July 15th, 2016
What Is Resilience?
Jamie Riches, DO
NEJM Journal Watch is happy to welcome a new panel of Chief Resident bloggers for the 2016-2017 academic year. Here’s a sample of what our new bloggers will be discussing, starting on August 1!
Jamie Riches, DO, is a 2016-17 Chief Resident in Medicine at Memorial Sloan Kettering Cancer Center.
“Resilience” is defined as the capability of a strained body to recover its size and shape after deformation caused especially by compressive stress.
On March 9, of this year, my colleagues (my friends) and I unclipped our pagers from our belts, scrub tops, and white coats to read, en masse, “Important announcement at noon conference today.”
At that noon conference, we found out that one of our fellow residents had committed suicide by jumping from the hospital housing building. This intelligent, dedicated, accomplished young physician was the third internal medicine resident in our 22 square mile city to perform this act with identical detail in just under 2 years. We were dismissed to return to our pagers.
We picked ourselves up, literally, from sobbing piles on the bathroom floor and answered our pages. The work did not stop.
Throughout the following days and weeks, we were offered grief counseling sessions and open forums during noon conferences, where we could discuss our feelings and reactions. One morning, we were given free breakfast. We received many emails detailing these logistics, often ironically referred to as “housekeeping” items by the administration. We were desperately trying to clean up our own mess. The work did not stop.
After more than 3 weeks of waiting for the institutional silence to be broken, we were again called to an important noon conference. We were addressed by a senior physician lecturer. He spoke about depression and suicide, and how these things can often be inevitable, unpreventable. We were reminded that we are in a high-risk profession. A stack of handouts made its way around the auditorium, offering a prescription for resilience. We were advised to train ourselves to develop a positive attitude, to face our fears and find a resilient role model. This was followed by an anecdote, highlighting the speaker’s ability to receive terribly tragic news involving one of his family members and to walk directly into a patient’s room to resume work after hanging up the phone. The lecturer proceeded to present his research on resilience, largely based on studies involving military personnel and prisoners of war suffering from post-traumatic stress disorder. Correlations were made between entering the practice of medicine and entering the battlefield.
As the lecture proceeded, I began to realize that the traumatic event to which we were referring was not only our colleague’s suicide, it was our residency training. Unfortunately, this is not a correlation with which I am unfamiliar.
The forum was then open. “Please share your thoughts, experiences… and let us know: What can we do?” What can we do?
After a long pause, one of our most highly respected senior residents spoke, expressing his frustration with the fact that we were expected to resume work minutes after being informed of this tragic and shocking event. He stated that the perception of needing anything more than to take a deep breath and simply get back to work as equivalent to weakness, in combination with the “fear of retaliation,” was likely why no one was saying anything in this forum. This was followed by a reminder from our program director that “some people were given time off, and some people are still taking time off.”
This was true. One or two people had taken time off. We were not yet aware of what the repercussions of this time off would be. One month prior to this event, our chief residents had sent email to some of the senior residents: “If you are getting this email, it is because you have sick days to pay back. Sick days need to be paid back before June 30 so the program can sign off on your 3 years of GME, so please pick up shifts when you can.” Any resident who had taken a sick day in the past year was instructed to find time to cover an extra shift in order to “pay back” the institution for allowing recovery time. I had a flashback to another mass email referencing recent lateness to an outpatient clinic shift: “These instances are deplorable… You will become that person whom people hate to work with because of your lack of professionalism. Don’t turn into that, there’s already plenty of them plaguing our health system and we certainly don’t need any more.” These words were sent from those chosen to be our advocates. A wise, seasoned (and resilient) mentor of mine once gave me this piece of advice: “The institution will never love you back.”
Despite these examples, I don’t consider my program malignant. Malignancy in residency training refers to those programs in which the residents are placed in a hostile working environment. Despite having rapid administrative turnover (four program directors and three medicine chairs in 3 years), we have administers who are generally open to addressing resident concerns and who attempt to make changes based on resident feedback. This larger issue is not institutional; it is systemic.
I pride myself on my resilience. I am a New Yorker. I watched the Twin Towers fall on September 11, 2001, knowing that my family members were inside, saving others’ lives and sacrificing their own. I shared the grievous guilt of every family member, not only acknowledging that it could have been me, but wishing it had been. When I was choosing my own career, my father sat me down at an old wooden table at Chumley’s Bar and asked me if I thought I was “too good for the fire department.” My fear of fire is one I chose not to face. During my first year as a physician, my intern year, I received a phone call from my mother’s husband, informing me that she was in the ICU, and it “didn’t look good.” My mother’s life was plagued by a series of self-inflicted illnesses, and its culmination was that of multiple organ failure and a series of failed and futile resuscitation efforts. When I got the phone call that “it was time,” I walked into one of my patient’s rooms and informed him and his family member that I would be gone from the hospital for the afternoon because I had something to take care of. The patient’s sister replied, “I’m sure you’re very busy and have plenty of things to do, but this is his life we’re talking about.” I’ve cried every time I’ve lost a patient, someone’s mother or beloved family member, ever since. I continue to reflect on my disappointment with the overwhelmingly accepted notion that our training — the apex of our years of education, the threshold of our careers as physicians — is a traumatic event unto itself. Although, I know, in some ways, this is inevitable.
We enter medicine as if we are walking into a sacred space: hallowed halls where hierarchical gods prevail and miracles happen… until they don’t. We spent thousands of hours staring at computers and making phone calls and answering seemingly incessant pages, attempting to address questions to which we may not know the answers. We struggle to balance quality of care with quantity of care. We carry the underlying responsibility for the most vulnerable, most intimate moments of many people’s lives. This can feel like both a blessing and a burden. We not only carry people’s lives in our hands, we feel responsible for their deaths. We are tested every single day. Our knowledge, our patience, our compassion, our skill, our determination, and our stamina need to be demonstrated, examined, and verified. We struggle to find ways to work within a system that often feels punitive for its own faults. It can be lonely. It can be exhausting. It can be traumatic.
The Intern Health Study, a longitudinal study of depression among interns nationwide, estimated that “suicide rates among physicians are something like 40 to 70 percent higher in males and 130 to 300 percent higher in women.” Statistical estimates state that as many as 400 physicians commit suicide every year. Three young men and women leapt to their deaths in one city, in 16 months. We are not experiencing a tragic event; we are experiencing a harrowing trend. What can we do?
“Our needs are our greatest assets. I’ve learned to give everything I need.” – Andrew Solomon
The quote above is from a TED talk that, for months, I watched almost daily during my commute. This quote and many others gave me a great sense of comfort when I was grieving, tired, lonely, insecure, and burnt out. Looking back on those words, I wonder if the sentiment itself, or my attachment to it, is a reflection of the pathological need of the physician to feel strong.
I stood up to speak, not yet aware that my emotional state was one in which anything less than an [administrative] offer to turn back time would be received as an insult.
The resilience lecture began to feel less therapeutic [albeit well-intentioned] and more like a venue for perpetuation and exacerbation of a culture that was in itself, the compressive stress. We were being trained like soldiers, in the wake of our fallen comrade, to go out and fight! Be strong! Our strength was being measured by our ability to silently struggle through whatever we were experiencing and get the job done. Admit. Discharge. Admit again. We were being given tools to obviate the natural human state of vulnerability. We were “tasking victims with the burden of prevention.” We were reminded to be proud of our ability to charge on. I ended my commentary by stating that we were using the language of an abusive relationship.
What can we do?
- Eliminate the word “burnout” from the lexicon: Not only does burnout minimize the severity of depression, detachment and (at extremis) suicidal ideation among healthcare professionals (HCPs), it implies that those suffering post-trauma have some inherent flaw or weakness that impairs their ability to remain functional. This mindset removes the onus from the system.
- End the stigma: Remove the question, “Have you ever sought treatment for any mental illness” from the job applications. We should encourage residents, physicians at all levels, and other HCPs to actively seek out cognitive therapy as we do vaccines or PPDs.
- Decide what graduate education is: If residents are primarily learners, we must protect their time and use it solely for educational (both clinical and didactic) purposes and not to provide underpaid labor to perform all tasks for which the hospital is at a loss, no matter how menial. If residents are employees, we must provide adequate pay for educational level, protect sick leave, and outline contractual responsibilities before enrolling in the agreement.
- Stop penalizing unwellness: Physicians and HCPs are as human as our patients. We are not immune to everything. There will be times when we will be ill, physically and emotionally. We will need time and space to heal.
- Structure the system in a way that minimizes fear of retaliation: If the person creating or enforcing destructive policies is the same person who needs to write the words “excellent candidate” on the letter of recommendation that carries the weight of your future career opportunities, your best and worst interests are one and the same.
- Embrace our own fallibility: Learn to be comfortable with imperfection. Let us have an equal respect for our accomplishments and failures. Employ mentors who set this example.
- Accept that medicine is not martyrdom: The work does not stop. Let it not deplete us. Let us take care of each other and ourselves and not give away everything that we need.
“Recover” is the key word in the definition of resilience. Physicians are intimately acquainted with the process of recovery; recovery is a process. I do believe we will recover from this event, although not quite restored to our original state. We can work together to implement changes to not only create, but demand an educational and professional environment of safety, wellbeing, and, ultimately, resilience.
120 Responses to “What Is Resilience?”
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Hi, and thanks for the article
I’d love to see the TED talk you mention – could you share the URL please??
Thanks!
Excellent article! Same problems here in India. To add to which there are third world problems (I dont think India is a third world country but as far as residents are concerned it is a nth world country). All the problems that you have outlined are here but in spades.
I think the most telling is the fact is that residents are used for jobs involving anything and everything. And why is it that they are underpaid so much? You have corporates running your health system, we have a dual system of public institutions (govt funded) and private institutions. The end result is the same. Compared to the amount of work that is done by the residents and what is expected of them, they are just paid peanuts. The carrot is the amount of money you make after you finish with your residency.
But what about your most productive years of life? Those years where you are enthusiastic, have the capacity to have fun and work?
The one thing that I cannot identify with is that despite a very traumatic event, you were expected to work on. What could have been done otherwise? Give mass leave to all residents to cope with the loss and shut down the hospital? However, I do agree that more leave needs to be sanctioned and not bartered for extra shifts. And that is a silly reason – we worked harder, can you not work this much?
Check out Tea and Empathy
https://www.facebook.com/groups/1215686978446877/
Less than 6 months old, peer to peer online support, already international.
It would be great to have some Indians join us and start to spread the word in India.
Amazingly thought-provoking and well-written, Jamie. I remember struggling with a lot of self-doubt and anxiety during my residency. These feelings surfaced after a rotation with a particularly nasty pulmonary fellow who seemed to have it out for me….never trying to help me learn, but frequently trying to put me down in front of others. Ironically, she committed suicide less than a year later. We were called to a meeting one morning, very much like the one you described in your piece. I came away from my experience during residency with a knowledge that criticizing and degrading learners will not improve quality of care. We are all human and will make mistakes. A good attending/fellow is there to supervise and educate, so that mistakes are avoided or quickly addressed.
I agree with both Nads and Stethoscope Nunchucks. I started medical school as a 36 year old mother, with three children at home. I completed the “old school” surgical residency of in house call averaging every other night, and call from home every night as a chief resident. We thought of it as “Boot Camp”, preparing us for life in the real world of surgery…all night emergency cases, followed by all day office or elective surgeries. It was not easy, but we worked hard, and we had fun! We would grumble about operating all night, but then talk all the next day about the great case we had done the night before! A lot has changed over the years, and most of the changes have resulted in the “fun” being sucked out of the job, and the stress compounded. We now spend about 1/3 of our time in patient care, and 2/3 of our time documenting and dictating. Everyone walks on eggshells for fear that they may “offend” someone with an offhand remark. We constantly have people, who are not trained in our job, looking over our shoulders telling us how to do our job, but we are not supposed to complain if anyone on our ancillary staff is not doing their job. Practicing medicine is hard. Telling someone that they, or their family member, are dying is stressful. Being unable to save someone’s life that is entrusted to you, leaves a mark on your very soul. You have to be tough. You have to find outlets for the stress. Some people are not cut out to be doctors; just like some people can’t run marathons or play in the NBA. No shame. Do something else. There is no glamour in being a doctor. It has to be a calling.
dr mom thanks for sharing your story. i hope im interpreting your comment correctly and would like to respond. i dont think the point of the author’s story was to state that “medicine is difficult” and that “people need to be tough” otherwise they need to find a different profession. all professions, especially medicine have ups and downs. and since medicine has especially emotionally and physically draining issues, it is all the more reason to ensure that safety nets and coping strategies are in place. allowing people to “tough it out” is simply not an effective strategy and is obviously not working since “burnout” is such a widespread issue. thanks.
Thank you for writing and sharing this very poignant piece Jamie. We’ve lost our own too, more than once, and are met with the same paternalistic advise; often with almost patronizing delivery (“surely, you all have acces to the counseling websites we’ve sent you…”). Your insight needs to be said and disseminated until this ‘culture’ of medicine evolves (demonstrates) some genuine humanism and compassion for the residents and fellows who keep our hospitals running. Your colleague – Susan
Hi Jamie,
I just graduated from residency, and I share your views and experience. Residency by itself is hard, but it’s made a more challenging experience by the hostility with which residents get treated on a daily basis. While attending physicians profess to teach us how to be empathize with our patients, they forget to treat us with the same respect and humanitarianism. After all, “they had it worse” and “why do these mere residents think they should have it any easier”?
There is a flawed system that thrives on pushing residents through the harshest working conditions. We are graded on how much deprivation we can survive. If we are sleep deprived and hungry for 16 hours, even better.
Someone or something needs to give. Residency training is built on an archaic system when depravity and hierarchy were thought to be an effective method of teaching discipline. “Keep them in their place.”
Instead of delving in Darwinian gimmicks, we need to acknowledge that residents are as human as the patients we treat on a daily basis. They deserve the same empathy and kindness that we offer our patients.
We absorb our environments like a sponge and the trauma from going through a tough residency can impact our psyches our whole life. We need to be able to create an environment of nurture for the next generation of physicians. Only then, can we truly take pride in our training system.
Most of the medical training is designed in such a way that primary output is scut work, training is a side benefit.
Long duty hours, per day, and per week tells you that the purpose is not education, but it’s the work they want from trainees.
When primary purpose of the programs will become training, these issues will go away.
Easy suggestion is that in any program, the trainees should not be responsible for the 24/7 coverage. They should be just part of coverage.
I did fellowship in such a program, and residency in the one which relies solely on residents. My fellowship was best educational experience I had.
As much as i would keep my suspicion that the suicide may not be related with residency itself as it is being associated to without any concrete evidence , i also acknowledge the fact that the stress during residency could be a strong driving factor for it if in hostile training environment .
The point 5 is almost 90% the reason behind a resident/fellow s drastic step if related with residency.I have seen the consequences of being more vocal in residency on one of my fellow resident who was first go through the probation and then teh circumstances were created for him to make work extremely stressful and to break him down . And once he was broken and committed a ordinary mistake which won’t even be noticed if you are a intern he was given either to resign or get fired. He chose resign for that year s credit but never matched int residency again . A life is destroyed a career annihilated. He showed resilience too but for what??
For me the-take away points
“The institute never loves you back ” and “Medicine is not martyrdom”.
This is a well written and thought out post on a very important topic. We should all be brainstorming solutions to this systemic issue as you have in your piece.
What were the Homocysteine Methylmalonic Acid and B12 levels of the suicidal person? Failure to properly test depressed patients for B12 deficiency in the age of FolicAcidOnly interventions in the food supply is legally medically negligent.
B12 deficiency is the dominant nutritional cause of high neuro-toxins homocysteine and methylmalonic acid in a folic acid fortified population. It leads to a myriad of pychiatric disorders.
I have met physicians with access to all kinds of “healthcare” (drugs that block B12 absorption, plant-based low-fat diets deficient in B12, nitrous oxide that inactivates B12 in the brain, multivitamins containing analogue unusable B12 but high in synthetic folate etc.) who don’t realize they themselves have a treatable micronutrient deficiency. They think a patient has to have macrocytic anemia to be B12 deficient. Not True – You need not be anemic nor macrocytic to be B12 deficient: http://www.nejm.org/doi/full/10.1056/NEJM198806303182604
“Suicidal…Before anyone bothered to check her B12” Sadly, this malpractice is widespread, based on ignorance and misdiagnosis of a common and treatable B12 deficiency. http://kellybroganmd.com/b12-deficiency-brain-health/
What was the young doctor’s B12 level? If no one checked her B12 Homocysteine Methylmalonic acid and offered her a trial a parenteral B12, she received Substandard Negligent Care.
Public Awareness saves lives and healthcare dollars. A well nourished brain can handle life events. True story: Feisty nurse takes on the medical establishment when she uncovers an epidemic of misdiagnosis – https://vimeo.com/ondemand/sallypacholokmovie
I recently left faculty in academic medicine for the same reasons. It was at the same place I did my training, and was a chief. With the amount of things we had to do, ensure hospital patients were taken care of, clinic notes signed, paperwork for all those patients completed, the resident & student evaluations, the medical school commitments, and then when you fall ill or sick, you were considered weak if you asked for time to recover. There was a backup system for the residents, but no consideration to ever have a backup system for the faculty. This cycle perpetuated the culture you speak of, and especially in academic medicine, the medical soldiers must not show weakness for fear of being judged. It was an unhealthy and unsustainable environment. If we can’t treat our faculty well, that will not bode well for the residents, and if we can’t treat our physicians well, how will they take care of patients?
Very powerful and well written article Dr. Riches. Thank you! I remember the abuse I went through in residency and I didn’t graduate all that long ago. I’ve recently become responsible for my group’s medical student program. For all intents and purposes, I’m now a program director.
Over the last few years, we’ve had a couple of student suicides from two of our main schools. Both of which, in my opinion, could have been prevented.
I remember all too well the “fear of retaliation” and “you can’t show weakness in medicine” philosophy that existed when I went through. I kept a countdown timer of my phone to end of residency to remind me that it would soon come to an end.
I think that the bottom line is that we, as physicians, have to step up and change the culture ourselves. Unfortunately, that might mean getting our hands dirty and going into academics so we can help guide and mentor these kids going through school and residency and bring the changes to the programs that are well overdue.
Our entire culture is wallowing in institutionalized trauma: most jobs involve some form of trauma, and many people — with the exception of straight, cisgendered, white men — live with a constant barrage of aggressions both macro and micro; verbal, emotional, and physical violence; and gaslighting and doublespeak. The medical professions are a Petri dish showing how certain subgroups are differentially affected by this trauma — I would bet that if you sliced the population by not only gender but by race and sexuality, you’d find that the cishet white men still survive more (show more “resilience”) than the other groups. Resilience is a lie designed to support the kyriarchy.
Your observations are astute and on-target, Dr. Riches. I hope you don’t suffer retaliation for them.
Good article, unfortunatly the veterinary residency /profession is not dissimilar and think we all have had resident, inter mate and classmates that have taken their own lives.
I am a medical professional’s spouse, and I witnessed med school, one intern year, two residencies, and a one year fellowship.
Your concerns are all so real. We spouses, significant others, and family have a front row seat. We also are completely affected by your profession’s systemic issues.
The issues are myriad, the answers even more complex. But the absolute first step? We need more residents and doctors. ASAP. There are not enough of you to cover the load. Almost all of the effects you list above can be tied back to this problem. You can’t take time off because you know there is no one else to cover you. And because you know there is no one else to cover you, you know that if you do take the time off that you need, someone else who is already overworked will have to cover YOU and work even harder. So you all never take the time off you need.
And you need it. Your job is more emotionally draining than perhaps any other profession. You suffer both emotional and physical trauma, probably in that order of harm.
Start with more residents and doctors.
Thanks for writing this important article about the stress and emotional work that medical residents face during their training. I did want to bring your attention to two items, in hopes that you will continue to advocate for stress reduction and suicide prevention from the perspective of a doctor. Among suicidology professionals, the term “commit suicide” has fallen out of favor – we prefer to use “died by suicide” or simply “killed himself/herself.” This avoids the stigma of the word “commit” which is typically associated with criminal acts or involuntary outcomes (ie: being admitted to a psychiatric inpatient facility.) Additionally, it is not recommended that the means of suicide be stated in articles relating to the deceased, as this can foster suicide contagion. Please see http://reportingonsuicide.org/ for more information.
This is all very true, but let’s face it, the trauma of over-worked, underpaid internships and residencies is inflicted primarily by the overprotecting medical associations, that drastically limit the number of licensed MDs in order to maintain their huge salaries. Both the US and Canadian healthcare system would work much better if there were more MDs, with (God forbid) lower salaries. And then both MDs and patients would be less stressed out and, respectively, better performers and better cared for.
Are you wiling to accept this or do you prefer to go through hell just to keep your enormous salaries in place?
Thank-you very much for writing this. The article both broke my heart and healed it. I have been out in practice for three years and still trying to heal some of my training wounds. I’m passionate about improving things for the future though and as one of my mentors Lissa Rankin has reminded me, you can not fix something and make it bad at the same time. Sna Chaylia, Dene for you have honored me.
First of all, I’d like to thank you Dr. Riches for writing this article. It takes a great deal of courage and mental fortitude to think about such a complex issue and address it head on. I’m one to think about such things as well and try to address them, even if they are very complex. For this character trait, I often catch quite a bit of slack from my classmates, and sometimes family even if they know my intentions are well directed. People often ask, why bother getting so involved in things that won’t affect you much longer, or when you’ll be done with that year of school, or residency, or place of life? For some reason, I feel it’s a bit of my calling. Perhaps what drew me to medicine, wanting to make other people’s lives better, and the program’s I’ve gone through better, is what still drives me in this manner as well. I consider the fact that I might benefit from these changes to be just an added bonus. They say sometimes our greatest strengths can also be our greatest weaknesses 🙂
In any case, I think your comments are extremely well directed, evidenced by the fact that when brought up with several colleagues and faculty at my program, I got some push back as well as some appreciation for sharing your article and bringing up such an important issue of residency. Being an intern who just started at the beginning of July, we walk a careful line of wanting to learn the ropes and just fall into line (without attracting too much attention) and do as we are told while also trying to learn how to practice in the enormous and weighty robes of which we’ve been bestowed. Part of us still feels like a complete imposter, tasked with doing things we currently don’t even believe ourselves capable. But gradually we learn and grow into the enormous responsibility we’ve been gifted… Or so I feel now 6 weeks into my residency. 🙂
Most residency programs bring up such topics as burnout and may even discuss some of the resources available to talk to if we are feeling depressed or burnt out due to our duties. Some are well meaning; others seem just to be cursory to say that your program has read the ACGME or DO equivalent of the accrediting agencies requirements for residency programs. In any case, my program seems to be far less caustic, and much more supportive than some that you have described, which may be your own program. I personally think it’s the least they can do for what we invest in the program, the hospitals we work in, and ultimately the patients we will serve for the next 3-6 years and for the rest of our careers. This completely bypasses the discussion of the $200-325K in debt we have acquired to get to this “opportunity.” With that said, I think our programs have some responsibility to support us and help us grow into knowledgeable, competent, and confident physicians in a medical system that simply wants to use the cheapest resource with a medical license to accomplish the job. Like you addressed, we live in a hybrid world of trying to be of service, but also be in learning situations where we gain something from the 80+ hour work weeks and up to 24 hrs. on call. Residents have suddenly been the ones to fill the role of staffing the hospital 24/7/365. The system by its very nature is abusive, and I think the programs have some responsibility to try to temper the enormous stresses we encounter on a daily basis, the situations we encounter for which we never truly feel prepared (especially as interns), and help guide us into making these situations good learning experiences. Some of that comes from making it OK to bring up emotional challenges we encounter, and to discuss them with our co-residents, senior residents, and faculty, and even IMAGINING that we as caregivers are struggling with some of the same emotional responses to disease, dying, quality of care, etc. as our patients and their families we try to “counsel.” I’m always disheartened to feel that someone feels so out of control and depressed about their current life and state of affairs to take their own life, but I understand, perhaps more than you may ever know, how that feels. Some of this is surely a biochemical abnormality that should be addressed no different than diabetes or hypertension, but for some reason our current culture still views the topic of mental health as taboo; such feelings are counterproductive and ultimately harmful to every single person in the US. In any case, it’s a loss for a family, all his/her friends, you as colleagues who clearly deeply cared for that person, your program, and most broadly, us an entire community who lost a doctor who cared about others and wanted to help improve their health through medicine. This is NEVER OK and should never be thought of as OK; our systems failed here and its time we accept some responsibility. I lost a friend at the end of the second year of medical school to an unexpected medical illness/likely cardiac arrhythmia just after she had taken boards. You all know how much stress and anxiety that entails. Next was supposed to be the part of medicine we’ve been working towards for 20+ years in schooling, and she never got to experience the fruits of the labor she had worked so tirelessly for, and had delayed other aspects of her life for. Instead she passed away with my friends doing CPR on her on a camping trip forever feeling guilty that they were unable to revive her after working on her for more than 1 hour. So your story touches me on a deeply visceral level. The thought that this could have been avoided sticks poignantly in my mind and I can’t help but feel disappointed and disheartened that this program tried to sweep the situation under the rug. We CAN and SHOULD do better. Thanks for helping to be part of this change by writing on such an important topic. I will do my part as well to drive this cause forward.
The well-meaning Intern ZKS
We’re fighting back in the UK. We have an online support forum, Tea and Empathy, doctors (and other healthcare workers) supporting doctors. The atmosphere is one of kindness and support. Only 6 months old, we are already international, with members in Europe, Singapore, Australasia and even a couple from the USA!
We’re less than 6 months old and still growing. Come and find us at
https://www.facebook.com/groups/1215686978446877/