demons of a past filled with trauma. This patient was part of a healthcare system with robust social services to help with social problems like housing and food insecurity. Interestingly, the social services this patient could access are exceedingly rare in the US. Most health systems don’t provide these services and most insurances don’t cover them.

I hoped the patient’s basic needs would be met. I hoped that when those needs were met, they’d return to clinic so we could start the cancer investigation process. I hoped it wouldn’t be too late. Even as a physician I don’t get to write the story of other people’s lives. As the story in the chart unfolded, I was grateful that the patient was receiving social services. I was frustrated that in most other US healthcare systems a different patient in the same situation would receive no help of any kind.

“Lost to follow up” is the phrase we use for patients who disappear from healthcare. It’s a term that provides a label, but it doesn’t explain where these patients go and why they disappear. The label can have negative connotations because it’s easy to be frustrated when patients don’t want to take our (their doctors’) advice and follow our carefully designed plans. It’s easy to forget our patients (just like us) are products of the social determinants of health. It’s easy to forget (just like us) they have lives filled with complex situations regardless of their use of healthcare.  

I’ve found that it’s worth stepping back and trying to see why patients decide to become lost to follow up. When I do this, I often discover that they aren’t lost at all. Rather, they are fighting for the most important things in their lives at that time. And the important things they see are usually different than the important things I see. Since patients are the experts in their own lives, they are often right about what’s most important. Frequently nonmedical things have a greater influence on patients’ decisions than their health needs as dictated by their doctor.

As the alerts came to my inbox for missed tests, I thought about the patient the first (and only) time I met them. They had answered all my questions thoroughly and without hesitation. I wondered if I’d see them again. I hoped they returned to clinic before anything devastating related to their maybe cancers happened. I cleared the alerts. The patient would write their own story; I’d be here if they invited me to partake in another chapter of it. Even tragedies sometimes have plot twists and happy endings. I always (and unwaveringly) root for happy endings no matter how stormy the story becomes. 

References:

Wikipedia on Maslow’s Hierarchy of Needs: https://en.wikipedia.org/wiki/Maslow%27s_hierarchy_of_needs

Article on the importance of the different determinants of health: https://pubmed.ncbi.nlm.nih.gov/26526164/

HHS overview of the social determinants of health: https://health.gov/healthypeople/priority-areas/social-determinants-health

WHO overview on the determinants of health: https://www.who.int/news-room/questions-and-answers/item/determinants-of-health

The Doctor’s Dilemma

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Being a physician is a career that can become one’s life. There are many reasons for this including the 24/7 need for healthcare, the pressure from healthcare business for productivity, the need for advocacy to improve the system and increase health equity, and the desire to help others. There is also the added stress that medicine literally deals with people’s lives and wellbeing. Given these career features, being a physician historically was a way of life, not just a job.

Despite the historical trend that being a physician was a way of life and an identity that trumped all others, there has been a shift in recent years. This shift started some time ago and was, perhaps, expedited by the COVID-19 pandemic and the severe toll it took on all healthcare workers. The shift is that newer ages of physicians don’t just seek to be doctors – they seek to be partners, parents, athletes, cooks, travelers, readers, vacationers, relaxers, and gardeners to name a few identities they claim beyond the physician identity.

As a member of the newest generation of physicians I find myself caught between the old dogma that to be a physician is to prioritize it above all other aspects of life with the newer view that to be a physician is to be a person with a serious career. I think of these completing identities of “way of life” vs “profession” as the “doctor’s dilemma.”

Sometimes self-imposed and sometimes externally-imposed the training physician (and all physicians really) are driven to do more. More reading and learning, more shifts, more leadership roles, and more research. It’s hard to balance the forces urging me to do more with the desire to also do nonmedical things like spend time with my husband, hike, and write. My medical training has taught me to hustle, be efficient, and work for long durations of time with high focus. As my training continues, I’m also learning how to say “no” and pump the break. Of course, these learnings are contradictory. The pendulum falls sometimes more on the hustle side and sometimes more on the relax side.

As I finish my 1st year of residency, I’ve been thinking about the doctor’s dilemma because in the remaining years of residency I’ll make decisions about my post-residency career path. While I contemplate my career’s trajectory, I also find myself thinking about other things in life. For example, living in a city apartment has made me miss walking barefoot on grass. I don’t suspect I’ll own a house anytime soon, but missing grass has made me think about homeownership more than ever before.

What do I put on hold and what do I pursue? What opportunities if not taken now will disappear? Where do I want to be in 5 years?

While wellness preaches “live in the moment” heavy careers, like doctorhood, require forward thought. Doctorhood requires the balance and blend of one’s professional dreams and identity with one’s personal dreams and identity. During my 2nd year of residency, I’ll become a team leader and gain more independence. With this greater responsibility doctorhood feels more serious than it did as a new resident when I had more people guiding me. As my training continues, it is my turn to step up with the answers. Patients will depend on me. Each choice, like whether to study or run, has a ripple effect on my future and (perhaps) on my patients’ futures. There simply isn’t enough time to “do it all” at the same time. Choices must be made along the way. The choice options are what pose the dilemma.

A Letter to My Intern Self

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Dear About-To-Be-Intern Self,

Intern year (as the first year of residency is called) is going to be tough. At times, in fact, it’s going to be downright awful. There will be stretches where you don’t see the sun and can’t remember the last time you felt anything but exhausted. The trend you noticed in medical school, in which current physicians and administrators don’t value your time (and waste it) and then wonder why your mental health is poor, will persist. You will be told by some to do more because “you’re a doctor now” and you’ll be belittled by others because you’re new and you don’t know what they think you should know.

You will be impressed by how your health deteriorates intern year. You are welcome to take some of the blame for your decline if you’d like, but the truth is that everything about intern year is the opposite of the wellness advice we give our patients. From your sleep schedule to your stress level, or from the food the residency program gives you to your work hours, there is very little healthy about intern year. It would be misleading to ignore these negative things that will unfold, one way or another, as they have for every intern. They manifest a bit differently for each person, but their occurrence is a guarantee.

Like all things in life, the negative of intern year is paired with the positive of these 12 months. First off, you’re paid – a huge victory after 4 years as a medical student. Your salary will be meager compared to your future salary (and it will be poop if you calculate the hourly rate) but remember that the intern salary is higher than the average annual income of Americans. Second, you are a doctor now. A real doctor. This title, alone, allows you to meet the most extraordinary people and hear their amazing stories. People will tell you things they never told anyone else. Your kind patients and your brave patients will be beacons helping you through intern year.  Focus on remembering the kind and brave patients more than the hard and mean patients; it’s the opposite of what your mind will want to do. I assure you that remembering the kind and the brave will help you more than you realize.

There will be difficult senior residents and supervising physicians; there will also be amazing ones. Take a moment to appreciate the inspiring senior residents and supervising physicians and reflect on why you respect them. You’ll be in their shoes before you know it and you can learn from them. Let the degrading and unkind supervising physicians and residents bounce off you; let them be a lesson of what you do not wish to become. The same goes for the nurses and other staff in the hospital. Nurses will be your biggest nightmare and your biggest savior throughout intern year. A knowledgeable and respectful nurse is gold. Thank the hard working and thoughtful nurses. Learn how to navigate the mean and not patient-focused nurses. You’re a doctor now and, once intern year is over, you’re going to be a team leader. Intern year is about getting ready to be a leader.

No one is good at being an intern when they start. Every intern gets better at medicine, navigating the healthcare system, and working with the interdisciplinary teams of healthcare. You won’t notice how much you’re learning at first. The days will pass slowly and the weeks quickly – before you know it, you’ll wake up and realize that you are a new version of you. You’ll blink and a new July 1st will be just around the corner. Then, intern year will be behind you…forever. I’m not delusional enough to say, “enjoy it while it lasts.” I am delusional enough to say fight for your health (because you’ll need to) during this year and soak up as much knowledge as you can. In the end, intern year exists to help you get closer to becoming the best doctor you can be. Intern year will force you to grow. It will challenge and push you to a new level. Always remember that intern year is finite and only one small phase of the Doctorhood Quest. It will pass.

You go this. I know you got it. At the end, you’ll know you got it too.

Yours truly,

Jett

Space

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I often think about space, specifically taking up/claiming space. My most conscious ponderings about space are while I’m running in the park near my house. I’ve observed that people are more likely to step aside for a male runner than me, a female runner. It’s so blatant that when my husband and I are running or walking together we strategically put him on the outside because people move over for him and not me. It’s an annoyance. I’ve started to run strong and serious. I’ve learned that a confident stride and a squared shoulder do help remind people that women also deserve to run without stride interruptions.

Guarding my lane while running is a newer claim of space for me. The first time I claimed space was changing how I sat. Changing my sitting stance was a project that took the better part of my twenties. For some reason women in my culture are taught to sit small and closed. I’ve found that sitting small is counterproductive. It has (perhaps) made it easier for males to harass me on public transportation and (definitely) made it easier for my colleagues in healthcare to ignore me. These days I try to sit large and open, just like my culture teaches their boys to sit. I don’t take the inside seat on the train/bus (that’s more for safety as I’ve learned the hard way) and I take up my whole seat even when it’s wider than I am broad. If there’s a seat at the table in a conference room, I take it. Which brings me to medicine, my most recent occupation (both meanings of occupation, wink, wink).

I have a very distinct memory from medical school related to being a female in medicine. I was mid-sentence presenting my section of a group presentation when a male member of my team cut me off, talked over me, and started his section of the presentation without letting me finish. It was so rude that several females in the class texted me in solidarity. The experience made me think about why seats at the table are not enough on their own. Seats must be claimed and, sometimes, defended.

Being a first-year resident brought with it a whole host of interesting space claiming challenges, many simply related to being a new doctor and some related to being a female physician. Filling the role of physician involved learning how to defend and explain my medical decisions, striving to take the high road and set boundaries when other members of my interdisciplinary team did not, and observing how physicians I admired conducted their doctoring and led their teams so I could model their techniques.

The challenge of being a new doctor exists for all new doctors. But filling the role of a female physician comes with its own occupational hazards. Here are some concrete examples from the past year of times I was reminded that I was female while at work:

  • I frequently must remind my patients that I am not their nurse — a challenge that my male counterparts don’t have.
  • My name is gender neutral, so nurses often think I’m male when communicating electronically with me before they meet me in person. (We have a secure chat in our electronic health record system that we use in the hospital). It is interesting to see how nurses’ tones change after they discover I’m female when they originally thought I was male. At times the tone change is dramatic and frustrating because I get more pushback as a female than as a male physician.
  • I have been lectured by a male supervising doctor about what clothes a doctor should wear. The lecture was somewhat confusing given that all the female residents wear exactly what all the male residents wear… scrubs of similar fits, styles, and colors. I doubt any male resident teams have been subject to such a lecture, but my all-female resident team was.
  • Several times I have found myself uncomfortable on rounds (that time of day when you talk about all your patients with the supervising doctor) because the male supervising doctor was very good at looking at my chest but never made eye contact.

The above situations illustrate that there are additional features of the medical terrain that female physicians must navigate that their male counterparts don’t experience.

As my second year of residency approaches (starts July 1), I’ll soon find myself no longer a first-year resident. In my second year of residency, I’ll start to be a team leader and I won’t be the new kid on the block anymore. I’m excited about this next step in my training. I feel ready to take on the challenge knowing I’ve learned a ton already and have a ton more to learn as a physician. I continue to have much opportunity for growth on my journey to lead with humility and excellence. As I wait for my second year to begin, I’m curious what the phase of “senior resident” (my title during my second and third (last) years in residency) will be like and the space challenges it will present. All adventures have space challenges however they present themselves in different ways.

I Don’t Let Anyone Die Alone

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I saw the nurse sitting calmly at bedside. I knew she was the night nurse; it was shift change. Usually, the end of a nursing shift is busy with finishing tasks and telling the next nurse about the patients they’re taking over. I got up to check on the nurse and the patient. We’d just transitioned the patient from full code to comfort care. “Comfort care” means no life-prolonging measures – just medications and other interventions to help people be comfortable as they die. Minutes earlier I had put in the comfort care orders.

“Hey, do you need anything else?” I asked the nurse. “I only put in a few orders and just wanted to make sure I wasn’t missing anything you need.” The nurse was holding the patient’s hand.

“No. They’re dying now,” the nurse said. She was looking at the vitals monitor; I shifted my gaze from her to the monitor too. The blood pressure was 15/0 (recall that normal is 120/80). The heart electrical line (usually a dramatic up and down) was flat. The patient was taking agonal breaths (the last gasps a person takes as they die; they aren’t true breaths). The patient’s eyes were blank. I had known that the patient would die that day but it was happening faster than I expected.

“We let the patient’s pastor know, but she won’t make it for another half hour or so,” I said. The patient didn’t have any family. They had listed their pastor as their emergency contact and the person who would make decisions for them when they couldn’t make decisions for themself.

“I know,” the nurse said. “That’s why I’m here. I’ll be here. I don’t let anyone die alone.”

The nurse sat quietly on a chair next to the patient holding their hand. I stood with her and the patient for a little while watching the monitor. Eventually I left the room and got my stethoscope. When everything on the vitals monitor was zero, the nurse closed the patient’s eyes gently. I did my exam and determined the time of death. Next time I looked at the room there was a picture of a butterfly on the closed door (alerting people that the patient inside had passed).

When I looked at the room later in the day the bed was empty and made with new linens. It was as though the patient from the morning had never been there. Yet, I remembered the nurse and patient holding hands as the patient’s heart stopped forever. I did not know what the patient did when they were alive but, at least, I knew they hadn’t died alone. I was reminded that small acts change lives. I was reminded that heroes only wear capes in movies. I wondered how many people die alone – I was grateful that this patient wasn’t one of them.

Springtime in Richmond

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The ospreys are back on the Richmond James River marking the arrival of spring in this city that sits at the hub of Virginia’s highways. Match Day, a different mark of spring, took place earlier this month. It always falls in March, an odd kind of Ides of March. This year, with that phase of the Doctorhood Quest behind me, I was unaffected by it. My Match Day will forever dwell on St. Patrick’s Day of 2023. That’s the day I found out I was moving to Richmond.

It was about this time last year when I saw Richmond for the first time. We visited the city only a week or so after Match Day to look at apartments. We wanted to move to our new home as soon as we could. I liked Richmond instantly. I’ve visited enough places and lived in enough more to know, as a gut feeling, if a place I visit is a place I could live happily. I had that sense about Richmond.

Spring is always a transition season but since I started the Doctorhood Quest it has come to mark additional important transitions that didn’t exist in my pre-doctor world. As I write this, I’m three-quarters of the way through my first year of residency (or one seventh through the whole thing). Residency years start on July 1, meaning that as spring slides into summer it marks the closing of one year and the opening of another year in residency. Residency years are hard years. As happy as I was last March when I transitioned from medical school for residency, I am enthusiastic to leave my first year of residency behind for the second year.

The seasons of my first year of residency almost followed the seasons as I knew them when I lived in Vermont. Summer was a glowing time when everything seemed possible because the leaves were new and vibrant; the sun stuck around longest. Fall was my favorite season because by that time the year was familiar; the weather was perfect. Winter was dark and gloomy; it was hard to understand why the world didn’t pause the whole season to drink mate and eat chocolate. Spring came with new hope and new beginnings.

With the ospreys back on the river and a recent vacation behind me, I’m excited to embrace spring. I love the ospreys and was so disheartened to learn last fall that they left for the winter. In Richmond there are numerous walking bridges across the James River from which you can see osprey nests and watch them hover-dive-catch fish. This spring marks a year living in Richmond and a year since graduating medical school.

Comparing this spring to last spring, I know the parks of Virginia way better now and so plotting my days off has become more exciting. And, more down to business, I’ve learned so much about medicine and how to be a doctor. The Doctorhood Quest continues just as the seasons march along unwaveringly. Year two of residency will be a time to develop independence and hone my knowledge. Internal medicine residency is three long years. So, I have two springs left before I get to confidently say I’m ready to work independently as a physician. Two more springs of celebrating the ospreys’ return as a resident. Then we’ll see where the Doctorhood Quest sends me. Perhaps I’ll also celebrate the James River ospreys as an independent physician too; only time will tell where I am three springs from now.  

The Doctor Pronounced Them Dead, The Doctor Was Me

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It was raining when I left the hospital. Perhaps the rain marked new beginnings for a soul recently gone or perhaps it was simply droplets falling because the clouds were too full to hold them. Death wasn’t new to me. My years in emergency medicine prior to starting medical school ensured that. I’d felt and smelled death before. I’d contemplated its inevitability and its conflicting identities of tragedy and blessing. Some of the deaths I’ve seen were sad beyond measure and some peaceful.

This patient’s death, the one I’d witnessed just before stepping into the rain, was my first as a doctor. For the first time it was my job to do the exam that declared the patient legally dead. It was my first time stating the time of death and filling out the paperwork declaring death. It was my first time calling a patient’s family to deliver the news that their loved one had died. I’d wondered how long after starting residency it would be before I would complete these somber duties for the first time. Now I know, 8 months.

It was one of the easier deaths I’ve witnessed. It came at the end of a long life. It was expected given the patient’s condition. In fact, just that morning, I’d started the patient on medications to keep them comfortable as they entered the home stretch of their life. I’d spoken to the family as they visited that day. As I walked in the rain, I couldn’t help but wonder if the patient had waited to hear their family members’ voices one last time before giving in to rest. After all, the patient died only hours after their family left the hospital. Their family wouldn’t see them again.

When a patient dies, we complete a discharge order, note summarizing what happened during the patient’s hospitalization, and progress note describing the circumstances of their death. This paperwork makes the process of death much like any other administrative task a doctor has. Yet, though technically similar, these notes feel different. Unlike other daily progress notes and summaries of hospital stays that fill patient’s charts, these death notes are not just a chapter but a conclusion and, because of this, they seem more important.

The inside of my car was fogged when I got in. Somehow the rain had cooled the outside while the warmth of the inside of my car lingered. I turned on the windshield wipers and blasted the air. I couldn’t really see but I decided I could see well enough to start slowly rolling forward. The rain drops bounced off my car. As I drove in the rain, I became sure that it marked new beginnings for a recently passed soul. Nothing else could possibly make the sky weep so beautifully. I wonder if the person whose soul had passed believed in some kind of afterlife. I imagined them observing my little car driving through the rain from wherever they were. I hoped they were happy. At least I knew their troubles in my world were done. May they rest in peace.  

The Winter Doldrums

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Winter in Virginia is quite nice from a weather perspective. Most winter days this year have been in the 50-70s and sunny. Yet, despite the loveliness of winter in Virginia, spending so much time in the hospital (as us residents do) means I only catch glimpses of it. Like a plant kept too far from the window, I feel like I’m missing the sun’s warmth. I’m in the middle of a several-month stretch of hospital rotations where either I have one day off a week or am working nights – which is the perfect environment for the winter doldrums to flourish. So, it comes as no surprise that I’ve found the doldrums creeping in around the edges of my life like a vignette Instagram filter darkens just the outer edges of photos.

My doldrums is a weariness that hovers below the surface and presents itself in small ways. Forgotten facts like place names and life tidbits that were once second-nature. Moments at work feeling longer than eternity and moments at home passing faster than light moves. Waking up tired after sleeping enough. Sitting on the couch sipping mate and watching my plants grow more often than I usually do. Contemplating where I’ve been and missing Paraguay as I trudge home from long shifts. Like most moods, I’ve taken some time to observe my doldrums. It seems stable and temporary, especially knowing better times will be here soon.

Learning medicine is a long journey where knowledge builds with each passing situation, decision, and interaction on the job. Now that I’m over 6 months into residency, residency (itself) is familiar. My focus has shifted from learning my new role and how to complete tasks to growing as a doctor and deepening my knowledge.

The doctorhood quest is a process with a high level of granularity. I make daily tradeoffs between learning more and undertaking life (chores, fitness, rest, etc.) – sometimes the pendulum falls on the side of learning and sometimes it falls on the side of life. Everything can’t be done at once, or ever really, but progress is made step by step.

The upside of the doldrums is that it’s a contemplative state which is suited for winter when the days are too short to maximize outdoor time. I’ve been thinking about what kind of doctor I hope to be by the end of residency. I’ll be done with residency sooner than it seems on these long winter nights. Just as winter will soon be replaced by spring. With the start of spring, winter and its moods will fade. The doldrums will melt away leaving a summer state of mind. Moods and periods of life are nothing more than a type of season. What a lucky thing that summers are long in Virginia and the winter doldrums finite.