I prefer a tikka masala sauce that is creamier and unbroken

ACGME and people in graduate medical education send a lot of mixed signals when it comes to physician wellness for residents. Much of it is program and facility specific. Some places do better than others, but at some point during this year I've had this growing awareness of larger forces at play. Retreats and local, ground level provisions are necessary and appreciated; but our day to day experiences expose us to the worst that humanity has to offer, contrasted, with varying frequency, the best humanity can impart.

A strategy has to be built to deal with the desperation and apathy we are faced with. Frustration levels are high with everyone, most of us, and I mean everyone in the hospital -- from the patients, patient's loved ones to all that participate in the success of a hospital as workers; clinical and nonclinical. Every single one of us has a valid reason for our frustration. We fight for people in an inhumane, rigid yet whirling machine that forces us to feel like compassion is a luxury and five extra minutes with a patient infringes on our paperwork workflow. I'm still strategically strategizing my strategy.

The leaders of this nation have added to the existential dread that seems to have gotten so much worse as of late. I think a lot of good people kind of hoped that the system that capitalizes medicine and healthcare had just been a mistake and not actually an engineered sham. I find it interesting that most doctor lounges, even those in California are more likely to have Fox News on TV than anything else. Admittedly, the channel selection is skewed by the fact that younger doctors, and ones that have good work ethics don't spend time in the doctor's lounge watching TV. Regardless, not many people have much hope for the immediate future and most of us are kinda hunkering down for the onslaught of even more undiagnosed and untreated "run of the mill" pathologies. Unchecked infections delighting in the patient who has neither the time, money or access to a primary care physician will be rushed to the ED in septic shock, with their life in jeopardy. Of course, more resources and money are spent on this patient's acute care than 500 primary care visits would cost -- that doesn't seem like an exaggeration, depending on the hospital course.

It is in this setting that empathy becomes so incredibly valuable. Small talk with jokes or solemn recognition of a patient's suffering, or whatever else helps keep the lifeline of human relationship patent and flowing with good will. Some patients are manipulative, some nurses and doctors are too. Deal with people with respect and maintain proper boundaries and this stuff becomes secondary, and much less of an emotional suck.

Nights are tough -- call nights with no chance for rest take their toll. In some ways though, I really like the fact that it feels more like a normal work shift. I mean, day time is filled with rounding, discussing, teaching -- us being taught, and us teaching students. At night, you get the work done and if that means 10 Uptodate articles, so be it. I like it. I've missed feeling like I have a "normal" job more than I previously realized. Doesn't mean I'm not going to take advantage of having tonight off and not leaving the house the rest of the day and ordering delivery Indian food, though.

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