I love puns. So much.

Christmas Eve.

Peace on Earth, Goodwill toward men. Ghosts of Christmas past, present, and future abound in the hallways of the hospital. As doctors we treat disease, but the building is impregnated with the memories and feelings of the people who have passed through it’s doors.

In the corner of one patients room stands a small, sad, Christmas tree. The kind you might see in a Charlie Brown special. The Patient has been in the ICU for 45 days, unconscious for the last 10 of them. Intubated, with enough tubes and wires coming out of him, and monitors hooked up to him that he could be a Christmas tree himself.

7 other patients reside in the remainder of my half of the ICU. A veritable menorah of the critically ill…only its not the lamp oil everyone is hoping will last out through the night. 

One patient’s church group came by to sing Christmas Carols. Most of my patients are unconscious or sedated, but I think the doctors, nurses and ancillary staff appreciated the gesture. Nobody wants to be in the hospital during the holidays.

And like the ghost of Christmas future, I go from room to room, showing the families a glimpse of what is to come. Up to my old tricks, I have held palliative meetings with 4 families in the last 2 weeks, changing the code status to DNR sometimes mere minutes before the patient passes away. I’m not doing it because I dont want to code somebody, but because I have learned to recognize when the battle has been lost, when aggressive resucitation would serve no purpose to anyone, least of all the patient. 

The internal medicine department can say what they will about my medical knowledge or professionalism, but apparently I am still good at convincing people to die. I second guess or doubt most of my decisions, I overdocument every thought process I have as if a trip to the bathroom could land me in court, I still have little to no interaction with any of my former fellow residents or attendings, and I am fine with that. But at least the ICU attendings recognize that I have an ability to relate to patients and their families.

I may be stuck here, with no light at the end of the tunnel, but that’s no reason to take it out on those for whom I am supposed to be caring. If I can focus on that, and getting my license, maybe I can forget that unlike Ebeneezer Scrooge, I wasnt given a second chance to change my future.

Merry Christmas to All, and to all a good night.

Probation begins Tuesday.

I had almost forgotten that I had to go back to work. The week I was on leave to consider my decision was so nice and unrelated to medicine at all that I didnt even have much time to feel sorry for myself. There were birthday parties, ceremonies, days at the museum, even mundane things like getting my oil changed to take up my time. And then Tuesday begins my year of shit. Starting back in the ICU, so at least not working with any of the hospitalists who forced me to this course initially, but among people who had certain knowledge that I was finished rotating through that department.

I understand the rationale. If there are all these supposed concerns about my ability to treat critical situations, it makes sense for me to repeat my training in critical units. Nevermind the fact that those were some of my highest evaluations the first time around. I have accepted the fact that I am going to be eating a lot of shit sandwiches for the next year, and there is nothing I can do about it.

The program director and administration are still looking for ways to remind me how serious this case was, you know, in case I forgot somewhere along the way of them ending my career, or maybe in case I am not appearing appropriately contrite enough.

People portray doctors as being arrogant or uncaring. It hurts. A lot. You do your best day in and day out, and feel awful when things go wrong. And now someone is accusing you of having committed malpractice in your efforts. 

So why did I take the probation? Why havent I fought this harder, or “lawyered up” if I really feel I am being that unfairly treated or targeted? Because I dont have documentation to prove that I am being picked on, and it is easy for my accusers to say they have been concerned about my knowledge all along because residents make mistakes. And a single one here or there in an evaluation no matter how good can always be pulled out, and used to show in court that there were supposed doubts about my ability all along

It kicks the shit out of you. You lie awake at night wondering if you’re going to lose everything you ever worked for. You cry. You think about quitting, but have to go on because you’re in too deep not to. With this sword of Damocles hanging over your head, you still have to go to work every day, and do your best for the patients who still depend on you. Some days it’s pretty damn hard NOT to start drinking.

And, deep down, you wonder: Am I really incompetent? You question your own judgment. Suddenly every headache patient needs a brain MRI. Every person you see is a time bomb. You start to view them as the enemy. People use the phrase “defensive medicine” in a derogatory fashion, meaning unnecessary testing doctors order to prevent themselves from being sued. But after something like this happens, you don’t give a fuck how much money the “unnecessary” tests cost. You’ll order anything to cover your ass.

And, regardless of the case’s outcome, it will forever destroy the beliefs that once drove you to dream of being a doctor. Even if new reasons are found later on down the road, you will never trust or have the faith in your colleagues that you once did.

I will fight this. At least, I will try to fight it. There isnt much I can do, but I will go down swinging.

Should I make it through, I will add another tattoo to the collection.

Should they win, I will stick around only until I can pay off my loans. And accept that I wasted 13 years of my life on something I wasnt meant to do.

And they thought I had an “attitude problem” before…

One Mistake. That’s all it took.

One mistake, and a committee came down to a split vote on outright dismissing me from the program, versus ultimately deciding to graciously allow me to continue, should I so choose, under probation. Demotion to r2 status with an extra year of residency. Guaranteed loss of the fellowship I spent months, if not years competing for. 

One mistake, and I reap a year of humiliation and condescencion. Having to tell all my friends I’m not moving, then explaining why. Having to work side by side among the current second years who will be talking about how badly I screwed up. Being made “the example” for the hospital. Having to stay in the same situation while everyone else moves forward.

One mistake, and one that more likely than not would have been treated more favorably had I not already been on remediation.

I have spent the last 6 months arriving at work, waiting for the day to end so I can go home, telling myself I could put up with any of it as long as I had my fellowship waiting for me at the end.

But now?

Do I really want to put myself through that? An extra year, to what purpose? I am burned out. I’m done. Even if I decide to graduate, I would be in medicine only as long as it takes to pay back my loans, and then I would quit and go back to enjoying my life again.

I should never have gone to medical school. But I guess that was just one mistake as well.

I wish this comic was less true. But for many families, being involved doesnt mean weighing the options and heeding the advice our education has given us, but dictating care according to what they think the patient wants or needs.

I find myself dreading my upcoming wards month…I dont want any difficult families. I cant afford to have anyone evaluate me as anything less than perfect. The human body was not meant to undergo these levels of stress for this long. And yet, here I am still plugging away, still hoping against hope that despite all evidence to the contrary, something, anything, will turn out right. I guess that is the difference between hope and faith…with faith, you dont have this kind of anguish, you simply know. With hope, you keep waiting for something to be snatched away.

I dont know why I keep recording this whole episode. Is it for you, or for me? If I make it through this, is it something I really want to remember? Will I one day look back on these posts and tell myself, oh right medicine isnt always easy, but you have been here before…or will I reread this and be like, this was your tipping point, when you had all you could stand and left a career that was doing nothing but breaking your spirit

I dont want to know the future, I just wish I didnt have to keep anticipating it.

I’m not sure I want to do medicine anymore.

SHould I even be putting this on a public forum? Are you sure you want to know what goes on inside your doctors head during the training period?

Maybe it’s just the people I am working with, or the string of horrible things I have had to deal with at work since august, but I meet all the technical definitions of burnout. A recent quality review issue that came up during nightfloat was deemed to not meet the standard of care (i.e.-something went wrong, and a committee decided it was my fault) and as a result, I am waiting to see what the next step is.

The options are dismissal, which I have been told will not happen, further remediation (meaning more time spent with people i dont like, dont trust, and who have zero faith in my abilities as a physician, and probably as a person), or probation and extension (an extra 6-12 months of residency)

The best case scenario at this point is further remediation. My inner pessismist has been rearing his head and warning me to start preparing for probation or extension-after all n one has been there to offer help or support the rest of the time in residency, why would they start now? And it is practically a guarantee that if I am made to do an additional 6 months of residency, I will lose my fellowship position that I worked so hard to get.

Oh yeah, also the humiliation of telling friends/family/whoever about why I am still in residency, not doing fellowship, etc. Cant forget that

I dont remember why I wanted to be a doctor anymore. I know at one point I did, or I wouldnt have been able to make it through medical school. I can read over past entries and see I was still bright eyed, bushy tailed, and hopeful. Now all I can think of is what I have to do before I can leave the hospital for the day, and even when that is done, how long I will have to work before my loans are paid off and I can stop doing this. 

Medicine isnt fun anymore-I used to like teaching med students, educating patients, making people feel better, talking about interesting cases with colleagues. Now I avoid interacting with my peers for anything other than specific patient care issues. I find myself dreading my next r service and what else my superiors will find wrong, when I used to look forward to having a new med student to teach and morning reports to learn from.

And if they take my fellowship away, why force myself to stay in this environment? I find myself wondering what other careers I could pursue to pay off my loans, checking the forums to see what else is left for me. I invested too much to not finish residency, and I will have to stay in medicine at least until my loans are paid back, but then? DO I really want to commit myself to a career in which I am miserable, or at the very least, not happy?

I spoke with one of my friends the other day, who mentioned how he used to be much more up to date with his languages, he would always be studying japanese, but now he finds himself reading neuro journals and hanging out at work because he loves what he does.

…

I want that. I want to enjoy what I do, and not have it be just a job or feel like an excuse for a paycheck…but is medicine still the way for me to achieve that?

And maybe all the stress is temporary and if i can get out of this environment my opinions will change.

and maybe it isnt.

I havent done a comics post in a while. Figured I would intersperse it with some personal thoughts. I think I am beginning to see the writing on the wall with my current relationship. Nothing is specifically wrong, it just seems that whatever I do will never be good enough. As per the excellent quote by @suuperstar in the last post, at a certain point you cant keep trying to change yourself especially when it doesnt seem appreciated or if the other person is willing to change for you. I like who I am, or at least I used to, and I dont want to lose that. Apparently relationships can fail simply from holding different viewpoints on life. Who knew?

I feel like this a lot at work lately…like somehow, I just dont get it. Like no matter what I do, it’s not good enough, and even when I do something right, someone is there to point out how obvious the solution was and how I should have gotten it sooner. 

I know this too shall pass, but I wish that i didnt have personal and professional drama going on at the same time. I guess it’s just because November is sweeps month, I am pulling stunts like this to garner ratings…

oh well, better than being canceled.

Taken in its entirety from @suuperstar, because i needed to see it today and will need to look back at it again in the future

“Sometimes you have to be strong for yourself. You have to know that you’re a good person and a good friend. What’s meant to be will end up good, and what’s not, won’t. 

Love is worth fighting for, but sometimes you can’t be the only one fighting. At times, people need to fight for you. If they don’t, you just have to move on and realize what you gave them was more than what they were willing to give you. 

Hopefully, people realize great things when they come around and don’t lose something real. 

Always fight, until you can’t fight anymore, and then be fought for.” 

Still having problems at work. more to come on that later, when i can motivate myself to setting something about it down. It sucks not being able to trust your own department