Thursday, March 10, 2011

it gets better

The lowest point in my residency was in January of my intern year.  I was a Pediatrics resident back then, doing a month-long rotation on "Team 2," which is what we called the general inpatient pediatric team, with a focus on the patients on our liver transplant service.

It was a very long month.

I'd get to work at around 5:45 every morning to pre-round, and invariably leave after dark every night--not difficult, considering that, in January, it seemed like it started to get dark around 3:30pm every day.  I was there much later than that, of course--most nights I'd leave around 7:00pm, unless I was on call, in which case I'd leave at around 10:00am the following morning.  We'd have pre-rounds and then rounds, then attending rounds and work rounds, followed by teaching rounds and radiology rounds, with time at the end of the day for sign-out rounds.  Twice a week we'd have Grand Rounds and Chief of Service Rounds.  How we ever got anything done with all this rounding, I'll never know.  How I ever got to spend time with any patients in between all these rounds is even more of a mystery.  It just felt like a day of endless, endless scut.  Losing the forest for the trees.  It would be a day full of writing down numbers and pagers beeping and phone calls and faxes and entering computer orders, and not nearly enough time practicing medicine or spending time with patients.  And then I'd go home and collapse and wake up at 4:15 the next morning to go in and do it all again.

It was shortly after this that I decided to switch fields, to Anesthesia.

But this entry is not about me and my switching residencies (though this is easily the topic that I get the most e-mails about--I think I've addressed it a couple of times on this blog, but for the most fully fleshed out explanation of when and how and why I switched residencies, I'd recommend you check out the book, it's probably one of the sections I spent the most time editing in order to get the details right), it's about something else that I want to talk about, which is this: residency can be deeply depressing.

And let's get this straight.  I liked residency.  Really, I did.  Yes, it was hard, and yes, I was tired basically all the time, but I expected that, and now that it's over, most of my memories are affectionate.  Residency, like medical school, was full of stories, and many of them, in retrospect, are funny--not at the expense of patients, but at my own expense, because lord, how serious and inexperienced and bumblingly well-intentioned I was!  But that first January of my intern year, I was very close to being clinically depressed.  It just all felt so grim and featureless and endless, and I felt more and more like I was just some kind of task-programmed automaton, not like the doctor that I thought I was supposed to be at this point.

 I wanted to quit.  Not just quit being a Pediatrics resident, but quit medicine altogether.  I was unhappy.  I didn't like my life.  I wanted to be done.  I know that this comic was intended to be a joke, but there were time, real times, when I passed by a Gap or a Starbucks or whatever, saw that they were hiring, and seriously considered stopping by to fill out an application.  At least they don't make you take call at The Gap, folding chambray button-down shirts at 2:00am.

Now I'm going to tell you a secret.  Everyone who has been through a residency has felt this way at some point.  Everyone.

Maybe you're feeling this way right now.  So here's another secret.  There's more to life than this.  Even though it feels like residency is your life, it's not.  There's more to life.  There's more to you.  And it gets better.

It gets better.

There's this great line from "A League of Their Own," which I adapt and quote often. "[Medicine] is supposed to be hard. If it wasn't hard, everyone would do it. The what makes it great."  However, don't get me wrong, I don't equate suffering with nobility.  Suffering is just suffering.  All I'm saying is that it's hard, but there's more, and you deserve to experience all of it.

Don't let your residency consume you, and don't let it make you believe that there's nothing else, or that there are no other options.  There's always more.  There's always what's next.

And you know what?  If you're really unhappy, and you want to leave medicine, there's always that too.  It's OK.  There's no shame in changing your mind.  The shame is hating your life, really hating your life, and doing nothing about it.  Who wins in that situation?  Not you, not your patients.

It gets better.  I know it's winter, and winter for a resident is long (oh lord, it's so long, it feels like you'll never see the sun again) but it gets better.  Just remember that.  Remember that you're a person--an intelligent, good person with free will, not just a cog in a machine--and I swear to you, the rest will follow.


  1. I'm really glad to hear that... Next year is fast approaching and the mixture of apprehension at how tired I'm going to be, and excitement at actually having a job are mingled!

  2. Anonymous6:59 PM

    I absolutely loved this post.

    By the way, I think the sunroom might be like a huge magnifying glass and might burn the kids? Maybe it could be a garden?

    Once again, LOVED this entry. :)

  3. I'm in the second year of my residency and it's so good to hear that there's a light at the end of the tunnel (though it still feels so far away). It's also nice to hear that even you felt this way, sometimes it seems like its only me that's struggling while others are cruising through.

  4. What a breath of fresh air! I'm beginning to wonder if every new scary chapter is like this, at least at the beginning. I'm in the home stretch studying for Step 1, and months ago I absolutely dreaded these last 4 weeks, I was so terrified. Now that I'm here, it's just a matter of following the plan I made. I know clerkships and residency (and beyond) will be tough, but I hope to keep the perspective to find the MORE.

  5. Anonymous7:26 PM

    This is so true...although for me the darkest time was actually near the END of residency, in my second to last month. I honestly didn't think I'd make it (and am sure if I went to see someone they would have put me on an SSRI). In retrospect, I am not really sure how I got through it, but I did. And things are DEFINITELY better now!

  6. Anonymous7:27 PM

    This post is going to be in the back of my mind for the next 3-ish years. Match Day is in exactly one week.


  7. Anonymous7:42 PM

    Thank you for this. You give such a great/heartrending description of the discrepancy between the way we want to practice medicine and the way that it has somehow become the norm to practice medicine as a resident. We have all been there, some of us (me) more recently than others, and we all benefit from the reminder that life post-residency improves.

  8. Love the League of their Own line. My patient centered medicine facilitator (I'm a second year med student - this is our learn to be a doctor class) says that to us all the time!

  9. Anonymous7:58 PM

    I'm waiting to see if I got accepted or rejected by medical school and I this is what I have felt like, every single day, for the past 2 years. Everyday, I try to accept the fact that I will never get the marks that the 'smart' kids do and I try to like myself, but I usually just end up sobbing and wishing I was someone else. If I can't even handle the pressure of getting in, how am I going to survive everything else that comes after? But anyways, thanks for your post. I like your honesty.

  10. This is exactly what I needed today--just talking about this with another mom-in-medicine. Thanks! PS buying the book :)

  11. I kind of felt that way about the first six months of stay-at-home motherhood. Endless, endless scut. The discrepancy between what I imagined (blissful nursing of my cheerful baby!) and the reality (yet another appointment with the damn lactation consultant). It was all, as you say, grim and featureless and endless. But that got better, too. I can't wait to read your book.

  12. Anonymous8:43 PM

    I agree with zinemama--the first two months at home with my twins were so bad that i told people that i would rather do another year of internship--and i did a peds internship before hours rules.

  13. Anonymous9:09 PM


  14. FLintern9:33 PM

    I'm an intern in a lifestyle friendly residency so life is already better for me but my months on internal medicine definitely felt like that. I absolutely would have quit then if I thought all of residency would be that way.

  15. Anonymous9:41 PM

    Anonymous @ 7:58 - I'm a pre-med student and feel exactly the same way!

    Is this a clear sign that we should steer clear of medicine? Or is there hope for us yet?

    Love the blog, by the way. Will certainly buy the book!

    - Long-time reader, first-time commenter

  16. Anonymous9:42 PM

    Thank god for people like you Michelle, who write about this. Most of the residents i know (myself included) suffered though miserable insomnic, apathetic, anhedonic winters. I only got through without completely losing my mind and will to live because of a kind attending that recognized what was going on, because he had been through the same thing. I remember him tell me that he was giving me homework after an emerg shift and i numbly said ok, thinking...well nothing except: here's yet another thing to do - and he told me to go out to the movies, watch something fun and tell him about it tomorrow. and i HAD to go out with friends. I will never forget that lesson.
    Its important to remember the good and the hideous things - anecdotal stats pegged my (completely typical) keenerific class as being so run down in residency/intern year that 35-45% had started on SSRI's.
    I'm so glad to be done - it is EXPONENTIALLY better.

  17. Anonymous9:49 PM

    What a wonderful post.
    In my program, our attendings are always telling us, "If you think THIS is bad, wait until you get out in the REAL world..." (which by the way most of them have never been in....anyway if residency is so stinkin awesome why aren't they all of doing fellowships or second residencies or something? Huh? huh?!)
    So nice to hear these words of hope!!

  18. I'm really glad to hear this, and I think a part of me really needed to hear this. Thank you for sharing this! I've never seen "A League of Their Own", but I'll have to find some time to watch it soon. :)

  19. working girl9:55 PM

    Hey Michelle,

    As usual you've posted some amazing writing. Just wanted to give you a heads up (if you didn't already know) that the "It Gets Better" campaign was started last year as a response to a rash of suicides among LGBT youth. The project aims to support LGBT youth going through particularly difficult years in adolescence. When I first read the title of your post I did start a bit. I've read your blog for a while and I know you would never try to undermine such a great project but it is possible to misread your title as such. Just a friendly heads up.

  20. I wish I wrote this, it is so true. I did a peds residency and survived and I tell the current residents the same thing :)
    Looking forward to the book.

  21. Great post - I'll remember this one!
    T minus 158 hours until I open my match envelope. Not that I'm counting or anything.

  22. Anonymous10:23 PM

    Don't forget that, after residency, in addition to finally getting to do things your own way, they pay you to do it! So much better. Two years out of residency, I'm still amazed every time I get a paycheck!

    In med school and residency, I became so jealous of the mail man. What a great job - exposure to the outdoors, some walking, and no one expected you to fill out paperwork, or take tests, or carry a pager or anything.

  23. Anonymous10:36 PM

    The worst part about residency (and now fellowship) depression is the vague hope that if you could just have a small accident (twisted ankle, minor hit by a car, etc) you would get a day away from the hospital and it would be so worth it.

  24. Anonymous10:38 PM

    Thank you for this post.

    Not just empty words. I really did need that and I don't think I'm alone in saying that.

  25. Brilliant post. I'm not in medicine but your writing, as it does here, transcends feelings that I've often related to in my life. Book is on pre-order. The quote from League of There Own is something I need to remind myself of on certain days.

  26. So true. I call it "the dark time". For me it's usually around the same time - Jan/Feb - in residency it was second year, in fellowship it was first year. I tell all the residents "This is the dark time. I promise it ends. Just keep going." Great post.

  27. you can pretty much apply the "it gets better" to any low period in life. truer words were never spoken. things, no matter how bleak, do tend to work themselves out if you just hang on and do what you can. that's why life is so amazing. and I can say this from a position of experience.

    but i love that you wrote it anyway! ♥

  28. Anonymous12:23 AM

    So well said. Thanks for giving air-time to the problem of (lack of) resident well-being. It always amazes me how doctors are supposed to be good at taking care of people, but they can't / won't take care of themselves. I wondered why I was trusted with medical decisions for patients when I had been awake for 24+ hours. In that state, I had trouble finding my car in the hospital parking lot and was terrified of falling asleep at the wheel. But it was OK for me to talk to patients and assess them and treat them in that semi-delirious state.

    I can vouch for your claim "Everyone who has been through a residency has felt this way at some point. Everyone." For me it was exactly the same time that you describe: January of first year of residency. The scut and long-hours weren't the worst for me - what catalyzed my burnout was two weeks of getting yelled at by patients, seniors, consultants, and nurses. It was demoralizing to know that I was stepping up to the plate when others slacked, only to get yelled at.

    But as Dr. Au says, it does get better, and it does pass. It didn't kill me, and with some meds and a therapist, that very dark time during residency has actually made me stronger.

    I'm less than a year out, and I couldn't have imagined how rewarding and fulfilling my job could be. *This* was the light at the end of the tunnel that kept me going. So for those in the trenches, just remember that there *is* a light at the end of the tunnel. Keep looking at it when it feels like everything's dark.

    - Another (Canadian) Michelle

  29. Anonymous12:33 AM

    Dr. Au, can I ask - what inspired you to write this post now?

    - Another (Canadian) Michelle

  30. Anonymous1:09 AM

    Thanks, Michelle!!! My two cents:
    There are many, many dark times during residency (internal medicine, myself). Some of the darkest are when your senior resident, fellow, or attending (heck even support staff like nurses and respiratory therapists) are just totally unsupportive or dislike you personally for whatever reason and you are either made to feel incompetent or invisible. The way I coped with this was to find those "kindred spirits" - the people that were able to recognize my value (quiet and sucked at being pimped but hard-working and able to get things done quickly!) and go to them as much as possible for whatever you need, whether it's information, or teaching, or heck even a laugh. Finally, as a primary care physician, the dark times are still there (who takes home $$$ barely more than they did as a resident - booyah!), but guess what I get to go home to my family every night, even if it's late and I have ten million notes and letters to write and phone calls to make. Really the keys to surviving dark times are 1) to realize that you do have control over certain things in your life and 2) to find, in the poop-storm, little pieces of joy (e.g., the newly discovered uneaten Twix bar at 3 am or the admission that came at 7:01 am the morning your were post-call. LOVE IT.)

  31. Anonymous3:30 AM

    Thank you. You don't know how much it helped to read this.

  32. Anonymous4:22 AM

    To the anonymous posters who are writing about how they feel this way as PRE-meds: I personally would re-evaluate my career choice if I was this miserable just trying to get INTO medical school. The getting in part is the fun part. Your White Coat ceremony will be the happiest day of your medical school career (capped only, possibly, by Match Day if you match at your #1 choice.) It's all downhill from there as reality sets in and your workload increases exponentially from level to level. So if you can't handle the pre-med stuff, you probably can't handle the med stuff, and definitely will not be able to handle the residency stuff. I'm a semi-miserable, semi-happy resident depending on the day, but I was one of those deliriously happy medical students who loved my time in med school. The people who were already burning out in med school are damn near suicidal in residency. It gets better after the low point of residency, but it doesn't get better after pre-med --> med: it gets worse. I'd go to PA school and take some of the pressure off, if I were you.

  33. Today makes it exactly 2 months that I've been an intern at a major teaching hospital in Australia. Your post sums up exactly what I'm feeling right now, and literally, there are days when I just feel like IF ANOTHER PERSON IS RUDE TO ME FOR NO REASON I WILL SCREAM.

  34. Anonymous6:36 AM

    The only reason you were chosen for medical school is because you would get up at 4:45 and do it all over again.

    Then you become an attending. You sleep in till 5:15. Beside an extra half hour what you gain is the responsibility. What you do really counts because THEY are just waiting to hand you your ass if you make a little mistake. Then Obama takes away the financial incentive.

    Happy Friday

  35. Anon @ 4:22 -- You have no idea what you're talking about. When you're trying to get into med school, you have no idea whether you will even have the opportunity to go to med school. You are constantly told you should consider other careers and that you are not good enough (see: your comment), and you don't know whether you're going to have to rethink your entire life if you don't get in. I used to wake up in the middle of the night in tears because I thought I'd missed one too many questions on an Ochem exam and that I'd get a C for sure and thus never be able to get in. Now that I'm here, sure it's tough. But I know in the end that no matter what, I'm going to get to be a doctor, which I actually like. I'm never going to have to go back to that job I had in my early 20s that made me want to kill myself, and that was a true dead end.

    Perhaps you should reevaluate your position? Because clearly, you have no idea what you're talking about.

  36. (Other) Michelle: The reason I wrote this post is because I've been doing some outside work around this topic, and I realized that for all the talk about how grueling the process of medical education is, it's almost always presented in the context of war stories or macho posturing. For all the healing we ourselves are supposed to be doing, the actual culture within medicine can seem alienating and lonely, especially as a trainee whose job it is to toe the line. I just thought it might be helpful for people to know that they're not alone, and that, in fact, we've all been there. There's the strange notion that we perpetuate that doctors are supposed to be somehow superhuman, or above the stressors that affect everyone else, but we obviously are not, and the sooner everyone realizes that, the more healthy an environment it will be for everyone.

    Working girl: I am very familiar with the "it gets better" project that Dan Savage started, and I think it's wonderful! Consider my title choice for this post an homage.

  37. Anonymous9:26 AM

    Dr. Au - great answer. Absolutely agree about the culture in medicine. For all our knowledge of psychiatry, some of our preceptors and department heads perpetuate the worst stigma about mental health. You are burnt out or have depression after being abused on the wards? It must be that your depressed behaviour caused those nurses and patients to react to you and therefore yell at you. As a med student you are upset that no one will help you understand why several of your patients died under your (team's) care? Your need to get answers makes your reaction pathological.

    Again, thanks for putting your energy and voice to this topic.

    - Another (Canadian) Michelle

  38. Anonymous9:41 AM

    March of my intern year, first day off in God knows how long. Between this post and the daffodil blooming in my garden, I just might make it. Thank you.

  39. Reading this makes me so greatful to be in a supportive program with reasonable work hours and a strong education over service evidence. Of course there have been hard times and I think back to my first year when I did tons of off-service call and wonder how I survived but having the support of the program director and co-workers is a phenomenal coping mechanism.

    Hope that with work hour limits and other strategies things improve for residents across North America.

  40. Michelle -- Don't even get me started on the macho posturing. I'm really glad you're taking this on.

  41. Anonymous11:16 AM

    Old MD Girl: from your posts is appears that you are still a medical student? I am not. I am a senior resident. I have been through far more of this process than you have. So telling me that "I don't know what I'm talking about" is pretty hilarious. Your opinion may differ from mine, but mine is from a more well-educated place than yours, so I certainly DO know what I am talking about. The tears overnight about your O-Chem exam? Multiply that by 1000x when you're studying for step 1. Your fears about every little thing you do on the wards affecting your clerkship grades and subsequently, your class rank and matching power? Much worse than wondering how your secondary application essay sounded.
    And then once you're a resident, and you finally really ARE guaranteed a light at the end of the tunnel in a field that you chose and (presumably) really love, you hardly ever have time to enjoy that feeling of accomplishment because you're working 80 hours a week, never seeing your spouse and children and family, and counting a "big night out" with your friends as getting two beers at the bar across the street from the hospital (in your scrubs!) before you all go home and pass out at 8:30p.
    I'm not saying pre-med isn't stressful. I'm saying med school is worse and residency is worse than that. Everyone says that residency is the low point and attendinghood is where you finally start to feel the fruits of your labor.
    So before you go mouthing off to residents about how little we know compared to you (you BIG, BAD MED STUDENT, YOU!) I'd think twice. Your mouthiness and rudeness will not get you very far in this profession that is built around service, teamwork, communication, and a modicum of decorum when speaking to your colleagues.
    Good luck, med student. If you truly get through your residency thinking pre-med was the worst part, then hats off to you, but you're the anomaly, not the rule.

  42. Anon - Interesting that you had such a difficult time with step 1 and your core rotations. I completed step 1 two years ago and never had any of those issues. I can't say that I ever was nearly as freaked out during my core rotations or my sub-i than as I was when I was trying to complete my post-bacc and apply to med school.

    Did you go straight through from college to med school? You sound like you might have. Trust me, being in a dead end job I hated with no light at the end of the tunnel was far harder than anything that med school, or even pre-med has been able to throw at me. I think it's pretty arrogant that you think that being a senior resident means you know more about the world that I do considering you don't actually know me. And FYI -- This is A BLOG. As far as I've heard I don't have to cow-tow to you and your wrong-ass opinions about the world just because you're a big bad resident in an online forum. Hell, you're probably 5 years younger than I am. Get over yourself.

    I have no illusions about residency being more difficult than med school. Just like everything else, I plan to take it as it comes.

  43. Sorry Michelle -- I just couldn't let this one slide.

  44. Michelle -
    my favorite post in a long while. So very, very true. Can't wait for the book (has been preordered for months!).

  45. Anonymous3:28 PM

    Hi Michelle,
    Love your blog and love the post. But as a member of the lgbt community and a suicide survivor-- I feel that the title was an unfortunate choice. It doesn't feel like "homage." It feels like someone with a whole lot of privilege comparing her highly privileged situation that she chose to be in with that of kids who are terrified and miserable and really have no way out of their situation other than suicide. As you wrote, you always had the option of quitting and working somewhere else. LGBT youth don't have the option of leaving their situation. They are truly trapped. I work at an lgbt center as a mentor and interact with teens who have fresh self-inflicted cuts covering their bodies, who have been kicked out of their homes with no where to go, who are working as prostitutes to pay for the hormones they need. Of course stressed residents need encouragement and support, but right now "It Gets Better" is a phrase with a very powerful meaning for a specific group of marginalized, vulnerable young people. Your choice to use that phrase was bad judgement and simply unnecessary.
    Regards from a fan,

  46. Anonymous3:36 PM

    Michelle, I have read and loved your blog for years but this post brought me to tears. I'm a third year peds resident and love my job but recently hit the lowest point of my medical training thus far. This post had such meaning to me and reminded me that things will get better. This is especially important to me because I have a three year fellowship in a challenging subspecialty ahead of me. Thank you for writing this. I can't wait for your book.

  47. "For all the healing we ourselves are supposed to be doing, the actual culture within medicine can seem alienating and lonely, especially as a trainee whose job it is to toe the line. "

    Very well put. This post should be required reading for all soon-to-be interns and then again during the low points of residency. Somewhere around the 5 month mark of internship I suddenly began liking my job. Not every moment, but enough of them. Around the 3 month mark, I stopped having the soul-crushingly awful days that left me wondering what the hell I'm doing in medicine. I grew at least moderately competent, which made all the difference in my experience.

    My colleagues and I laugh a lot together. I have a lot of fun while I'm at work (tho' the work itself is so not fun) b/c honestly I don't have a lot of extra time at home to set aside for formal "fun." It made a huge difference in my outlook when we stopped commiserating about the inequities of our program.

    I'll do my best to keep all this in mind when I start my residency program in July, and I'll definitely revisit this post when appropriate.

  48. Truly, thank you for this. My husband and I are both peds interns and just had our first baby. I'll bet you can guess that there have been more than just fleeting thoughts of "Maybe this whole 'medicine' thing was a mistake" around our house lately. Your post gave us some timely encouragement today!

  49. Great post, Michelle. You have a wonderful way of giving us your perspective on a situation we have ALL shared. As you say, at one point or another, ALL residents feel this way. I loved what you said about working at the Gap. There were many, many days that I left the hospital after 12 or 14 hours (especially in my last year of residency when I studied every possible moment that I wasn't also working) and the only way I could get up in the morning was to think to myself, "if tomorrow is as bad as today, I can just quit and go work at Pizza Hut." Truly. That thought is what got me through the worst of it - I knew that at least I still had some choices left in life and I could just do my best to make it through each day one at a time.

    AND NOW, after 8 years as an attending, I can say that unequivocally, it has all be worth it. The job, the money, the lifestyle, the freedom to practice medicine the way I want - I am so happy with my decisions and SO HAPPY that I am not working at Pizza Hut!

    Anyway, thanks Michelle for another great post and as I sit in Puerto Vallarta with my family on vacation, I wish your book was released already so I could be reading it now.

  50. Christine5:00 PM

    Thanks for this. I loved your tweet this morning because I actually read this post while I was on call overnight last night! So necessary to be reminded that of course it sucks, of course you feel like crap after an 110-hour week, of course you're demoralized after getting yelled at for the eight time that day for things that aren't actually your fault. It's easy to feel isolated and alone. This was a good reminder to reach out to fellow residents to support each other through this. Thanks again.

  51. Anonymous6:44 PM

    Exactly what I needed to hear right now. Thank you.

  52. Anonymous8:25 PM

    Old MD girl, I pity you. For all of your pre-medical school real-life experience, you don't seem capable of having a conversation (or debate) with someone without being personally critical of him or her.
    Not that I need validation from you, but I took 2 years off b/w college and medical school to work in my research lab. I then went on to graduate in the top 5% of my medical school class, Alpha Omega Alpha, and matched at an elite residency program. Clearly, whatever stress I felt in medical school was not anything that defeated my ability to continue to do extremely well academically. I did, however, feel that it was much more stressful to be IN medical school than to TRY to get into medical school. That is my OPINION, and by definition, opinions *can't* be wrong. They can be different from yours, but that doesn't make them wrong.
    I hope that your attitude towards your senior residents on the floors is far more professional and appropriate than the attitude you have displayed on this forum. Otherwise, I doubt you'll meet with the kind of success that you could otherwise have achieved.

  53. Anonymous8:35 PM

    And one more response to Old MD Girl before I walk away from this ridiculous online fight for good: in my opinion, there are two kinds of medical students. Those that wish to do as well as possible in medical school so that they will have their pick of specialties and residency programs, and those that feel that getting IN to medical school was the hardest part, and now as long as they pass, P = MD and they'll be happy to just match somewhere, doing something, as long as it's doctorly.
    I was the first kind of medical student. Because of my stress over doing well on Step 1 and on the wards, I managed to score highly and graduate at the top of my class, and had my pick of residency programs in a fairly competitive specialty.
    The people who coasted through medical school did fine in the match, for the most part, but maybe did not get their top choices, or even had re-think their specialty selections. I didn't want to be in that position. I wanted to write my own ticket. For me, P = MD wasn't enough. Maybe for you, it will be, and that might be the difference between those who think that getting IN is the hard part, and those that think that doing WELL in med school is the hard part.

  54. Hey hey hey WHAT is going ON here?

    (That was to be said in a Mr. Belding voice.)

    You know the biggest reason that I hypothesize medical school and residency is so stressful for people? Because people who go into medicine in the first place always try their hardest to do their best, no matter how difficult the circumstances. So it's good to remember that when we deal with each other, both in and out of the hospital. We may be doing different things, or respond in different ways, but we're all just trying our best.

  55. Anonymous9:19 PM

    So this is like Trevor Project for residents???

  56. Anonymous10:37 PM

    Thank you so much for this post. I'm on my surgery rotation currently and needed to hear this. I seriously do not know how surgical residents do this every single day.

  57. Thank you for this post.

    Even though I don't know you personally, I've been reading your blog for over six years now (since I was a 2nd year medical student), and as a fellow girl, future mom, and eventual surgical attending, I am VERY glad to hear you say it gets better. I also appreciate the homage to the Trevor Project, which reminds me of how fortunate I am to exist in a safe and supportive environment. (And reminds that, in fact, I DO live in a safe and supportive environment, despite my sometimes feeling otherwise.)

    And the quote from "A League of Their Own"? Pretty much my mantra when I start feeling like I can't take this residency crap any more.

  58. @ Anonymous 10:36pm - During the winter months of last year, I kept thinking how awesome it would be to get appendicitis. You get taken care of for a change and get to lie in bed all day and eat Jello and watch "Angel" on TNT at 6am when all the other surgical residents are rounding on their 40-patient census.

  59. Kristi12:33 AM

    I must say that I was quite amused at Anonymous' initial response to Old MD Girl, assuming she was a pre-med. I follow her blog as well, and knew she would not let that slide. I actually agree with Old MD Girl that trying to get onto medical school is harder than being in medical school in some ways. For me, the uncertainty of whether I would get in or not was much worse than the stress of doing well in medical school. I obviously want to do very well in school, since I am trying to Match in California, so clearly my lower stress level is not because I am operating on a C=MD mentality. There are different kinds of stress, and some people handle certain types better. Stress does not go away in medical school and residency, but I feel that is a different type of stress.

  60. Anonymous3:20 AM

    February of my intern year. Seriously considering SSRIs even though I've never been depressed before this.

    Thanks for this post. It helped.

  61. Anonymous doesn't seem like a very happy person. How apropos for a post about depression.

    - Another senior resident (-cum-attending in July, wahooooo!) ;)

  62. I don't know, I think OLD MD GIRL was picking a fight with anonymous more than the other way around. Anonymous defending their opinion doesn't make them an unhappy person.
    I also don't think anonymous ever accused OLD MD GIRL of being a pre-med (but said she was a med student, which seems accurate.)
    Why doesn't everyone just stop insulting people on an anonymous blog commenting forum? Geesh.

  63. Thanks Michelle! I am not a doctor but law school and the first couple of years of law practice were like this for me! Stressed out and not thinking it was going to get better - but it did!

    An i have to agree with Zinemama about the stay at home mother thing - it was endless seeming at the time.

    So looking forward to your book!

  64. Laura -- I just said that anon should stop suggesting that pre-meds who are overwhelmed should consider other professions. That med school has been *less* stressful for me than pre-med. That his / her experience was not the same as mine. Then he got all "I'm a big important resident" on me. God forbid *I* have a different opinion and express it on a blog. Sheesh. Perhaps anon is too far removed from pre-med land to remember what it was like. That is all I was suggesting.

    (And I'm really sorry that you think the response I got from anon was justified. IMO that puts you in the same category as him/her.)

  65. I think on a personal level I was irked by the accolate-listing/horn-tooting and the emphasis on hierarchy... both implied somewhat in Michelle's post (more the latter) and seen here in the comments. I went to med school at a very old-school northeast institution and since I've moved out west I've just seen less of that. Not a good memory. I wonder if any of that is more regional? Anyway, not trying to stir up a controversy here. I liked Michelle's comment... we're all just trying to do the best we can.

  66. Anonymous12:39 PM

    Wow, what an ugly battle of egos. Why are you even arguing about whose life is more stressful than whose? Anonymous seems to be warning that the stress gets worse - s/he is is absolutely correct about resident suicides - no one talks about it, but it happened in my program and another one in the country last year. It sickened me to read the arguments - and notice that both of you are focused on yourself - will I get into med school? Will I get into my top choice of residency? If doing well on a stupid test was so stressful for you, how will you cope with something that actually affects other people (like, your patients)? Me, me, me. Neither of you brought up being concerned about learning to be the best doctor that you can be, and making the right decisions for your patients.

    - Another (Canadian) Michelle

  67. Anon -- I'm a researcher right now, and that's what I want to do with my life. That's probably why I didn't bring up patients. I do enjoy working with my patients and I do want to be the best doctor I can be (although I admit as a physician scientist I probably won't be), I just haven't seen one in almost two years. I'm sorry if that offends your sensibilities.

  68. Great post. I'm a *just* a premed, but I'll keep this in mind when the going gets tough in a few years!

  69. Anonymous4:07 PM

    This post was so timely - you have helped so many, so thank you. I'm at a career crossroads at the moment, and am seriously thinking about the Gap option. I want to say thanks for your thoughts. Sometimes hearing them from a stranger a long way away is more affirming than from your own colleagues, whose input can be dismissed as overly well-meaning and pitying because they like you personally but lack objectivity to really tell you how it is. I'm not sure which direction I'll take, but if I stick to this path, you have helped me focus on a positive light that I can't quite see right now on my own. So thank you. Really and truly.

  70. Anonymous5:14 PM

    I was one of those who was severely depressed in med school (put on tricyclics - this was pre-SSRI), even suicidal. Somehow I managed to get through. I wasn't depressed in internship, just scared and still convinced I made the wrong decision in wanting to be a doctor. But then, I adored residency. My program wasn't particularly supportive. I think it was just that I was finally learning to do what I really wanted to do, ie practice that particular specialty. I loved having more responsibility, loved patient care and I blossomed. I was one of the best residents in the program, whereas I'd been at the bottom of my class in med school.

    I continued to feel med school and internship had been "worth it" for several years as an attending. But, not for some time now. Things are just so different these days with managed care, malpractice fears (I haven't been sued - yet), decreasing reimbursement with increasing overhead, more and more time spent doing uncompensated things, longer hours, less family time, interrupted sleep. It would not have occured to me to work at the Gap before. Now, it does.

    My SO (also a doc who had a very similar experience as I did, and used to love medicine) and I are in the process of simplifying our lives, selling our house, getting rid of a lot of stuff to move to a small place in a small (cheap) area so we can retire early. We just can't take it anymore.

    None of our friends who are MDs would tell their kids to go into medicine. They are all trying to dissuade them, in fact. I strongly suggest if you're pre-med, talk to as many docs as you can, get their opinions, and even (if you can swing it) shaddow them for a few days.

  71. Anonymous6:16 PM

    I didn't think Anon was ego thumping- he was defending his opinions (which Old MD Girl promptly dismissed as baseless) by listing his qualifications to make those statements. It was Old MD girl who devalued and dismissed someone elses opinion outright.

  72. Anonymous8:55 PM

    Old MD Girl - too bad age doesn't guarantee maturity. Is it so hard to respond to differing opinions without getting so defensive and personal? For example your last response ending with "I'm sorry if that offends your sensibilities" was completely unnecessary. Take a step back and a deep breath.

  73. Anonymous10:11 PM

    OK, OK. Both Old MD Girl and Anonymous picked fights with each other and are overly sensitive. They are both wonderful humans, I'm sure; they just happen to be the type that vigorously defends themselves. Now no more fighting. It just makes us all look stupid.

  74. Young LGBT MD1:53 AM

    Using the Trevor campaign slogan to talk about a very privileged path that you have chosen for yourself (and that you can get off of anytime) is insensitive, hurtful and wrong. It's not paying homage, it's mocking.

  75. Anonymous3:18 AM

    I don't think she titled it "It gets better" in reference to the Trevor campaign initially. When she said to think of her title choice as an homage, I think she means after the fact. Michelle's message and the campaign's message may apply to very different situations, but they both offer the same comfort that what they are feeling and experiencing will not last forever. GLBT(etc) youth and young residents are clearly different populations (with some overlap of course), but each group can experience the same feelings of hopelessness, despair, and suicidal ideation, even if the root causes are very different. It's the message that is important.

  76. Anonymous3:32 AM

    I agree with the above. I don't think it was unfair or out of line for Michelle to use the "It gets better" title. I really feel for LGBT youth and think the crap they have to go through just to be themselves is totally shitty and completely wrong.

    However, the phrase isn't lessened and doesn't trivialize their situations by using the same to describe the situation of medical residents. Remember that doctors have the highest rate of suicide of any profession. While I agree that physicians are relatively privileged, they can't really jump off at any time as you say. How do you pay off $150,000 in debt when you haven't finished your residency? What kind of job could you get to repay those loans and the looming interest piling up and what if you have a family and other financial obligations?

    I'm NOT equating the two situations. But why does anybody get to say our situation is worse than yours, therefore we get a monopoly on that phrase. Why can't anyone who needs it take comfort in the words of those who've gone before them when they say "It gets better"?

    It should be used to help anyone who is feeling helpless and out of options, regardless of which group with a shitty situation thought of it first.

  77. Anonymous11:26 AM

    I just think that the "It Gets Better" slogan is very visible right now and a very focused, laudable effort to connect with LGBT youth in an attempt to help them STAY ALIVE. Sure, medical professionals are at risk for suicide, too (who isn't?) but they are not kids who literally feel like they have nobody in the entire world -- parents and family included -- who can help them. Sure, residents get depressed sometimes too; as I said before, who doesn't? But hopefully, a 27-year old adult in a medical career would have access to more mental health resources (and knowledge about how to access them) than a scared 12-year old boy who gets beaten up every day in rural BFE America for deigning to wear a purple belt. There's a vast difference. A HUMONGOUS difference.

    Utilizing this particular very well-known and identifiable phrase to write a post about how residency "will get better" more than 2 years after Michelle has finished residency and less than two months before her book about residency comes out all smells very icky to me.

  78. Anonymous12:26 PM

    Um, the LGBT community does not have a monopoly on the phrase "it gets better", period. Michelle, you have every right to use a COMMON ENGLISH PHRASE however you wish. May everyone who struggles with intimidation and oppression find the external support and personal resilience to rise above it.

  79. An Ally12:32 PM

    You seem to be implying that Michelle used the "It gets better" phrase to draw us in, then hooked us with an advertising ploy. That she purposely used a visible phrase to get us to read the content of this entry. That's ridiculous. The simple fact is that she doesn't need to do anything to get us to read her entries; we already do. Michelle has a large fan base (as far as I can tell) and does not need to resort to such tactics. Also, if you have read her blog at all, you would realize that she would not do that. Clearly, I do not know her in person, so she could be hiding all kinds of heinous qualities, but I don't think I am wrong to say that Michelle would never purposely use the "It gets better" movement for personal gain. All she was trying to do was tell her fellow health care professionals that residency sucks, but it does get better. It isn't as if the Trevor campaign is the first entity to come up with that phrase. We all tell friends "it gets better" after a hard break-up, or the death of a loved one. The phrase is in the vernacular, and is used hundreds of times a day to apply to many different situations. There's nothing wrong with that.

  80. Anonymous2:44 PM

    Again with the comparing of whose life is more stressful or sucks more than whose. Why can't we all just get along? As others have pointed out: when someone is down, it helps to be reminded that it won't be like that forever. Dr. Au isn't trying to start a campaign here, and didn't steal a trademark. It's a title of a blog post for crying out loud.

    - Another (Canadian) Michelle

  81. Anonymous8:41 PM

    wow, people need to chill out!! no panties in a wad, please.

  82. Anonymous9:07 PM

    Michelle - thank you. I recently came back from a year of leave after I burned out first semester senior year of college. (Fun fact: I was actually supposed to graduate with your youngest sister - I hope she's doing well). Reading this was a much-needed reminder that things do get better and there are people out there and around me who know exactly what it's like, and are willing to help.

    I'm definitely going to order your book after I graduate in two months, can't wait to read it! Thanks for everything.

  83. An attending told us in medical school that "if you keep waiting for something better to happen you are going to be waiting a long time".

    His point being that at every step there are things that are extremely difficult and at times you wonder why you have subjected yourself to all of this, but try to find something good about today-be it an accomplishment, a moment shared with a family member or friend, getting a few minutes extra sleep-whatever. Being a resident will be hard it's own way, being an attending is going to be hard in another.

    Life is short and in medicine, we see it cut shorter everyday as our patients are diagnosed with horrible things, get maimed and killed in horrendous accidents.

    Find joy in the little things, that's what keeps us going. Medicine is an amazing career and I feel so honored to be a part of it. There are still some days though that I wonder why.

  84. Outre1:54 AM

    So when I told my straight, almost 30 female friend “It gets better.” I guess I used the Trevor campaign. No. I know what the Trevor campaign is, but at the time I said that, I was desperate to give her anything - even if it seemed like a microscopic speck of light - to get her out of the deep darkness she was in. (She’s suicidal and I’m terrified when I don’t hear from her for half a day she’s tried again)

    wether the post was meant to draw new traffic doesn’t matter. A new post will always draw new traffic, through search hits or link sharing.

    IF she had titled “It will get better.” would that have been better for those that feel the use of the phrase is wrong/mocked? It’s a common phrase... come on!

    Though not in clinical healthcare (I am in healthcare related field that is competitive and specialized). I went through horrible depression starting my senior year in college that progressed into suicidal depression at my first job. (I paid my dues so to speak). I wish I could have read/talked to others in my field who’ve been through similar but didn’t have the chance to. It’s too small, everyone knows everyones business, so you don’t want to be known as the ‘crazy’. Pretty sure based on lunch time conversations, that my coworkers would not have understood... “Oh, everyone has a bad day.” That day, I wanted to scream out, ‘Really? Does your bad day consist of wishing someone would push you off the platform onto the on coming train in the subway? I don’t think I had the energy to scream though, just mustered enough for a smile here and there for pleasantries. I eventually got on an anti-depressant that lifted me out and for a while, even though I felt better, my brain had been so wrapped in depression that not-depressed felt wrong and oddly uncomfortable. (partly because I was waiting for the other shoe to drop.. meds to stop working and I’d be worse off)

    So Michelle, I think it’s fantastic you posted this and that it has clearly helped people. Sometimes I look back and don’t know how I’m still alive and wouldn’t wish what my brain did to me on my worst enemy. No human should ever experience that.

  85. Outre1:56 AM

    Ment to say in my first paragraph, No. I know what the Trevor campaign is, but at the time I said that, that wasn’t anywhere on my radar. I was desperate to give her anything - even if it seemed like a microscopic speck of light

  86. Anonymous9:17 AM

    j- thanks michelle, what an encouraging post!

  87. Anonymous11:30 AM

    Outre, you sound like you continue to need serious mental help... hope you're getting it.

  88. I worked at GapKids/babyGap in high school and early college (1994-1996ish). Zero stress, but they actually did make you take call. (Unless you had enough seniority to refuse it.) If someone calls out sick, you have to come in. And if it's the holiday season, you're there until midnight folding shirts.

  89. Thanks anon, I’m fine now. That was years ago. I guess I didn’t make that obvious.

  90. Anonymous10:09 AM

    As a member of the LGBT community AND a resident in a very competitive specialty, let me just say that I think the outrage about using the "It gets better" phrase is...unfortunate. Having been there personally, I understand how important it is for LGBT kids to have some attention cast on their situation. The Trevor Project is wonderful, incredibly necessary and long overdue. I've spent hours watching the videos on the site and have considered submitting my own. On the other hand, though, that particular phrase is comforting to many people who are not in the LGBT community. Several other posters have remarked that the phrase "It get better" is ubiquitous. And they're right. Who hasn't felt comfort from a friend or family member saying, "I promise. It WILL get better." when they're feeling particularly hopeless? It's a human expression of comfort and hope that shouldn't be isolated to a single group. And for what it's worth, as a member of both communities, I have felt the same senses of isolation, hopelessness and judgment as a resident as I have as a person of "alternative sexuality." For those who disagree, consider this: For many people, medicine isn't "just" a job; it's an identity and a calling. I knew I wanted to be a doctor before I knew that I was gay. I've been preparing for it since I was 14 years old and have over $190,000 in loans to prove it. Is it a calling of privilege? Absolutely. 100% But, on the other hand, I couldn't stop wanting to be a doctor any more than I could stop being gay.

    1. Anonymous12:59 PM

      Thank you for expressing that so clearly. I feel the same. (That's so crazy! I too knew i wanted to be a doctor,around age 14, before I knew I was gay).
      I welcome the compassionate, "it gets better, I promise..","it will get better...","everything is going to be will ALL be worth it in the end" from a person who truly means it out of care and not pity, during a difficult time or during an endless period of feeling drained and robotic.

      I think when a person "shares" those very same comforting words ("it gets better") to another person going through something painfully trying he/she also/already has been through is mature and less alienating. And I have cherished it both during the time of being disowned by my parents(and a few close family-friends) after coming out, and during the time I thought the USMLE Step 1 was going to take everything I had and then some...

      I feel the same way. I can't undo the self-awareness that I am gay. I can't imagine being happy and fulfilled in any other profession other than medicine. I agree. Our personality, our sense of belonging and our experiences in our profession makes up a huge chunk of our identity. A cop's identity is being a police officer. A teacher's identify is being a teacher. A doctor's identity is being a physician. No matter how painful and exhausting this journey has been, I do not care to do anything else. I can't imagine doing anything else! Sometimes I feel, we do not support each other enough in med school, residency and fellowship. Sometimes, sometimes! It feels like its every man/woman for himself/herself, and therefore to share any sense of feeling overwhelmed with a peer or mentor would be an admission of incompetence. There is strength is admitting we need help. I have had to learn the hard way. I have seen colleagues I respect and admire for their strength, attitude and hard work, ask for help. It opened my eyes.

      Thanks to all those who shared their stories of when they were burned out and how they handled it (seeking help, and showing up). Thanks for reminding me, us that it gets better... I believe it. And for right now that's exactly what I needed

  91. Thanks for writing this very insightful piece- well said! I went through some pretty low points during my internship & & beyond but not to the point of needing meds . Suffice to say, I was NOT happy. Was however fortunate enough to meet & marry a guy who was supportive of my eventual decision to stop practicing clinical medicine. Have never been happier or felt more fulfilled than I do now.

  92. Anonymous9:00 PM

    THANK YOU for this post. I'm an intern (in my second intern year after switching specialties, no less) and this post actually made me cry- I'm at this point and it's good to know that everyone's been through this.

  93. It only gets better if you inherently like your specialty. If like me you were forced into it(forced as in the only alternative to not doing this was to go on social assistance, or into something else more terrible), then there is never a light at the end of the tunnel. Just endless tunnels. Waking up is the worst part of my day, because I know that every second thereafter is a reminder of my uselessness and failure.

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  96. Anonymous11:53 PM

    Hi Dr. Au. I'm a PGY3 in radiology (so a 2nd year radiology resident) and am seriously considering three options: (1) finishing radiology residency (my least favorite); (2) dropping out and going back to the normal work-a-day life of a pharmacist (what I did for 6 years prior to med school); and (3) switching to anesthesiology (what I think was my gut choice originally, prior to letting my brain override it for "the right reasons").

    I enjoy well-defined patient encounters, my wife, my hobbies, and the sun, and thinking in terms of physiology and pharmacology comes much more naturally to me than the concrete-yet-constantly-hedging manner of radiology. I enjoyed my 2-week anesthesiology rotation as a med student, and found the few "real" codes I've participated in exhilarating.

    Now for what I hate: being pulled in 10 directions at once which I didn't realize was the way of things in radiology, constantly having to write good quality stuff under lots of pressure (which I somehow didn't realize is more important in radiology than probably any other field in medicine), and not having all the things I described liking above.

    Unfortunately I'm also pretty sure I'm "burned out" and don't know if I could muster the energy to be excited about anything (like spending extra time shadowing in anesthesiology and trying to switch residencies) enough to put in extra work on top of my god awful shitty stressful shitty ass shitty schedule.

    If you have an opinion on "what I should do" and get a chance, I'd love to hear what it is. I've recently told my program director about all this and just started talking to a psychiatrist at our medical center who apparently specializes in this sort of thing. Somehow though you seem like a better resource. (Note: flattery.)


    1. Anonymous5:42 PM

      I'm a 4th year medical student who is having second thoughts about going into radiology because I don't absolutely love it...or even really like it for the reasons you mentioned. I have the grades for it, which I think caused me to pick the wrong specialty in the first place. Thus, I've been thinking for a while about switching specialty (this blog is inspiring me to do anesthesia!) but it is hard because now I just don't trust myself to make the right decision about the career I want. So just curious, what did you end up doing?

  97. Well, I wrote that post a week or two ago, so I'm still just agonizing, sleeping very poorly, and half-heartedly trying to convince myself maybe I'll like being a radiologist. I actually already switched radiology residencies, since the one I originally matched at wasn't the academic program I thought it was. That process was so stressful that, I'm being a little dramatic here, but I wonder if I/my career/my marriage would survive switching yet again.

    Anyway, I would suggest you actually spend the time to do those personality tests to see what medical specialties suit you. Different specialties suit different types of personality. Going into radiology is a big leap of faith because (1) you can't simulate it as a med student the way you can other specialties and (2) it's a long fucking hall (5 years of residency plus 1, and not infrequently these days, 2 years of fellowship). In radiology EVERYONE does a fellowship, unlike most other specialties.

    So, do those medical specialty personality tests, talk to guidance counselors, read about what it's like, talk to multiple REAL practitioners in the field, not just the academic idealists who are always going to say they love it, and believe me when I say that this effort and the possibility of missing your chance to match this year is worth picking something that suits your personality/temperament the first time.

    Long winded response, but I hope that's at least a little helpful.


    1. Anonymous9:37 PM

      Thanks mike,
      I applied to a couple of specialties actually and maybe I'll try to just match into a prelim year to figure everything out. Thanks!

  98. Anonymous5:52 AM

    Sounds like a good plan. I think most people understand not being sure about what to go into. It's a really big decision (but not irrevocable...although revoking it is a huge pain). Good luck,

  99. Anonymous7:01 PM

    Old MD Girl, I think you missed understood. Anon said in her opinion if one struggles at the premed level, think long and hard because Step 1 is much more stressful and so is residency. You are not a resident, and most likely won't be one, so you should probably not speak to what you don't know. Furthermore, it sounds like you didn't struggle at the premed level. You were just very anxious about getting in so you would be able to work in a profession that didn't make you want to kill yourself, as you say. For surely you aren't saying Step 1 is easier than a simple Orgo test, are you? Because that, IMHO, would be a wrong ass opinion. As you say.

  100. LeeAnn10:04 AM

    i saved this post to read in the middle of my intern year (ie right now). it spoke to me when i first read it as a med student and even more so right now as i sit as a post call and delirious intern. thank you for writing it! there are moments i absolutely love my job, and there are moments that i just hate the paperwork, and red tape of it all. and in those latter moments i think back to what you wrote here and remind myself of the instances that make it worth it for me. it's exhausting but i know there is a light at the end of the tunnel of residency!

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  102. Anonymous4:58 PM

    this is just so true...i am feeling so down as i am about to start my 2nd year in pediatrics tomorrow.

  103. Anonymous5:03 PM

    Medicine can be a really lonely calling. I am in the beginning of a three year fellowship... and I feel lonelier than ever. At least in Residency, I felt like we were in the trenches together. In fellowship, however, at least in my program, we work alone, and it feels much more competitive. That, and uprooting your life every couple of years... I work long hours and then come home to an empty apartment... and I'm not sure that this was all worth it.