There are two moments of my intern year I will never forget. The first morning, during orientation, 30 minutes after receiving the code pager, a code was called. My co-intern and I ran to the room and found a bone marrow transplant patient in cardiac arrest. I started CPR on his frail chest. I felt his bones break while my mask and gown were spattered with the fine mist of blood showering from his mouth with each compression of the chest. I recall the standstill shock of my co-intern, my devastation at the loss of the first patient I encountered as a physician, and the catastrophic grief of the family as we explained that, despite our efforts, he did not survive. I also remember how we all walked out of that room, diffusing our own ways throughout the hospital without a word. Not a debriefing of what happened, a thank you for all your efforts, nor a query as to whether or not I was actually okay. Medicine marched on; there were more patients to see and 29 hours of my shift left to go, including eating ham and crackers during the shift and sleep filled with dreams of intern anxieties on whether mistakes were made. On the last night, a patient with a massive GI bleed in the setting of cirrhosis was admitted, and despite all efforts, it was bleeding faster than we could transfuse. As my senior resident desperately tried to provide further care, I called for help. I was berated for waking the fellow, informed of my clear incompetence, and 3 hours later as the scope was being completed, was again berated for not calling earlier. In all settings, somehow it was deemed my fault. The patient miraculously survived, yet this memory haunts me. It reminds me of how, in the straits of distress, it is easy to forget that physicians are humans too.
Why do I share these memories? Why are they important?
Because they represent the darker side of medicine. The side that leaves residents feeling overburdened and underappreciated, like failures, unsupported and vulnerable to further mental health decline with depression, anxiety, and burnout. As faculty, we cannot forget, lest we continue to perpetuate these bad behaviors.
February 22 marks the Gold Humanism Honor Society ‘Thank A Resident Day,’ resulting in celebrations of appreciation around the US for medical residents caring for patients, ensuring that the practice of medicine not only continues, but advances, for future generations. All too often, we forget to thank the residents (students and fellows) for their tireless work. We forget the burdens carried by those still in training as we as faculty physicians carry our own burdens, both past and present, of this healthcare field. I hope that February 22 also serves as a reminder to all those physicians in practice that the road trodden in training is a difficult one. We fell often, and no one reached down to pick us up. We dusted ourselves off and moved forward. We can do better; medicine deserves better. May today remind us all–resident, faculty, patient, nurse, pharmacist and more–to show our appreciation for the efforts to improve healthcare. May we show our gratitude to those carrying the burdens, not just in words, but in helping to carry the burden together.
The poem below was first published on the UNMC ID Division blog in 2018, as a thank you to our residents and continues today as a shared message of appreciation, caring, and gratitude.
To the resident who is exhausted & overwhelmed, thank you for putting the needs of your patients & team first.
To the resident who covered for a sick colleague, thank you for keeping our patients & colleagues healthier by your service today.
To the resident who feels like they are not good enough, thank you for showing up every day & continuing to forge ahead. The road is not easy, it is ok to ask for help. Success is not in knowing everything, it is about developing the competence to know when you need help & to get it. To the resident who is teaching all of us on rounds, thank you for your initiative & know you are bringing value to the entire team.
To the resident who had to break bad news, thank you for your support & care for that patient & family.
To the resident toiling on research on nights & weekends, thank you for working to improve medical practices.
To the resident dreaming of leadership roles, keep dreaming! You are the future leaders – thank you for your future innovations.
To the resident who wants to quit, know you are not alone. Thank you for carrying the emotional toll of medicine, but now it is time to ask for help carrying that burden. Please talk to someone, seek mentorship & help. Thank you for your bravery in doing so.
To all of the residents working around the clock in hospitals, emergency rooms & clinics, thank you for being part of this healthcare team.
Thank you for your dedication, your blood, sweat & tears. We need you, we appreciate you even if we are not always expressing this as often as we should, & we are grateful for you.
-Dr. Kelly Cawcutt