Arnav Agarwal is an Internal Medicine Resident (R1) at the University of Toronto. Check back the last Thursday of each month for a new featured piece as part of his series (Doc Talks: Reflections to Reality)!
Once an elastic band is stretched beyond its limits, it is difficult for it to return it to its unstretched state. Burnout represents a similar phenomenon: an erosion of one’s sense of self and a reflection of emotional over-exhaustion, leading to disinvestment and depersonalization. Years of intensive training, long working hours, increased managerial responsibilities, resource limitations, emotionally-involved patient and family encounters, fear of limited job prospects and litigation, and mounting clinical and non-clinical responsibilities, among other demands: physicians and other health care professionals represent a highly vulnerable group susceptible to burnout, with some estimates suggesting close to 50% of physicians being affected. Evidence suggests that physicians experiencing burnout are more likely to make poor medical decisions, share more tenuous relationships with co-workers, experience more individual and personal relationship challenges, and suffer higher risks of anxiety, depression, and suicidality. Physician burnout has also been associated with differences in overall quality of care, system-level costs, and rates of staff turnover and absenteeism.
This piece focuses on the compromise some residents and physicians make in placing themselves second while dedicating themselves to the care of others, and the silence that some encounter while struggling with burnout. It is encouraging to observe that dialogue around burnout and mental health is growing at individual, institutional, and systemic levels over time. This piece is part of that conversation.
pacing the hospital wards.
Day turns night turns day—
if it weren’t for a momentary glance at the clock,
I wouldn’t know otherwise.
I scribble the letters “AKI”
across the lined A4 sheets in my charts.
My last drink was 12 hours ago.
By some stroke of irony,
it ceases to matter anymore.
The regular family banter and friendly exchange
lights up my phone screen, unanticipated—
I swipe it away quickly without a second glance,
without allowing myself more than a transient thought—
I have no space for this: for me.
I had dreamt about this all my life.
Stethoscope around my neck,
a physician’s ID badge hanging against my chest,
caring for patients.
Was I not living the dream?
I look around me
to find others—my colleagues, my juniors,
toiling through their EMRs and paper charts.
I wonder if they ever glance back and wonder the same:
am I alone in struggling through this?
Can they hear me?
They all seem to fit in the jigsaw of the hospital,
their confident voices drowning me out as I search for mine.
Posterchild for ‘imposter syndrome,’
I wonder if I’m the wrong piece for this puzzle.
I continue my rounds—
patient by patient, room by room,
listening closely to the crackle of drowning lungs,
convincing myself I appreciate the weak double waveform of a neck vein impulse,
poking a tender belly and digging into the intimacies of a relative stranger’s bowel patterns.
Along the way, I console an anxious family member,
hold the hand of a sick patient left in solitude,
explore the delicate prognosis of an end-stage cancer patient,
MSIGECAPS my way into the deepest corners of a struggling patient’s journey.
Is your mood okay?
Are you sleeping okay?
Are you still interested in your hobbies?
Are you feeling guilty?
I look around the room for a moment,
catch my reflection in the window.
I can’t help but wonder:
what would my answers be?
I stop myself short of answering—
I feel guilty for wondering.
pacing the hospital wards.
Day turns night turns day.
If it weren’t for just a moment’s reflection
or an occasional external unwanted reminder:
I’d forget about me.
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