Tuesday, April 08, 2008

Tired.

The easy, quick explanation for why I have waited so long is, quite simply, this one: I'm tired. Yes, the 80 (and sometimes more than 80 – shh, don't tell anyone) hour work weeks, the 30 hour shifts, the two week stretches without a day off…they’ve been piling up fast. So fast, in fact, that I only notice anymore by monitoring how soon I go to sleep. Let’s just assume for now that your average ridiculously handsome but still charmingly shy 26 (or even 27) year old heads to bed anywhere between 10:30 and midnight on any given night. In August, I was usually in bed 11 PM at the latest. By December, the occasional "in bed just before 10" was not that surprising. But now? I've caught myself crawling into bed at 8:30 PM, which basically makes the only non-work but still awake time of my life that glorious dinner hour and the four minutes I spend on the toilet in the morning (and just because I have no shame whatsoever, that four minutes used to be fourteen when I had more free time and could sit triumphantly on my throne, but now are only fourteen if I accidentally fall asleep while on the pooper).

However, there is more to this notion of being tired than what I have just described. Because, in all seriousness, this job has weighed on me so heavily that I have found myself beaten down, succumbing on a daily basis to many thing. Just tired...

Tired of the perpetual stress – of course every job has it’s stress, but I can only now grasp why the life or death aspect of medicine sprinkles in that extra pinch of chaos when compared to other jobs to make sure that, as the lowly intern, you are always one slip of just about anything (whether that be a needle or your pen) from killing someone.

Tired of the system – one of many systems where hyper-educated individuals are routinely thrust into a system that, at a local, state, and national level, is so beyond fucked up there is really no way to grasp the magnitude of it. But while inefficiencies in other fields may hamper your taxes, your business, or your local schools, it seems especially upsetting that inefficiencies in this system have killed, are killing, and will continue to kill on an alarmingly regular basis your grandmother, your friend, or even you. At least, as a once and future consumer of health care, it is upsetting to me. But to also know that some of the solutions are so simple (umm, national computerized health record please?) but so impossible to achieve in today’s reality for reasons beyond my control makes things all the more maddening.

Tired of the position – here’s where the intern-specific whining comes in, and yes I know that all of my superiors had it worse and blah blah blah I don’t care: being an intern has to rank up there with cleaning up the elephant poo at the zoo as one of the worst jobs on Earth. There is nothing quite like being caught in a tug of war between demanding attendings who require a long list of things to happen for a patient, nurses who actually have to do those things (take a deep breath…ok), and patients who half the time seem hell bent on refusing what we want to do but refusing to leave. Multiply that by 10-20 patients, 5-10 nurses, 2-3 attendings and 30 hour shifts…and then do all that while this thing attached to your hip keeps vibrating over and over again with new and different requests from any of the aforementioned parties and you’ll have a small idea of how painful intern year is for the schmuck intern caught in the middle of these forces. Something tells me I’ll have more to say about all that before this is through.

But mostly I’m just tired of the reality. Being confronted with society’s ills, in every sense of the word (because it turns out this job encompasses the literal medical ills, the economic ills, the social ills, etc., which is a lot more than what they advertise in medical school), on a daily and nightly basis is like (warning: over-used cliché alarm) being forced to push an immeasurably heavy stone up an unbelievably steep hill…only that the stone keeps getting heavier and the hill keeps getting steeper on a daily (or even hourly) basis. There is absolutely nothing more tragic to me than telling a sweet seemingly healthy middle-aged women that she has inoperable metastatic lung cancer to her brain, and then walking to the next room over and get cussed out by an otherwise healthy crack addict trying to abuse the system for pain medications, knowing that the former will probably never walk out of the hospital but the latter will keep leaving and coming back over and over again to abuse every last resource she can get.

It is this daily tragedy, unfolding before my eyes, that has been building up inside of me for the last 9 months, sinking me in and out of a mild depression each and every day, making it harder and harder to get any sleep at night, but forcing me to try to go to sleep earlier and earlier.

It is also why I have decided to start writing again…because for whatever reason, I feel better after writing about this, even if I’m usually not writing about why it is so catastrophically depressing all the time. If that means forgoing a bit of sleep to whine endlessly to myself, then so be it. Better than becoming so tired I cannot even function at all, I suppose.

46 Comments:

Blogger Mel said...

i'm thrilled that you're writing again. welcome back!

10:59 PM  
Blogger EthidiumBromide said...

So glad when I saw your blog pop up on my RSS reader -- I've missed the humor. Good luck surviving -- intern year is almost over!

9:13 AM  
Anonymous Anonymous said...

Welcome back. I wish I could offer you some comforting words.
There are none.
Things do get even worse, though. You get used to it, somehow. Do not even ask how.

BV

10:59 AM  
Blogger FASHIONABLYSLIM said...

I'm very happy to see you're writing again. I work in India and to say the last, bureacracy is much much worse here, if that makes you feel any better. Reading your blog makes me feel better that I didnt choose to study medicine and instead chose to study something as practical as literature! Keep sharing your misery. It makes all your readers feel better!

5:25 AM  
Blogger Doc's Girl said...

I'm sorry about the schedule--I started living with my bf right before he was on trauma for a few months... During these months, it was hard to watch what he was going through...but I'm so glad that I was there to help out with things that lose their importance (laundry, grocery shopping, etc.) when you've slept a total of 8 hours in 3 days.

When he told me that those few months were what his ENTIRE first year was like, it just blew me away.

But, thankfully, it gets better. :)

I suppose that is the only thing that is driving you right now! I'm so glad that you blogged! YAY!

5:01 PM  
OpenID aridice said...

OMG you're back!
*goes into teenage fangirl mode*
seriously, though--good luck in residency, and congrats on almost finishing intern year!

7:20 PM  
Anonymous Anonymous said...

Welcome back! Hang in there.

7:45 AM  
Anonymous Anonymous said...

YOU ARE BACK!!!!!! YAY!!!
cant wait to read your posts, i loved AYMS.
- nurse charlene

7:43 AM  
Blogger Karen said...

Glad to see you're back and still somewhat alive!

You'll find some purpose that will keep you going even through your worst hours. You're doing an invaluable service and it's a shame the US system endangers their pt's by trying to kill their residents of exhaustion... try coming to Australia or Canada :) Hang in there!

9:54 AM  
Anonymous Anonymous said...

It just goes to show you, the night nurse can be your best friend (protect your precious sleep) or your worst enemy (call for MOM at 3am)! It always pays to be kind to the nurses! So happy you are back! Our residents (almost) always make it through!

2:21 PM  
Anonymous Anonymous said...

Yay! I'm so glad you're back!
I've been reading your blog for a couple years and obviosly learned nothing since I'm starting med school at UCLA this fall...(Some of your old posts made me think you went there...)
I hope you can get some sleep soon.

NJ

5:41 PM  
Anonymous Anonymous said...

oh god, that page was hilarious.
cheered me up tremendously on this crappo morning.
thank you so much for writing about your experiences.
the goblin thing just blew me away.

4:45 AM  
Blogger gabbiana said...

Welcome back, ex-fake doctor. I will keep reading you even when you depress the ever-living hell out of me.

6:42 PM  
Blogger Melissa said...

your blog is really funny. but you're freaking me out about going to medical school! i guess "ah yes, medical school" has served its enlightening (is that a word?) purpose afterall. of course, i'm going to apply anyway and give it a year to sink in.

8:02 PM  
Anonymous Anonymous said...

Welcome back Handsome Jewish Doctor! What a pleasant surprise to visit this site and find you have resumed your oh so entertaining writing (you really should be getting calls from publishers by now). Glad that you discovered writing is your catharsis and coping mechanism. All the best in this intern adventure!

Rolande

7:20 AM  
Blogger Dragonfly said...

Hooray!!!!!

10:12 PM  
Blogger Katie said...

I'm so glad you're back! I was beginning to give up hope. I'm another one of those foolish people you failed to turn away from medicine... med school starts for me in three months. Oh well, at least I can't claim to be surprised when the misery starts. Hope residency gets better for you, or at least that you find some hilarious people to make fun of!

11:16 AM  
Blogger Dave said...

So excited to start my intern year now, lol

10:08 AM  
Blogger Kate said...

Welcome back!

8:55 PM  
Anonymous Anonymous said...

read your essay with care, remotely knowing about your dissaperance and it's effects on your fan base. in my opinion you were saying something important, but i couldn't quite grasp what. unsatisfied with the previous fan's comments in that regard, nothing sublime nor pithy enough comes to mind.

what comes to mind: that sucks bro

5:24 PM  
Blogger adventures in disaster said...

I wish you had started writing
If your orders and instructions are good you will only get paged for very bad things, when your orders suck..well you already know.

There is unfortunately no cure for the rest except getting to the place where it is no longer important. You will stop tilting at windmills and your frustration will disappear. Acceptance that the system is a total crock of shit will come and then you just do your job the best you can and move on. As long as you can say to yourself " I did everything I personally could do" you begin to feel like it's not your fault or your responsibility.You have to force yourself to see and acknowledge every good thing you see each shift.This will balance out the other crazy shit you have no control over.

Intern year is a year of culture shock, the shock from not only being wildly lied to during med school but also having some of the lies you may have told yourself most of your life revealed.
The things you thought you believed in will be revealed to be bs. That dream of being non judgmental disappearing after your first meeting with the crack head demanding more drugs for their "fibro flare up".
All this is painful and hard not only because you are a walking, talking zombie but because you will try to hold on to some of your own bs very,very hard.
Once you let go and stagger through Kublers stages and get to acceptance everything gets easier. It's just that to get there you have to experience each step and a lot of the time people get hung up at anger for a very long time.
It does get better.
You will find your humour again because you will soon see how competent you have become.
Competence and acceptance will help you make the most of the sleep you do get. A hard line over the pager will help too.

1:47 AM  
Anonymous Anonymous said...

!this is hilarious, your conversation with the nurse at 3am is precious! I have had thoes conversations as a med student (and am starting a residency this July in NYC) and can only anticipate more of that to come. keep on writing!

9:49 PM  
Anonymous Anonymous said...

Sorry your intern year has been so craptastic. I find the worst part to be how everyone else pretends they're holding it together just fine and you're not supposed to talk about it. And the fact it will get better eventually does not make it any easier to get through the next 3+ years. Keep on hanging on,
~mutually miserable

5:51 PM  
Anonymous Anonymous said...

welcome back we miss you over at bellevue!!

7:32 PM  
Blogger genderist said...

So glad you're back!!

2:53 PM  
Blogger frylime said...

yay! you're back!!!

6:49 AM  
Blogger Heather said...

Good to see you back!

9:51 AM  
Anonymous Anonymous said...

Dear Ex-Fake Doc,

I don't know what to say. I'm glad to see you back though.

Peace.

7:01 AM  
Blogger anna gregory said...

It's brilliant to see you back. In the UK we have the European Working Time directive which (Apparantly) has put an end to the massive shifts like you have been working.
Please, Please keep blogging
Anna

3:17 PM  
Anonymous Anonymous said...

6 weeks left, you can do it.

twice during my intern year I thought about leaving medicine.

As a second year resident i seriously thought about going directly into industry if I didn't match for a fellowship. I also hated my program so much that I fantasized about scrambling into a new one for the third year (totally unrealistic).

Right before the match I felt so burned out that maybe I would not even do a fellowship even if I got a position.

Now I'm a third year resident, 6 weeks away from finishing, about to start a great fellowship program that I'm completely excited about...moving to a great city.

The last three years have been so hard and depressing. Stick it out..if I can make it anyone can.

I promise you it gets better as a 2nd and 3rd year. Not easy, but better.

10:15 AM  
Anonymous Celeste said...

Welcome back. We've been waiting for you.

8:59 AM  
Anonymous surgpgy1 said...

ahhhh residency blows donkey balls! can pgy2 blow even more?

7:49 PM  
Blogger Sarah said...

writing is excellent therapy. it got me thru some unbelievably tough times myself. hang in there.

12:26 AM  
Blogger Sarah said...

writing is excellent therapy. it got me thru some unbelievably hard times myself. hang in there

12:29 AM  
Anonymous Anonymous said...

thanks for writing again - this is pretty scary though. i know i won't do well with exactly what you're talking about and i start med school in a few weeks. i know i get to postpone it for four years though... try to write something optimistic if you can.

7:27 PM  
Anonymous Anonymous said...

As I tell the residents when they feel bad when things don't go right, "Welcome to the rest of your life." Medicine ain't easy. If you choose to do anything significant, to actually take care of sick people, not just healthy people that want to feel better about themselves, you're going to be faced with a lot of hardship. It's part of the job. Nobody said it was going to be easy, and believe me, it NEVER gets any easier. Internship is hard work, no doubt, but it's fairly hard to screw up in any major way. Plus, all the bullshit of what we do doesn't really affect you. Nobody is going to expect you to know what a 99223 is. When you get out though, you find that the light at the end of the tunnel has actually been an oncoming train.

I wish I could be more positive, but like I said, "Welcome to the rest of your life."

1:09 AM  
Anonymous Anonymous said...

oh you're back! i missed you! hahahaha XD *proceeds to read other posts*

also, *pats* i think you're going to be okay~

2:32 PM  
Blogger Noel Hastings said...

I know this comment is very late as I have taken a similar hiatus from blogging, but I hope to be back for a bit. I understand this post as do we all in the field. Although I am about to start my intern year I just finished my 80-90h work week EM rotation at the county medical center. My goal for the coming months before my intern year starts is to get as healthy and rested as possible and hopefully that "momentum of health" will get me through a month or so... People have not gone through this don't really understand the emotional toll this takes. It is the hardest thing I have ever done and not in the way that most others think medicine is hard. It is a totally new hard...

10:04 AM  
Blogger Nathan said...

I know the feeling. I've written like two posts since residency started for the same reasons.

8:54 PM  
Anonymous Kendra said...

so f-in on the nail. stop taking the thoughts out of my head and writing them on your blog.

k, thanks.

6:01 PM  
Anonymous Anonymous said...

holy f$#k^n s#it you're back! just in time for my med school experience... Let the joy begin :)

5:34 PM  
Blogger FrigidIce said...

I'm happy your back Fake doc! I found your Ah Yes Medical School AFTER you stopped posting - read every single post, then waited for you to post something on your promised "Ah Yes Residency"

Applying to medical school in a year - if I get in! (That's what my blog's about actually..)

12:00 PM  
Anonymous Anonymous said...

Fake Doctor, where are you?! We miss you! (I'm not a nice, single Jewish girl but I love you anyway).

9:26 AM  
Anonymous Anonymous said...

awesome, thanks so much for writing the truth. my favorite doctor out there!! so great to see that you are back again, your writing got me through medical school as well and now i join you on the journey of residency...keep going, we need people like you to stay in medicine and try to fix the broken non-system we have.
thank you, ls

9:46 PM  
Anonymous Anonymous said...

I miss your blogs!!
They made me laugh so much!
Please write some more!!

10:39 AM  
Anonymous Anonymous said...

My dad is doing his IM residency right now and I'm an ICU nurse (in different states, though). I can totally relate on the pages and the attendings (I work in a univ. hospital) and our residents. I love baking cookies and bringing food to the resident's lounge on our unit - makes their mornings better, I think, when they look like crap from the night before. Just because I've heard similar from my dad's stories, I try hard not to page and not to ask stupid questions. You guys are so valuable... My dad said 2nd year sucks even more, but now they want him to be chief resident. So 3rd year is going to suck even more... just think you're one year closer to being done. :)

2:29 PM  

Post a Comment

<< Home