Big Dreamers

Last week I switched to a medicine wards month. Sometime in my first few days I dreamt I woke up in a hospital bed on a ward that was outside, a cool blue feeling permeating the corridor like a heavy morning dew. My team was rounding. It was my team in both senses – I was a patient on their team, and also I was one of the team’s interns. They rounded on me in the manner of the latter. I gathered I had been out of it for a while – I didn’t know the day or what was going on – but soon pieced together that I had ovarian cancer, and my status had been grave at first. They told me my hemoglobin was 2.0 on admission.

The team talked shop for a while about how I was doing and what the next steps were. The attending concluded by saying to the crowd, “I knew we should have imaged you when I felt that mass on exam a few months ago! I told the oncologist but he wasn’t impressed. And look at that – fucking ovarian cancer! I told him!” He hadn’t told me he’d felt a mass at my last visit.

Like many of my dreams, this one will be a fun one to talk about in psychoanalysis when I finally have time for 3 hours of training-focused therapy a week. I think even with the most simple modalities of reflection this dream says a lot about some of the worst places of turmoil we go as residents.

How does someone be a doctor and a person at the same time? How do you navigate your role as intern on a team without losing the perspective of the patient? What if you’re sick too?

I spend a lot of time on teams feeling like the one closest to patients, feeling like it’s my job to play arbiter in the ways I can, to try to pick through the politics of maintaining safe and congenial team dynamics without feeling like I’ve thrown patient respect out the window. It’s hard to remind doctors to take a minute to remember the person without tromping all over the ways they’ve developed to cope, and without layering on too much acerbic vibes between you and your co-workers. It’s especially hard when you’re having trouble remembering yourself.

And, of course, there’s the Resident as Patient theme. I was a patient and my own doctor in this scene. I think it indicates I see myself as sick in some ways. This isn’t new to me. Residency makes you sick. You work more hours than you ever have with more responsibility on your shoulders you could have imagined – you get worse before you get better. You become less human before you become more human. But how do you treat yourself? It’s the obvious question, especially given that as doctors I think many of us are reflexively trying to come up with the treatment plan.

The finale is the gaslit resident who goes to work every day absorbing the message that all of the hardship we witness and work through in hospitals is somehow okay. In this dream my attending sends me the message, “You were sick, very sick, for three months. I didn’t tell you. Now I’m talking about it as if it’s not a big deal.” Gaslighting in residency – the underlying message sent when we avoid talking about the subject that what we witness isn’t a big deal – is something I’ve been running up against a lot the last few months.

Doctors cope with the nature of medicine in a lot of different ways, and it’s hard to be too judgmental about how we make it through. I understand that talking about how messed up everything is all the time isn’t sustainable, and that some form of repression/suppression is necessary to make it to tomorrow. But medicine is hard. I know that’s never gonna change. I’m not asking for it to – then it wouldn’t be medicine, and it wouldn’t be the career for me. But I think the way to achieve wellness in residents necessarily involves having better ways to talk about the hard things, to share the ways we get through them, and to have mentors that help us see how to become doctors that are better at appreciating humanity and more human themselves. I know that nobody’s really figured that out. But we need to be brainstorming more. My examples shouldn’t just be ones of repression and jaded hardening. They should be ones of stoic triumph in the face of huge challenges. We should at least be talking about how to get there.