Happy July 1 to everyone starting residency today!
As someone who just finished residency, I thought I would share my advice for the next few years. Not on how to function within the hosptial, but about how deal with your life through the next few years. Because it will be hard, and maybe not in the ways you expect (and conversely, some of the things that you think will be hard may actually just not be a problem!).
Figure out the difference between "this is out of my comfort zone" and "this is unsafe". You are going to have to do a lot of things that are out of your comfort zone in order to grow. But if it is crossing over into things being unsafe, then you should 1000% call for help. It is OK to call for help, to say that something is not OK, to wake somebody up in the middle of the night. They may be grumpy, but it is still the right thing to do.
If you can take something off your plate, do it. I pay someone to come and clean my apartment every month; I have since I was at the end of med school, I can clean my apartment, and it seems like an extravagance but…the fact that I can just eliminate that portion of the mental load makes such a big difference. I was out at dinner once with a group of women from my residency program, PGY3 through second year attending, and only one of us didn't have a cleaning lady; this came up because she was struggling with balancing everything in her household. The rest of us very much advised her to just hire someone because taking some responsibility off of your plate is hugely impactful.
If something little and stupid makes your life easier…it is not stupid. Having a coffee maker that starts on a timer and brews into a thermos? Having all of your travel mugs use the same lids so that you don't have to go hunting around in your cabinets in the morning for the right lid? Only parking in certain places in the parking garage so you can remember where your car is? All reasonably little things. But all things that can make your day just a little better.
If you think you should pee first, or have a glass of water first, always do it. Never turn down a break. The answer to being told you can go home now is…to go home. Always take the opportunity to take care of yourself when it is given, becuase there is no guarantee that the opportunity will stick around.
Wear the good comfy underwear. When the day is long and difficult, and so much of it is out of your control, getting rid of some of the little physical discomforts can make a difference. So if you have determined that these compression socks are the best, or this sports bra bothers you the least under your scrubs, or whatever…go ahead and have a pair for every day of the week.
Plan B doesn't have to look like Plan A but worse. It can be completely different. Maybe your schedule doesn't let you go home for Thanksgiving, and trying to have a not-quite-as-good Thanksgiving dinner in your apartment will make you sad. So do something completely different, that will feel good on its own, that won't feel like you are failing to live up to expectations.
You are allowed to have fun in the hospital. Even if the situation around you is objectively terrible, you are allowed to feel good because you coworkers are awesome, or you are just feeling the fuck yeah feeling of taking care of something really hard. The best rotation of my intern year was a two week stretch of cardiology nights where we took constant admissions, managed all of the RRTs for the oncology and cardiac patients on the floor, and ran all of the codes in the hospital. Most nights, I laughed so hard that I could barely breathe. I have honestly had fun in multiple situations where there was more than a whole blood volume in a puddle on the floor, because the people I've been working with have been great, and we have been doing damn good work. And you are allowed to feel good!
You are allowed be upset by things. We see a lot of shit, and I guarantee you will see some things that stick with you for the rest of your life in a bad way. And you are allowed to be upset by those. You are ALSO allowed to not be upset by taking care of somebody going through something that is objectively traumatic. And you are allowed to be upset, or frustrated, or unhappy, about things that other people might tell you are not a big thing.
Failure is an option. As much as I love Apollo 13, sometimes things just aren't possible. Sometimes the best solution is to say that failure is not an option, and go kicking and screaming and fighting the whole way. Sometimes the best option is to say that the fight isn't winnable, and look at how best to lose (or to redifine success). Sometimes you redefine success not as getting to the moon, but just as surviving. This is true in the hospital; people die. Maybe it means comfort care, or hospice, or a death with as much dignity as can be mustered, instead of a bunch of painful invasive things ending in chest compressions. But it is also true in your life. Sometimes the schedule will win, and you can't just make it work. And that is OK too.
Manage your expectations. Residency takes a lot of something that you can either call serenity or resignation depending on how positive you are feeling. You can't change so many things; the call schedule, the admissions, the OR status board, who comes into the ED. And if you get too excited about the fact that it looks like you are going to have an easy day, and that doesn't happen, you may feel worse about it than if you had set reasonable expectations. There are a lot of systemic things in health care that should be changed, and maybe one of them is the hill you are going to die on. But you cannot fight every single thing all the time or you will explode. Learning how to accept some of the shit that is thrown your way and just…let it it roll off will make a huge difference. You don't have to agree with everyone. You don't have to let everyone's opinions actually matter.
Don't let the schedule win. You are going to work a lot of hours, and not have control, and there are going to be things that you are simply going to miss or not be able to do, and that sucks. But you can actually do a lot of things and live your life, it just sometimes takes some aggressive planning.
Some days, all you will want to do is make the beeping stop, and that does not make you a bad person or a bad doctor. I wish I could remember who told me this when I started residency, but they were right. There are going to be things screaming for your attention all the time - your pager, alarms, people asking you to do things. And you understand there is a patient on the other end of all of those things, and that should be your motivation for doing your tasks. But some days all you want is for your pager to just stop going off, and you are just ordering the Tylenol to make things stop screaming at you and not because you particularly care about the pain. And that is OK; it just means that you are human and doing something really hard.
Ginger ale + cranberry juice + hospital ice in the big clear plastic pitcher will make you feel better if you are a little overheated, nauseous, dehydrated, or hypoglycemic.
