Feeling the Burn

In medicine, we talk a lot about how much “reserve” a patient has. “She doesn’t have much pulmonary reserve,” we’ll say, or, “Let’s keep in mind that this patient has a low cardiac reserve at baseline.” We talk about how little or big of an “insult” a patient can take before they’re tipped over the edge of the cliff that separates well from sick. Can we give the patient as much IV fluid as we would give one without congenital heart disease? If a patient with chronic lung disease due to prematurity catches a cold at daycare, we expect that patient to get sicker, and need more respiratory support, than a healthy child with no underlying lung disease. We know to treat our patients with low reserve–whatever organ system that may target–with care, because just one little thing can tip them over the edge.

Lately, I’ve been feeling pretty low on reserve of another kind–emotional. When I started residency, I knew that I was in for a long hard road, and I knew that I would be tired and stressed and constantly learning and sometimes doubting my abilities and always challenged in some way or another. I saw the residents who went before me, and, especially as a medical student, I thought to myself, “Surely I won’t be as cynical as them one day.”

But as I reach the end of my intern year, I find myself becoming jaded, a little cynical, and generally less spiritually resilient than I was this time last year. I no longer have the emotional wherewithal to deal with challenging families without having to rant to my co-interns about how difficult it all is. I find myself literally trembling when I leave rooms of particularly tough patients, patients who are dying or very sick, patients whose parents seem to have no hope in their eyes. I grit my teeth as I interact with parents who, for some reason or another (many of them circumstances outside their control), cannot or do not care for their child the way they should. When I get a “social” admission–code for a patient for whom we may well have to call Child Protective Services because the home situation seems neglectful–I sadly mutter to myself, “but I’m sure this child will go right back home to this family.” I say this because I’ve seen it before, more than once, and it makes me sad and it makes me feel powerless. For many of my patients, the sad truth is that being at home with parent who is at best unreliable is better than any other alternative. Two years ago when I was doing my pediatric sub-internship rotation, I would volunteer to take on socially challenging patients, in order to build my skills and in hopes of using my empathy to work with the patient and the family. Now, when a challenging discussion has to occur with a family, I turn to my senior residents and ask if they can do it for me, because I just can’t.

The emotional and spiritual and mental homeostenosis has invaded my life outside of work too. I am more absent-minded than normal. I make snap decisions that aren’t fully informed or educated. I literally scream in my apartment when I realize I’ve done something stupid and ended up wasting a few hours of the precious little free time I have. I’m a generally high-strung person at baseline, but I am also very quick to cool off once I get upset. These days though, being unable to fill out an insurance form online or attempting to make yogurt that stays milky despite my best efforts or an extra-long morning of rounds will push me over the edge into a grouchy mood for hours, or even the whole day or longer. I perseverate on my mistakes and the time and energy wasted in making those mistakes. I cannot seem to uncoil myself from the tight ball of energy and gritted teeth and determined-to-make-it-through that I’ve become. My health seems to show it too: I went to the doctor the other day and my blood pressure was higher than it normally runs.

Ever since medical school, my peers and I have been hearing lectures about burnout. You know what I mean, the ones entitled “How to Thrive, Not Just Survive, in [insert challenging period of school or training here].” I have generally been fortunate enough that I haven’t experienced the kind of mind-numbing, emotion-stunting burnout that we’re all warned physicians may get. For better or worse, more often than not, it’s my personal life that stresses me, and work generally is an engaging escape from the worries in that realm. This year though, for the first time, I am beginning to understand how it feels to burn out. My peers and I have all been go-go-going for the last 11 months, and we’re starting to run on empty. The novelty of being a real doctor no longer outweighs the frustrations we sometimes (not always, I should say) encounter at work. Still we press on, and we try to bring our best selves to work every day. I’m not sure that I always succeed, but I guess trying is half the battle. Let’s hope things get a little bit easier once we’re on the other side of intern year.