It's Saturday night, and two of my friends and I are doin' what we do: sipping wine, knitting, watching Pride & Prejudice (Keira Knightley version. Yes, I know the BBC one is better, but who regularly has 6+ hours for P&P?). The movie is over, we've muted the credits (despite the lovely score) and talk turns, as it always does these days, to residency applications and rotations.
Maybe it's the soft rain hitting the trees and pavement outside, and maybe it's the melancholy touch of cool in the air coming through the windows, but tonight the talk is different, deeper, more honest.
We talk about the B word, but before we even talk about the B word, we talk about the A word: apathy.
Part of fourth year seems to be this glorying in apathy. "Who wants to do that admit? Not me, 'cause I'm a fourth year! Don't we have some JMS up in here?" "I could tell the resident sort of wanted me to stay but I was all, 'peace out! I'm a fourth year!' " These aren't the stories we tell tonight, but they're the ones we've been telling: to our classmates, to our fourth year friends at other schools...we revel in the fact that as senior medical students, we were told that now we've "made it" and with ERAS submitted, all bets on effort are off.
One of my friends says something that strikes a nerve: "I'm not afraid of the mistakes I might make as a resident when I'm tired or I'm on call for long hours. I'm afraid of the mistakes I've made when I just didn't care." The essential truth is this: when you're tired, yes, of course it's easy to mix up a medication name or a dosage and make a mistake. What's worse, though, is that sense that what you're doing doesn't matter; the resulting apathy sucks all the drive to be diligent and detail-oriented right out of your mind.
What has brought on this disregard? It's not the patients; many of the stories we tell (sans identifiers, of course) are the patients whose care has changed us, fundamentally. The patient who was deathly ill in the MICU; the patient who lingered on; the patient we grew too attached to; the patient whose care had been delayed or inadequate elsewhere--these are the patients who stick with us, the negative examples whose care has shown us the pitfalls of medicine and, occasionally, its strengths. These patients are what strengthen us; each one is a line tattooed on the heart and connects the disease to the person who suffers.
Instead, this overwhelming fatigue is what makes us stop caring. For many of my friends, we took all twelve months of third year filled with academic requirements and one elective, to earn a much-coveted third month of vacation as fourth years. Yet the first few months of fourth year are consumed with anxiety: high-stakes electives or sub-internships in our field of choice, compiling and submitting our electronic residency application, finding mentors to write letters of recommendation, studying and taking eight- and nine-hour board exams. All of this just weighs upon us, and everyone keeps up the mantra that the class above us repeated ad nauseum: fourth year is awesome, it's the good life, it's your last chance to relax, it's when grades practically don't count, fourth year is awesome.
But it doesn't feel awesome right now. We are tired, so tired. When I go on dates, the guy wants to know what I do "for fun" or in my "free time." I am more and more reticent to answer, knowing my response is too often "Collapse on the couch and watch Hulu. Does that count?"
This was my first "vacation" time in 14 months, and I spent it studying and taking board exams as well as submitting my residency application. Next month feels like a "real" vacation, but it's an anatomy elective. Medical school teaches you to always be working, so that doing only half as much work feels like a vacation.
At the beginning of med school, we must have had lectures on Burnout--the B word--several times over the course of the first year. "It will happen!" and "Beware--seek help!" were what they warned us. They neglected to mention that medical school itself engenders burnout. I can't imagine what residents must feel after a time; for me, ever the optimist, I lay my hope in the fact that I'll be doing what I've wanted to do for nearly my entire life. I'm hoping my unbound enthusiasm for women's health will carry me through the day.
Maybe fourth year will get better. Perhaps this is a product of anxiety about interviews (or a lack thereof); perhaps once you've been on a couple interviews you can start to live the badass, carefree life you've been promised.
After all, we're fourth years.