Recently, I have been reflecting on some of the challenges of a medical career, specifically how isolating it can be. In a recent conversation with one of my trainees, we commiserated about the difficulty of spending her first Thanksgiving away from family. Personally, as a foreign medical graduate, living in the United States for the past decade initially on a work visa, I have spent most holidays and special occasions away from family who live on a different continent.
The lifelong commitment of being a physician here in the United States involves grueling years of switching cities and states in pursuit of medical school electives, residency programs, and possible additional fellowship training. Our lives’ timelines are often different from that of our non-medical peers. Working weekends, holidays, and nights means that we inevitably miss many important life events, especially during the earlier years of our training. Studying for medical, certification, and re-certification exams at all stages of our careers occupies many nights and weekends. Financial concerns while juggling massive student loans and spending your 20s and 30s on a trainee’s salary working 80 hours a week with inadequate parental leave may mean that many delay starting families, and some are never able to.
The medical culture is rooted, unfortunately, in “toughing it out.” Mental health is deeply stigmatized, and individuals are often penalized for disclosing mental health struggles during credentialing and licensures. While there are ongoing attempts to change the culture and to create safe spaces to share struggles, the burden is often placed on the individual to combat burnout by increasing their personal resilience. These two terms are received with mixed feelings amongst the medical community, as they may contribute to disregarding systemic failure and placing the responsibility—and the blame—on the individual.
Advice for increasing resilience is often rooted in “grounding yourself” by carving out time for friends, families, and hobbies. In my opinion, this could further isolate some who don’t necessarily have the privileges others do. Many don’t have the privilege of a supportive community, especially those who are underrepresented in medicine. Some may not have the safety net of a supportive family to begin with; others may have families living in different time zones or continents. Adult friendships are difficult to form and maintain. A career that demands frequent relocation and long hours may not support nurturing meaningful relationships but rather give rise to situational friendships that fade with distance and job changes, especially with the added stress of juggling the many commitments of a demanding career.
Within the practice of medicine, there is the need to integrate quickly with new teams, colleagues, and learners. For an introvert, in a world that prizes extraversion, it can be particularly exhausting. While there is an increased recognition of how introverts can be effective leaders, it is still an uphill battle in a culture rooted around networking and first impressions. This can further contribute to the feeling of isolation if your personality does not conform to the outgoing, sociable type that our culture so reveres.
The older I get, the more I stop offering platitudes of advice and simply strive to become a safe space for others who need empathy much more than they need generic solutions. It is also important to first determine whether someone is seeking advice or a listening ear. Normalize conversations about difficult transitions which can occur at any and all stages of the medical career. After all, to paraphrase C.S. Lewis, friendship is born at that moment when one person says to another, "What! You too? I thought I was the only one!”
As I approach this holiday season, away from family, in a new city, a new institution, and a new role in my career, I reflect on my moments of gratitude during the past challenging few months of yet another transition.
- I am grateful for the new coworker who answered my phone call at 1 AM to review a tough clinical case with me and be my sounding board.
- I am grateful for the colleagues who stop by and say hello and welcome me into a new and unfamiliar place and offer tidbits of advice that range from where to find the best coffee on campus to offering to introduce me to someone they think could be a potential collaborator.
- I am grateful for the peer who forwards me a career opportunity, saying, “This made me think of you—it’s a perfect fit!”
- I am grateful for friends and allies who reach out to share their uplifting wins and moments of joy, because I thrive among likeminded individuals who come together to celebrate successes and create a supportive community.
- And, most of all, I am grateful for the handful of individuals in my life who will recognize my moments of struggle when I break my usual habits and provide a safe space without judgement.
That talk with my trainee was a reminder that the holidays are not always a time of comfort and joy for everyone. This is a season when many struggle with the disappointment of not being able to see family due to work schedules, or with the stress of juggling multiple work and family obligations, or with the sadness of being far away from loved ones.
Transitions are hard. Ask a colleague or friend how they are doing, with the intent to actually listen. Provide a safe space. Respect personal boundaries. Share wins and celebrate successes. And always, always be kind.