Expectations
“I can’t do this.”
“I feel like nothing. I feel numb to everything.”
“This isn’t for me. This isn’t the life I want.”
These are just a few of the texts I sent my fiancée during my first month of inpatient general medicine, which I finished just a few weeks ago. There were moments when I thought about walking away from the path that I’d chosen and there were moments where I felt my worth was that of the gravel that coated the parking lot of the hospital. Suffice it to say, it was not the best month I’ve ever had. It was one of the most grueling and self-revelatory periods of my life. However, I look back on those four weeks now with a fondness that is based in the lessons I learned and in knowing that my feelings were not congruent with the reality of the situation I was in.
Perfection
Like most in the medical field, I’ve always held myself to high standards and have had high expectations for myself in every aspect of my life. And also like most, I did a pretty good job of living up to those expectations. I felt confident throughout medical school in my ability to work through most any situation on my own and come out successful. But, I quickly realized that this wasn’t going to be possible during my first day of inpatient internal medicine.
I walked into a list of 12 patients with the expectation of knowing each of them and being able to present their stories and their plans on Day 1, and it felt that my attempt to do this with our new attending was nothing short of humiliating. I was reeling. How was I supposed to know these patients well enough to present them adequately on Day 1? How was I supposed to get orders in for each of them? How was I supposed to make sure they all had labs the next morning? And write notes on each of them that weren’t being discharged? And help admit two more new patients on that same day? And on top of all of this, how am I going to learn the medicine?
It became obvious that I couldn’t live up to the expectations I had for myself. I couldn’t be perfect. I couldn’t do this without help. I didn’t feel like a doctor. I felt inadequate. I didn’t know exactly what my role was. I felt like I didn’t belong at a place like Duke. I began to feel hopeless, and that I’d never learn the concepts of general medicine necessary to succeed as a physician and adequately care for patients on my own one day.
Many of my days were spent thinking, “How can I call myself this patient’s doctor when I don’t even know the ins-and-outs of how we are managing them?” I felt like I was drowning. I felt like an imposter.
These feelings grew daily, to the point that I truly believed the words above. I wanted to walk away. I felt like I was failing my patients and myself.
Family
I had shared some of these thoughts with some of my (wonderful) co-interns during my first few days of that rotation and they reached out to a faculty member to share their concerns about me. I received a call from a faculty member one night after getting home from a long day at the hospital. We spent about 20 minutes talking about my experiences and about the things I was feeling. He assured me that what I was experiencing was normal—par for the course—and that nobody can come into intern year and manage all of these things alone, and that I can’t expect perfection. He encouraged me to keep my head up and not let this experience break me. He also encouraged me to lean on those around me.
I was also lucky enough to have three half-days of clinic during this four-week rotation. The thought of being able to leave the hospital and go back to ‘home base’ at Duke Family Medicine was exciting and gave me something to look forward to as I entered each grueling week. During each of those three afternoon clinic sessions, the senior residents took the time to ask me how I was doing, how things were going. I was honest—I told them that I was struggling. I told them about the thoughts I was having. I talked about my worries, concerns, and doubts. What I received in return were stories similar to my own. I received encouragement and praise for continuing to push through and I received advice about resources and methods I could use to be more efficient and make things just a little bit better.
Each person that took the time to talk with me and share with me could have continued to work on finishing up their busy clinic days, they could’ve gone to go spend time with their families, but they didn’t. Not before taking the time to check in and offer whatever advice or guidance or support that they had. These conversations weren’t going to make me a wizard on my inpatient service and help me to suddenly become the picture of efficiency and knowledge, but they gave me confidence and hope knowing that I have a program and home base to always come back to where we are all supported, cared for, and treated like family. These conversations and these colleagues gave me comfort, knowing that I’ll get there—to that end goal, whatever it may be—as long as I continue to work hard and lean on those around me.
I see now that my expectations for myself need to be tempered with each new experience. I see more clearly that medicine is a team sport, and we must rely on each other to not only get our work done and learn the medicine, but also to struggle (and thrive!) through the difficult journey of residency training. I also see that the thoughts I shared with my fiancée were not based in reality, but were an emotional reaction to the experiences I was responding to through a lens of unrealistic expectations.
Today, I know I can do this. I don’t have to be perfect. I don’t have to know everything. But, I need to be willing to learn and be willing to push through the moments of struggle.
I feel like I belong. I am surrounded by like-minded physicians-in-training and faculty members who push each other to succeed and who support one another with fervor.
I feel privileged to care for others on a daily basis in a variety of settings and I feel incredibly fortunate to be able to do so in the company of those above.
I know that that is for me and that is the life I want, and I look forward to the continued growth of myself and my colleagues, who have consistently shown authentic care for one another and for those they care for daily.
And I know that difficult times will certainly be found ahead throughout the remainder of this three-year journey, but I am excited for the challenges that lie ahead and for the growth that will accompany them.
Joseph Colosimo, M.D., is a first-year resident with the Duke Family Medicine Residency Program. Email joseph.colosimo@duke.edu with questions.
Editor’s note: Duke Family Medicine residents guest blog every month. Blogs represent the opinion of the author, not the Duke Family Medicine Residency Program, the Department of Family Medicine and Community Health or Duke University.