Processing

Once again, I do not know where the time goes. I blink my eyes and suddenly it’s June. And yet I feel like I’ve been a first year fellow forever.

I finished my 4-month inpatient child and adolescent rotation at the end of April, and it took me a whole month to recover. I’ve finally been able to take my time to reflect and process it all.

First of all, I realize we are all at the mercy of systems. It’s ironic to me that an entire system can herald altruism and yet be rooted in narcissism. But maybe I’m too idealistic. If it yields an altruistic impact, why not? Well, the issue is that narcissism can be harmful and deceiving. I wish I could say that people on welfare are treated the same as people with private insurance, but they are not. I wish that hospitals truly card about the things they claim to care about, but they do not unless there is material reward. I know I sound jaded, but it’s the truth.

Here comes the biggest dilemma and source of moral injury. How do medical trainees maintain our empathy? How do we, who went into this field wanting to help others, keep focused on that goal in spite of everything we go through?

So far, I’ve found AN answer: to stick together. (Hopefully there are more answers.) I find that having co-residents/fellows and mentors that share my sentiment to be the saving grace. It’s this unspoken understanding that we are all in this together. I felt it in residency, and even more now in fellowship. I consider myself very lucky to be in a specialty where people are particularly keen on this camaraderie.

On the last day of my inpatient rotation, I finally felt like I could depressurize my brain and let out the fumes of my anger and frustration. I just cried. I was frustrated that my words so often did not matter. I was angry at the system that is so hierarchical and resistant to new ideas. I was devastated that some of my patients were not getting any better. I was sad to see the burned out faces around me.

But then I realized something. This was it. The way to make progress is to make an experience personal. You can throw as much logic at a system as you want, but it won’t move unless there is emotional salience. So I see that this struggle is worth something. Because now I am driven to draw new boundaries and move systems.

As I take on the chief role this year, I am extremely uncomfortable, not going to lie, but also hopeful and excited. But even more than that, I hope to pass this feeling of camaraderie on to the next group because nobody can do this alone. And also because so many systems actually rely on compassion at its core.