I haven’t posted in over a month. Every day, after I have worked from 6-6 or 6-7 or 6-9, driven home, bathed and put Little E to bed (on the days when that is possible), I am faced with a “decision”: stay in bed or get out of bed and try to do something. Invariably, E has placed her tiny hand across my arm as I hum our bedtime song over and over again and I am so deeply exhausted that there is really no decision. I slip into the comfort of sleep leaving the rest of me fallow for yet another day. The sleep I get from 8:30pm-midnight beside my baby is the sweetest and the only reward I have these days and I am reticent to give it up, even for just one day, to get my shit together in life’s other domains. And so: no writing. No responding to emails, no exercising (I am about as strong and vital as a bowl of tapioca pudding these days), no doing writing for the research projects that I am still ostensibly participating in. Just sleeping, waking, working, and doing whatever small amount of mothering I can do in the hours between.
It is hard to know whether to tell the truth about internship. Doing so seems like a betrayal, but of whom? As in any hierarchical culture (think: the military), there is an unspoken taboo against speaking out about how it feels to be at the bottom of the pile. We instinctively identify with the system that we are trying to enter and to speak about its flaws is to risk being exiled from it. The first rule of intern year is: You do not talk about intern year.
But, I did not join the military or fight club. I decided to become a doctor, a healer, a person tasked with the care of those who are suffering. And right now, I am exhausted, uninspired, and in an unhealthy place physically, spiritually, and emotionally. I find myself wondering about the merits of the current culture of medical training, whether it produces the kind of doctors we want caring for us, whether it is the system or me that requires reform.
So here’s the truth about internship: It’s really, really hard. I have never felt so exhausted, so consistently pushed past my limits. After a lifetime of working to cultivate an open heart that is strong enough to face suffering, I find that I have to encase it is armor just to survive the days. There is just no time to process and integrate everything that I am experiencing. Instead of being wiser than ever about people, I am less and less wise, harsher, more judgmental, and less patient. I am in constant physical pain, unable to do the exercises and get the rest that I need to keep my back healthy. I resent my job every day because it does not allow me to be the kind of parent and spouse that I want to be. I began this path hoping to become a strong warrior, guide, and advocate for those who are suffering and now find that I am the person who is suffering, who is in need of guidance, of compassion, of healing and recovery. Perhaps this is the deeper intention in this training model?
Medical residency was at the start designed for unmarried men who committed to live in the hospital for the duration of training, hence the term “residency.” There is much nostalgia in medicine for the time when the ardent mission of medicine was all-consuming. There is certainly precedent for this kind of professional training. In prior times, apprenticeship in many fields required a period of servitude to a master, often of a live-in nature. Perhaps the gravity and complexity of medicine requires a period of complete 100% commitment in order to master. In which case, perhaps 32 year old people who are also parents and spouses are simply ill-suited to the acquisition of this profession.
But then I think of all the other people in the hospital–nurses, psychologists, chaplains, radiology technicians, the list goes on and on. These people are all protected with respect to the amount of time they are expected to work. In fact, it would be considered unsafe for many of these people to work more than a certain amount per day or per week or per month. How exactly are doctors different? Are we immune to the effects of chronic exhaustion and life deprivation or do we just think we are? I get that doctors are the people who have to made difficult decision and judgements in the toughest moments for very sick people. I get that some training under pressure is necessary to be able to rely on people to consistently make these decisions correctly. But does it have to be so relentless for so long?
I challenge myself to think of a better training model, but to be honest, I am simply too tired. My brain is in survival mode. I guess the best thing to do is to keep my head down and keep going day after day, and hope that when it is over, the person I was is still in there somewhere, ready to care and feel things deeply again, ready to find a sustainable balance between service and self-care.