S5E25: Confessions of a Medical Resident

Leen: Welcome to the hot mess episode.

Harjit: We'll all lead together. Together forever.

Margaux: That's the way we've been doing it.

Leen: Gosh, you guys. How many years have we been doing this? Get your dynamics together.

Margaux: All right. Should we get started? Hey, everyone. Welcome back to "Bundle of Hers." We have Harjit, Leen, and Margaux in the studio here to do a Resident Confessions 2.0, PGY-2. Whatever you want to call it, we're here.

And so this is a continuation of the last episode, which was "Confessions of the Med Student." It should be fun to compare their confessions to when we were med students. And in continuation of that series, Leen, Harjit, and I are going to do "Confessions of Residency."So welcome to the conversation.

Some of us are post calls. Some of us are on vacation. Leen, what are you doing?

Leen: Some of us just stayed up all night for no reason and now is here. Night owl problems.

Margaux: So we are at the end of our season, which is really exciting. We've made it through a whole other year, and we've had the wonderful support of our new med students, which has been awesome. But this episode is just "Confessions of Residents" in our second year.

So I think it's really telling that all of us had to scramble to sort of come together to make this episode, because as residency progresses, you get to find you have less and less time to do the things that you love. And so here we are.

Harjit: I think we're at the point of PGY-2 where everyone is jaded. But I think that we're second-year residents, jaded just means "I'm tired." It's been a long, long time, and I feel like this is the moment where it really culminates to.

I remember also talking to my sister who's a doctor. I remember she told me that by her second year of medicine, she was also jaded. I feel like there's maybe some hope because she likes her job now.

Margaux: That's good.

Harjit: What I'm saying is I love psychiatry, but I'm just jaded with everything else.

Margaux: I think jaded is also a more blunt version of burnt out. It just means you're not as excited about being a resident, but you do it and you know what to do.

Harjit: That's my current state of being.

Margaux: Same.

Leen: I don't know why you guys are jaded now. I was jaded for a while for this year, but I think now we're given more senior responsibilities. And I learned something about myself. I am not a good junior. I'm not a good follower. I think I just am the kind of person who likes to take control of things. And even though I might not be good at it, obviously, because it's what? Day one of being a senior? I find myself enjoying the shifts where I'm a senior and I'm actually in charge and actually allocating and learning at the same time.

And I'm actually finding that some chief complaints, I walk in, and I'm just like, "I already know what I'm going to do for you." It saves me a lot more time for other things as well. And then I'm also finding myself communicating with my patients a lot more easy as well.

I think now you're able to be more confident about your plans and you'll be like, "Okay. So this is what we're doing and this is why." And they'll be like, "Oh, my gosh." Little cute scenario there.

I also realized the reason I was really jaded as well . . . Is that the word of the day? I think another thing I realized as well is that a big part of why I think maybe burnout was a big thing for me or I wasn't as excited is I love to teach.

And even if I'm wrong, I love to at least talk out plans and really come up with plans as well as bring up past things we learned and kind of just refresh your memory, and I think working with medical students really helps me do that. And now that you're being switched into that senior role, I think we're also in charge of med students as well.

Margaux: I would love to be your med student, Leen. You're such a great teacher.

I think too what you were saying, Leen, and in the theme of jaded of this episode, is part of that comes from a little bit of confidence in that we actually have learned a lot the past two years, so we can sit back and be a little bit more relaxed.

Like you were saying, most chief complaints, you already go in knowing what you're going to tell the family. You don't need to double-check with the attending what the plan is, and you have that confidence, which I think is really cool. And then you can also pass that along in your teaching.

And so maybe part of this jadedness is actually confidence and comfort level increasing with our training. So maybe we should give some credit to that.

Leen: I guess we could revisit at the end of being a senior, and we'll probably be even more jaded. Who knows what we'll be like? We'll probably be really tired, but I think as a start, it's a good energy to start with.

Margaux: Or maybe we can start to now add in our own flavor. Like you said, you have a specific way you like to teach and now you have sort of the power to influence that as a senior. And so maybe towards the end of being a senior, towards graduating, we're adding our own flares and flavors of what we want to be as an attending, which is kind of cool and exciting to think about.

Leen: It's also terrifying as well because you start to realize, "Oh, my gosh. I only have what? One to two years left to learn all the stuff that I need to really be a good attending?" And I'm just realizing, "Why did I sleep in that journal club? Why did I not fully focus?"

Margaux: I think it's easy to think that, but in the moment when you're working 13-hour days and you feel exhausted, it's really hard to learn at that journal club and stay awake.

Harjit: I will say I've been struggling with that feeling a lot because I feel like my brain is not as quick as it used to be. I used to be super quick, could remember things, could think faster, and now I'm like, "Wait, I need a second. I need a second to think."

Leen: No. Low key, I'm still like, "What did they just introduce their name as to me? I feel so embarrassed about this." It's low-key early-onset dementia.

Margaux: For me, this past month, I was the newborn nursery senior and we do 24-hour shifts and you're the only doctor on at night. Of course, you have your attending and your NICU support if you need it, but you're basically the one resident in charge of like 30 newborn babies.

And when problems come up, it was kind of surprising to me how much I did know what to do. I think when you're forced in the moment by yourself, we can. I can think quickly, and I do know. But when it's more like you're talking about, more didactics or rounds, and you're being asked pimp questions, for lack of a better word, it doesn't always come very quickly.

And so I really wonder if that comes back to the comfort level of being like, "I don't have the mental capacity or energy to answer your question right now. So, no."

Leen: Right?

Harjit: Yeah. I also think it's being more confident that you can handle the situation. And sometimes the anxiety is good, but sometimes it's okay to also be like, "I know the steps. I know what I'm doing. If something happens that isn't in the order, I know how to handle that."

So in that way, it is kind of cool that we have a little bit more knowledge, and we know what's going on and being the only person in the room. I totally get that feeling because, in psychiatry, we don't even have the attendings around on nights. It's just us. I mean, they're a phone call away, but we are the ones who are in charge of the hospital. There are only two-night float residents, but we know what to do. And if we need more help, we know that as well, right? We can send them to the ED if things aren't going well.

I was thinking also of reflections we should have about how we've grown as people or things that have happened this year. Margaux, I think this is a good question for you because I think this year has been really important in a lot of ways.

Margaux: Yeah. So becoming a parent in residency was a big transition for sure. I think that having a baby has made me prioritize things differently, so I'm not as anxious about staying late or feeling the need to "perform" for attendings and be there early or be there late. This is my time at work and then this is my time at home, and I feel like that's much easier to be clear-cut about.

I wish I could have known that before having the pressure of having a baby because I think that's so valuable for every medical trainee, to be able to know that they can go home and turn everything off.

It also made a lot of family situations, especially in pediatrics, land a lot more differently, because I often envision, "What if this was my child?"

Harjit: What's funny is I haven't had a kid, but I think I've had the exact same reflection as well in my PGY-2 year. Number one is my time. I don't always have to be a resident. That was kind of my mentality as an intern, like, "I always have to be available. I always have to be going." And I think that came with learning about my boundaries, right?

And this is something that I've been thinking a lot about. I think people who are fem presenting or identify as women often fall in this role of, "You have to fulfill everything," or, "You have to do all the things," because that's kind of the way that we're socialized or grow up.

In this setting, the authority is our attending, right? Not even our patient. It's our attending, and we have to make sure that they're happy. And so we do everything. We sacrifice everything to make sure they're happy, and they're the ones who we have to "please," which is interesting because it really then doesn't become about the patient.

And honestly, I feel like I've struggled with that my entire career. Even in medical school, I felt like things were more riding in medical school on them being pleased.

Now, I'm like, "What my job is, is to be a good doctor, and be there for my patient, and put their needs at the highest. And they're only going to be there for 30 minutes, right? Or 20 minutes or even the entire day, but I need to focus on them when we're rounding." And that's where my priority now is. I think that's helped with my boundaries.

And also, within patients, I often forget there's a team that's helping me. And so I need to be able to delegate tasks and make sure I'm not burning myself out.

So in the beginning I said I'm jaded, but I will say I do feel like I'm turning a corner. I'm really excited for third year, because I think that now I'm good at working on my boundaries. That's kind of been my personal journey this year, is boundaries. How do I set them and also how do I be kind to my own self? I was always here to be a doctor, so how can I go back to the reason I came into medical school?

And interestingly enough, I'm going to laugh about this, but I won the professionalism award again this year. So I won it three times in a row. And the reason I'm laughing . . . I mean, in some ways it's kind of nice to get acknowledged that you're being professional, but in my head I'm like, "I wear open-toed shoes to clinic because I'm trying to be more my authentic self." I mean, they're still cute because that's my style. I was like, "What is happening?"

I just think it's so funny because that's not what I care about anymore. I was talking to my sister and she was like, "You wear those to clinic?" And I'm like, "Yeah." How is me wearing these shoes going to impact my care for my patient? That's what I'm saying. That's kind of been my journey.

Leen: That's hilarious because I always wear leather boots to work. And so everybody is like, "This is Leen's staple, is leather boots."

But one thing for me, I think especially being at an academic program, everybody is always really big on research and fellowships. "What are you going to do for your fellowship? What are you doing after this?"

And I realized the one thing that I think still haunts me to this day is just the interactions I've had with people telling me, "You're not good enough because of your grades. You're not good enough because you didn't do research."

I realized, "Why am I doing this again to myself?" It was already traumatizing as a pre-med. It was traumatizing as a med student. It was traumatizing going through residency. Why am I doing this to myself?

And I had to take a moment back and it's like, "Why did I go into medicine in the first place? What is it that truly made me happy?" And I really love, love, love making the connections with patients. I love seeing patients as a whole. They come to you at their worst day, they come to you with an emergency, they come to you with a sickness, but they're still a whole and you get to really connect with them on that basis. And I thought, "A fellowship is not going to get me more of that."

I think just coming to those realizations . . . And I think being jaded is a good thing in this situation, because it really helps you take that moment to be insightful. I think we're very much very reflective people. I think when we're jaded, we don't just sit there and let us be jaded. I think we're very reflective about that. We go through these stages for a reason.

So I would almost say it actually helps us build who we are and really take a step back and finally we've made it. We've made it to where we can be attendings. We can be the doctor. And so what is it that's really going to make me happy now?

Margaux: Totally resonate with everything you just said. I think intern year, first year of residency, and medical school . . . You talked about the trauma of being forced into, and like Harjit said, these professional boxes and ideas of what we have to do to be a "good doctor." But what we're all reflecting on is our values of actually coming back to the patient as a whole and connecting with the patients as being important, not only to us but to medicine.

And so I wonder what you guys now that we've gone through two years . . . And I think we're all at different places in our residency. So I have three more years, and I think both of you have two more years. What are your goals for next year as a third-year looking forward into being seniors?

Leen: For me, I would say is now I'm actually able to focus on what I need to know that's important. Kind of fill in the gaps. I think we learn to just really get into a routine as intern years because we're just rushing around, we're just trying to get things done, we're just putting in labs. But now I'm trying to build that system where it's like, "Why do they do this? Why should we do this? What is the actual right standard thing to do?" Really refining that practice back to what is good for the patient.

Harjit: I want to reiterate what Leen said, and also include that for me as a third-year is the first time that we get experience in outpatient psychiatry. I think it's going to be a really huge shift for me and kind of see that longitudinal care model, what it means to be an outpatient psychiatrist, when to know when to refer a patient to the hospital, and how much can you take care of outpatient. That's going to be something that I'll be learning a lot about.

Also, I think there's more autonomy in the outpatient setting. So those are the things that I'm looking forward to doing.

And I'm also looking forward to going back a little to the reason why I wanted to be in medicine and psychiatry in general. I requested for a half-day research elective, but hopefully, I'll be doing decolonized research. Basically, I'm using that time to share knowledge because that's what I really care about.

Margaux: I agree with both of you that up until this point, I had also been very reactionary, and I think it's just by nature of training because we're thrown into it and we have very little time to think, and you're just doing this and mimicking what you're attending tells you and sort of going off of those models and protocols.

But now that we're seniors or will be seniors next year and have a little bit more time to think for ourselves and sort of establish our own teaching methods and interests, that's really what I'm looking forward to, is being able to focus more and hone in on the areas of adolescent medicine and psychiatry that I'm very interested in pursuing as a career instead of having to do all these required rotations and things.

I have had good learning, but I am looking forward to getting more dedicated time to reading more about catatonia and treatment in adolescents and spending more time with adolescents.

And I think that'll be really exciting to, like we've been talking about this whole episode, come back to why I went into this residency program and into medicine in the first place, is just coming back to the patients that I want to hang out with.

Leen: Also, I'm going to start traveling more this year. I'm going to start going places. I'm going to start exploring more this year.

Harjit: Yeah. I love that. I think that's on my plan list as well this next year, is traveling more, getting out more. I think the pandemic really changed the way I started interacting in the outside world, so I want to get back to who I was before or a newer version, a better version of me, a more grown-up version of me. But I'm really excited about that too, Leen.

Leen: Yeah. I think it's important. I think we see a lot of people on their worst day in the hospital, and I think it's starting to also maybe jade us a bit. I think it's important to see what people are like on a normal day so that we can still stay in tune with the world, because this is really isolating.

Harjit: Oh, definitely.

Margaux: Agreed.

Harjit: I think with that, I also wanted to talk a little bit about our goals for "Bundle of Hers." I'm really excited about our medical student voices. I think they've been adding a lot to the conversation. Our new Bundlers, they're super thoughtful, super kind, and also I think really good friends to all of us, which has been great.

But I'm really excited for "Bundle of Hers" next year. I think that it's been cool to see its growth, and I feel like we're doing topics that are important, a little bit more radical. I think that's been our goal ever since we graduated medical school, is to have really honest and thought-provoking conversations about how we feel and things that impact us. And it's been really great to have more people added to the Bundles and now our Bundles are growing.

Leen: I think it's important. I think they're going to keep us connected on a continuum of who we were and where we're going. So I think it's going to keep us humble in a sense, right? Because we're going to remember, "Oh, yeah. This is what it was like." And they're going to look at us and be like, "This is what it can be like." So it's going to be cool. Maybe when we're attendings and they're residents . . . Oh, that'd be even cooler.

Harjit: Yeah, manifesting our thoughts. Yeah, Leen, I think that's so important because there are a lot of divisions that are created with hierarchies. So I think this is our way of imagining how our world can be. We can learn from each other, and grow with each other, and, again, look at a decolonized view of what it means to pass on education or learn from people that are in younger times of training than us.

So I'm really excited about another season, and so happy that everyone in our audience has been joining us since we've started, since we were baby second . . . Were we really second-years when we recorded our first episode? I mean, we were starting. Yeah, that's crazy. It's been kind of like a full second-year circle, right?

Thank you so much for everyone who listens to "Bundle of Hers." If you've been an OG fan, or if you've just started listening, we are super grateful for you.

You can listen to our podcast on all podcasting platforms. Leave us reviews. Please send us messages on Instagram @bundleofhers so we can really see and understand how these episodes are impacting you. If there are things you want to listen to, please let us know.

Thank you so much for joining us through our journey and also our new season. Again, we are so thankful for you. I think that's pretty much it. Right, y'all?

Margaux: That sounds good. You're just missing your own "bye-bye."

Harjit: I can't do that. Oh, I did miss Bushra. Shout out to Bushra.