Thursday, December 10, 2015

"Residency is like delayed adolescence"

The other day my attending, who's main focus in life and teaching, said to us "training is like a delayed adolescence. You want to be off on your own but still want the protection of the 'adults.'" He gave a couple of examples of how, developmentally, we trainees are basically a bunch of teenagers trying to navigate the system, grow and develop, try and gain new responsibilities, and assert ourselves while still gaining valuable information from our attendings. I felt like this really resonated with me. Particularly because earlier that day, with that same attending, I felt an overwhelming need to rebel against him. He asked me a question during rounds, one that was very easy to answer, but I just didn't want to. I had no good reason for not wanting to answer. I just knew it would confound him that I wouldn't do it. And like the teenagers I work with, when asked why I was behaving that way, all I could say was "I don't know." Residency has been great. It's hard, and I struggle sometimes with the workload. It's not perfect. But compared to medical school, it's like a dream come true. There is a developmental life cycle to medical training. Residency is like being a teenager again. You're expected to do things on your own, but you are always under the watchful eye of your superior. At the beginning of residency this is very comforting. You are thankful for adult supervision to navigate this new and scary world. You get responsibility but you never have full responsibility. It's a safe time to test the waters, try new things, and start thinking for yourself. You always know that if you make a mistake someone will be there to help you through it. As you get further into your training, you start getting more responsibilities. You are given less supervision, but still know that someone is watching out for you. Slowly though, you get annoyed that there is someone you have to answer to. They get to make all the rules, and you are just expected to follow them. You want to make your own decisions but you can't. Someone else always has the final say. Sometimes you understand their reasoning for the decisions they make. Othertimes, it seems more like a "because I said so" that you are just expected to follow. You will find yourself rebelling for no good reason. You think you know everything. You think you are indestructible. You learn to manipulate your attendings into doing what you want. And when you mess up, they clean it up for you. Near the very end of training you find yourself with conflicting emotions. On the one hand you feel ready to go off and be an adult, and resent having to still be "under their roof" of training, but you also are fearful of being an adult and not having someone to rely on. I assume the first few years outside of being an attending are like young adulthood or college. Attendings really are like parents. They watch over you. They help you out of jams. They nurture you and take care of you. Sometimes they have to discipline you. They think they know it all. How many times have I heard the "when I was in training..." from an attending. I once told an attending "yes and I'm sure you also had to walk uphill in the snow both ways without shoes when you were in training, but that's not how things are anymore." Luckily I went to a training program where the attendings have a sense of humor and put up with my sarcastic, whiny teenager remarks. Different attendings have different parenting styles. Some let you sink or swim. Others hold tight to the reins. And others have that perfect balance of teaching while also letting you learn for yourself. One attending intern year said "I basically let you do whatever you want up here. As long as you have a reason and the patient isn't going to get hurt because of it, I want you to learn by trying different things." Others were like "under no circumstance will we try new medications that I haven't had experience with yet." Another similarity between being a resident and being a teenager is your concept of time. Teenagers have only lived for less than 18 years. So to them, each year is an eternity. Telling teenagers that high school is only a couple of years always falls on deaf ears. Because to them four years is almost a fifth of their existence. Training feels the same way. When you're in your late twenties or early thirties, another couple of years can seem like forever. People decide against fellowships because they already feel like they have wasted too many years in schooling. But to attendings, a couple of years is nothing much. They seem to forget how much each year of training felt like an eternity. Their parent-like advice falls on deaf ears, as you think in your head "you were never this young once, you don't know what it is like. YOU JUST DON'T GET IT." In my second to last year of training, I feel more and more like my teenage patients. I want to grow up but don't want to. I sometimes think everything will be perfect once I'm out of training. I tend to rebel needlessly against my attendings. But I'm also terrified of growing up and having to make it on my own. The struggle is real.