The last year of residency has been the most unsettling in my three-year journey so far. As I look forward to my next step, I cannot help but look back and reflect on what has happened. As terrified as I am to face the real world solo, I also struggle to find gratitude in the work that I have already done. For the very first time, I am questioning myself. Do I have enough gratitude to finish this journey and commitment that I started 10 years ago? My mind flashes back.
The death of my first patient echoes in my mind. That day is etched in my memory despite multiple conscious attempts to erase it. The sheer look of devastation on the parents’ faces. The tears in the younger siblings’ eyes. The feelings of failure and guilt in my heart and soul, like a black cloud. There were no feelings of gratitude, just remorse. Even now, every time I think about it, I feel shivers down my spine.
I am thinking now about the first time a patient’s parents were angry with me. It was my first year of residency and I had barely gotten my feet wet. The parents felt that my physical exam technique had caused their child pain. They started talking to me in louder tones; they said some very hurtful things about my skills as a doctor. I had never been in a situation like that before, and my nervous reflex was to smile. I unknowingly aggravated the parents more and they kicked me out of the room. I remember feeling so disappointed that night—disappointed in myself for not having the capability to alleviate the parents’ anxiety, disappointed in my skills as a physician. Over the last three years, despite becoming more seasoned, I have had countless similar encounters. My mouth has learned never to smile. Unfortunately, my heart has not learned how to not be disappointed.
In my memory now is an image of fumbling hands. It reminds me of a day when I failed to perform a procedure, and a superior shunned me for it in a condescending manner. My hands have struggled with a needle ever since. In fact, that experience has made me scared to share my weaknesses for a long time. Instead of asking for help, I nurtured self-doubt.
And now, I must pause. In my reflection so far, my mind has been building a tower of the days that I failed, the days that were hard. Where is the gratitude? Why am I finding it so hard to find a single moment of gratefulness? Did a parent never thank me for helping their child? Did a senior never say “good job” for the work that I did? Did I never feel self-satisfaction for taking good care of a patient? Did I never have a meaningful conversation with a child?
And if I didn’t, is it the fault of a ruthless system that buries us in documentation and demands perfection?
The reality is, I did have all those moments. Sadly, I was so overwhelmed, so preoccupied with doing things right, I forgot to notice what I was already doing right. I kept looking for gratitude externally when in truth, gratitude is internal. When my patient died, I was so overpowered by guilt that I forgot to give myself credit for showing up to work the next day and helping another patient. When parents were angry with me, I forgot that I was courageous enough to apologize to them, to put the child first. I forgot all of those hugs, smiles, and high-fives that I received from children over the years. I forgot all those moments of commendation from my peers and superiors.
At the conclusion of these three years, I agree that residency was the most physically and emotionally exhausting time of my life. But if I must choose one thing that I failed at the most, I would say it was to take personal responsibility for my own gratitude.
Saba Fatima, MD, originally hails from Karachi, Pakistan and is currently training as a Pediatrics resident in Philadelphia. She has a passion for children and writing, and she hopes for a world where no child has to die because they can’t afford to live. She was a 2018 Doximity Scholar. She tweets @SabaFatimaAli and blogs here.
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