S8E7: Burnout, Identity, and (Re)Finding Yourself in Medical Training

Hạ: How was the half marathon, Lilly?

Lilly: I did a full marathon.

Hạ: Oh, yeah, the full marathon. My brain's not working well. How was the full marathon, Lilly?

Lilly: I wish it was a half when I got halfway. It was so hard. It's hard to wrap your head around the idea of running across an entire bridge. They're freaking long. They're a mile-plus. And I did it five times. By bridge three, I was like, "There's no way there are any more bridges." And then you hit the next one, and it's dead silent. You just hear people's feet stomping away, and I'm like, "What am I doing? I have been running for almost six hours."

But it was so fun. All of my co-residents made these big cutouts of my face, and they put them all over the VA and The U workroom. So everyone knew I was running a marathon, and they sent me with some of them. So it was fun. I got to see my family holding up signs and stuff and find them in between. Every few miles, there would be someone waiting and stuff. And then we did dinner afterwards. It was very wholesome. It was very cute.

Hạ: Oh, so cute. Yes. Yay. Hello, everybody. Welcome to another episode of "Bundle of Hers." Well, first off, this is Hạ, if you don't recognize my voice. And I have in the virtual studio with me Lilly and also a special guest who is back. It's Harjit.

Harjit: I'm so special.

Hạ: You are special.

Harjit: Did you recognize me, everyone?

Hạ: Harjit. She is back. The OG Bundle.

Harjit: Hi, everybody. It's Harjit Kaur. I used to be in the "Bundle of Hers." I guess I'm still . . . I'm a lifelong "Bundles" member.

Lilly: Oh, yes.

Harjit: Currently, I am an attending psychiatrist in Oakland.

Lilly: A true adult.

Hạ: Is there a light at the end of the tunnel, Harjit?

Harjit: I feel like I'm too young of an attending to say that right now because things can be a little bit difficult and hard. I always felt when I was a resident or even a medical student that someone had my back, even if they didn't check my notes or check my work. But it feels like I'm doing things on my own. People still support me. I have mentors and stuff. But it is, I think, a little bit difficult right now.

Transitions and new jobs are difficult, but I've been here for a year. So I feel better. And yes, I feel like there's an ending at the light of the tunnel. And I also think it depends on what specialty you do too.

Hạ: Good to hear. #Lifelonglearning is what I keep discovering.

Harjit: Lifelong learning is the type of learning I feel like that is paramount.

Hạ: I think that is a cool segue to actually introduce the topic of today. The topic of today is to focus about losing and re-finding yourself in medicine and basically about navigating burnout with the medical training, all of the sad vibes, and everything like that.

But before we begin this conversation, which I am very, very excited to have, I first always have to give our disclaimer. And it's a reminder that our views don't represent our respective institutions. They only belong to us. They are our views.

As I've been going through residency, I've been navigating this tension essentially between who I thought I would be as a resident and who I feel like I have become. I am always so really tired and burnt out, and the system is really rough to navigate. And it's something that I did not anticipate, feeling this chasm between those expectations and reality as deeply as I have felt it.

But yeah, I guess in starting off with this conversation, I would just love to hear when I say losing and finding yourself in medicine, what are your immediate thoughts?

Lilly: I think for me, at least, I went through a pretty severe quarter-life crisis when my mom passed away last year, mostly because I had chosen to go into neurology because of her and try and care for patients with similar diseases and deficits to hers, especially because she suffered from a lot of different things that fall under neurology, whether it's headaches, seizures, cancer.

So for me, when she passed away, I very quickly was like, "Oh my gosh, why did I pick neurology? I'm going to be surrounded by this for the rest of my career, and now I feel like I have a tainted view of the field."

I was in my medicine years. I was like, "Well, maybe I should do medicine. Maybe I should just not do neurology, and that way I won't be so exposed to it." And it was a good two or three months where I was so lost, and I was like, "Why'd I even go into medicine? I'll be caring for strangers."

I couldn't even save my mom, which realistically, when you're of sound mind, you know there wasn't more you could do. But I was thinking, "Wouldn't it have been nice if I was in a completely different field and never had to step foot in a hospital again unless something were to happen to someone else?"

And now I think being in neurology all the time and that's all I see, especially working in a neuro ICU, I still get moments of that where I just feel so lost and . . . I don't know. I wish I wasn't there sometimes. But you kind of have to just put on a brave face.

Some of the patient cases we get are just so heartbreaking and very triggering and just really sad situations. And as the neurologist, I have to lead a lot of those difficult conversations. The patients will never really know that I've had very similar conversations with my own family or in a very similar hospital room on the other side of the bed.

I'm still kind of navigating that and falling back in love with neurology and trying to think of it as a way to connect with my mom, a way to see my mom in my patients, and give them the kind of care and love that I would want my loved one to receive. But it's also a hard balance of just being around something all the time that you don't have the best interactions and connections with anymore.

Harjit: Yeah, I think for me, when I think of my identity evolution . . . We all kind of carry multiple identities throughout our life, but I think there's always one that is put into focus.

I do find that for especially people who are marginalized or who are minorities in medicine, in education, that often those are kind of the identities we lean heavily on. And I think a lot of people have to do that to survive, so they can really fit a goal, really know themselves in one place, and then can make a name for themselves, make money so they can go up in higher classes of the social ladder.

Sometimes I would look at some of my classmates, be it medical school, residents, even undergrads, and I'd see them juggling so many of their identities with each other. And I would always be a little like, "Why can't I carry a whole bunch of identities at the same time like a lot of these other folks?"

And I think that's where, again, power and privilege come into play, because I don't have that same mindset. I've never seen it. I've seen my mom be in a motherly role and my father be in a provider role, but I haven't seen the other assets of them. So that's not what I'm used to. I'm used to kind of the one identity of theirs that made them providers, and I think that's what I feel like I end up focusing a lot on.

Growing up, it was, "I'm a girl, I need to go to school, and I don't want to get married." In college, it was, "I'm a woman of color, and in higher education, I need to work hard and kind of learn about systems." And then in medical school, being a first-generation medical student I think was a huge identity that I held on to.

And then in residency, I think it became, "Okay, I'm tired of all these." Because all those identities were tied to my worth as being a physician so I can make money and be on my own. I wanted to start exploring identities out of that.

But in that process, I think it became really convoluted because you're working a lot, you see a lot of stories, then you're like, "Why am I doing this? What should I care about?" And that kind of creates this cycle where you kind of get lost.

That's how I felt a lot as a resident. And now I'm kind of getting back into, "This is who I am, and I have to kind of mesh these pieces together. Now that I do have power and I do have privilege, how can I bring everything together?" That's how I feel.

Hạ: Both what you, Lilly, and what you, Harjit, said was so powerful. And I can see this underlying theme that I resonate with in a way, is this idea of how a lot of our path . . . We kind of center it around particular identities and goals, and a lot of it is very much based on community and our identities as women of color. And the problem is a lot of times what I then struggle with is the system itself that often really conflicts against that core identity.

I was reflecting a lot. I think what dealt with a lot of my burnout in residency is I always felt like when I was measured against a lot of other peers around me, I never felt like I was completely enough, but I was like, "Well, at least I have this." And so I would center on those things and go, "That is that the thing that I bring to the table."

And one of the things that I kept feeling and brought to the table a lot was my focus on how a lot of the things that drive me forward is my community, is the experiences of my family. That's the thing that makes me care so much about being patient-centered and being able to really converse with patients.

You all probably remember, but throughout medical school when we're getting graded in clinical rotations and all of this thing, it was really frustrating. But the things that I kept going was, "But I know I have great bedside manner. I might not score well, I might not do all of these things, but I believe that I have good bedside manner, and I can talk about these social issues, and I can be so cognizant of it all." I really centered on that.

And then I went to residency and suddenly with complex patients and interacting with families dealing with their most stressful time, and that tug in pediatrics of everyone really caring for the child, but everyone going about it a very different way. Not just from family and healthcare workers, but also among healthcare workers too.

I suddenly felt that thing where I was like, "But I'm great at centering community and bedside manner," and all of that just felt like it was thrown out the window, and I wasn't performing in that way. And so I sat a lot and went, "Then what am I doing here? What do I even bring to this table? Am I even a good clinician?"

I would even listen to my old episodes or reflect on the episodes that I did in "Bundles," and I'd be like, "Wow, I have just become a completely different person than I felt like I was previously."

It's really hard trying to navigate that. And at the same time, you're like, "Well, I came here because I also wanted to provide a stable income for my family and all of that and have that stability. I have loans, and I have all of this."

So I kind of now feel like I'm stuck here. But all the things that I thought I was going to be able to do and that I could bring to the table, I can't feel like I bring anymore.

And so when you both were talking about it, I felt very emotional because even though the contents and specifics were very different, I still felt that resonating theme of where we're drawn into medicine for our identities, and yet now the way the medical system is built and what we go through makes our identities feel really shattered oftentimes.

Lilly: Yeah, I feel like you really hit it perfectly. Even now, when I go through thinking about all the reasons I went into medicine, it's because I enjoy being a caregiver, a provider, being a comfort to someone in a time of crisis.

And like you said, sometimes . . . I remember attendings would call that your soft skills, like, "You're really good at bedside manner and things like that." And that would stand out to them when we would go through evaluations. But I always thought that was so interesting because I thought, "If those are soft skills, shouldn't everyone have them?"

But then you're praising us for having such wonderful bedside manner and building rapport and trust with patients. So I don't actually think it's as easy as it seems.

But now, as a resident, we do those things, but then we get held up at other parts of care. We'll have patients who are unfunded, and it's hard to get them to the next step in their care, whether that's rehab or a safe home or medications that they need. And sometimes they're just staying in the hospital trying to figure out this plan.

I could have the best bedside manner in the world, and the patient enjoys seeing me every day, but ultimately, I feel like I'm not pushing their care forward because the system isn't in a place where it can provide them with proper care.

And I get really frustrated because it's not a problem I can fix or my attending can fix, or something that case management or social work can fix. We're all just trying to navigate this complex system. And then you really question, "What am I providing this patient right now? They're just sitting here waiting for us to get them to the next step," and it gets really frustrating.

Harjit: I find that when I think about this a lot, it does make me feel exhausted and tired, and as you said, Hạ, really, you feel like your identities are shattered in medicine. But I find that the answer is also to lean into our identity so we don't burn out, and we make that shift.

So I taught some cultural psychiatry when I was at the University of Utah, and I'm teaching cultural psychiatry to the current residents at the institution I'm at right now. And I prompt them with three questions. I ask them, "What are your identities? What are your values?" And then I ask them to remember a distressing time in medicine. And oftentimes, that is in opposition to their values or their identities.

I think that's so important because we need to recognize the distress that we have in medicine to not only understand our patients, because I do think people end up caring for themselves more than they care for others. Let's be honest, we're all individuals. We think about ourselves, our needs, how we're feeling.

So if we're able to understand who we are, we're then able to understand our patients. And then we're also able to understand structural reasons why our patients aren't getting the care they need. That is all to say that being a critical thinker is important and necessary.

I always lean on . . . when I feel burned out, I'm like, "I'm doing this for this reason, and this is the ways that I'm going to make impacts." And sometimes they're not big.

So I would say those bedside skills are not soft skills. I think they're important and main skills that allow us to provide good care so we can be critical about, let's say, a lab number or a physiological process or "Why is what's happening to this body . . ." It's not just a body. It's a person with their own identities that have to exist in a home environment, a skilled nursing facility, or whatever.

I think that's what keeps me not feeling burned out, is at least I'm making friends, at least I'm getting to know people, and with boundaries. Making friends with boundaries, as in making therapeutic relationships. I'm getting to know people and their identities and what makes them happy and what things they care about. 

Sometimes leaning on your values can be hard. One of my values is being an advocate and it's hard because I'm just like, "I'm not utilizing my value to feel better." But then I also remind myself that the small things matter just as much as the big ones.

Lilly: I have so many thoughts. I think in talking about our values at least and how that dips into the feelings of burnout, one of my big values is building community and having those therapeutic relationships with patients. I love the idea of doctors back in the day that used to make home visits, and patients would know who they were in the store, and everyone knew who the town doctor was. I love the idea of a small community. And I know that's not realistic in this day and age, but I do want my patients to feel like I'm someone they can be comfortable with.

And so sometimes, if my patient really had a hard day or something, or they're about to discharge, they'll be like, "Oh, I just want to give you a hug." And I'm like, "Of course." But I know that's one of those things that some people will say you shouldn't hug your patients. You should keep that firm boundary.

Sometimes I'll get advice from seniors that sounds kind of paternalistic and things like that. And it's hard to not want to just assimilate or normalize into the culture because I'm worried about getting negative feedback that goes against my values. But then I also wonder how much I can go against the grain and still be true to my values.

I think as second year has gone on, I've definitely dug a little more into my values and been like, "You know what? If I see this patient in clinic and we have a therapeutic relationship and they're going through something really scary, but they felt like I listened and they want a hug, I'm okay giving them a hug." And if that's the kind of provider I am and that's the kind of provider you're not, that's okay. We can have different practices, and I need to start to shape myself into becoming the type of attending I want to be.

I think it's just important to have healthy boundaries, but also know what's important to you. And to me, it's not just an interaction, it's not just a business, it's not just a transaction. If I don't have those small moments with my patients that humanize us, I think that impacts me even more when it comes to burnout.

I was feeling so exhausted after a four-week stretch on inpatient and feeling like, "I don't know anything. I don't know how to run a code stroke on my own. I don't know how to read imaging very well. I don't know all the doses of the medications that we use, and I'm constantly having to ask questions."

And then right towards the end of one of my shifts, I was telling my patient in the morning, "Oh, I'm going to be off service tomorrow. You're going to have a different resident taking care of you. I was so privileged to take care of you, and I'm excited for you to go home."

And she was on a walk with PT, which is physical therapy, and when she saw me, she grabbed me and was like, "Oh, this is my daughter. You met her in the ED. She just got back," and stuff. We were chatting in the hallway, and she was like, "Oh, I'm so sad that you're going to be off service, but thank you for taking care of me." And then she gave me a hug in the middle of the hallway.

Even though it was such a small thing, it made the last four weeks feel so much more impactful than I thought they were because I was being so hard on myself as a junior resident.

Hạ: I love that story, Lilly. I think that oftentimes going through the training system, we do feel like we have to mold ourselves into what everyone else expects us to be.

I felt in med school it was a lot easier for me to feel like I could push against the grain. And it is likely in part due to being surrounded by people like you two always reminding me about who I am and what I care about.

But in residency, it's often very hard for me to be able to do that, also because everyone's just so busy and so tired that sometimes we're just thinking about getting through the work shift and then getting time to eat food and sleep and just doing basic necessities.

But one of the things I was kind of reflecting a lot more about was I finished second year on PICU, and then third year, I started being on my palliative elective. And it was really interesting because I was seeing exactly all of the patients that I had met in PICU, but suddenly, I was seeing them through a different perspective.

And we spent a lot of the time in the rooms asking about, "What are your goals? What are your interests?" Talking with families about patients, like, "What does this patient love to do? What matters to them?" and having that switch.

First, it was kind of this moment where I felt a little bit of existential crisis, because I was like, "Oh, God." I had been here for four weeks with a lot of these patients, and I didn't know any of this because it was just impossible for me to ever have that moment.

But also, then the other half of it was seeing how powerful just being able to sit and actually centering, as you mentioned, Harjit, on the identities of the patients themselves and where they're coming from. And then also approaching it very differently, because palliative, I feel, approaches medicine very differently than what a lot of medicine does, like what you were referencing, Lilly. And I could see how powerful and transformative it could be.

It's something as I've been talking through with my therapist and working through now, I've been trying to do this thing where every day, if I have a patient encounter or do more patient-facing things . . . because sometimes as a senior resident, I don't do that that much. When I call my mom every day, I try to tell her one good thing that happened from a patient care perspective a day.

And it starts making me think that even though the whole system as a whole really sucks, there are those little nuggets that feel really good. They don't need to be the most profound thing, but they can be a small thing, like antenatal counseling where you're just so in awe by everything that the pregnant mom is saying, or just having a family smile at you, or looking at a really cute NICU baby in a very cute outfit for the day. It makes medicine a little bit more bearable.

Harjit: Yeah, I agree with that. And I want to go back to something that you said, Hạ, that really resonated with me. You were saying that you felt a little bit better in med school because you had a community that you really could identify with. And that kind of goes back to identities.

I'm friends with you because we're from the west side of Utah, and I feel like we have that connection. And I'm friends with Lilly because she's Afghan, and I feel like Punjabis are very similar to Afghan people, and I see her generosity and her welcoming of people, something that I also really, really value.

I find that it's hard as a resident because you don't have the time to make those connections. People do come from all over the place, and they might not think like you, which is okay. But there are some core values that are important in making those connections and being like, "Oh, at least work is hard, but when I'm outside, I can hang out with my friends and feel a little better, or we can vent about stuff, and that would make us feel a little bit better."

So I think that's also important, not only leaning on patients and their stories while you're in the hospital, but outside of the hospital, being able to meet people that have similar values or identities as you and taking that time to make those connections, which can be very hard when you're a resident.

Lilly: I feel like that ties really well, Harjit, into talking about how we re-find ourselves in medicine and how we reconnect and recultivate that relationship with ourselves and try to pull ourselves out of the burnout, which I feel like I'm still working on. I'll be honest.

I think second year of neurology residency is really tough, but ways that I feel like I've been able to at least try and find myself again is making those small slivers of time for my loved ones outside of the hospital and outside of the clinical setting.

And I remember thinking, "Oh, I'm just so tired, and I don't get to see my loved ones outside of medicine enough. So I'm going to prioritize making time for them."

But I've also realized that it is nice to make time for your co-residents and your coworkers, people I worked with in IM and in neuro, psychiatry residents that I've met. It's so nice to connect with them outside the hospital.

And like Harjit was saying, you can vent, which I always think is very cathartic and I love doing, but then you also can see them outside of the walls of the hospital, maybe at a yoga session or at someone's birthday. It's really nice to humanize them and yourself in those moments and connect about other things.

I was just talking with two of my co-residents about how we should do something for Nowruz, which is Persian New Year. And it really took me back to third year of medical school when me, Mariam, and everyone wanted to do something similar. And that's how we built our community. That's how we filled our cup.

And in the last three years, I haven't done anything for Nowruz because I've usually been working or tired and sleeping. Just talking to two of my co-residents, they're both Iranian, we were like, "Yeah, we need to do this." It motivated me, and I was like, "Yes, I have something to look forward to, to pull me outside the hospital, to remind me that I enjoy hosting and having people over and connecting over our shared community and food and culture and traditions we grew up with."

Especially living far from, I guess, home now, because my family lives across the country and not having that sort of home base to return to, to have that smaller version of that here in residency is really nice.

And then also I think having opportunities for self-reflection, like this podcast. I really feel like every time we record an episode and we have these conversations, I feel a little less heavy afterwards when I returned to the hospital.

All of those little outlets really help because it also reminds me that this is temporary. I thought med school was the hardest thing I ever went through, and now I'm in residency, and I think it's the hardest thing I've ever gone through. And I'm sure when I'm in Harjit's shoes, in my first years of attendingship, I'll think that's the hardest thing I could possibly go through when there's no one to truly be that safety net.

It just shows how we still survive those hardest days and things can get better. And I still have hope that I'll get more comfortable and maybe that'll help with the burnout too.

Hạ: I love that, and I love really centering on there have been so many things that have been hard, and we have still been able to resist and surmount and still keep parts of ourselves, despite the fact that the system really is built to carve you into not who we are as our identities.

It's similar for me. The way that I really try to recultivate parts of myself is centering in community. I love being able to yap with people and to be able to talk about stuff. I also have been trying to re-find other parts of my identity that I've been forgetting, which is, for instance, reading.

Fun fact, I loved to read as a child. I would go to the library every week to read a lot of books. And then I went to college, and my reading-for-pleasure momentum died really quickly. And it's been kind of a long process trying to pick it up. But these last few years in residency, I've been really picking up reading a lot more, and it's been a really nice way to remind myself that there's more than just the hospital itself.

And then I also have been trying to go bouldering a lot more with my co-residents. That is also nice, except when I get tendonitis from all the typing and bouldering, and then I need to take a pause.

But those little moments. I think it's funny because sometimes I feel so overwhelmed, and then there are little moments where I'm able to go out. Like I'm submerged in the water, and then I manage to swim up to breathe for air a little bit, and it's filled with community. It's filled with things for joy. It's filled with getting to look out at the sunshine instead of entering the hospital when it's really dark, and leaving the hospital when it's really dark. Those things kind of help me continue forward and really re-find joy in medicine.

Harjit: Maybe because I'm a psychiatrist, but another psychological thought that I think a lot about when we're talking about this is that change is inevitable and our identities are supposed to change.

Sometimes we do kind of miss parts of our lives, and we're like, "Oh, why can't we be like the way we were back then?" But we also need to realize we've lived in different places, we've interacted with different people, that having those changes in your identity or feeling that maybe that one identity was so in the front and it's not, that's okay. It's okay to know that things change.

So I don't think anyone should ever feel bad. Sometimes I remember, like when I was in residency, I'm like, "I feel bad I'm not doing the things that I value or pushing for the things that my identity really taught me about." And I think that's just a way to give yourself a little bit of grace, and know that things are supposed to change. So I think about that a lot too.

And then I think journaling and writing can be really helpful, like writing your values and things you can do for that. Or what identities do you want to focus on now? I just got married, so I was very focused on my personal life, and looking towards the future, I probably want to have a family. So that's what I'm going to focus on.

So I think it's okay that sometimes some identities take front and center, but I think what's most important is always to be able to juggle all your identities together. I will say it's easier when you have a little bit more power and privilege as you go higher in training.

Lilly: I loved how Hạ described coming up to the surface and getting some air. That's truly how it feels, especially when in med school and residency we have very regimented schedules, and we don't get a lot of say in the time that we get off, which hopefully that is better on the attending side. Harjit is nodding, so yes.

I think the idea of a golden weekend is something that is so holy to me. And as soon as I have a golden weekend, I'm a whole new person. I'm so much happier. I'm so much calmer. I'm so much more at ease.

I used to be the kind of person that would only ever make time for things related to pleasure or extracurricular. It's kind of like how I was saying with reading. I wanted to do my exercises, I wanted to do shopping, I wanted to do cleaning, everything on the weekends. And in residency, you don't really get that many weekends. You get one day to get your whole life together, which isn't realistic anymore.

So I've been slowly trying to find little pockets of sunshine throughout the week where it might be a Tuesday night and I have work in the morning, but yeah, we can take 30 minutes and go get ice cream. Yeah, we can take an extra 20 minutes to go on a dog walk. It's okay if we watch a movie on a random Thursday night, and not trying to be so regimented in the way that I pictured my life before med school to now what my life is like in residency.

I'm not trying to live for the weekend but rather just live my life throughout the week, which I think has helped a lot with burnout and coming to terms with not having a lot of control over my schedule and where I'm going to be at all times.

Hạ: I feel like sometimes, in medicine, I just want to go all in if I'm doing something, but I'm learning to step back.

Lilly: Yeah, same. Make it smaller, more digestible chunks.

Harjit: I also just had another thought, but I also wanted to remind everybody that many people who have minoritized or marginalized identities also are existing in a system where their identities weren't really taken into account, in fact, is harmful. So I think that's the other reason why a lot of us struggle at times.

Even having this conversation, who really talks about this as something? We talk about wellness. I think this is a huge part of wellness, but I do think that we're talking about this because we think about this a lot.

But I just want to say it's a very normal experience to feel uncomfortable or feel like you are losing parts of yourself. Some parts of yourself are getting shattered. And I think it's important then to do all the things that both of you have said. Build community, do something fun, do something that brings you joy, and it doesn't have to be all centered around medicine. Most of our life is medicine, so just doing something different is already helping you expand in that way.

Lilly: Yeah, I think that's a really good point, because as a brown girl coming from a community where we don't have a lot of doctors and we don't have a lot of representation . . . I try to look up statistics all the time about how many Afghan doctors there are in the U.S. and I can never find a statistic because no one cares to study it. No one wants to know how many of us exist in this space because nobody cares. At least that's been my experience.

And for me, I balance and have difficulty with balancing a lot of my identities as a daughter and a cousin and a relative and a niece, and trying to make as much time as possible for my very large extended family, who always wants me to come visit them and be there and not to miss out on anyone's wedding or birthday.

Any event that they're having, they always want you to be included and involved. They're like, "Well, just tell them you need off. Just tell them you need to come. Just tell them that you're sick." And I'm like, "That's just not how it works. I'm in such a small cohort. I can't just ask for a random weekend off because your son is having a birthday or a wedding."

As much as I would love to fill my cup in that sense, I feel like I do fail a lot of times as a brown girl in my community, wanting to be there with my family, but then also having this big responsibility of being a provider in the hospital who someone physically would need to be taken out of another space in order to provide the care that I'm supposed to be giving patients.

I think that really contributes to my burnout, is trying to wrap my mind around failing in other aspects of my life because I've committed to this job. And I think sometimes when I try to relate that to other people I work with, they don't understand those kinds of pressures because that might not necessarily be a core value in their culture.

People just understand, "You're in medicine and you need to be in the hospital, and that's important," which my family understands, but they also think that they're just as important, which is very fair.

Hạ: I think, also, part of the thing I appreciate is when we're able to name that this is . . . like what you did, Harjit. This is what is built and ingrained in the system. And recognizing that is always this nice step towards being able to first recognize that it's not us. It's a system that has made us feel like that. And then thinking about tiny ways that we can do resistance.

Lilly: It's so hard to digest this big topic. And burnout is something that's so intimidating and real that trying to find those little pockets of happiness, trying to build your community no matter how small or different it looks in different aspects of your life, is super important. And reminding yourself of who you are.

I really liked Harjit's idea of journaling. Unfortunately, I am too tired at nighttime to journal, so I love to talk out my feelings with my family and my loved ones of, "This is the hard day I had, but this is one good thing I did. This was my peach and my pit." And those really help not just internalizing all of my feelings.

And reminding yourself that there are other people out there that you can talk to, whether that's therapists, friends, mentors. Reaching out to those people and really sharing your experiences, for me, at least, helps a little bit with processing my burnout.

Harjit: I really like that, Lilly. I think identities are created to be told, so I really think it's beautiful that you said that. And I think speaking about yourself, speaking about things that you value, things that you care about, allows you to feel powerful in your own self. And I think that really, really, really helps as kind of the next step.

Hạ: I love all of that. And to just wrap it all up, as you all know, this season, the theme was growth through challenge. I think that's why this topic and a lot of the reflections that we had today, it feels really poignant, however you say those fancy words.

But it feels very beautiful in thinking about that even as we're dealing with this really deep, shattering challenge that really pushes against how we view ourselves and how we think of ourselves through community and through being able to have these stories and talk in this way. We're able to come together and hopefully find ways to put those pieces that are shattered back together and create something even more beautiful, like a mosaic.

Lilly: I was thinking a mosaic. Yeah, it's broken and you put it back together.

Hạ: Or you know those potteries where there are those kits that you do with the gold plating?

Lilly: Yeah.

Hạ: Yeah, all of that. So I hope that our conversation helped anyone, if you're feeling lost and confused, find some clarity. We're always available, if you have anything that you want to share. To our dear listeners, please like and listen wherever your podcast. And it's been an honor to be here to talk with you all.

Harjit: Hooray.

Lilly: Bye.

Harjit: So fun. Bye-bye.