It was a familiar scene. I pointed to the vacant seat next to a coresident at a recent noon conference. After piling 2 slices of pizza on top of salad I walked toward him, hoping the paper plate would hold up. Then I felt someone tap me on my shoulder.
“Hey, man, could I ask you a favor?” he asked in a hesitant tone.
He was known as the respectful and dapper resident. A soft-featured guy who wore a gray cardigan sweater, sharp brown watch, and burgundy loafers with hospital scrubs. If anyone were to ask for a big favor, I thought, it wouldn't be him.
“Yeah, sure, what's up?”
It had been a challenging few weeks for me personally, and it was difficult to articulate why, exactly. Was it the little things? My phone running out of battery? The scrub machines not having my size? Circling forever to find a parking spot? Dirty sheets in a call room? Not being able to check e-mail on a hospital computer? But no, these were petty things. How could I lament a missing phone charger after an end-of-life discussion in the intensive care unit with a patient around my age? Beyond these things, something more was weighing me down.
“Would you switch this Saturday evening with me?” he asked, leaning over to show me the date with his phone.
I recognized it immediately. It was an opportunity to see a professional basketball game as part of a larger overall wellness initiative sponsored by the residency program. Average tickets cost a few hundred dollars, but these were completely free. And it was not just any game: arguably it was one of the best teams of all time, with complimentary food and on-court access after the game. Throughout the year he and I had talked sports: this would be a special night.
“Let me think about it, and I'll get back to you,” I said. “It's been a crazy few weeks.” He was surprised I didn't say no outright. The truth is that I didn't know what was right for me.
The basketball tickets represented a solution to a problem I had. I needed to diagnose my problem and I could not, which was unsettling. I could not order a lab test, listen to heart sounds, or get imaging to gather more information. So I did what every reasonable resident does to feel better—I went to the chief resident's office to grab some candy.
Eating a Butterfinger, I looked at my coresidents as they busily typed away on a row of 3 computers in the lounge.
At the first computer, I saw the puffy eyes and large teal coffee mug of a coresident who had just completed another night shift. Sitting to the right, I noticed a condolence card next to another resident as she tearfully tried to book a flight home. At the last computer, I heard a sigh, and watched another resident get up and insert white ear buds as he stepped away to give his mind a break. They represented 3 causes of burnout: physical, emotional, and mental. Was I missing another?
While walking back up to the seventh floor I took a moment to look out a window, and I noticed something truly majestic. The Golden Gate Bridge, peeking through the fog with its orange hue and recognizable shape, made me stop and wonder. I have asked myself the same questions about life's meaning and my purpose so many times before—beneath a mountain, on the shores of an ocean, or on a road that goes on for miles in the desert. These questions hinted at the last missing cause of burnout: spiritual.
At that time, I had my “a-ha” moment. Each cause of burnout has a unique solution. And so, I took out my phone and texted my coresident, letting him know I would work Saturday evening so he could go to the game.
After my shift that night I put on gray sweatpants, threw on all of the reflective stickers I had in my bike bag, and pedaled toward those majestic pillars with little flashing lights. I rode through the pitch black. I smelled pine cones as I raced up the famous hills of the city. I blew on my hands to warm them as I approached the Golden Gate Bridge. It all felt like a deserted movie set. I rode on the bridge that night, stopping a few times to hear the waves beat down below and watch the city buildings turn gray. I found answers to the questions that were rumbling around in my mind.
We are all affected differently by the physical, mental, emotional, and spiritual challenges of residency. And wellness is highly individualized.
That night I sat alone. My coresident was surrounded by 20 000 other fans, flashing lights, and thumping bass. My night was one of serenity, introspection, and reflection about the purpose and meaning of my work. His was packed with entertainment and quality time with his significant other. As it turns out, we both made the right choice.
The author would like to thank Drs Johanna Shapiro, Audrey Shafer, and Alex Macario for their support of medical humanities and their sincere encouragement.