The following manuscript was published as part of the March 2019 s/p The Match — One Year Later theme issue.
Editor’s note: The author’s identity has been withheld by the in-House Editorial Board due to the sensitive nature of the article.
I am an intern physician currently enrolled in a residency program, writing anonymously for fear of of retribution. I am also chronically injured and disabled — I won’t divulge the details, but I will say that it has recently interfered with my ability to perform my duties at work for weeks at a time. Incidentally, my injury was exacerbated by conditions at work, including standing for extensive periods of time and continuously ignoring my body and its needs, in the service of my calling.
In my time off from work, I’ve had the chance to reflect on being injured in residency, and one particular incident comes to mind.
Just prior to my injury, I had the special privilege of attending that top secret of all recruitment rites — the rank meeting. I don’t know what I was expecting. I knew the rank meeting might be vaguely dehumanizing. Perhaps we would have extensive conversations about board scores and med school reputations. What I didn’t expect was rationalized discrimination.
The meeting began innocently. We flipped through each applicant on a PowerPoint, which included a photo, board scores and medical school attended. We, as residents, were asked to comment on our interactions with those applicants during dinners and conferences. Of course, none of us spoke or interacted with any given applicant for more than a few minutes at at time. We had to form judgments on the basis of little information. That is just the nature of the process. Miniscule interactions form lasting impressions which we use to determine if an applicant would be a good fit. Now that I am on the other side of this process, I am all the more cognizant of the serendipity of this process. All of this, I could accept.
Then we reached an applicant who had encountered chronic medical issues in the course of their medical school career. Those issues had been reported and discussed, and per their physician, they had resolved. There was a pause in the room.
“I just don’t know if this applicant has the stamina to make it through our program,” stated one resident. Everyone around the room nodded emphatically.
I remember feeling hurt and shocked. On paper and in person, this applicant was otherwise entirely qualified. However, the mere suggestion that they might be less than perfectly healthy was enough to disqualify them. I had heard accounts of applicants who admitted their mental and physical illness on ERAS forms and then struggled to match due to their radical honesty. But here I was in the room where it all happened. I was now a participant. I was now complicit.
The message was sent to all of us in the room in that moment: If you are anything less than perfectly able-bodied, if you are anything less than airtight mentally and emotionally, we don’t want you. We want interesting, but we want the “right amount” of interesting. We are terrified of hiring a resident who — god forbid — needs to take time for themselves and be anything less than perfectly productive in the course of their residency.
The truth, of course, is that residents and physicians are anything but airtight, physically, emotionally or mentally. We are human. Our refusal to acknowledge this humanity has resulted in some of the highest burnout, suicide and depression rates of any career in the world.
Of course, this culture in part is born from limited resources. Co-residents and residency leadership bear some of the consequences and burdens of any resident forced to be human.
My fellow residents would need to cover my patients and add to their already inhuman stresses (if or when as applicable) I take time off to be a mother, to seek treatment for depression, or a physical injury. No wonder they fear for our humanity so deeply.
If we fear our own humanity and judge it as an inconvenience, how do we treat and feel about the messy humanity of our patients? How long before we start to see them as inconveniences too?
I struggled with both mental and physical illness in the course of medical school. I chose to be upfront about these struggles only once I started residency. Now, I regret not admitting my own struggles during the application process, because I’m not sure how I feel as an employee of a system that treats human beings this way.
As a currently injured resident, I am appalled by a culture that denies the very real human experiences of our medical trainees. I now know that they see me as an inconvenience in my currently injured state. They will judge me and resent me and push me until I am productive and working again up to their standards.
To the applicant we denied in that fateful rank meeting — I applaud your honesty and candor. I hope you’ve learned valuable lessons in the course of your illness. I hope they allow you to serve as a compassionate healer. I hope you help reform this broken system, because God, do we need it. To be honest, I don’t think we don’t deserve you.
Image credit: “Stairs” by Shawn Zamechek is licensed under CC BY 2.0.