Residency is hard. Anyone who has gone through it can attest to that. While I was getting intimately acquainted with this reality in August, 1.5 months into the first year of my internal medicine residency, my soon-to-be fiancé was diagnosed with cancer. Navigating residency requires a lot of stamina to begin with, but it was even more taxing while feeling physically, mentally, and emotionally maxed-out. During my intern year, I was simultaneously learning how to be a doctor and a husband and not knowing if I was doing either one well. Being a physician, more-so a resident, creates a unique set of challenges when your loved one is sick, and I learned some lessons the hard way as I struggled to keep all the plates spinning.
To give some background about Megan, she is a heart transplant recipient with Type 1 diabetes. She was born with a single ventricle and received her transplant at 10 years old. She did not let her heart condition, transplant, or diabetes stop her from living life to the fullest. She always had an adventurous spirit and wanted to try new things and see new places. She acted in plays and played sports, traveled, and volunteered.
Meg went to school for occupational therapy and found that she enjoyed helping people work on their functional skills. While working on her degree, she was diagnosed with cancer for the first time. She had post-transplant lymphoproliferative disorder (PTLD). PTLD is a type of lymphoma that arises due to the anti-rejection medications interfering with the body’s ability to fight off cancer cells that it would normally eliminate.
Despite this, she continued school and her clinical rotations while undergoing chemotherapy for three months. She pushed through it and wanted to stay on track as much as possible and ended up graduating on time. Unfortunately, three years later, the PTLD came back.
The word comes from German Zug ‘move’ + Zwang ‘compulsion’, so that Zugzwang means ‘being forced to make a move’. Games like chess and checkers have “zugzwang”; a player must always make a move on their turn even if this is to their disadvantage.
The stereotypical internal medicine doctor spends too much time overanalyzing data, makes rounds last way too long, and sometimes doesn’t end up changing anything. I fit into this archetype nicely. I was talking to one of my chief residents about how I have been struggling with making decisions inside and out of the hospital. “You mean as an internal medicine doctor, you have a hard time making decisions and constantly overthink things?” he said sarcastically, “that’s quite a shock.” I laughed because he was right. Just before this conversation I spent way too much time with one of my interns discussing whether we should keep a patient on a low-sodium diet.
The year had been filled with making decisions that I did not want to make. Should I send out a program-wide email to let everyone know what’s going on even though I would prefer to keep things private? Do I transfer to a residency program that will be closer to Meg? When should I take a leave of absence? Should we try to plan a wedding despite all of this? I hated making big decisions yet was faced with a dozen life-changing ones.
Common phrases I would hear are “there is no right answer” or “you have to do what’s best for you.” These are said with good intent, but to someone paralyzed by indecision, it can make things harder. There was this perpetual feeling that every decision I made would be the wrong one. Zugzwang encapsulates this feeling in a single word, and I would often feel it hanging around each decision.
“I don’t know how a man decides what’s right for his own life, it’s all a mystery. Cause I’m a man, not a boy, and there are things you can’t avoid, you have to face them when you’re not prepared to face them.” —Fight Test, The Flaming Lips
Jordan Morrison-Nozik, DO is an Internal Medicine resident at the University of Rochester Medical Center, from which he is planning to graduate in June 2024. He attended the State University of New York at Buffalo for his undergraduate degree and the University of New England College of Osteopathic Medicine for his medical degree. He enjoys hiking, skiing, photography, and relaxing with his cat.