Progress Notes

Beyond resilience: The importance of community and personal identity

At first, it was hard to get through The House of God. Although I knew very well it was a satirical novel, there were many startling truths in the subtext surrounding dehumanization and psychological harm of resident physicians. I couldn’t quite fathom how my exuberance about caring for patients and scrubbing into cases could be challenged by a culture of overprescribing, emotional tyranny and burnout.

Written by Dr. Samuel Shem, a pseudonym used by Dr. Stephen Bergman, The House of God was published in 1978 and follows a group of medical interns at a fictionalized hospital. Unlike most novels, this one graphically depicts some of the more troubling and paradoxical aspects of training in medicine.

Readers learn about not only the origin of terms such as “bounce back” and “turf” that have become part of modern medical language, but also how issues of patient safety, quality of care, health care spending, and resident morale unfold in the hospital workplace.

Jackie Olive with her grandmother.

Even as a fourth-year medical student, I’ve encountered several characters who’ve played the role of “The Fat Man” on my own clinical rotations. Be reassured, however, absolutely no rule breaking occurred. Period.

The author ends up training to become a psychiatrist, and some of the most impressive and professional discussions I’ve had about the concept of resilience during medical training took place recently during my last core rotation in psychiatry. Tired headlines with wellness buzzwords leading into familiar statistics with the ultimate call for a “cultural shift” typically do not give me pause — until I came across a study recently published in the Annals of Thoracic Surgery surveying cardiothoracic surgery trainees in the United States.

More than half of respondents met criteria for burnout on the basis of emotional exhaustion and depersonalization. Over one-quarter would not complete training again. More women than men reported poor quality of life during training due to missed health appointments, negative impact on relationships and self-perception.

Perhaps these are not “new” findings; rather, they make an appearance in the literature at a timely period in public health history and in my own personal career journey.

Although a high prevalence of depression and burnout exists, Chow and colleagues note that a sense of purpose and fulfillment from their daily work drives trainees’ ongoing success and resilience. As such, they recommend that mentors should more often recognize trainees’ development and accomplishments.

Their manuscript also touches on several other important topics, including sexual harassment and discrimination, that are beyond the scope of my written thought exercise. Instead, I want to refer my readers to this excellent blog post written by a mentor for more insight and practical tips. In the remaining space, I’ll expand on the idea of career enmeshment and how we must be intentional about both leveraging and tempering its powerful force on our lives as health care professionals.

On my personal blog, I wrote about my own career aspirations and clarity of professional purpose, and how these vital parts of my identity have endowed me with strength and composure in times of loss, after my grandfather’s passing–and times of confusion, amidst the COVID-19 pandemic.

In surgery, long hours are often rewarded by greater opportunity to take part in patient care and hone technical skills in the operating room. They may also lead to promotion, raises, prestige and self-efficacy. In the early years of medical training, hours and even days spent together with colleagues in the hospital as true “residents” led to a unique bond and camaraderie from which to create community resilience.

Over the years, however, we have adopted more of an individualized notion of resilience focused less on these informal networks and social support. Taken too far, such intense personal career engagement displaces other activities and relationships that are important for diversifying our own sense of personal identity.

In our workplaces, we’ve demonstrated the collective benefits of diverse teams. In investing, diversification is important across different types of investments to maximize the odds of success due to market volatility. Why do we not invest more in diversifying ourselves? Do you really know who you are? And do you really want to live this way?

I contend that we may be able to tackle the burnout crisis a little bit better by working to answer these existential questions for ourselves and our colleagues.

An unassuming woman of few words, my grandmother lived a life of vibrant nuance. Amid the uncertainty of her declining health, several close calls, and the overall safety of out-of-state travel during the pandemic, I feel fortunate to have made it home to Los Angeles just in time to see her before she passed. An immigrant from the Netherlands following World War II, she was a firm, yet loving matriarch, who outlived many of her friends and her own husband. She raised me, and I owe her my eternal gratitude.

Several days ago, the hospice nurse had asked if she was holding on for someone… maybe it was me? I read more about this will to live in patients nearing death and learned that more so than physical issues such as dyspnea, appetite and appearance, psychiatric and existential issues such as dignity, meaning and self-perception underpin the innate human resilience to live, even in our final moments.

I hope that we may recognize this as members of the medical profession, that we are worthy of all the roles we occupy, inside and outside the house of god, and even beyond our own understanding.

-By Jackie Olive, fourth-year medical student at Baylor College of Medicine and editor-in-chief of Progress Notes

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