A Reflection on My Time in Residency

Shannon Fagan/123RF.com

Reflecting on the end of my residency is impossible without reflecting on my life.

I knew I wanted to be a physician when I was 5 years old. Whether by parental grooming or destiny, I proudly proclaimed my intents throughout my childhood. I fondly look back on my teenage years spent accumulating accolades to “beef up” my resume and make me stand out in the sea of “outstanding scholars.” My mother always beamed with pride when detailing my GPA and community service efforts.

Something shifted while I was in college. The only career path I’d ever known and the core of my identity seemed to have flaws and cracks I’d never noticed before. My blossoming interest in psychiatry was met with eye rolls and scoffs as people I admired deemed it “not real medicine.” My excitement of attending an osteopathic school brought passive aggressive questions about my academic ability. All the hours of studying, volunteering, research, community engagement, and personal sacrifice was starting to seem in vain. I was hesitant, but I persisted.

I unraveled in medical school. The years of self-neglect in order to achieve the goal of becoming a doctor had taken its toll. I couldn’t sustain the façade. There was no amount of studying that could overcome my crumbling mental health. I almost lost myself, but I wedged a path to recovery.

After all I’d been through, I entered residency hopeful but skeptical. It was as if I was in an abusive relationship with my medical career, but we’d reconciled and were on the mends. I’d come to terms with its flaws and was learning to set healthy boundaries. I entered determined to find a meaningful path without sustaining any further emotional damage. I was naïve.

My patients have always been intrigued when I tell them “I’ve been there, too.”  Others somehow sensed my unseen wounds and felt connected to me when I thought I was merely performing my duties. I truly did and still thrive on the plethora of unique stories and experiences I encounter daily. This was only tainted by the unavoidable encounters with the bureaucracy. I quickly learned about RVUs and productivity, administrative time and clinical care hours, prior authorizations and medication assistance programs. I learned how to type more than 70 WPM so I could leave work at the designated time. My first year taught me, above all, the fine line physicians walk. I realize now as a quasi-adult that people have a love-hate relationship with doctors. We’re perceived as type A demigods wielding swords made of money, deciding the lives and deaths of our patients. The dichotomy is that, as much as everyone seems to hate doctors (who frankly had little say in all the things people complain about- decreased clinical time, increased paperwork and use of EMRs in appointments etc.), our privileges are emulated and challenged by paraprofessionals.

My second year was a period of emotional growth and resilience. The thing that attracted me to my residency was the independent psychiatric emergency room. My time managing the ER alone overnight, as well as call for the adjacent acute and chronic inpatient units, “thickened” my fragile “skin.”  I wasn’t prepared for the loneliness that being on an alternative work schedule would bring, but I tried to spend it in reflection. I challenged preconceived notions I had of others and myself. I know for my husband it was painful to watch and to be alone at home, and know that I spent months of my time alone. At the end of the year, I felt I’d found my voice as a resident: not angry but not soft; I became succinct, blunt, determined. I found my footing.

My love for psychiatry was rejuvenated in the third year. A year designated to outpatient psychiatry was what my soul needed. All my years of schooling and grooming were being used on a daily basis in complex ways. There’s nothing like being able to see a case from start to “finish,” watching how the simple mouse clicks made in office affect people in the real world. I revered the effect my language had on my alliance with patients. It was as if, with my computer and my mouth, I was building a bridge - one that grew stronger with every interaction and success and weaker with any misunderstanding or medication failure. I cried, rejoiced, consoled, laughed, played, and even danced with my patients. The weight of the bureaucracy of medicine seemed lighter and distant. I flourished.

Considering all this, I entered my fourth year more knowledgeable and confident as a physician. I’m still aware of the lifetime of professional and personal growth ahead of me, but I’m not as naive about the process. An era of work and aspiration is finally coming to fruition, and it’s scary. While my peers became “adults” in the early-to-mid 20s, I’ll be turning 31 before I have my first “real” job. I’m currently making the mental shift from student to societal contributor. Attending physicians, I’ve found, treat me with more respect in nuanced ways I had never before noticed. I have more autonomy in decision-making, and more people are making an effort to call me by my preferred professional name (Dr. Ekeanya), rather than my first name. For the first time in my career, I’m being sought after for employment rather than proving my worth against a sea of qualified applicants. I’d been trained to withhold my personal career preferences in search of a broad education, but now I’m learning the power of honing my interests and asking for what I desire in a career. It’s truly a breath of fresh air. My medical students often ask me if I would do it all again if I had the chance; my answer is complex. On one hand I’ve suffered and sacrificed a lot to get to where I am, and perplexingly, at the true crux of the beginning of my career, I find myself tired. Medicine isn’t a poor person’s game and not for the weak-willed, so I do fear for those entering it without that knowledge. I also know that this is the only career I could have ever imagined myself in. I can honestly say that this year has been one of the most fulfilling in my adult life. As much as I’d like to think, “This is it,” I know there’s a battle ahead for all of us new residency graduates. We have to fight for healthcare coverage of our patients, for increased training for paraprofessionals asking for greater practicing rights, and for a decrease in the suffocating amounts of paperwork we complete in comparison to patient-care time.

Yea, I’d do it again.