February can feel like the hardest month.
Overwhelmed and exhausted, a resident recently came to me to ask, “Can we do something about call?” Defeat and despair had taken over his psyche. He felt unable to cope with the tasks of residency, including the seemingly never-ending demands of fielding consults, pages and patient needs. He imagined that the problem could be solved by taking less overnight call.
Hitting the bottom in mid-winter is a perennial problem inherent to the structural stresses of residency training. I by no means want to minimize the exhaustion from sleep deprivation and long hours in the hospital, but I do see unique biorhythms in residency training that create emotional sine waves across the academic year.
Program directors are especially familiar with the annual swings of a typical year. July arrives with the palpable nervous tension of residents starting new roles with new responsibilities. A fresh academic year is exciting and terrifying. Adrenaline surges and the learning curve is dizzyingly steep. By September, the new routine becomes comfortable and residents have assimilated and settled in. A collective calm develops over the program as residents focus on mastering new tasks, taking on new management roles, and achieving independence.
When the holiday season begins, stress naturally increases as residents jockey for time away, and family and social demands kick in. Fatigue starts to accumulate and compete with professional enthusiasm. The honeymoon comes to a close sometime in late fall or early winter. After the holiday season concludes, the long dark tunnel of winter converges with a sense of unending work. The learning curve has plateaued and the repetition of job duties becomes monotonous. Encouraging feedback may taper off as faculty begin to expect that the residents have mastered their roles.
And then February hits. In the north, the weather is rotten. Spring is nowhere to be found. The end of the tunnel seems as far away. Here in New Hampshire the sun may not emerge for weeks and temperatures hover around five degrees Fahrenheit. All that one sees outside is grey-tone. Months of snow, denuded trees, slushy pavement, and salt-encrusted vehicles banish any memory of light and color from our minds. The patients feel it too. The post-holiday, mid-winter crash of patients with chronic or terminal illnesses plagues oncologists, internists and geriatricians. Trauma services are populated with folks falling on the ice. Flu season compounds the despair and misery in and out of the hospital. This is the time of year that must be endured, rather than enjoyed.
Program directors just want to hang on and get everyone through to spring in one piece. The light will return soon, and residents will start to sense anticipation of the next phase of training. In the immediate term however, the exhaustion and demoralization of a really bad call night can feel catastrophic. My advice to residents is to not overreact. You are most likely doing fine. It is just February. The sun will come out again.
I recommend these basic recovery steps to survive the February fatigue:
- Become aware of your physical signs of stress such as body aches, stiffness, headaches, sluggishness, nausea, changes in bowel habits, “stress eating,” or irritability.
- Get some rest. Practice good sleep hygiene such as darkening the room, limiting caffeine and alcohol before bed, and turning off noise and screens.
- Carve out time each day for a mental break. Try to let go of the issues at work. Don’t ruminate.
- Exercise. Let your body help itself feel better by generating some endorphins.
- Prioritize your nutrition. The benefits of a healthy meal cannot be understated. Better yet, share a meal with someone else and enjoy good conversation.
- Talk to someone about your experiences, debrief, write and reflect.
- Build your confidence and enthusiasm. Start by examining the positive contributions you have made.
The doldrums of February are temporary. Residency tends to amplify the well-recognized phenomenon of seasonal affective disorder, but there is hope. Once again the path forward will unfold before you, and all that you have learned this winter will provide the platform to move to the next exciting phase of your career.
A program director’s perspectives on practical wellness in residency and how graduate medical education leadership can facilitate housestaff resiliency and self-advocacy.