While medicine is touted as a profession filled with meaning, it can also be filled with loneliness. Many feel that they have to be perfect in medicine, and this can contribute to a feeling of burnout. Burnout is a huge issue among medical professionals, and our members have written about it at length, from talking about where they find comfort to highlighting the suicide epidemic among clinicians to taking responsibility for their colleagues’ wellness. One way to combat burnout is to talk about the bad days, as not every day in medicine is filled with miracles. Our members have also written about other ways they have fought against burnout, including reclaiming time for themselves, what to do at work, becoming emotionally literate, and hosting a conference around fighting burnout.
Writing and speaking about the not-so-nice parts of medicine helps fight the feeling of being alone, so we asked our members to tell us one of the worst days they had during residency. We would like to open up a conversation about the bad experiences that clinicians live through while trying to provide the best care and keep their patients alive. We’ve included these stories below.
It’s day one, literally the first day of residency. While we have officially been in the hospital for two weeks, that time encompassed BLS, NRP, PALS, and ACLS as well as getting a partial layout of the hospital, getting badges and computer access. The day went by quickly with countless pages to the ER and direct admissions. It’s not after 4 pm and the entire team has left except for the on-call team which includes me. Breathe, it will be okay, I tell myself. 4:35 pm check out rounds are complete and I receive a stat page to the cardiology floor. I run into the room and see a gray baby. I stop and check my own pulse first.
My most startling experience was walking into a patient’s room to find him butt-naked and … how to say it delicately? … enjoying his own company. I turned on my heel, walked out, and asked him to let me know when he was done. (Why couldn’t he wait to pleasure himself until he’d gone home?!)
I had a patient threaten me with a lawsuit. The patient was having a procedure and was scared. He wanted his advanced directives signed right away. The only problem was it was the middle of the night. I was the overnight call resident and responded to the nurse’s page. I calmly explained to him that the medical staff could not sign as witnesses for the advanced directives. He responded by yelling and threatening to sue me. For the first time, I stood up for myself and yelled back. He apologized the next day.
My first month as a senior resident was at an affiliated community hospital. On my first night on call, I responded to a code blue for a patient I was not covering. A moonlighter running the code stopped and pronounced the patient dead. Walking away, he left me to call the attending who in turn, instructed me to inform the patient’s family. In the middle of the night, I called an unsuspecting wife to come to the hospital. An hour later, I broke the news to a total stranger that her husband had died.
There was a shootout in the hospital once. The patient I had admitted and saved the previous week was shot dead by her husband in a murder-suicide incident after I downgraded her from my ICU.
My last night on call as a resident, I admitted a devotedly religious woman with Stage 4 breast cancer. She had been self treating it by washing with holy water. When uncovered, her ribs were exposed and the smell of necrotic flesh hung in the air. Later that night she began to hemorrhage from the wound and exsanguinated.
The outburst of racist slurs hit the team hard. He did seem confused. Our attending tried understanding the reason for his feelings but was steadfast in support of not tolerating this kind of behavior. After it was apparent he did not have capacity due to delirium and discussing with the family, we decided to continue caring for him. Few days later, on my morning rounds, I saw him sitting by the side of the bed and he greeted me with the biggest smile, “How are you, my young friend!” I almost dropped my stethoscope! It was him, finally out of delirium. He had served in the military and suffered from severe PTSD. When his family told him about the things he had said, he was genuinely apologetic, in fact almost hurt and angry at himself.
My last admit for an MICU night shift was a previously healthy man about my age who within an hour of walking into the ER with a complaint of difficulty breathing was now intubated, on pressors, finishing his fourth normal saline bolus, and a continuous bicarb infusion. While calling my fellow to help figure out his care plan, he codes. We get him back, but a short while later, near the end of a bloody central line placement, he codes again! I spent the rest of that harrowing shift at his bedside trying to determine his next of kin and reviving him after another two codes.
20-year-old female with minor back trauma in a resuscitation room. In a matter of minutes, she transformed from having rosy cheeks to pallor and a distressed facial expression. Her exam went from a scaphoid abdomen to rapidly distended and firm. Her CT showed extravasation in the area of the right kidney. Multiple units of blood were rapidly infused to keep up with her losses. Just before I intubated her, she asked, “Am I going to be OK?” After intubation, she dropped her pressure and coded. I jumped on top of the gurney and pressed on her chest as we wheeled to the OR. Her abdomen kept growing and becoming more tense. Later, my surgery colleagues told of the horrific explosion of blood in the air like a geyser when she was cut open.
During my fourth year of residency, my program director, chair of the Department of Surgery, unexpectedly passed away. He was steadfast, and a giant in not one but two subspecialties in my field. Medicine is a marathon of sacrifice that you hope provides long-term personal and professional return on investment. To watch a mentor, who achieved the status you hope to attain, prematurely die while devoting your time, your energy, and yourself, to those ambitions, is perspective-shattering. It changed everything for me. Sometimes you should meet your heroes. Occasionally they fail to disappoint, but instead, life does.
They say all physicians are psychiatrists to some degree. Nothing could be more my second year of medicine residency working on the ward.
I admitted a "frequent flyer" with known CAD for rule-out MI. He refused discharge and claimed he was suicidal. After psych cleared him he complained of dysuria and hematuria (hx of renal stones). Luckily his sitter had witnessed him picking a scab on his leg and squeezing it into the urinal. Then he had hematemesis, after inducing vomiting followed by squeezing his bleeding wound into the toilet. Eventually he was escorted out by the police.
Another patient, admitted for priapism (that he was quick to show EVERY person that walked in his room) stole a pair of scrubs and told female patients he was an ultrasound tech required to give them a pre-exam. He was escorted out by police as well. Needless to say I was more than prepared for my psych rotation.