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After the Match

After the Match

Breaking Up is Hard to Do

Cook, Thomas MD

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doi: 10.1097/01.EEM.0000473173.77603.4e
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    Winter is setting in for interns, and most now understand what residency training encompasses and the sacrifices they have to make. The excitement and anxiety of practicing medicine subsides as each resident looks down the long tunnel of training but cannot yet see the distant light of graduation. They settle in for the long haul, and new processes become boring routines.

    Many casualties come out of this annual process. The dreams of what they would achieve during training are moved aside by the realization that medicine is difficult, and patients are often grumpy and insensitive to their plight. “Are you just an intern?” is a common patient refrain as they repeatedly ask for pain meds.

    But several residents lose much more. They lose the girlfriend or boyfriend that celebrated with them so intensely just a few months earlier on Match Day. Those were giddy times with a sense of extreme accomplishment and the anticipation of a life full of success. The person they fantasized would share their failures and triumphs for the next few years, however, is gone, and it makes the process at hand that much tougher. Breaking up is hard, but when you are working at a new job, living in a new town, heading into winter, and slaving intensely at something you are not very good at yet, being alone when you go home can make it a lot tougher.

    I have had several residents who went through this. They eagerly showed off the love of their life in June when intern classes awkwardly mingled for the first time. The anxiety they felt about starting residency was elevated by the concern for their partner's happiness and ability to find a meaningful life (and a job) in a new town. But as the saying goes, “We make plans, and God laughs.”

    The Meat Grinder

    One person moving his life is tough. Two people moving their life is likely to result in mounting tension and the end of the relationship. Sadness ensues, tears are shed at work, and behavior can be erratic when the tension ratchets up in the meat grinder that is the emergency department. They end up in my office at some point to confide their sense of loss and why it all went wrong. Those meetings take time and patience, but they are some of the most memorable of my career.

    But we know misery loves company, so you residents are in good shape. Look around and you will find survivors of similar and far more difficult tragedies. They are tough to see at first. Some might say they are cleverly disguised. But nonetheless, they are right in front of you. They are your attendings.

    Residents, you look at attendings as mountains of knowledge and accomplishment who know everything about what you seek to understand. By now, however, you have had enough beers with the upper-level residents to get the lowdown on each of them, and some of the luster has worn off. They all have peculiarities and biases, and they appear much more flawed. But you will see many more scars than you can imagine if you scratch a little more past the surface.

    Words of Compassion

    A good friend of mine likes to say, “Behind every front door, there is a story.” Having worked (and often socialized) with my partners for two decades, I can tell you that all of them have had a broken heart. It may not be from losing a lover, but life inevitably comes with sorrow, even if you are smart, work hard, and are admired by society.

    The common maladies of divorce, drug use, cancer, children with disabilities, and death are not the exclusive domain of the impoverished (and often foolish) patients we routinely see in our EDs. They eventually creep into the lives of even the most resilient member of society: the hardened, tough emergency physician.

    Do two things if you find yourself on this path now. Reach out to your program director. You are not the first and will not be the last resident to have problems. We all tend to think of ourselves as unique, but our problems are common. Your program director will have likely heard a version of your dilemma before and can offer advice. If you just need an ear and a few words of compassion, you might be surprised how even the toughest program directors can be comforting during a quiet conversation.

    And, secondly, relax. Understand that residency is not so much a struggle on a hospital campus as one that blends your lifestyle with that of being a physician. The fall of your intern year can be melancholy, but a metaphorical spring will find you at some point during your training.

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