#pgy4

[beingdreeyore]

We had an incident at work today. So much drama. It's been the longest day. People died.

It's funny though. I see myself as a difficult person. A hard person. Abrasive. Difficult to get to know. Difficult to keep. My standards drive everyone away. Well, except the men I'm dating who refuse to meet those standards. Those men I keep around because apparently collecting red flags is a hobby of mine...

But when shit goes down, I know I'm a good person to have. I'm loyal. I'm good in a crisis. I care about what's right. I will wage war against those who have done wrong. I never learned how to sit by when I see things occurring that I think aren't just.

So I don't get why, when someone working their second day as a psychiatry registrar was irreversibly traumatised, when I told them to go home and I'd cover them and their patient load, people said kind things about me.

Helping others in crisis should be the bare minimum. The very bare fucking minimum that we can do for each other. And yet when I called him to ask if anyone had offered to take the on-call shift he would have to do once his normal day ended, he sounded surprised. Like why would anyone?

When I said to him "it's not okay this is happening to you" he got emotional. Because management hadn't checked in. His consultant hadn't checked in. He thought, on day two, that he was already failing because something that no human should ever have to experience had left him vulnerable. And surely if this went beyond the normal experience in the role someone would check in. Right? RIGHT?!

So I got angry, in that arrogant way that I do, and told him that me working his shift this evening wasn't up for discussion and that if management had a problem with that he was to tell them to call me directly.

I burn bridges. I know that. I know better. But I do it. Because the hospital system is brutal and broken. Because it's not okay to let other humans suffer like that.

The thing though, is that when other registrars messaged me about it, presumably because he'd told them, I didn't reply. I don't want compliments on how "kind" or "sweet" I am. What I want is for all of us to do better. To be better. To demand better. Why did I have to be the one saying he was in no state to work tonight? Where was management when I was having that discussion with him? Some of the members of management are doctors. Fucking career psychiatrists. Where were they when he was being interviewed by the police or talking to patient families on day two in psychiatry and without a senior in the room?

I'm so angry. I'm angry at the system that is broken. I'm angry at the consultant who refused to support his registrar. I'm angry at the management team that refused to do anything that might equate to work. And I'm angry that any human should have to experience what that registrar did without a support network to catch them.

Adding 5.5 hours to my day so that he isn't traumatised for life isn't an act of kindness. It's the bare minimum. And it should be the expectation. This is fucking psychiatry for god's sake. If we refuse to protect each other from severe emotional trauma then what the fuck are we doing here and how can we expect other disciplines to do better???

[loulovestowrite]

I’m trying to work out some picture of my future…

A friend on the same training programme asked me yesterday what area of psychiatry I want to work in. 🤷🏻‍♀️

Today another friend (who, curiously, we both know) asked what my ideal work day would be. 🤷🏻‍♀️

To both I replied something about marrying rich and spending my husband’s money all day. But back in reality I have no clue. None whatsoever. So much has changed since I knew the answer to those questions.

So tell me, medblrs and non-medblrs, what would your ideal work day look like? What’s your perfect day at work???

[mashupofmylife]

Life lessons from the psychiatry resident workroom

[doctorspork]

"I don't need mnemonics; I have residents for that." - ED attending

[15-blade]

Ah a few minutes of rest... time to attack the email inbox 😖. First a medblr update. Does anyone even medblr anymore? Who cares I need to vent.

The last few months have been the busiest of my entire residency career and, well, life actually. Maybe I’ve been sheltered so far in my residency but this is the first time I felt, like, this is what is meant by “residency” where you live breathe work residency and reside at the hospital. I think I thought that a few times before but the past few months really blew that out of the water. 100% of my time not sleeping has been devoted to residency. 100%. And the sleeping has been pretty limited. I’ve been on the busiest rotation of my program, and we’ve been the busiest we’ve ever been. On top of that I had to do a lot of work to facilitate graduation for our chiefs and now I am taking over as chief and taking on all of that work. On top of that, I was interviewing for jobs this spring and have finally signed an offer letter because there was a bit of back and forth to make sure they have everything I need to practice the way that I should (yay! but stressful). On top of all that, my co-resident has not been doing well. Actually, she has not been doing well this entire residency. Many people have tried to help her along the way, including me but she is her own worst enemy. And her lack of competence. And her ability to take feedback and improve. And her inability to accept fault ever. And her fucking antagonism. She is the most antagonistic person I’ve ever met. I don’t really believe in personality disorders but hooo boy does she have one. Maybe the most difficult person I have ever dealt with on a prolonged basis. So she is being held back a few months. This is good actually because I was wondering if we were going to graduate an incompetent resident. I’m relieved that our program director does not want to do that. Wish I could go into it more but don’t want to even on an anonymous account. She is going to stir some shit though. Given that I have dedicated so much to my program, which I genuinely feel is giving me great training, I have some feelings about it.

Anyways, been doing all the work plus more.

As one of my attendings told me: the reward for winning a pie eating contest is - more pie. (if you do good work you only get more work to do)

[tachycardic--tendencies]

One of the faculty that was hired into our program this year was hired because his research somehow involves improving rheumatology-orthopedic surgery relations. And ngl, looking at some of those ortho bros and all their muscles, I’m kinda out here trying to be volunteered as tribute. 

[md-admissions]

Help and Failure

As someone who is often put in a position to offer advice and as someone who has never shied away from being very open about my own less-than-smooth journey in medicine, I want to share something that happened today with you all. Especially the young ones, who are just starting or have barely started their journey in medicine. 

Let me start by saying that I have never been ‘naturally bright’. Every ounce of ‘intelligence’ I have been praised for having was either through titanic amounts of work and tenacity, seeking tutors and friends to help me. A lot of failing and learning from the failure to rise up and improve. So I’m no stranger to the humility and shame of doing poorly, and the important lessons it teaches. 

That said, I’m still a human being so I still really hate being wrong or failing. And growing up, failure was not met with kindness. It was met with yelling. A lot of yelling. Yelling that extended beyond the grade itself into unnecessary dissection of my personal faults and decision making. For you see, my parents loved to ‘diagnose’ problems. B- on a test? Must have been because we let you get dinner with your friends. That was a mistake. Didn’t make honors? Why are you crying, you weren’t honors material anyways, you like reading comic books too much to be in the honor roll. Stuff like that. That’s the kind of, ha, encouragement, I received. 

So understand that I don’t, at baseline, have a healthy relationship with failure or asking for help. It took me years of therapy, finding good role models, taking to mentors, findings supportive friends and family members to unteach and help me learn better ways to frame the narrative of my failures into stepping stones upon which to build my success. And on the whole, I do pretty well these days. 

But today was very disappointing. Already really down from my grandma’s passing, my program director, who is amazing and meant no harm and was wholly pleasant and kind and supportive about the whole thing, asked me to come to her office. She wanted to arrange a time to meet after my grandmother’s funeral to talk about my abysmal in-training exam score and how we could come up with a study schedule together based on my weak areas from the test. It came to no surprise to me that I had tanked the test. I blew through it, not really interested or focused, because I knew that if I didn’t hurry, Lord knew how many consults would be waiting for me. And I had already gotten into the funk I always do with standardized testing: I’m gonna suck at it anyways, why try harder. I can usually lift myself but I was so stressed out, so nervous. So I knew when I got that score back, I’d hate myself for it. I just didn’t think anyone would care enough to notice or point it out. 

Initially, when my program director brought it up, I felt like my cover had been blown. Not only was my grade, albeit not a real grade that counted for anything except personal pride, not up to snuff, but also an attending I really admire had mentioned in her eval that she loved my enthusiasm and desire to learn but wanted the program to help me shore up my ‘fund of knowledge’. Shit. I had always known. My medicine program never prioritized my education. What I knew, I had to forage for myself. I think it’s fair to say that most of what I learned in residency was self-taught. So of course, I already felt like an imposter, getting into my dream fellowship, a place I never thought would take a scrappy, foulmouthed internist like myself. I actually recall myself physically wincing when I heard that, although I knew no one would strike me. 

Internally, I was a storm of guilt, shame, embarrassment, and self-hate, but also strangely relieved. I felt like a cry for help, no matter how soft, perhaps even one I had been trying to hide for a very long time, had been heard. It was also the first time in a very long time anyone in a position of authority did not ridicule or belittle me for my shortcomings, did not threaten me with the specter of punishment or disappointment, but asked to help me without any trace of pity. She genuinely just wanted to help me do better for myself. 

I’ve spent so long in residency depending on myself. Hell, I’d say in life as well. Although an uncomfortable and sad experience, it was also very healing and I felt hopeful. Perhaps this time, as I often have to do, I have to take the long road, the harder road to get to where others get to easily. But I take comfort in knowing that this is the road I always have to travel. I am tired of traveling it, but it’s nothing I can’t do. And I will have some help along the way this time. 

[biwenmd]

Tumblr is still here - I think I'll start again.

Trigger warning: suicide and mental health will be mentioned in this entry.

Hello, Tumblr.

How have you been?

It has been a long time since I've blogged. I'm now a registrar (PGY-4) in Australia. I work in a major hospital in a big city. I've survived medical school and intern year. I'm making it through the pandemic.

So why haven't I posted or recorded anything for the last few years? I have been interested in recording my experiences. I enjoyed using social media. So why I have stopped?

I stopped because Social media was exhausting.

When I started this blog in 2014-15, I was a naive little medical student excited to share my experience in knowledge.

However, by half way through medical school, I was burnt out. My undiagnosed general anxiety disorder and depression finally pushed me over the edge; I was an anorexic, 26 year old medical student who desperately sought comfort and friendship in people who were clear in their disinterest in me. After a few months of playing tug of way between happiness and anger, sudden crying fits in front of my roommates, worsening tremors during presentations, I snapped.

There were two triggering moments that led to me to attempt suicide.

One of the them was when a classmate found out about this blog.

I made the mistake of revealing my identity to a group of friends one night. Someone in our little gathering found out the existence of this blog and ask about it. I admitted that it was me.

I should have realized that from then on, I wouldn't be able to post any opinions or make observations without someone taking it personally.

One night, I received a text message from a former roommate who assumed one of my entries was about them. That particular entry was making a generalized comment about small classes and gossip. It wasn't about her in particular and could be applicable to any class or school. Unfortunately, I was cursed out for being ungrateful. So I apologized.

Since then, I have tried to avoid any entries that contained opinions. That made blogging less interesting.

And then I stopped.

Nowadays, I keep to myself. I haven't been able to keep friendships for long because I am too frightened of losing people's trust by saying or doing the wrong thing. I am scared of personal rejection, even though I am in a field where I can face rejection any time and anywhere.

I know. It's not healthy.

Therefore, I have decided to try again with blogging. Not necessarily to find a masked audience to like me or to find friendships without the fear of face to face rejection - but to have an outlet about my experiences as a doctor during a pandemic. And to record my experiences so that I can look back and learn from mistakes I had made.

So, cheers.

Here is to another attempt.

[beamseyeview]

On an elective in #londonontario and found an old sketchbook from when I first started doing oncology doodles in PGY2. . . #breastcancer #radonc #residency #pgy4 #radiobiology #sciencedoodles #doodle #medicinedoodles #radiationoncology #radiationphysics #radiationtherapy #radiationart #radiationdoodles #biologydoodles #cancerart #oncologyart #oncology https://www.instagram.com/p/Bj2siH1nFZn/?igshid=vj64nuw9p8ak

[pleasedotheneedful]

Re: that horrible incident from peds urgent care last fall

My PD attempted to put me on a "remediation plan" so I called GME who said "uh no all remediation plans must come through us first". The plan involved 30-something extra peds urgent care shifts, at the expense of my evenings, elective, and educational time. A plan made for someone to fail.

I also called a med ed-savvy lawyer who helped me write a rebuttal letter. The CCC met with me a month later, reduced the number of shifts by about 66%, and then said "no, this is a 'performance improvement plan.'" They did not have me sign any weird documents.

In the same meeting they also said this wasn't based on one attending's feedback, but at no point do they ever show additional negative feedback and nor have I come across any in the extra shifts I've done. In fact, one told me I didn't need to be so overly cautious because I knew what I was doing.

I was going to provide another rebuttal but decided you know what, fine, I can handle the modified extra shifts. I didn't want to burn bridges, I'm still grateful I was able to come here.

However, I worked with the dreaded attending today and it was as bad as one can expect--as a PGY4 I was grilled like an intern playing "guess what I'm thinking." Later they asked me what my plans were after residency, I mentioned a couple of job offers I was weighing and they said something to the effect of "you're probably a better internist than a pediatrician."

Honestly, I'm not even mad at him. This is who is is, this is what he does. And I still respect the way he thinks about patients, and he's pretty knowledgeable--most attendings couldn't keep up with him.

I am pissed at my program because they have not only NOT supported me during all this, but took his feedback as gospel and put me through all this bullshit... then continued pulling the scab with a new meeting every 3-4 weeks. I process, I get better, and then we start all over again.

This is becoming physically intolerable to deal with over and over again based on something that remains largely unsubstantiated. I really don't want to get my attorney back in the fold but if the program tries to add more bullshit to this "improvement plan" we're going full-court press.

Also, huge conflict of interest as the attending in question is also head of GME.

[beingdreeyore]

I just saw a Telehealth job advertised online that I got excited about... that's the first time I've felt excited about work in about, oh, two and a half decades...

It's a work from home, start part-time, set your own hours job... Working fairly autonomously with a good training budget...

And I am so unbelievably tempted.

I've been thinking pretty seriously about taking an entire year off to do locum work or to do things like surgical assisting. I'm not happy and I haven't been for such a long time... Everyone is saying I need to stick out the psychiatry training but I have three entire years of exams left and that's IF I pass everything. The training programme just keeps getting more and more added to it...

If I'm not bold enough and brave enough to take a whole year off, maybe I could start with something as simple as taking one day a week off doing some other kind of work that breaks up the monotony and the misery...?

Is that insane...?

[loulovestowrite]

At work today was a good day though.

It was the easiest day I’ve had all term.

So much gratitude for that.

[mashupofmylife]

Confused myself and everyone else in the OR when I tried to introduce myself during huddle. “I’m with anesthesia” “I’m psychiatry but that’s not why I’m here” “I’m an off service resident” In the end, I forgot my name and then rambled for a minute before shutting up.

[15-blade]

I’m reviewing residency applications and I’m subtracting points if you’ve done any missionary work. It’s my turn now to judge your life, bitches. 

[tachycardic--tendencies]

Still not really feeling the decreased level of supervision we get in fellowship. Like, I really need help making some of these decisions and it seems unsafe to let us just be doing things alone. Particularly when we’re mucking around in the immune system.

But sometimes I feel like the attitude is “just be a doctor about it” and “did you read about it” and like pardon tf out of me for having some questions about the nuances of scary drugs and weird conditions.

[md-admissions]

Admission: Healthcare Proxy

I have a semi-joke with my closest friends from residency that if there ever comes a day when his spouse refuses to pull the plug, I will step in and make the hard choice. I say joke because this is what amounts to a joke in medicine; it’s said while laughing but we’d only ever say something like that to people we trust completely.

Just caught my favorite attending yelling across the hall to another attending who was his co-fellow while training “YOU HAVE TO PULL THE PLUG IF MY WIFE CAN’T.”

The other attending yells back, “WHAT THE ACTUAL HELL BUT YEAH OF COURSE I WOULD.”

Which was basically how my conversation went down so I’m glad some things are universal and I’m glad my favorite attending continues to give me reasons to call him my favorite.