S8E8: The Loneliness of Medical Training

Laurel: So I thought that given we were talking about loneliness, which is such a fun and joyful thing, that maybe we could talk about the last time we hung out with someone or had some version of community connection as a way to sort of, I guess, frame the conversation, I think, of "inverse of loneliness is connection." And so I figure we'll probably touch back to it. So maybe we can think about the last instance of that.

Hạ: Nose goes.

Austen: I can go. I'm a fourth-year right now. For people listening who are maybe unfamiliar with the med school setup, generally, fourth year, you have a lot of time, which is fun and exciting and really nice because third year tends to be pretty hectic. And third year was definitely when I felt loneliest, most isolated.

And so I think this year, I've really tried to put in the effort to make sure that I'm connecting with people, I'm seeing people that I love, and spending time with people that I love.

I feel very lucky to say that I was just hanging out with friends. Yesterday, I went for a walk with two of my best friends, which was nice. On Friday, I was hanging out with some of my really close friends as well. I've had more time to connect with people, connect with people that I love and people who are in my class as well who understand what it's like to be a med student and be in this journey. So I feel bad starting off and saying that.

Laurel: Austen, I like that in our conversation about loneliness, you start by pointing out that it can improve and there can be situations in which you get to connect with folks.

Austen: Yeah, definitely, Laurel. It's been nice, especially, again, coming out of third year when I think that's sometimes the first real experience with feeling lonely in the journey for a lot of people. So it's been good.

But Hạ, how are you doing? When's the last time you connected?

Hạ: The last time I connected? So my mom visited me last week, actually.

Austen: Oh, fun.

Hạ: And I love my mama. She visited, and my mom and I are both introverts, and so we kind of like to recharge on our own time. But what my mom and I really like to do with each other is we kind of . . . I'm a pediatrician, y'all, so I like to say parallel play a lot. We parallel play a lot. And so my mom will be on her iPad watching her Vietnamese-dubbed drama and I'll be on the couch reading a book.

And that's what I did on Saturday on the last day that my mom was here, because she just left yesterday. And that was really nice. I felt very connected and healed in my own introvert way. So it was very fun.

Laurel: I feel like that's one of those things where people get really variable on the definition of introvert versus extrovert, where introvert doesn't mean that you don't want to be around people or cherish their company. It just means that you perhaps engage with energy levels differently. And so I feel like parallel play with your mom, watching dramas is real introvert success.

Hạ: It's so true. A lot of people don't think I'm an introvert because I like community and I like hanging with people, but sometimes you've just got to sit in silence and do your own thing with community.

Austen: That's fair.

Laurel: That's very fair.

Austen: That's like self-actualization in my mind. If you can just sit and enjoy the quiet with someone that you trust and care about and you still feel cared for, you've reached the mountaintop.

Hạ: Wow. Thank you, Austen. You made me feel so good about myself. I at least reached self-actualization in one aspect of my life.

Laurel: Really cool to cover the grounds of fourth-year community and self-actualization, as I bring us down to, "Let's talk about being lonely," says Laurel.

But I think it's something where I'm in a funny position right now in my PhD, in the pre-dissertation writing final rush, and I think it's making me think about the beginning of my PhD where I went in one fork in the road, and then a bunch of my friends went into third year, and then I didn't hear from them in a year. And that made me . . .

I've just been really reflecting on what does it look like to both have the space, take care of ourselves, which is sometimes alone, versus being social creatures who we require some amount of human connection to satisfy the literal biological reality of our species?

And so, yeah, I've been thinking a lot about my experiences and maybe thinking a little . . . As we already kind of touched on, I am a little lonely right now, but I've been a little lonely before, and I've had great times with community in the interim, and I'm sure I will again.

One of the questions I was kind of thinking about is if loneliness is a thing that occurs even when we are around people, working around patients, etc. . . . I guess what does that mean to y'all?

Because I think there's loneliness that is COVID, you're in a studio apartment by yourself for six weeks or whatever, but I think that hopefully that is not the case for most of us now, that we are going about and engaging with the world, but perhaps still not necessarily feeling that connection.

Hạ: I think that's a really great question, Laurel. And for me, I feel that when you were talking about your transition stages, you kind of highlighted how I think a lot about loneliness even when we're connected to people.

We both went through med school during the COVID years of isolation. But I would actually even say that wildly enough, even though I was physically isolated during the COVID years, the times that I felt the most loneliness was not during those times, per se, but it was actually times when I could still physically see people.

And what you had alluded to, Laurel, was I think a lot about as transition times when you're coming in and you have to build new community. A lot of times that has been often the loneliest times for me. I felt that when I started med school, I met a lot of really cool people, but I still hadn't really formed close connections where I felt like I was fully seen yet. And so that was a very lonely time.

And then when I started residency . . . What's really hard about medicine for our listeners who don't really know as much about the weird mechanics of it, because I didn't even know it when I went into med school, let me be real, is that when you're a fourth-year med student, like Austen is right now, we apply for residency and we go through this match process.

In a way, you rank all the places you interviewed and they rank you and there's a high chance that oftentimes you're basically upending your life and ending up somewhere new.

And when I started residency, that was also a huge time of loneliness for me, because it was moments where even though I was seeing people on the day-to-day, I didn't have my people per se yet. And that was really hard, especially when you're going through things that are really hard, like medicine.

Austen: I like, Hạ, how you mentioned these periods of transition where you could be surrounded by people but still not have that sense of community yet, still not have those people who really can relate to you, can understand what you're going through.

And I think, similarly, that's when I've felt the loneliest in this journey, feeling like, "Yes, there are other people around me, but they don't understand being left alone to really reflect on how I'm feeling and the things that I've experienced," and feeling like there are only a handful of people who get it.

I remember I went home at some point during medical school. I think it was last year. I was in rotations. I was busy. I hadn't really been able to see my friends. And I was surrounded by my family. My family, for those listening, all live across the country. So I'm the only person in my family who's in Utah. And I've been here for a while though, so I feel like I've built a sense of community with friends and a great support system.

But it was interesting going home and seeing these people who I love so much, more than anyone else. I was excited to see them and I was surrounded by them, but I still felt so lonely.

It was so surprising and I think a little alarming to me, because I think, for so many people, whether it be your family or whether it be really close friends, you have people in your life who you value and you cherish so much.

And I think prior to starting this journey, they are like a safe haven for you and you feel seen and accepted, and you don't really feel lonely when you're with them oftentimes. Then here I was, and I had precious time to be with them, and I just felt like, "I have things that I'm experiencing, I have things that I'm thinking about that no one gets. No one understands."

No one else in my family is in medicine. My mom didn't go to college. My older sister is in business. My younger sisters are still getting their education. No one in my family is in medicine. No one understands how stressful it's been and no one understands how emotionally taxing it can be.

And so I think, again, Hạ, just like you said, you can be surrounded by people and even people that you love, but when you feel like, "Maybe they just don't understand," I think that's when loneliness really creeps in.

Then it feels like you're having this singular experience that no one can really connect to, and I think it's when we feel this disconnect, when we feel almost untethered from the people around us, that we feel different, we feel isolated, we feel just emotionally cut off from those around us. So I think that's been a big thing for me.

And then even when you do have those people that you can rely on, sometimes in this process you're just so busy that you cannot meet up, you cannot connect, you cannot spend the quality time that you need to, to unpack and to feel human and feel like yourself again.

And so I think those are the two main things for me, just not having the time to reach out to those who would understand, and maybe having people around me who I love and I cherish, but who still don't really get it at the end of the day. And that can lend to a feeling of loneliness.

Laurel: Yeah. I think it's really interesting to me, Austen, how you bring up that sort of end of one experience, right? Because I feel like that's something that I've been on the other side of, of my friends going through third year and the gulf between us.

My partner loves to quote the SpongeBob episode, "You, me, and this brick wall you've built between us." But it is something where people who I absolutely adore, I'm seeing them . . . I say this with so much love. Kind of like Hạ now, incredibly sleep deprived where we're excited to see each other, but perhaps we're still not able to connect as much as we would with a full night's sleep.

And I think it's something where in medicine, there's this level of specialization, right? Each clerkship is different, and then you're going into different residencies where it's something where the career necessitates such focus that in a way is also increasing that distance between you and others.

I think about how . . . I was about to say maybe this will sound silly, but hopefully it won't sound silly because y'all get it, but that's part of it, is the caveating. But it's something where my career goal is pediatric medical genetics.

Hạ: Woohoo. Peds.

Laurel: Woohoo. Yay. Hooray. I'm very excited about it. There are folks who are in our med school who are intending on pursuing more pediatric emergency medicine. We might be in the same room and we're both interested in pediatrics, but we have very different interests. And it's something where maybe Year 1, we were all med students together, but then you start to look at, "We're not only going into different specialties, but we're moving to different cities."

And I think that there's this challenge, at least from my perspective, where medicine is both extremely acute where you are trying to get through day-to-day, and patient-to-patient, and shelf-to-shelf, but also incredibly long-term where it feels transient as a moment in a long career where . . .

Hạ, was it you who made a comment about not being with your people yet? There's this sort of anticipation. And I think that it's difficult to connect when you're not, I guess, in the moment. Or present is perhaps another way of saying that.

So I'm curious how y'all find ways to maybe be in the moment when it's pretty freaking hard, it turns out.

Hạ: One of the things that I was starting to think a lot about is . . . especially, Austen, when you started talking about people that you love just not really seeing you. I was also thinking a lot about how medicine, the way that it's built, is so intense and there's such a steep learning curve and so much happens. Sometimes I feel that who I am one day and the next day is so different just because of what happens on a shift or things that come up.

And it means that a lot of times the people . . . even among my co-residents, even among my closest friends, even with my mom, I feel like I've changed so rapidly, and then also my friends in medicine are also changing so rapidly, and then everyone outside of medicine feels like they're still chugging along at their normal human pace.

I think that's where that disconnect comes from and it feels so alarming, as you were saying, Austen, because they've been there forever and yet the change and the disconnect feels so quick, so immediate, but it's because of how medicine is built.

But then when I am trying to combat that . . . and there are moments where I walk out of a community encounter and I'm like, "I feel this is so weird. It's people that I love and yet I only feel more distant from people." But then there are some times where I walk out of an encounter and I feel very fulfilled.

What I start realizing is a lot of times it's because my own personal mind is getting into the weeds and really sucked into all of the things that make us different, and also searching for feeling completely healed and connected because that's how I see community as.

But what I've learned to realize as I go to different community interactions is just appreciating different people where they are and also understanding where they're coming from, and also recognizing my boundaries. So knowing that if I had a really terrible PICU shift, maybe this community event is not going to do it for me and I just need to read a book instead to resettle myself. But then when I've been able to reframe that, I've found that I've had a lot more joy when I am in community.

One most recent thing is I've been all in my head. For context, as a third-year pediatric resident, this is the time where we start thinking about if we're sub-specializing . . . which everyone has fellowship matched already, so woohoo, congrats to my fellow R3s out there . . . or we apply for jobs.

I've been in the job search process and it's been super stressful and I've been getting in my head about it. But then we decided to organize a Whine and Wine for all the peds R3s in their job search.

We were there and all of us were just talking about our different job search journeys, what our goals are. And it made me feel so much . . . it felt like I wasn't doing this alone and that there were all these different people who are thinking about the same thing, struggling with similar things.

And so long story short is I think that even though there are moments where I do feel very lonely, even in a room filled with people, when I start re-centering on meeting people where they are and then also just centering on the little moments of joy . . . It doesn't need to be like, "I walk out of this community encounter and my life has changed," but there's just a little bit of laughs, a cute dog to pet, and things like that. I feel just so much more situated and full.

Austen: I love that you mentioned that, Hạ. And I feel like, Laurel, back to your question of what we do, I think a lot of what I do kind of mirrors what Hạ mentioned.

I think sometimes you will go and meet up with friends and have these great expectations and be like, "I'm going to walk in there and I'll feel overcome with this warmth and with this love that I have for these people, and I'll leave feeling great and recharged." And that isn't always the case. Sometimes you leave a hangout with friends and you're more stressed for some reason. You feel more disconnected, just like Hạ mentioned.

And so I think things that I've really been trying to implement is having maybe more realistic expectations and then kind of a goal every time I hang out with someone. That sounds maybe weird and almost clinical, but I've found that it's a way for me to not get overwhelmed and also to stay hopeful about the genuine connection that I am making with people.

So when I will hang out and go home with my family, I have this beautiful, big, boisterous family. I have five sisters and my parents and my grandparents and I have cousins, everyone. And I think sometimes when I go home and I'm just like, "I'm going to connect with everyone. It'll be a great time," I feel so disconnected and then I'm frustrated with myself.

But when I go home and I'm like, "I really want to build my connection with Helen" . . . Helen is my younger sister. She's seven years younger than me. We are very different, but she's so cool. I can be like, "I want to build my connection with Helen," or, "I want to build my connection with my mom."

I think it's more feasible for me, especially when I feel such a gulf sometimes between myself and other people, to choose one person where I really just want to have a genuine connection.

I really want to get back to common ground that we have and kind of remind myself even though I'm changing at a different rate, just like Hạ mentioned, and even though they're changing at a different rate, we still have this shared common ground.

And sometimes it's nice to just get back to that and revisit that and strengthen that so that I feel a little less alone, so that I can be reminded, "This is a meaningful relationship to me because of this right here, because of this special little sauce that we have, just the two of us."

And then once I build on that, then it feels a little easier to connect with everyone else. I feel a little bit more enmeshed in a healthy way with everybody else.

So I think, yeah, that's kind of the way that I've been approaching it, is really just picking out a single person to have a genuine connection with for each setting. And sometimes it's a couple of people, but really just trying to focus on nurturing individual relationships by getting back to shared common ground and the things that kind of bonded me to them in the first place.

Laurel: I think that makes a lot of sense. And I think it's something that I've been reflecting on. I made a joke to a person in my lab the other day, and Hạ, you'll appreciate this, where I was like, "I used to throw a lot of parties and then I stopped." And the person in my lab said, "Yeah, that happens to all of us."

Oftentimes in healthcare and medicine, we're very much perfectionist. And so we're like, "I'm going to hang out with people and we're all going to get matching shirts and we're going to do this synchronized choreography or whatever. I'm going to friend the friend the most," or whatever.

And so I feel like having, kind of like you said . . . What are they? Smart goals that are obtainable. Maybe I could, but maybe it wouldn't be healthy for me to throw a party where everyone gets a custom cocktail this time, right? But making sure that I spend time with people I care about, even if it's just us on the couch, catching up on an episode of something rather than . . .

I am guilty of trying to turn my downtime into not downtime, perhaps. And I think recognizing that the connection I feel with my loved ones is just us being together and not me providing an activity.

I think earlier, Hạ, you mentioned kind of in contrast to our journey that other people are at a human pace. I think so often we take the human-ness of ourselves out of the equation. And so I think spending time with people like you and me in a space coexisting and sharing as opposed to . . . Yeah, I don't know if that makes any sense.

I find myself often professionalizing my hangouts where I am like, "I'm going to get an A in being a host and doing the social." And I think that that's just something where, especially when you are already short on energy from your actual work, making your fun into work too is perhaps not the way to do it, and also not the way to be vulnerable and actually maybe connect with people.

Austen: Yeah.

Hạ: Hear, hear. I'm a big fan of hanging out with friends by doing errands together. Laurel, you and me doing a Costco run? Life-changing. I love a Costco run.

Austen: That's so fun. I think that's fun, and I think that also speaks to ways that you can build time for connection with people even with a busy schedule. Laurel, just like you said, I think a lot of people in medicine are used to being perfectionists and being really high achieving, and so they feel like they've got to ace being a friend or they've got to ace connection.

But the way that you ace connection isn't by doing a million things with each other and, just like you said, having personalized cocktails or anything like that. The way that you ace connection is really just by meeting someone where they're at and being there with them, sitting in whatever situation they're in with them. And whether that's at Costco when you guys need to pick up food, or hanging out with a friend after a shift and maybe you're in scrubs and they're in pajamas and whatever.

I think that at the end of the day, the way that we approach our friendships and the way that we succeed in being a good friend perhaps and making genuine connections isn't by the quantity of time you're spending with them or even the quantity of activities that you're doing, but the quality of that time and activity. And it can be so fulfilling doing the most mundane things if you're trying to be vulnerable with them still and have a deep, meaningful human interaction.

Laurel: You know what's funny? I was thinking in this whole conversation we're having about, "And what does it mean for the patients?" But I feel like without me bringing that up, you already perfectly sort of encapsulated it with, "Maybe you don't always have the most time. And so it can't be quantity. It has to be quality."

And so I feel like it's kind of funny to sort of flip things almost in my brain in reverse. Normally, I'm thinking, "How does me, the person, impact me, the provider or the healthcare worker?" And I'll be so honest, the thing that I am the worst at so far in my medical career is sticking to the time limits of healthcare, because I want to know everything and you can't do that, it turns out, in the typical appointment time, which is why I'm going into rare disease.

But anyway, I think I really value making the most of what I have when I'm in clinical conversations with patients. And it's kind of funny to think about that in reverse and be like, "Huh, I guess that is also probably a good approach for the people in my life where we're often ships in the night."

Especially the people in my MD-PhD cohort, who are all in this . . . Not all of them, but generally we're at a similar time point where we're all in the nuts dissertation prep, just ships in the night. We wave and wish each other well. We could have opportunities just being human with each other and connect where we can instead of not connecting just out of some concern that it's not going to be 100%, A-plus, majored in friend, or whatever.

Hạ: I feel that's so true in thinking about it. In primary care clinic, as a pediatrician, oftentimes you go in and it is just a well-child check and you're just joking around, but sometimes they come in and it's the one time they come a year and they bring in 50 things to talk about, and you feel very overwhelmed.

I felt like there were many moments where I walked out and I was like, "I did not address everything," but things that I do realize as time has gone on is it's just building that connection and hearing them.

When patients feel that you are trying your hardest to address a couple of things and have a plan to move forward and that you're also seeing them as a person than just a problem list, ultimately, it's appreciated.

It's something that is hard to let go. And I guess this does . . . Laurel, you made me have an aha moment where I realized that my anxiety with friendship connections and also managing my patients' problems in primary care and everything is all interconnected.

Laurel: You're welcome, I guess.

Hạ: Thank you. Self-actualization Part 2 in this thing.

Austen: Oh, man. I love what both of you said. Hạ, I guess both you and Laurel are spot on, that what we've been talking about, how we can have genuine connection, can not only impact our personal relationships but then also our professional relationships, our relationships with patients, our care of patients.

I feel like Laurel and I are in the same boat. Any time we had an OSCE, I was always running out of time, whether it was actually interviewing the patient or writing the note. I don't know why. I felt like I was moving in slow motion sometimes with the typing. That's my own thing. I've got to work on that.

But with actual patients, I felt like I wanted desperately for the patients to know . . . And this is when I'm on clinical rotations as well, but I wanted patients desperately to know that I care about them. And I think so often I conflate that with, "So I have to spend as much time as possible with them."

And I think as a medical student, it's a little more feasible, right? I'm caring for less patients than Hạ would be as a senior resident. And so I feel like I have more time to be spending with patients.

But then just like Hạ mentioned, she has a day full of patients and some of those patients, yeah, it might be quick, easy visits, but other patients, maybe they have more acute concerns that need to be addressed.

And I think that is something that I'm trying to master, trying to show that I care, not only in time, which feels oftentimes like the most valuable commodity when you are in the medical system, is your time.

I think, often, time is thought of as a measure of how much you care, and I don't know if that's true because I feel like I have great experiences with the people in my life who I love and it's not like, "Well, my best friend, Kim, only spent 10 minutes with me, so she must not care about me today." I never really think that. But I think it's easy to kind of slip into that mindset when you're in a clinical setting just because time is so valuable.

Laurel: I really appreciated this conversation. Sorry, I looked at Hạ and then my brain went, "A Hạ moment," instead of, "Aha moment." But no, I think it's been helpful for me, again, in my little bubble of thinking about colon crypts and not much else to reflect on both the relationships with people in my community and long term in my care, and how those aren't necessarily completely split off, siloed parts of my life.

I am me in all of those rooms, which means how I enter those rooms with friends or patients is going to kind of have symmetry. And so it's good to think about.

Now, not the last time I hung out with someone, but the second to last time I hung out with someone, we were going to watch a movie, and then we talked so much that we didn't have time to watch the movie. I don't know if this has ever happened to y'all, but this is a problem.

So I thought maybe before we said goodbye and released this podcast into the universe where it can be listened to wherever you stream podcasts, maybe we could all pick a movie so that way the next time my little squad of co-workers . . . Are we co-workers? I don't know. Academia is made up. But the next time we get together, we can pick a real movie. What do you say? Give me your flick recommendations.

Hạ: I want to really watch . . . I haven't watched it yet, but I want to watch the third "Knives Out" movie.

Laurel: It's so good.

Austen: Yeah, I just watched it.

Hạ: Oh, okay.

Austen: It was enjoyable. I have this special talent when we're five minutes into a movie or whenever the villain is introduced, even if you don't know the villain, I can tell who the villain is. So I was watching the movie with a friend actually, and the villain came on and I was like, "That's them. I don't know how they did it, but that's who did it." But anyway, it's really good. I second the "Knives Out." That's a fun movie.

I think also . . . I'm trying to think. I recently watched "Tenet" for the first time the other day.

Laurel: Oh.

Austen: Man, was I confused for a lot of it, but it was interesting.

Laurel: Yeah. That's a strong endorsement. The movie that I thought about proposing with my lab mates the other day but didn't was "I Saw the TV Glow," which is a phenomenal film, but I was like, "Do I want to do emotional damage to these folks? Probably not because I'm going to see them all tomorrow and we've got to not be crying." That keeps you from looking at your computer screen. So cool.

Well, thanks so much for hanging out with me and giving me movie recs and reminding me to person, because sometimes I forget.

Austen: Yeah, it's hard to remember. But thank you for having us on. I guess we're always on, but thanks for spearheading this discussion. I think it's so applicable and so needed, and just like I said before, I feel like I've learned and grown, so thank you.

Hạ: It's always a good time on a "Bundles" episode. I now feel less lonely about sometimes being lonely.

Austen: Truly.

Laurel: We had an "a Hạ" moment.