S6E15: Transitioning from Medical School to Residency

Leen: Sorry, I'm processing. I don't have the latest iOS update in my brain right now. But we are now post-match. Oh my gosh. What's the feeling?

Lina: There are a lot of emotions. Hi, everyone. Welcome to "Bundle of Hers." We are in the virtual studio. We being me, Lina, and I'm here with Leen and Ha.

Hạ:Hey.

Lina: So we are post-match. Yes, you are right, Leen. And I matched into OB-GYN, and I will be heading to Philadelphia to work at Einstein.

Hạ:Yeah. And I matched into pediatrics, and I will be heading to the Bay Area to work at UCSF.

Lina: So proud of both of us. So excited. We're both kind of relocating from Salt Lake City to different places. Leen, you did the relocation when you moved for residency.

I guess first move that I can think about is moving to Utah from back home, I guess, for undergrad and then moving to Salt Lake, and that's just separate from where my family is in Logan. That's kind of the big move that I've done in my life. I don't know, it was obviously a major shock, major change, but there was a lot of always worry about community and finding people and having people around me.

For both instances, it was kind of easier to do in undergrad because I was with my family and I kind of had family friends as well. But the move to Salt Lake, it was kind of a lot on my own, and so a lot of that community I had to work for and find. And it took a while, but eventually I got there. But now, thinking about my move to Philly, it's a whole other change that I'm starting to think about and worry and being nervous about.

Leen: You bring up some really good points. I moved for medical school. It was still within the state, and then match took me all the way across the nation. You're going from a completely different environment that you've studied so hard to work into and get grades into and know how to work with that patient population, that team, that hospital, and now you're going to be thrown into a whole new system, right?

So I matched in 2020, and that was the wonderful year of COVID. There were no communities. There was no support. Isolation was big in and outside of the hospital, among the community, in society. This was a huge thing we were all tackling, right?

At first, I was like, "Okay, it's fine. I'm going to be drenched in work. It's whatever." But it started showing even within our residency class how important it was to have those connections, to have that support system, to have those community networks, right? Even our program director was like, "How do we fix this? How do we get this class, this specific class of COVID, to get that network going?"

Residency is not like medical school in the sense that . . . Okay, yes, you are in the hospital, but, one, you're actually taking care of patients. The learning curve is not steep. It's a straight line up, right? That's how I'm going to describe it. You have to be quick on your feet, you're learning, you're trying to mold into this position and into this environment and get to know all these new people and everything like that.

In some ways, it's such a wonderful challenge. You find yourself growing so much and you start seeing yourself forming that personality of who you are going to be as a doctor. I think that stuff is so fascinating. You start to see it and you're like, "Wow, I can't believe that's me."

But at the same time, you start realizing there are things that you need that support for. And especially during COVID when even co-residents weren't necessarily talking to each other that much, you really found yourself isolated.

And so during the last two years, I really decided it's time to build these networks, it's time to get out of this bubble, it's time to . . . We're not all just medicine. I know on this podcast we've talked about this several times. We are not all just medicine. We are holistic people. We come from different backgrounds, different ambitions, different hobbies.

And so the last two years where I feel like I was so drenched in that work of, one, the curve of being a resident, and two, COVID, I was like, "It's time for me to find myself again."

Don't just stick to your community of the hospital, but find your community outside the hospital as well. Find that support system.

I know oftentimes in the last year I've been saying, "Man, sometimes I wish I matched closer to home because I need that support." But I don't think that's necessarily a reflection of where I matched. That's more of a reflection of, "It's been now three years, and I'm trying to now start to find that community."

Hạ:Yeah, I think moving . . . it's kind of interesting whenever I think about the move and thinking about trying to find community. For me, this might seem like it's going to be the first big moves for me, but in actuality, I kind of moved a bit bigger for a portion of my life away from my home base of community of Salt Lake.

So, for undergrad, I actually moved to Boston. And so for me, going to the Bay Area actually feels a lot closer to home, a lot closer to my base.

But I am still really scared about going out to residency because of the fact that, as you were alluding to, Leen, residency is just a very different life and a very different style and very different communities than the community that you might see when you're 18 years old and you're moving to an undergrad location. Everyone is on on-campus housing. Everyone wants to meet, make friends when it's orientation.

But when you are now at this point . . . And this was something that I also felt, because going to school in Boston and then going back to school in Salt Lake City, by then I really did feel like . . . Unlike a lot of my peers who had gone to a lot of the Utah schools and had already had friends from undergrad going into medical school, I also felt like I had to rebuild a community again within medical school.

And I feel that in medical school, it was just a lot harder than it was in college, even though I was situated right at home versus in Boston I was very, very far away from home. And I think it's just because we're all at different points in our life. There are a lot of different priorities and relationships also look very different. And that's something that I'm very fearful about with residency.

When I was looking into residency places, it's kind of funny, but as a single person, programs that said, "Oh, we only had three single persons per class," really freaked me out because I just thought, "Are these people going to let me third wheel them? Am I going to find a community of people who want to hang out with me, or am I just going to be sitting alone and sad?"

But hearing what you said, Leen, about looking for community even outside of the residency bubble is super helpful and a really good reminder that even though residency makes it feel like we have to be besties with the people within our cohort, we can definitely make friends and build connection outside of that cohort too.

Lina: Yeah, I feel like when I was looking at . . . Just throughout the application cycle and looking at different places, different programs, a big part of it was kind of the city and the community in the city, and not necessarily the community in the program, like my co-residents.

And I feel like that was a big thing that at least I was paying attention to because I did want more of that community around, at least people that I could connect with on a lot of my other identities other than medicine, right?

And I feel like we've talked about this, Leen, about just kind of looking for more Palestinians around us and more people that we can kind of share that identity with. And so I was looking a lot of places that just had bigger cities, those bigger communities.

It's one thing to kind of find it in and around the residents, but I feel like a whole other thing to have it around you. I mean, a big part of our time is going to be in residency, but I think it's very good to also remember that there is that life outside that and there are people outside that that we can connect with.

Leen: And coming off of that point, I'm not saying we are completely obsessed with validation, but at the same time, validation is a very important aspect of trying to get through such a difficult time such as residency.

And sometimes when working in a hospital . . . I mean, from my EM experience, nobody likes the ER, right? We're the people who give you all the work. We're the people who consult you in the middle of the night, so nobody likes the ER.

I think once you go through such a trying time like COVID plus residency, plus moving out to the middle of somewhere far away from your base support system, you start to almost forget how much you've accomplished, what you've gone through to get to this point.

And so when you find your community outside of the hospital, these are the people who don't necessarily know the cultural systems within the hospital of consulting and all these little minute things, but these are the people who just look at it from 1,000-foot pole and are like, "Wow, you are a freaking doctor."

And I can tell you that just seeing that from your community, from your outside community, that perspective, that validation really lights you up again, and you're like, "This is what I'm doing it for."

Being minority, underrepresented, being people who maybe just don't necessarily think mainstream thoughts, to get to this point and to get that recognized, especially by the people that have supported you before you were a person of the hospital, is very validating.

It really helps target that burnout that you feel when you're bogged down and you're like, "Man, why am I getting yelled at again by a consulting service?" I hope none of us get completely yelled at. But the culture is there. It's the nature of the work. It's the nature of the stress we are under. And so it's good to find that support outside.

Hạ:I also find support from outside also helps keep me really real and keeps my perspective a lot bigger. I even notice this when I ever get meals or talk with friends who aren't in medicine, whether it's within Salt Lake or Skyping. Or not Skyping anymore because now we just FaceTime and Zoom. FaceTime and Zoom them, my long-distance college friends.

And one of the things that I really appreciate from them is that they . . . Sometimes when I say stuff and I just see the look of confusion or the look of horror in their eyes, it helps keep me real, and it also helps keep me humble and it helps me not get lost in the frenzy of medicine.

I think one of the things about the medical community is that it can suck you in and it kind of creates a little hive mind sort of deal where you are in this hole, in a sense, of a certain way of thinking.

And when I get out with other people and meet other people who approach things differently, it helps remind me that there's so much more than those hospital walls, and that there's so much more to me and there's so much more that I need to recognize. It helps me be a more fulfilled person.

Leen: It absolutely does ground you 100%.

Lina: Yeah. I feel like it increases that pressure. When you're focused on just the community in medicine, it increases that pressure to have your identity be solely about medicine. That can lead to burnout really, really quickly.

It's just kind of, "Oh, this is the only thing I'm good at," or, "This is the only thing that could bring me joy." And we all know that medicine is hard, and there are going to be a lot of hard days. And it doesn't necessarily, like we've said again and again, have to be just about medicine.

And I feel like I've done that. Even just starting medical school here, I think there was a lot of pressure initially that my community has to be my medical school class. There's always that pressure. Even just thinking about first year of residency, I already feel a little bit of that pressure having that community be my co-residents.

But even just remembering how I progressed through medical school or how I started making a lot of those connections that were outside my class, and whether still in other classes or even beyond that, just outside people in the community, it did ground me. It did kind of remind me of what I am and who I am as a person, a lot of other things that I love and enjoy and feel healing with and feel safe with. And it also just kind of reminded me of why I'm doing medicine and my passion in medicine as well.

Hạ:And it's also one of those things that . . . I feel like I get really anxious about a lot of things. And even during the whole match process and trying to figure out rank lists and trying to figure out a lot of these things, I remember going to a lot of meetings with people to try to process and figure it out. And I just unveiled all of these anxieties, including one of them as trying to find community, trying to find my people.

One of the questions that one of my mentors always liked to reflect back on me was . . . he always liked to ask, "Did you feel this anxiety before starting med school?" And I would always just pause and look at him and go, "Yes, I felt all of these anxieties that I've told you."

I remember the first day of med school before transitions to medical school. I was calling one of my best friends from college, and I was freaking out and I was going, "I don't know if I'm going to make any friends. I don't know if I'm going to fit into this Utah culture of, 'I love to be outdoorsy and I love to ski.' I don't really know if I'm going to find my people, especially in a very otherwise pretty homogenous state." So I always feel these anxieties.

And truthfully, for the first half year of the first year of med school or so, I really did not think I would find my people within the medical school because it was really hard to connect to people. And then naturally, as I gave time, things just happened, and I just slowly gravitated.

I think this is something that I try to really hold onto me, is just that reflection of, "I'm coming back in with the exact same anxieties I had coming into medical school, coming into college, and it all eventually works out," and trying to find strength from that too as I think about building new communities.

Leen: I don't know if anybody else can relate to this, but I think growing up, we were always ambitious. Clearly, we went through medical school. We're now going through residency. We definitely had some sort of ambition, whether to start or if it's still there. But I think a big part of it, for me at least growing up, was friends, support system, these things come secondary to me doing well in school.

Then I finally hit medical school. And I remember I told Harjit this, and to this day she will not let it go. But it's kind of a joke running between us. I remember walking into medical school and saying, "I'm not here to have friends. I'm here to do good."

Lina: She has told us this joke as well. She blasted it already.

Leen: That's the culture I came from, where friends are a distraction, right? And so then my mind, I was like, "I'm not here to be distracted. I'm here to be a doctor." And ironically, I found my sisters through medical school, right? And they're the closest people that I've ever been close to.

And so starting residency, I approached it a bit different. I actually went the complete other way, and I was like, "I'm here to try to get to know everybody at some level," which in the East Coast, people thought that was super weird.

I got that a ton. I got a lot of that feedback first and second year. It was like, "You really know a lot of people." And I was like, "I feel like at the end of the day, everybody had some difficult journey to get to where we are, and so why the heck are we just greeting each other like working bodies and leaving? We should be able to function as humans as well."

That first month, I remember my chief said, "The first month is you to get to know people. Just go around, get to know people, and get to know your staff, get to know your nurses, get to know your team. Just get to know people and let them get to know you." And that really set the basis for a much easier system going through residency in the first place.

You get to commiserate with people much easier. You get to know people on different levels. And hey, sometimes they network you outside of the hospital, and then you find people outside of the hospital. So I think that would be my biggest advice there.

Hạ:I love all of your wisdom, Leen. Thank you for just sharing it with us.

Leen: Wisdom or trial by fire? But it works, I think. I don't know. And sometimes you need to go back to your old support system. I think third year, man, I think it was just short staffing, healthcare crumbling. Sometimes you're being yelled at by people. People don't necessarily understand our field.

There's a big mistrust of physicians nowadays, right? I ended up going back to my support system from medical school. I talked to Harjit. I talked to Margaux. It almost just kind of resets you back to that time when you were a med student, and you kind of talk through that, and then you outreach to people even before that.

Sometimes even just sitting down and looking at your resume. I know that sounds so weird. But I looked at my resume, and I was like, "I did all this? I feel like this was a whole different life ago." These systems, these networks, these things that you need in residency come in all sorts of ways and all sorts of tactics.

Lina: I think you bring up a great point. I guess they're not as rigid or closed as we, I guess, expect them or assume them to be, and that's okay. A lot of these relationships, it doesn't necessarily have to be just your residency relationships, but even going back to your relationships in medical school, or even before that. I still kind of have a very strong relationship with my friend before medical school and sometimes I need that.

So being open to the concept that it can be just wherever you've had the community, and it can come and go, and that's okay. But it also is there for a reason. We've made these relationships for a reason. We have these close friends for a reason, and we can rely on them. They don't necessarily have to be around us 24/7, but we can use that as support.

And I think the other thing that I think about is . . . I guess originally, thinking about starting medical school, there was a lot of pressure that, "Oh, I need to find a community as soon as I can." And I think part of that comes from the fear that I don't want to be isolated, I don't want to be alone.

And so I feel like I put a lot of pressure on myself to find a community fast, and I may have jumped into relationships. Looking back, I'm like, "Why did I do that?" It just purely came out of pressure.

And I think just even now, going into residency, I want to give myself that grace that it's okay if that community doesn't happen from the very beginning. I don't have to have all these friends and connections from the very beginning. It's okay that it may take some time. I shouldn't pressure myself or feel the pressure to not be alone, because in reality I shouldn't, just even looking back at the relationships I've made from medical school and where I am today.

Leen: Yeah. I would definitely say the biggest thing is to be well within yourself first because residency is isolating. That's, I think, something that a lot of residents feel. But once you're well within yourself, you will be able to motivate yourself, push yourself to outreach for the connections that you need in order to . . . whatever it is. Whether it's to commiserate or to get over something, whatever it may be.

But if you don't find that fire within yourself, if you don't find that wellness within yourself, sometimes it's hard to get yourself off that couch and go out there and try to get that connection.

At the end of the day, we're humans, and I think sometimes, or maybe all the time, the system forgets that. It's not normal to be awake 24 hours plus. It's not normal to be thrown into these really chaotic situations and you're just MD Day 2. It's not normal.

It's not normal to assume that this person, now that they have an MD behind their name, suddenly knows all of medicine. Obviously, we do not know everything about medicine. Obviously, we are human. We on micro-level tend to forget that within ourselves and within others, and we forget that everybody else is also working just as hard and trying their best. Not to put a gloom on residency.

Hạ:I really love what you said about really knowing a bit more. I can't summarize it as beautifully as you said it all, but really just trying to understand yourself and grounding yourself as you try to build new relationships.

I do think when I reflect back about the evolution of my relationships in medical school, I realized that things started progressing and I started finding people when I felt I wasn't forcing myself to find people. But what I was really doing was I was just centering on the connections that I already had.

There was a point first year of medical school where I was just focusing a lot more on talking with my friends from college, even if it was long distance, maintaining connections with my friends from when I was doing research and in high school, and really spending a lot more time devoting energy into things to build myself up and working on advocacy work and finding things that I was passionate about. And through those things, that's how I ended up finding the people that gravitated towards me.

I sometimes forget about that. And just hearing what you said, Leen, really helps me remember this fact and know, "This is really true. This is something that I've experienced." But sometimes it's so easy in new moves and in vulnerable states to get swept up and forget that you've experienced it and that you've learned from it.

Leen: Yeah, absolutely. And the people that you connect with, the people that you have conversations with, these are the conversations that also keep me grounded as well. They keep me down to earth. And I feel like sometimes in residency when you are bogged down seeing so many patients, you almost forget that whole connection and you forget to be that person who connects with patients.

I was telling my program director the other day, "They used to call me the patient whisper in first-year." I could go up to the most agitated, aggravated patient and just get them to calm down and talk to me. And I was telling him, "I don't think I can do that now. What's going on?" And we talked about how responsibilities shift during residency and change, and that it's still within you, but at the same time, under a different stress, it might not be showing as much.

That's when I went back to Harjit, and I was just ranting with Harjit and telling her about these things. Recognizing that as well, recognizing those changes when you feel like your passion is not being fulfilled completely, being able to verbalize it, discuss it with your support system is so important.

And so always remember those people that you have these conversations with, the ones who can relate to you with these conversations, and touch base with them.

So I don't know. I mean, there are so many changes that go on within your brain in residency and it just forms you. It really changes you.

Lina: Well, I guess we'll get there.

Leen: I know that was a rant.

Lina: No, I am excited for all there is to come with residency. And obviously, we have you and Harjit and Margaux to help kind of talk to us throughout all of this. But for everyone else listening, this is why we have these conversations. We're trying to portray, I guess, the journeys that we've had so far, whether in medical school or residency, and what we've learned for that, and how we've supported each other and how we can support you guys, right?

My takeaway from this is just being open going into residency, going into the communities, and I think grounding ourselves and reflecting on who we are, and where we've come, and our passions, and having people to remind us that if sometimes we can't remind ourselves of that, right? I don't know. Did I miss anything?

Hạ:No, I think that was very beautifully said.

Leen: I like it.

Lina: Okay. Well, thank you everyone who's been listening. If you are doing a big move or a small move or anything . . . I think honestly even just starting residency from your home can be a change. Share with us on Instagram @bundleofhers and tell us your story. You could get a pin that says "Power from Identity."

We hope that you continue to listen to us and to our stories wherever you podcast or wherever you listen to your podcasts, and we'll see you next time. Bye.

Leen: Power in identity.

Lina: Yes. Love that.

Leen: That's exactly what ran through my head when I heard that.