McGill residents candidly share their personal stories for THRIVE
Winter 2021
Staying Active During Residency…and the Pandemic
By Dr. Catherine Boutet, PGY3 Internal medicine
Re-thinking wellness in residency — The COVID 19 Outbreak challenge
Residency is always hard. It demands long days, which become long nights. We are regularly asked to make many sacrifices in order to learn, as we become highly skilled, compassionate physicians. Residents accept these sacrifices because being a doctor is our dream, and we know eventually there will be a light at the end of the tunnel. For many of us, the demands of the Covid-19 pandemic have now acutely increased the hardship of residency, and some will feel that light becoming dimmer.
At the MUHC, the usual training for internal medicine residents has shifted on many levels. While the core rotations continue, redeployment to the COVID wards and ICU have become the new emergency curriculum. The daily bedside teaching, group lectures and simulation training sessions have been cancelled due to the pandemic, and social events are postponed until further noticed. Additionally, new residents (having just graduated from medical school) have not yet met their senior counterparts in person due to the pandemic, meaning the crucial bonds of friendship which tied residents together in solidarity are now tenuous. The long-term effects of these changes on trainees remain unknown. A small survey of internal medicine residents at McGill during the second wave of COVID-19 conducted using the Maslach Burnout Inventory showed that 25% of residents felt that the pandemic was hardening them emotionally and 28% felt more callous since starting their internal medicine residency.
These results are deeply concerning. As the chief resident, I know that these results are very real because I also see and feel the increased stress caused by the pandemic. The constant redeployment, the frequent exposure to COVID and the prolonged isolation from my family and friends is a lot to handle, in addition to already-grueling training to become a specialist. As a chief resident who values wellness, I wanted to reach out and connect with our residents from a safe social distance. I had to be creative. I decided to launch a virtual wellness challenge, with the intent to increase the communication and interpersonal relationships between colleagues, and overall wellbeing of the residents. We achieved this with a team-based health and fitness challenge that unfolded via The Outbreak app. Each resident/attending controlled their own character through real-world steps and exercise, which were synced to the game via Apple Health kit, Google Fit, Fitbit, Apple Watch etc.
Participants used their steps and other exercise to unite in one common goal; to combat the virtual zombies. In total, we had 150 residents and attendings participate. They were divided into pre assigned teams from the local hospitals: the Royal Victoria Hospital, the Montreal General Hospital and the Jewish General Hospital. Teams could meet virtually and connect using in-game chat rooms on the app, as they stepped, cycled, and ran in order to defeat the zombies. This forum created a platform for discussion and the sharing of motivational and encouraging words between the attendings and residents.
The post wellness challenge questionnaire demonstrated that residents felt more energized and felt less callous after the challenge. The residents also reported feeling more physically active and engaged with their attendings. After discussing with residents, we identified certain elements that could explain the overall positive outcome of this challenge. Firstly, the teams were randomly created by the chief medical residents, which promoted the formation of new alliances between junior residents, senior residents, and chief medical residents from all three sites. Attendings were distributed randomly among the teams and many residents felt their participation helped connect with mentors on a more personal level. Lastly, the challenge was a welcome distraction and helped insert some positive energy into the stressful environment. Residents felt less isolated and more connected with others.
Residents and the medical attendings have battled COVID-19 for almost a year, and its impact on our healthcare professionals has certainly been felt on many levels and will have a lasting impact on many of us. Creative ideas must be used in order to promote the healthy relationships between colleagues and help us regain the sense of hospital community we long cherished prior to this pandemic. Nevertheless, digital and app-based platforms for team activities may be what is needed to reach out to residents across the city and help them feel connected during this time of significant isolation. I think this challenge had a positive impact, which extends beyond those who participated. It may become a yearly event in our department in order to promote wellness and lighten the load on our trainees as they strive to care for themselves, and their patients.
Spring, 2019
Work-Life Balance in Residency
Work-Life Balance in Residency: The Power of Stillness
By Maria Agustina Lopez, PGY-1 Internal Medicine
For as long as I can remember, my dad has always half-jokingly told me that the upcoming academic year “was going to be tough”. As I made my way through elementary school, then moved to Canada from Uruguay and started school in another language, then med school, he would always say it, and it became comforting to realize that I had made it through each of those ‘tough’ years. Now, residency happened. I thought I knew what to expect – long hours, stressful situations, doing everything for the first time. I was so happy to have reached this step and I thought I had prepared myself to face the challenges that would come my way.
The first six months went by like lightening. I started off with busy rotations back to back with CCU, ICU, CTUs… My head was always spinning. Of course, there were moments where I felt overwhelmed by it all. But to my biggest surprise, it was not until I was on vacation that it all crumbled down for me. My mind, which had become used to spinning all day everyday, did not know how to handle free time. I was scared of not enjoying my time off enough, not doing enough “fun” stuff; I was flooded by anxious thoughts about how to make the best out of this free time. I felt the pressure of achieving work-life balance. Ironic, right?
I always thought that work-life balance in residency was going to be about doing all these things that I wouldn’t have time to do – going out with friends, sports, hobbies… The reality is that we do so much during our work hours, that maybe work-life balance is found in actually not doing. I don’t mean sitting in your couch and watching time pass you by. I mean making a conscious effort to notice and enjoy some time of having nothing to do, nothing to think about, nothing to manage – and, most importantly, to embrace it, without guilt or second-guessing.
I believe that a lot of peace and quiet can be found if you spend just a few minutes thinking: “There is nothing else to be done, nowhere else to be.” Now I call it the power of stillness. It allowed my mind to find comfort in downtime, and avoided it from being flooded by thoughts and worries about what to get done next. Creating space in our minds for a few moments of tranquility can allow us to function better when stakes are high because it teaches us to focus and to be more present. A small amount of nothingness everyday made me feel at ease and allowed me to go through my day in a more grounded state of mind, regardless if it was a workday or a play day.
We all know eight hours of sleep is impossible: Realistic tips for self-care in Residency
By Nehal Shata, PGY2 Pediatric resident
As residents, we have the most difficult job description. We deal with life, health, and death on a daily basis. The physical and emotional demands on residents are so intense that we risk our own health. Just one night in the ICU can include so many patients, tasks, life and death, happiness and sadness, it’s amazing that we can do it all.
Or can we do it all? Do we forget to take care of ourselves sometimes within all of this?
Life and work are both important parts of residency. Having fun and wellness time are equally important. (Sometimes even more important than going to work!) Giving yourself some time to rest and recharge your battery for your next duty is important. But why is it important? How important is it?
Doctors have the highest risk of burnout than any other profession, especially residents.
Burned out doctors can exhibit exhaustion, headaches, sleeplessness,can become emotionally reactive and have compromised cognitive function. All of these symptoms affect productivity and patient care. Compromised patient care leads to a feeling that we are inadequate and increases stress, making burnout a vicious cycle.
I recently read a book talking about doctors’ emotions and I strongly recommend it: What Doctors Feel by Dr. Danielle Ofri, MD. In the book, Dr. Ofri talks about how residents deal with a heavy dose of emotions, breaking bad news, dealing with death, or even the shame of a medical error. All of these emotions are difficult enough, but on top of that, we have to be ready for the next patient in all moments. After reading Dr. Ofri’s book, I began to think about these ideas. We think that to be more professional is to suppress or ignore the emotions that we feel with our patients. But the problem is that suppressing this emotion may lead to burnout or even contribute to worse conditions like PTSD after an emotionally tragic situation with a patient.
Talking about your emotions more with your friends, family, and even your co-workers is always a good idea. I had an experience in the ICU after the death of a patient. We had a debriefing session, kind of like a support group. We discussed our emotions and what we could do better next time. To express your emotions and not to suppress them is a part of self-care.
Sometimes, we think that if we want to be more productive, we have to work harder, but sometimes the opposite is true. Sometimes we have to stop to let ourselves feel. And we have to practice self-care.
We’ve all heard about self-care, but what is self-care, really?
Self-care is to love yourself as if you were your best friend. We all know that getting eight hours of sleep is impossible in residency. But we have to do what we can. Self-care is anything that prevents burnout. Self-care is addressing the emotional side of our work.
At one stage of my residency, I worked every day without a break or doing any hobbies that I liked. At the end of that period, I realized that I burned myself out, and I didn't have any life during that time. I was emotionally drained. I promised myself after that to take an hour every single day to do things that I liked. I had to change my pattern to be a successful resident.
Other things I’ve tried have helped as well. Having daily small talk with co-workers and people I interact with every day helps to make work feel like home, not a place of stress.
It helps me remember that we are all in this together. If I try to make work an enjoyable place instead of working like a machine to get the job done, it improves everything. Residency is like a journey and it is our choice to enjoy it and make it a better journey.
Here is a list that isn’t perfect, but here are some tips that I thought of about self-care, besides the normal advice to eat healthy and get sleep:
Common Sense Tips for Self-Care and Avoiding Burnout:
Recognize when you are burning out as early as possible and take care of yourself.
Talk about your emotions
Take mini vacations at work, stop to have some small talk.
Enjoy your snack break
Have fun at the hospital
Make friends at work
Appreciate each other
Spend quality time with family
Make “Me” Time
Do the activities that make your soul happy
Lay down on the couch and do nothing
Our work is stressful, and to de-stress is to make it more friendly, human, home. In summary, life is hard, and residency is harder. The art is to enjoy the journey by having time for yourself. Self-care is the key for your own health, sanity and for your effective patient care.
FALL, 2018
Optimal Nutrition in Residency
By Mahmood Hasan, R5 Emergency Medicine
As a resident in the emergency medicine program, it is really challenging to maintain a stable healthy lifestyle due to the nature of shift work that changes constantly. But, at the same time, I have the flexibility to work around that and manage my life accordingly. I think it’s all about being committed to that kind of lifestyle and making sure to make the most out of it.
In terms of getting ready for my night shift, I usually tend to wake up early in the morning, as I am a morning person. During this time I study, exercise, or meet with friends. In the afternoon, I usually sleep for a minimum of 2 hours, then wake up to prepare my meals for the night. Before the shift, I take it easy and eat a meal that I would usually eat for breakfast. My breakfast meals are high in carbs so that I have the energy I need to make it through the night.
Shift work requires me to prepare my meals in advance to avoid being hungry on a shift. I eat regular and frequent meals, which usually works out to about6 times per day. I try and eat every 2-3 hours, mainly snacking during shifts. I pack things that are easy on the go, such as fruits and vegetables, protein bars, shakes, nuts, or rice cake with peanut/almond butter.
I think the best advice I would give to any resident is “eat clean”. I believe it’s all about what you eat, more than about how much you eat. It all adds to boosting your metabolism, burning fat faster, and giving you the energy you need.
SUMMER, 2018
Sleep in Residency
By Anali Maneshi, R3 Emergency Medicine
As someone who works many shifts, I’ve figured out getting a light workout, having a bit of breakfast, and going to bed around noon after an overnight shift is what ensures I get a straight 7-8 hours of sleep. What works for me may not work for you, so try different things and pay attention to how you are feeling.
I think what is most important is to be realistic with yourself. Committing to mentally tedious or physically demanding tasks after working a few or even just one night in a row may not be wise. I often do a lighter work out and will do chores like getting groceries, vacuuming, or things that don't require too much mental energy.
Something I have also learned through personal experience and in talking with colleagues is avoid making huge decisions (e.g. booking an expensive vacation, or relationship decisions) after a string of nights. It is easier to be impulsive and often regret these decisions later...or maybe we are really happy we finally caved and bought the running shoes we had been after for so long. Depends on how you look at it.
Being honest with yourself, your family, and those closest to your about needing sleep or a more relaxing day post-call will remove any unnecessary expectations or guilt for not going at 100% and will probably let you sleep a little better when you finally can.
SPRING, 2018
Mindfulness in Mental Health Care
By Maria Psihogios, Pediatrics- PGY3
Jon Kabat-Zinn, developer of Mindfulness-Based Stress Reduction (MBSR), assigns the following operational definition to the concept of mindfulness; “paying attention on purpose in the present moment and non-judgmentally.” To a great extent, this particular way of being - of being mindful, nurtured my personal learning, connection with patients, and sense of personal wellness, during my most recent child and adolescent psychiatry rotation.
The nature of the rotation was one that required a great deal of resilience when it came to emotional health and wellbeing. On a daily basis I was esteemed to the responsibility of attempting, to my best ability, a therapeutic connection with mostly adolescents who were presenting at extremely vulnerable points in their lives. The “histories of presenting illness” were often laden with a heaviness, as patients recounted personal experiences involving debilitating anxieties, low mood, dark thoughts, social isolation and hardships that at times challenged their very will to live.
Being truly and intentionally present in these patient encounters quickly came to carry on two distinctive and equally important meanings for my practice as a resident – both a shared and introspective presence became the cornerstones of my practice. Firstly, being present meant mindfully engaging in a shared presence with the patient; ensuring that through conscientious listening and thoughtful discussion the patient felt heard, felt validated, felt rightfully seen as a whole person. Through this intentional shared presence, I had better chances of transforming what could be solely experienced as history taking into what I hoped would also serve as a therapeutic intervention. Secondly, my mindful practice also drew on engaging in an introspective presence. More than ever it became important that I attend to my own emotions in response to the patient encounters that I was experiencing. In order to work towards emotional resilience and so that I may maintain my own personal wellbeing, I worked on my capacity to not only identify the emotions that I was feeling but also to observe them as outside my immediate experience in order to better understand them, and react more mindfully. This approach proved to be protective – a means of “debriefing with myself”, so to speak.
It was inevitable that the patient stories before me had the inherent potential to evoke strong emotions in me; by practicing mindfully I was able to exert some control over how these thoughts and feelings affected not only my ability to be present for the patient, but also safeguard my own wellbeing.
What I love and find most humbling about medicine is the idea that, by building a therapeutic alliance with a patient, we become woven into each and every patient’s unique life story. These life stories, as in my psychiatry rotation, can sometimes be considerably heavy and emotionally demanding of the physician. In these situations, a mindful practice has the potential to not only ensure a stronger therapeutic alliance between doctor and patient, but also fosters greater emotional resilience for the physician.
Smiling, Healing, and Saving Lives
By Nehal Shata, Pediatrics
I once spoke to an anxious mother who was worried about her sick child. I spoke to her with a smile and I listened to her, and this helped her sleep better. This is what mindful practice in the hospital means. Sometimes the smallest things help more than we think.
Because sometimes no words can explain. It is so hard to reassure a broken-hearted mother. Sometimes nothing can reassure her except time, and a smile, and listening in an engaged, mindful way.
The language of communication between doctor and patient is more about listening than anything else. Listening can reveal more about your patient than you may think and this will help you create a better management plan.
Even though it is often the small things that we do which are most helpful, the work we do has a bigger picture that will also help us to remember.
Sometimes it helps to look at the greater meaning behind medicine. We can forget that in the rush of the work day, but when we step back to remember why it is that we do what we do, it will help us enjoy our work more.
As doctors, we are not only taking care of the signs and symptoms, but we are also humans taking care of another human, as if a heart taking care of another heart. An eye taking care of another eye.
Think of the hospital as a gate of hope. People usually come to the hospital in very stressful situations. It might even be the worst day of their lives. Therefore, in the medical profession, we have a chance to help them through this day and make them feel better. What goes around comes around. This is the universal law, and you will offer hope even with just a small mindful act like smiling and listening.
It is my belief that when an individual saves a life, it is considered that they have saved an entire world. What we do as medical professionals is so much more than we realize, and it helps us to remember the meaning behind what we do. This will help us thrive as doctors and medical professionals.
Nehal Shata
Fall, 2017
Reflections on my debut as a surgical resident
By Maria Aboukhalil, General Surgery - R3
I started my residency in general surgery determined to continue to be a hard worker. I remember thinking I was immune to fatigue, and that being a surgical resident meant sacrificing my own interests. I stopped things that I cared about: sports, cooking and spending time with friends and family. For a couple of months, I neglected to listen to those close to me who would tell me I lost my work-life "balance" and that the hospital became my life. I dismissed their comments thinking that balance had to be secondary now. However, ignoring things I cared about did not make me a better resident, as I had hoped. To the contrary, 6 months after starting, I saw in the mirror a tired resident who did not recognize herself and was close to burnout. And something had to change. I learned to better organize my time at the hospital to be able to continue to do things I like outside the hospital. I got back to exercising which gave me more energy than it took from me, I rediscovered the culinary scene in Montreal, I spent more time with friends and family whenever I could and then, my smile came back. The most important thing I learned in my first year as a resident was that a big part of taking care of others is taking care of yourself.