Three Months to Go

I am closing in on the end of my first year of residency, my intern year, and have only a couple more months to go before I lose that lackluster title. Currently I am back working in the ED and have one last very hard rotation to look forward to, the MICU before I coast out with my final ED/vacation month and a month of OB/GYN focused on delivering babies. This year I have seen many challenges both from my residency and personally, just as most of us have. I have seen residents starting families, some ending relationships. Most everyone is 10 years younger than I am and going through the tough growing & self-realization process of become an adult amidst the demands of this most intense training period. We have our own struggles and there are only a few of us that understand the struggles that come with being older in this world. As with everything, it is never one sided though. I have had a set of skills I could draw on to help manage my struggles that are unique to being older and I don't forget to credit my past years and careers with helping me, but the years definitely make some things harder.

When you are planning for your 40th birthday while most others are planning something just shy of their 30th it is true that work hours are just harder! Physical & mental fatigue set in about 4 hours sooner I think. I am also the only single resident in my class and being that I don't easily fit into the "young couples" get togethers makes finding new friends and supports a bit more difficult. There is not much time outside of work to find a community and it is made harder that by my age most people have their communities all carved out already. They don't go out looking. When there are events with other residents often the choice of activities to blow off steam are things I no longer find interesting, like increasing your blood alcohol level in loud environments, or involve pushing the limits of youthful vigor with more sleepless nights on top of an already maxed out schedule simply to get in a few turns of skiing. I find music, silence and peaceful repose more attractive that I sometimes like to admit to myself. Mostly I love time for reflection to absorb all that is happening.

I should not complain about all of it though because being "mature" has had benefits too. I have felt a level of emotional comfort with these new challenges that I see many of the younger residents struggle with. Once you have had multiple careers and started your life over multiple times you soon realize that nothing here is permanent, including the damage, and that your self identity is more solid and tied in one place than when you were younger. I have seen some younger residents eviscerate themselves when they stumble, make mistakes or don't meet their own expectations. I often worry that the emotional burdens of medicine and residency are sometimes beyond the emotional maturity level of many of those being trained. When this happens I fear the stresses may cause permanent changes to some, turning them into angry and disenfranchised worker bees. I find these situations just as tough to bear at times, but I also understand I am a good person and that I have many excellent skills and talents despite my occasional inadequacies. I know I will fail at some things and I am okay with that. I know I will succeed at some things and understand this does not make me special. We always run into tasks beyond our ability and we survive to see ourselves succeed at different tasks that others may stumble over. This does not take away all the pain of failure, but it does give you a bit more of a cushion. It is also nice to have enough anecdotes or wrinkles that my patients feel comfortable with me. I don't look like I just left high school and I can find common ground with most anyone now, whether they are an auto mechanic, a housewife or a particle physicist.

Despite what I feel is a balanced approach overall, I am happy to see this process moving every day towards its eventual end and the beginning of a more autonomous life focused on my goals and not those of some upcoming board exam. There are still situations here that I am trapped in and that hurt very badly and that cause me to struggle with myself unnecessarily. The old phrase "that which does not kill you only make you stronger" is great for the young, but you realize as you get older that sometimes permanent damage to your soul is worse than dying. Some hard things hurt you and don't go away and there is no point in trying to test yourself against them because it is a lose-lose proposition. I miss my friends dearly in Seattle and I struggle with the fact that their lives are growing and moving onward without me. I have little time to reconnect with my fractured family now that the desire to do so has grown so much. I have seen so much of who I am as a person fall to the wayside or atrophy from lack of use. I realize now that being a physician, although satisfying and challenging, is far from enough to make me feel whole. It is merely one more tool, a good and useful tool, but one of many that are needed to create the life I hope for. I long for creative and social outlets to share and explore all that I have learned these last years. I see new value to so many things and can't wait until I can prioritize my life according to my needs and values and less so for a residency's needs or board exam's demands. I see this training and career as a new beginning to a much larger understanding of the world around me and I simply want to experience it in all the facets that are available and especially through those facets which I have had to ignore for so long. This hopeful feeling for the future is my last weapon against the sadness I feel when I see how much of my life and opportunities have passed already - how much I have missed out on during the pursuit of this profession. Nothing comes without a price and the price is heavy, but the only way to justify the cost is to make as much as is possible out of what you have earned. That is what I plan to do and that planning keeps me going, and will keep me going through the next 2 years of training. I hope when I am done that I will be a competent Emergency Physician, but more than that, I hope that I will again feel like a whole human being.