I recently worked a 28-hour shift in the hospital. I am on a rotation where I work these long shifts every four days, and my last 3 or 4 of these shifts have been the kind that really tries a person’s soul. I got called all night to see new patients and take care of existing ones, and mind you, this is after a 6:45 a.m. to 5 p.m. day where I also pre-rounded, rounded, and then worked all day to coordinate all the plans we recommended for everyone. The next morning, the overnight resident stays until we have at least discussed the new patients with the day team (most often we also go with the team to see the patients again and repeat the history/exam), which extends the length of the shifts up to 28 hours. And now after my third or fourth grueling 28-hour shift in a row, a lot of the painful emotions that have festered throughout residency are coming to a boil. I found myself in the call room feeling nauseous, having a migraine, and crying at 5:30 a.m. on the last shift when things finally quieted down after my seventh consult of the night. I was physically and mentally exhausted so at the time, all I reconciled was that they were tears of frustration. But the next day when I was at home, I explored those feelings a bit more since they continued to fester, and they were reminiscent of feelings I had … in prior romantic relationships.

While it may sound silly or overly simplified to say this, residency often feels like a one-sided or toxic relationship. Despite programs’ best efforts to support their residents, the reality of the system in the United States is that residents of all specialties are overworked, underpaid, and underappreciated (that may be the case in other countries too, though the systems are quite different). We find camaraderie in our co-residents and often in our attendings as well (as well as mentorship). This softens the blow, but it doesn’t change the reality that we are likened to a partner in a relationship, or even a parent to a child that does not understand or acknowledge the possibility of the other individual giving an extremely unequal amount of effort and energy toward the recipient (i.e., the metaphorical culmination of all the requirements and expectations that are thrust on us in residency). The result, at least for me, is that I’ve been struggling with feelings of bitterness, resentment, and chronic stress, which precipitate a lack of motivation and increased insecurities about my abilities to take care of patients as a strong provider. These feelings really get highlighted on the long stretches of inpatient months where the hours are the longest, and the patients tend to be the sickest.

However, what I’ve also noticed and take great comfort in is that regardless of the negative feelings, every time I walk into a patient’s room, I feel a renewed sense of care and interest. While I sometimes feel exasperated overnight receiving the call to see another patient, as soon as I go to see the patient, I feel the call to help somebody. When they start telling me what’s been going on, I feel a renewed sense of fascination for the pathophysiological processes that I suspect may be going on. My mind rattles down a differential diagnosis, and my curiosity is piqued to check for specific things on their exam. This feeling reassures me that even though I am struggling with insecurities and negative feelings, I am certain I chose the right profession. I know things will continue to get better over the years as my provider role settles into the niche of the specialty that I am pursuing, and there will be more pure medicine and simply caring for people. I know there will be other struggles that come with time as well, but I’m certain as my confidence grows and my day-to-day becomes more aligned with what I choose to do in my career, that my role in this relationship is going to feel more balanced and less one-sided. But for the time being, it really does get painful.

Stephanie Wottrich is a neurology resident.