How are you (honestly)?
By Michael Barthman, MD
From the outside, I probably looked thoughtful, maybe devilish, like I was coming up with something clever. On the inside, my conscience had perked up, waiting to see if the truth came out of my mouth when I answered. Ellie, the medical student who’d been working with me, had asked me how I was doing.
The truth is that I was lousy, but hadn’t quite figured out why. It was winter, which isn’t a bad time of year for me. Winter in Rhode Island is a cute impression of winter back home in Wisconsin. Nevertheless, it had drained as much warmth and sunlight from the world as it could without wiping out the things holding onto life below ground. I was spending most of my time in the hospital, convincing other doctors that my patients—who are the best part of my job, no matter how bizarre, sick, or complicated their situation is—have real problems and need help. This was year two of training to be an ER doctor, a year that was draining from my world as much warmth and sunlight as it could.
“Pretty lousy,” I answered.
I told her about residency and tough realizations about medical training, some being pretty sour. She listened and it felt catawampus to have affirmation and reassurance travel from mentee to mentor. It felt vulnerable, like pushing on a belly for the first time as a medical student. But she was doing what she does during our shifts: learning. She was seeing what lies ahead, offering the same encouragement I try to offer her—which is a good, normal, human-y thing. Still, it nagged at my conscience that this dynamic seemed weird.
Did I presume she can’t empathize because she’s a student? Did I think she’d be disappointed to find out the grittier realities of medical training? One of my sourest realizations has been how dehumanizing medical training actually is (you can’t really appreciate being dehumanized until it happens to you and your friends). I do my best to be alert for it, but this was an instance where I’d taken part without noticing. A piece of me was trying to dehumanize her by withholding truths about the life she’d signed up for, as if she lacks the wherewithal to handle it—as if I’d somehow been granted the power to withhold it. If anything is clear to me, it’s that medical training doesn’t need my help to dehumanize its participants. My grumpiness had saved me—kind of. I was open, but I wasn’t candid about the experiences that await.
Wellness initiatives are everywhere, but the culture of medicine seems to change at a glacial pace. I’ve witnessed the actual number of hours worked by residents of certain specialities. They defy the duty-hour “limits” set by the overseeing bodies to protect them. I’ve watched residents break into tears as they tally the consults they’re left on their own to see while their senior resident naps. Maternity leave? There’s not space here to do it justice—and don’t forget paternity leave. Sexism? I’ve seen female doctors mansplained into silence. I’ve seen attending physicians explain to female residents the positive effects of squats on the female form. Then, we’ve jumped back into rounding on patients. My conscience still elbows me for what I didn’t defend in the moment, for the times I haven’t spoken up. These things and more chip away at who we are and our desire to simply help patients—despite all of those resources being applied to wellness initiatives. I question how things got so screwed up.
My fallback is to believe it’s a generational difference, that time might iron out the wrinkles. We’re hindered by our original reference point for medical training, which is best summarized as 1) being a male and 2) literally taking up residence in the hospital for an indefinite number of years. Recently, a one hundred hour workweek was acceptable. This isn’t a standard that’s hard to beat and it doesn’t compel us to keep improving. I know the term “burnout” gets bandied about as a diagnosis that we aren’t coping with our chosen vocation. Honestly, I think our chosen vocation isn’t coping with us, our partners, and our families. In the months we worked together, Ellie had a gift for pointing out the injustices faced by our patients, whether they were perpetrated by society or the health system. She sees the wrongs most of us are lulled into accepting as commonplace. It stung when she pointed them out to me as I moved on to the next patient—but, it should sting. Creating humane medical training means departing from the status quo. We can only depart from the status quo if we acknowledge how it makes us feel.