Sometimes, things can get overwhelming on the path of medicine. That niggling sense of always not being good enough – for your patients, for your preceptor, for your family, for your friends, for time management, for research and innovation, for advocacy, for continuous learning, etc. – is usually manageable. You might actively throw yourself into work to mitigate the sense of inadequacy. You might be so busy day-to-day that the feelings get pushed back. You might fill up any free moments with weirdly addictive cell phone games or horizon-expanding podcasts.
But, having done all of the above myself, here is the problem that I recently re-learned.
Those uncomfortable feelings do not always go away.
Sometimes, the compartmentalizing works. You put your feelings on the shelf. Sometimes, those feelings abate due to new developments – the achievement of something having go well at work, a wonderful evening spent with people who validate your worth in direct and indirect ways.
But sometimes, those feelings don’t abate. The weeks at work continue in a status quo manner. You done nothing well on the ward, in the clinic, or on home visits. You feel like you’ve made zero difference in the lives of the people in your care. You’re the most mediocre (or frankly awful) medical student or resident to have passed through the supervision of your preceptor. You are so bad at time management that your family and friends probably feel only disgust when they think of you because of your extended absence and inability to be present. Or maybe they feel nothing at all because nothing you do matters, and you don’t matter.
Does this sound familiar to anyone out there?
And here is another kicker. In moments of clarity, people might actually hear that audio track above playing in their head, identify it, and then hit pause to examine the validity of the track itself. In moments where one feels too busy/overwhelmed/wrapped up in the feelings themselves, it can be so hard to identify and examine the litany of frankly self-abusive thoughts swirling around in your mind like a never flushing toilet full of – well, you know
So, I fell prey to this swirling toilet from hell for a few weeks. Not the first time, not for the last. I had been free of said swirling mental excrement for a while though, long enough to forget the warning signs and not identify when it started again.
Here is where two things came to the rescue.
- Good people are in my life.
- I was open with the good people in my life.
Having Good People in Your Life
Some people need more relationships. Some people need less relationships. Pretty much everyone needs at least one solid relationship. Even the people I know who are most comfortable on their own still nurture one or two relationships.
I meet patients who might find themselves with no relationships with others, or with only non-deep and/or non-nurturing relationships. This is almost never a content and secure person, and that impacts their life (which also impacts their medical care).
I have good people in my life. This is from a combination of luck (for meeting these people in the first place), effort (in longitudinal nurturing of these relationships) and some more luck (that the other people were also interested in longitudinally nurturing these relationships). I plan to continue appreciating and nurturing these people for the rest of my life (or theirs). It’s nice when we can smile in anticipation of being in our 70s together and laughing at our younger selves for our current follies.
Sometimes having these good people in our lives is enough to make us feel better about whatever situation we find ourselves in. “Hey, there are these awesome people who still want me around. I must be doing something right.”
Sometimes, it’s not enough.
Being Open and Drawing on the Strengths of Others
This part can be tough. For people who are used to being problem solvers and care providers, we might be used to being the ones that others come to for help. We sometimes provide surgical solutions, interventional solutions, or medication solutions. We always strive to provide realistic hope and emotional support.
Sometimes, we are the ones who need help, though. And it can feel weird to reach out for help and accept it.
I found myself in that boat – twice – a couple weeks ago, of reaching out, listening to advice, and accepting support. And it is a rarer occurrence, I guess – one of my friends on a three-way call commented, “I’m just glad to be here for you. You’re usually the one who is here for us.”
Setting Yourself Up for Success
I must admit, I did not actively reach out for support. The two opportunities came by through pre-planned relationship nurturing. One was when I was at a pre-arranged hang out with a good friend. We were on the couch at her place, we have a long history of being open with each other, and my current struggles just tumbled out of my mouth. BUT. Had I not been there with her, had we not arranged to hang out, I probably would not have sought her out to chat about my feelings until things had gotten much, much worse.
Another one is the three-way call I mentioned. The three of us decided a little over a year ago that we were important to each other. Though we all lived in different cities (one of us in a different time zone), we would like to keep in touch in a deeper way and with regularity. So, we set up a recurring monthly 3-way call. We have had to reschedule these calls at times, but are probably 95% faithful to having them occur every month. Again, had these calls not been pre-scheduled, I would not have reached out to either friend until things got much, much worse.
Bottom line: consider setting up some kind of regular touch point with the people who are important to you. That will make it easier for you to seek support when you hear the disaster-train coming – not when it’s about to run you over.
Listen
This harkens back to being a helpful ear, but from a different angle. If you are reaching out to someone for support, and they offer advice, actually take a moment to listen. I found I had to pause myself from saying, “yes, but” and discounting my friends’ thoughts even before I had taken the time to reflect on what they were saying. This is not because I think their opinions hold no value, but because I was in an emotional state that made it hard to hear opposing stances to the negative self-view and skewed priorities I was swimming in at the time.
Consider these steps. Listen. Pause. Evaluate. Sit with these new ideas, let them roll through your mind and your feelings, and see what sticks. Is it possible that there is another way to look at what’s going on, even if you may not agree entirely with the other person’s perspective? Going back to the other person’s view – are they, in fact, completely right? What would it mean if they were?
The back story to all this is that I had recently relocated for an elective. Different province, different system, different coworkers/team, different (a.k.a. no) daily routine. I was feeling more stressed than usual, had lower self-confidence than usual, and just received positive feedback recently that completely did not match the extremely poor self-evaluation I had of recent clinical encounters. This discrepancy in self vs. other-evaluation – even though positive – further shook my self-confidence because if I can’t self-evaluate, what will I do when I am out in the work force, practicing independently, with no oversight?
I did not want to worry my parents. Mr. Sparks was in an extremely busy time of the year. And generally, I don’t like to “burden” other people with my problems. But with my analog and digital pre-planned friend hang outs that pre-dated my current struggles, I was able to seek support. And, as expected, they said very insightful things that I was able to mull over in the ensuing days.
This niggling self-doubt is always going to be there, I think, in one form or another. Even if I was FIRE instead of FI, it will just morph into something else. In some ways, this self-doubt fuels my drive to improve, which can be adaptive. And when it gets out of hand – as it occasionally does – I hope to again turn to my external strengths, those family members and friends in my life, to nudge things back on track.
Do you have similar experiences?
-Dr. FIREfly
Medical training is simply something to get through with your humanity intact. Enjoy the people you befriend. We all learn the required info.
Most if not all the adulations and criticisms are merely distractions. I would not put too much emphasis on them either way.
You seem to care about being a good physician. That is more than many can ask for. Do the best you can and that is all you can expect of yourself.
Thank you for your words of wisdom. Will continue to try to grow as a person (encompassing as a physician), and do the best I can 🙂