When It Gets Hard

One of my favorite books as a child was Ender's Game by Orson Scott Card, a science fiction novel that depicts children trained to be military strategists in a war against aliens. There is a scene near the end of the book where one of the characters breaks down. In the middle of a battle, Petra is caught off guard and overwhelmed, and she suddenly falls apart. In the moment, she freezes, breaks into sobs, and needs another player to salvage the situation.

Things like this happen in residency. Both during my intern year and this year, co-residents have had overwhelming challenges that stress and exceed their limits. Sometimes so much is happening that we cannot function effectively; I've had situations where I've received so many pages, I cannot feasibly respond to them effectively. But more than that, something usually tips us over. Superimposed on a baseline of stress, we encounter a patient death, a delayed diagnosis, an iatrogenic error, a clinical mistake. And then we shut down; we cannot function effectively, we are overwhelmed with emotion, we stop thinking. When this happens, we rely on our co-residents to carry us, and as co-residents, we give as much support as we can. The enterprise of medicine is not an individual effort, and when one of us stumbles, the rest fill in to keep everything going.