Since entering the world of medicine, I have always marveled at the knowledge of those above me on the hierarchical ladder; my residents, fellows, and attendings. Surely, I would one day follow in their footsteps and experience the joy I associated with being in their shoes. Indeed, when I was a medical student, I wanted nothing more than to be like my residents, who would confidently nod their heads on rounds in shows of understanding as the attending explained the differential for a patient’s anemia, or knew exactly what questions to ask a patient presenting with a specific chief complaint.
When I finally began residency, I was unknowingly plunged into chaos. I jumped through the fire hoops of internship, always sprinting to patient rooms or answering pages in a frenzy (or both, simultaneously), and was constantly looking to my senior resident for guidance. I remember being frozen stiff during a Code Blue, not remembering the dose of lorazepam to order when a patient was acutely seizing. I would cry in not-so-private corners of the hospital because month after month, I still felt like I had learned nothing and helped few. Yet, I reassured myself that internship was bound to be difficult and that things would feel much smoother as I progressed through training. My dream of being like the residents I was so enamored with as a medical student was very much alive.
After internship, I became a “senior” resident, and spent most of my years in an ICU. My understanding was flipped on its head as I was again plunged into a world I was unfamiliar with, one where I was ill-equipped to present liver transplant patients in front of a crowd of more than 20 clinicians or propose changes to an anti-epileptic medication regime for a neurologic syndrome I had never heard of. My presentations were inevitably interrupted and corrected with alarming (and disheartening) frequency. On the outside, I pushed through my patient presentations. Inside, I wanted to curl into a ball and disappear into the wall behind me. Between the seemingly endless learning curve of residency and a never-ending barrage of patient care needs, I battled through each day, wondering why being a resident wasn’t as good as the romantic draught I had concocted in my head for what the future would taste like. Instead of feeling confident and knowledgeable, I was left feeling lower on the totem pole than ever before, full of self-doubt, and frighteningly burnt out.
But still, I had hope. For when I became a resident, I once again began to look ahead, wanting nothing more than to be like my fellows. I envied their deep knowledge of their chosen field, their autonomy to make medical decisions, and the way they seemed to know everything about every patient on the unit when I, as a resident, struggled to keep track of my single-digit patient load. I admired their ability to keep calm no matter what the day brought. But here I am, now a fellow, experiencing a different reality than I had imagined for myself. My hunger to feel competent and knowledgeable feels even less satiated as the learning curve has only gotten steeper with the pursuit of subspeciality training. I do not feel autonomous in a new hospital surrounded by new people. For much of the day, my stomach is in knots and I feel flustered by my patient load, the needs of the unit, and thoughts of if I am worthy enough to be here. Instead of savoring where I am, I now dream of being an attending, confident in my subspecialty practice and having the authority to lead a team. Only this time, I stop myself from idealizing my next destination, because I know that being an attending too will not live up to my glamorous expectations, not only because I have heard attendings express their troubles to me themselves, but also because this is what medical training has taught me; there are highs and lows with every stage of this process, and the grass is never as green as it seems on the other side.
In medicine, we love to not show weakness, to maintain a shell of composure and skill. We rarely, if ever, create space to share our struggles, failures, and disappointments. Why would we, in a highly competitive field that demands machine-like perfection? And yet, we do the sea of medical trainees who look up to those further along than them a disservice by maintaining the illusion that if we just get to the next rung of the ladder, things will magically be better. I never could have imagined that walking now in the shoes I was desperate to wear seven years ago that I would still yearn for so much and that my struggles would be many. Perhaps it is my fault for being so naive, or perhaps I am the byproduct of a system that teaches us to keep our heads down and keep pushing ourselves through one more rotation, through one more sleepless 28-hour call, through one more missed family wedding, until we make it to the other side. While surely there is joy to be found in the practice of and completion of each stage of medical training, the reality is that there is no “other side,” no matter what stage of training or post-training you find yourself in. There is and will always be swamps to trudge through and sunshine to bask in. There is no VIP club, get-out-jail-free card, or golden ticket. There is only the present, and what we make of it.
What do you make of your present role? Share your green grass in the comments.
Sara Khan is a first-year neonatology fellow at UCLA. She is passionate about health equity, medical education, and reducing physician burnout. She was a 2020–2021 Doximity Op-Med Fellow.
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