Emergency Medicine Internship: On (Almost) Dropping Out

This morning, I work my first shift in the ED (Emergency Department) as an upper-level resident with a new set of interns. I’ve met some of the incoming cohort, and they seem bright, happy, and eager to learn. I remember myself from this time a year ago, gearing up to start internship, and I wonder if anyone else is feeling the way I did then: secretly terrified and filled with dread.

I knew that I was lucky to get into my residency program. It was my top choice, and a hefty measure of imposter syndrome contributed to the anxiety I felt before ever stepping foot in the ED. I was afraid of messing up, of hurting someone, of being exposed as a failure and a fraud.

The feelings did not go away after I started working. I came home after my first shift and told Yohannes, “It will be a miracle if I don’t quit or die.” And I meant it. I felt incompetent every time an attending corrected my plan, and I felt annoying every time I had to ask for help with basic tasks. I dreaded going in to work every shift, and whenever I had a day off, I spent it obsessing over everything that could possibly go wrong on my next shift. I had anxiety attacks where I had to talk myself down from hyperventilating. I had difficulty sleeping, and when I did sleep, I had nightmares about work. I felt too anxious to eat and lost 20 lbs in my first two months.

I don’t know how my story would have ended if I did not have people in my life looking out for me. I spoke to Yohannes, and to my mother and sisters, who asked me if I could take some time off. I said I couldn’t. Residency is a huge commitment, and any day that I didn’t work in the ED was a day that one of my co-residents would have to cover for me.

The face of burnout

I delayed the inevitable for longer than I should have, but it finally set in that something had to give the day I spoke with my sister on the phone and she said, “You have to ask for time off. This is an emergency.” And I knew she was right. I was unwell. I needed help. But in my mind, I was still calculating how many extra shifts others would be forced to work while I was out. I started making a plan in my head, and it involved telling my PD (program director) that I was dropping out, but giving her enough notice to hopefully find a replacement to fill my position.

As I tried to mentally prepare for what was ahead, I began to isolate myself. I stopped participating in my residency group chats, because I felt like an imposter being included in a group that I planned on leaving. I stopped talking with my med school friends who all seemed to be doing well in their respective residencies because I was ashamed of not being able to handle mine. I sidestepped or outright ignored questions about how work was going from family and friends.

When I finally worked up the courage to talk with my PD, she listened patiently and empathetically as I explained my situation, but when I started to get to the part about leaving the program, she very firmly stated, “You are in crisis right now. This is not the time to be making big decisions.” She immediately approved a two-week sick leave and then walked me through the process of extending that to a four-week leave of absence. She connected me with employee and resident resources, who in turn connected me to a psychiatrist and psychologist who helped treat my anxiety and depression.

I have very little to show for my four-week leave of absence. Writing has always been a way for me to process difficult situations and emotions, but I felt too raw and vulnerable to publicly share that after all the years of school and clinicals, after moving my entire family and taking out a mortgage, after the hundreds of thousands of dollars in student loans, I wasn’t sure I was going to make it as a doctor. But little by little, the nightmares stopped and my appetite returned. I don’t know if it was the long walks in the woods, the therapy, the antidepressant or a combination of the three, but I began to feel alive and happy in a way I hadn’t felt for a long time.

Practicing self-care during my leave of absence.

I didn’t feel like restarting work at the end of four weeks, but I was eating and sleeping again, and I thought it was time. My anxiety was still there, but more of a rain shower than a hurricane. I worked an enjoyable shift with an attending that I had imagined hated me, then another enjoyable shift with an attending that I had imagined thought I was stupid. I remember the day that I told my therapist that I almost looked forward to going in to work the next day. And then there was the time when I did look forward to going into work.

A year out from when I started, sometimes I cannot believe I am still here. But even more surprising for me is that I am glad I am still here. I enjoy my job, and I love my coworkers. I learn something new every day and I look forward to working in the field of Emergency Medicine in the future. I can’t believe how close I came to walking away from a rewarding career that I worked so hard for. I feel so lucky to have matched into a program with a PD who truly cares about her residents, and I can honestly say that I would not still be in this program if it wasn’t for her.

I know that sharing this information publicly may come with its own repercussions and stigma, but I don’t want anyone who is going through something similar to think they are in this alone. If you are struggling with anxiety and depression or other mental illness, please know that things can get better if you get the help you need. Find a safe person to ask what resources are available to you. If you are an employee at UVA, reach out to the Faculty and Employee Assistance Program, and if you are a resident, ask them about the Clinician Wellness Program. I am happy to talk about this experience with anyone who has questions and hope to be able to share more in the future.