“I want everyone to think of a ‘win’ they had this past month. Take a few minutes and write it down and then we’ll discuss as a group,” one of the social workers who was leading a wellness session instructed.
The room was quiet for several minutes as residents stared off into the distance, fidgeted with coffee cup sleeves, and occasionally scribbled something down on paper. When time was up, she asked for a volunteer to share. The silence hung in the air in the auditorium, growing more present as the seconds ticked by.
Finally an intern broke the silence, “OK, so I don’t really know about anyone else but I’m just having a really hard time with this because I can’t think of any wins! Sorry,” she confessed.
Suddenly the room was filled with chatter as people emphatically agreed that they felt the same way.
“I just had a nice five minutes thinking of everything I did wrong instead,” one of the seniors joked.
With some exasperation, the social worker leading the session eventually coached residents to share “non-work wins” instead. Someone ran a race, another person adopted a puppy, someone finally finished re-tiling the bathroom in their new house. It was clearly not how she’d intended the session to turn out, but perhaps the camaraderie we discovered with our collective zero wins had created some “wellness” anyway.
I fully identified with the intern who had confessed that she had no wins. I too had sat in the auditorium thinking of things I could have done better in the OR, patients with delayed discharges, and med students I should have mentored better. The problem is that we interact with important stakeholders all day and night whose goals are often at odds, making it very hard to ever definitively “win.”
There was a morning my intern year when a patient had unexpectedly arrested on the floor around 6 a.m. My PGY2 had stayed to resuscitate him with the code team while I completed morning rounds and staffed all of the patients on the service. We’d gotten the patients the care they needed despite an unexpected and challenging morning and kept the service afloat — something worth being proud of as two junior residents. However, the chaos of the morning had meant that two attendings had to preop, position, and prep the patients on their own for their first-start OR cases. We walked in late to the ORs knowing an attending had expected a resident to be there. Although we’d communicated what was happening on the floor and they’d been understanding, it still felt like we’d let them down.
There was a day as a second year when I’d been firm with a patient we’d found using outside drugs in his hospital room. I’d told him that it was important for his safety and for the safety of other patients not to do that again. I’d drawn clear boundaries, I’d set expectations with him, and we involved the necessary parties from hospital security and nursing. I’d felt like I’d dealt with a complicated dynamic well … until the nurse paged me that he had left against medical advice several hours later. It was hard not to feel like I was responsible for it and that if I’d looked the other way maybe he wouldn’t have left.
There was a day I’d tried to teach a new-hire PA how to place an arterial line in the burn unit. I’d talked her through how to do the procedure and although she’d gotten a brief flash of blood, the wire wouldn’t pass and we saw a large hematoma on ultrasound letting us know this spot was no longer an option. The attending had mandated that no more than two sticks be used to get access. I got the art line on the next attempt and I’d been happy with my success on an objectively difficult line. It was something I didn’t think I could have done even six months before, but it was impossible to ignore the fact that I’d unceremoniously taken the procedure away from the person I was supposed to be teaching.
These dynamics that exist within the patient care team have multiple stakeholders with different goals. Between the patients, the family members, the nurses, the students, the attendings, etc, an optimal outcome might look much different for each party. What makes this dynamic even more complex is that stakeholders outside the patient care team — such as insurance companies and hospital administration — might have yet another agenda that may be at odds with our own idea of what constitutes a “win.”
With so many goals at odds with each other, it was easy to feel win-less; especially in a surgical field that doesn’t have a long tradition of positive feedback. This, coupled with very type A residents who likely are very hard on ourselves at baseline, makes the whole auditorium of win-less residents an entirely unsurprising phenomenon.
Finally, I think most residents from my generation live under the very large and present shadow of those who trained before the ACGME mandated an 80-hour work week. We’re told directly and indirectly that we have it much easier than they did, and I think many of us internalize that as another layer of inadequacy: another non-win. If I’m tired, imagine how tired my attending was back when they were training. If I get frustrated with sexism today, imagine how much worse it was for the female attendings who trained decades ago. We feel guilty enforcing work hours for junior residents (or ourselves) when there are omnipresent comments online, at meetings, or in the physician’s lounge that my generation will never be as well trained because we’re selfishly choosing to go home and sleep after 24+4 hours on call.
Recently, however, I’d traveled for a wedding where I saw a number of friends and acquaintances from high school for the first time in a while. I’d left the hospital on Friday night, frustrated by a similar lose-lose situation to the ones I mentioned above, but I was stunned at how different my high school friends’ take was from the narrative I’d built in my head.
“Wow, so you stay at the hospital for 24 hours straight on call? When do you sleep?”
“You don’t sleep? You just take care of patients all night? Wait, you operate at night even?”
“So, like if I go to the hospital, is there some way I can avoid having someone operate on me who’s been up for 24 hours? No offense … but for real though, who do I talk to about that?”
A girl who taught elementary school pointed out that sleep was important for consolidating memories and learning, and another had read that there were often medical errors when people had been awake for too long.
They all had incredibly valid concerns, and I found myself torn on how to respond. The old guard whispered in my ear that the point of residency training was to introduce appropriate rigor and that sometimes working for 24 hours allowed for continuity of care and more OR opportunities. “The problem with q2 call is that you miss half the good admissions” is the adage after all. But from a patient/caregiver’s perspective, they certainly had a point. I was struck by how shocked they were, and how interesting it was to examine the phenomenon of residency from outside my bubble of people who’d been with me on this journey since the day I took the MCAT.
As the conversation wore on, I was also struck by how normal I found many of the truly extraordinary things we do every day.
“So you’ve done a real surgery before? Like a real legit surgery in the OR? Could you take out my appendix?”
“You’ve done it all by yourself? They let you do it on real patients? You’re just like Turk on Scrubs!”
“More just like Grey’s Anatomy! Is it like Grey’s Anatomy? Have you ever seen them have to use the paddles on someone? Ah, that’s so insane!!”
I reassured everyone that residency was generally very un-like "Grey’s Anatomy," but I couldn’t deny that the rest was true. After a few long years of not winning (and seeing few people outside of the “residency bubble” due to COVID-19) the conversation with high school friends had given me some much needed perspective. It doesn’t matter if we don’t work as many hours as people did in 1987. It doesn’t matter if an attending had to preop their own patient one morning, a patient left against medical advice, or an abstract got rejected by a journal. At the end of the day, what we get to do as physicians is incredible and unlike anything else, and that alone should be enough to count as a “win.”
What's a recent "win" for you? Share in the comments.
Colleen is currently a general surgery resident in Salt Lake City, UT. She hopes to pursue a career in academic surgery where she can continue teaching, writing, and research in addition to clinical practice. She has an MD/MPH from Tulane University in New Orleans, LA, and hopes to continue to use public health principles to improve surgical outcomes for patients. In her very extensive free time as a surgery resident, Colleen enjoys art, skiing and snowboarding, hiking, writing, dancing, and practicing yoga. Colleen is a 2021–2022 Doximity Op-Med Fellow.
Illustration by Diana Connolly