UofTMed Alum: How Therapy Revealed the Ills of Residency

I think of my second year as an internal medicine resident as the year I became a bad person.

While determined to keep learning and growing, I started to become perpetually angry, frustrated and anxious. I discharged patients too early, and had to readmit them days later. And I’d loathe them for coming back – as if they were doing it to spite me, to prove I wasn’t smart or capable enough. I stopped asking questions and instead began cramming facts into my head, just so I could spontaneously say clever sounding things like, “…and you wouldn’t want to forget tularemia.” 

I made it through on far too much dark humour — what we call “coping.”

It wasn’t until 10 years later that a psychiatrist made me realize just how unhealthy that was.

I had gotten through residency, advanced in my career and was working as a critical care specialist at Sunnybrook Health Sciences Centre. Then, in the span of three years I had two children, one of whom was very sick in the first month, and I lost my father to cancer. I was broken by the intensity of all this, and terrified at the prospect of having to return to work in intensive care.

This time, I got much-needed anxiety medication and psychiatric help. It was as if the future opened up to me. Instead of feeling like there was no way forward, I started to believe that though it was challenging, I’d figure it out.

Not only did visits with my psychiatrist help me through my grief and the emotional turmoil of new motherhood, however, they also uncovered unsettling insight into my medical residency and my profession. This is why I continued going to therapy for three years.

One of the first things my psychiatrist told me was that I didn’t have enough compassion for myself. That the language I used to describe myself and my experiences were not kind or helpful – I spoke of not doing enough, not meeting all the expectations I had set for myself. I had to change that to “I’m doing my best.”

This isn’t an attitude we’ve embraced in medicine. And yet, your best has to be enough – because in this environment of endless ambition in medicine, you will never be satisfied.

These are the three big revelations I had about medicine and my residency, while seeing a therapist:

1. Medicine isn’t about you, or me

It’s about the people we look after and the people we work with. Whenever medicine becomes about whether or not I looked smart or someone respects me or I impressed someone, is when I lose sight of the goal. 

In my second year of residency, I was terrified by the designation of “senior” resident. And what was my biggest fear? That the first-year resident would know more than I did, and make me look bad in front of my attending physician. 

But we become great at what we do by focusing on our patients’ needs, and on collaborating with colleagues, not trying to compete with or impress them.

2. Being a good physician is exhausting

To do this job well – to be kind, compassionate, composed, ethical and supportive – is exhausting.

The difference between a “good” and a “bad” week in the intensive care unit for me is never the medical pathology or patient load. Instead, it’s the emotional weight: the sad stories, the unfair diagnoses, the dramatic family dynamics, the painful decisions. By the end of a week like that, I’ve got nothing left to give, and I just want to crawl into my bed and shut my eyes until I’m ready to face life again.

3. We need to refuel

Our ability to show caring and compassion is not infinite. It gets depleted and can become replaced by dark humour, cynicism, anger, resentment, complacency and, worst of all, apathy. 

This job doesn’t make you a bad person. You don’t lose your empathy or your goodness. It’s just hard to care about other people when you don’t feel cared for, or are not caring for yourself. Knowing what refuels you back to your normal, good self is as important as knowing how to resuscitate someone who is sick. What makes you feel better, like the real you?

For me, it is spending time with my kids, my husband and friends; listening to podcasts; watching The Simpsons; going to a matinee movie alone on a post-call day; and rewarding minor victories with new shoes. These things can get me back to my old self, and ready to work again.

We don’t tend to talk much about our personal lives in medicine, as if being busy with work is the only legitimate priority we’re supposed to have. But we also need to be allowed to refuel with the people and things in your life that give us the energy to give again.

___

If I had these revelations during my residency, I would have been kinder to myself. I would have seen how having compassion for myself would lead to being more compassionate to everyone else. There would have been less anger, fewer tears, less inappropriate humour – less need for “coping.”

As a clinician educator, I talk a lot with residents about their experience and their stories. But I find that sharing my own struggles with wellness is what really gets the conversation going. I think those of us more established in our careers need to open up a lot more about our own journeys – and not in the form of inspirational success stories, but as unpolished accounts of how we learned to thrive within this stressful, exhausting, painful – but also wonderful and rewarding – profession.

Shelly Dev, MD ’01 PGME ’06, is a Faculty of Medicine graduate, a professor in U of T’s Department of Medicine and a critical care physician at Sunnybrook Health Sciences Centre. Hear more stories like these at our upcoming UofTMed Inside the Issue event June 7th and in the next issue of our award-winning UofTMed magazine. Get in touch with our alumni relations team to share your own story.