The following manuscript was published as part of the March 2019 s/p The Match — One Year Later theme issue.
The faint glow that is the light at the end of the tunnel hits my face as I realize that intern year is almost over. One would think that having been through the personal loss I have — losing two beloved older brothers at a young age — that intern year would be more than manageable. Yet this past year has been, for me, a chaotic roller coaster ride.
The transition from a fourth-year medical student to a first-year intern was not a simple process. The overwhelming and perpetual need to prove my self-worth very quickly stripped away my individual identity. I felt like just another anonymous first year intern waiting to be molded into a competent resident. All the unique cultural identity and self-confidence that I had built up in my years of education and life experiences prior to intern year were suddenly lost, replaced by anxiety and self-doubt. I eventually started feeling alone and began to believe that my experience was isolated and that I must have been “weaker” or “less resilient” than my peers, none of whom seemed to be struggling with the same issues.
Now with the end of my intern year in sight, I want to say to my peers who have made this journey with me, and for those who will come after me:
Listen. You are not alone.
High emotional exhaustion, high depersonalization, and high burnout rates are a few of the symptoms that medical residents experience at higher rates as compared to the general population. In a study conducted by three freestanding children’s hospitals, 20% of pediatric residents met criteria for depression and 74% met criteria for burnout. To date, only limited types of interventions have been successfully implemented into residency programs to address wellness.
Yet as we wait for our teaching institutions to devise solutions, we must not overlook the fact that we are surrounded by resilience. I recognized this in my own friends and colleagues who tethered me to sanity throughout my first year. The skills of a physician can seem inversely related to the capacity to be a human being, but that has not been the case in my colleagues. While my patients taught me how to be a physician, it was my colleagues who reminded me how to be a human being.
One of my colleagues has major depressive disorder. In spite of this diagnosis and her struggles with depression, she still manages to be an amazing clinician. It was actually her diagnosis that helped her be so empathic and emotionally in tune with her patients. More importantly, her frankness about her depression is particularly admirable in a field where vulnerability is far from the norm. Her courage to proclaim “I have depression,” in a culture that predominantly promotes silence, reminded me that depression is very much a reality in medicine and that with acceptance and treatment, we can still be successful clinicians in spite of it.
Another colleague lost a close family member during inpatient wards. Amidst her personal chaos, she was able to compartmentalize and take care of her patients to the fullest extent. Yet, she recognized that she could not adequately fulfill her duty to her patients to be a fully present and aware physician unless she first addressed her own healing. As such, she took the time off she needed in order to attend the funeral and grieve with her family before returning back to wards. As interns, we often tell ourselves that “It can wait.” Whether it be a phone call to our parents, a get together with an old friend, or even sleep, our mantra is that “It can wait.” Yet time stops for no one as we complete our residency training. We should make time for our friends and our loved ones while we can.
The stories of my colleagues do not end here. One has a history of deafness, and that experience transformed her into an amazing “listener” of her patients and a strong patient advocate. Another grew up with multiple foster siblings and carries the biggest heart towards not just patients but also colleagues. Each of my fellow residents have their own stories, and their stories remind me that we are all human beings, who are not defined simply by our presentations on rounds, our procedural abilities, or medical knowledge.
We need to learn to take care of ourselves and overcome the stigma that self-care equates to weakness. Barriers to mental health care continue to exist. Approximately 61% of residents felt they would have benefited from psychiatric services but only 24% of those actually sought treatment.
With close to 50% of American pediatricians reporting burnout, the longevity of the profession is now at risk. Yet one should try not only to avoid burnout, but also reclaim the value and meaning behind our professional calling. “Ikigai” is a Japanese word for “reason for living” or “purpose of life.” Perhaps as residents, we need to remind ourselves of our own ikigai to improve wellness and overall sense of “self.”
The M.D. behind our names is a huge burden to carry. It is a privilege that we have earned through years of studying and unfortunately for many of us, mountains of debt. It means we have the skills and training to care for those in need. However, we often forget that right before that M.D., is us: our identities, our “selves.” As we make at times great personal sacrifices to be better physicians, it is common to lose sight of who we are, our purpose, and how to feel.
To the incoming interns, I write this to say that it is okay to talk about these issues and it is normal to have these feelings of anxiety and self-doubt during your first year. Know that you are not alone in this process. Remind yourself why you decided to pursue medicine. And while you attend to your duty to heal patients, do not forget to also heal yourself. If you ever feel disheartened, most of all, look towards your colleagues to reignite that fire within you.
Intern year will be rough, but you do not need to endure the year suffering in solitude. Seek out the help of your friends, family, and colleagues. Remember who you are, your sense of self, your ikigai. You have been building yourself and who you are, from the ground up, from the time you were small, long before your M.D. came along. Do not forget to keep tending to that name, to you. It is not only okay but in fact critical to focus on yourself and your wellness, rather than always on that Medicinae Doctor after your name.
And above all, remember that you are not alone.
Author’s note: This piece is dedicated to all my colleagues, to those who have paved the way, to those who will come after me, and to anyone who has ever felt alone in this journey. Sincere thanks to all my colleagues for inspiring me. Explicit permission was granted by each individual to share their stories. Special thanks to my program director, Dr. Eyal Ben-Isaac for providing me guidance and support. In loving memory of Stanley Kuo and Sammy Kuo.