This summer is supposed to be my turn to start residency in the States. I hear enough about work-life balance; but have mostly seen residents push the limits of what could be considered a human existence because it’s known: If you don’t work yourself to death, someone else will. I’ve heard conversations about whether it’s proper to get married or have children during residency. Usually, the consensus is “no.” Is all this just contained within residency, or does the intensity dial back when we become attendings? I saw the rare days when the afternoon ICU rounds finished early as a student. I asked if the interns and residents would go for a beer? Their eyes flashed like I’d insulted Stalin in Red Square. They worked too hard to be seen (even to think of themselves) as having free time. It was beneath their work ethic. Once, an emergency intern suggested I walk hurriedly up and down the corridor rather than chatting with the residents if I ever wanted to be a resident there. Maybe he was right. I didn’t get residency there, but I’m sure of this: The mentality is wrong. It’s the wrong way to run a hospital and a life. That conversation was the final straw that sent me back to Israel for a few years. I will never argue against hard work; but I will argue against creating work or putting on a show (for yourself or others) to seem the unceasing work machine. I went to medical school in Israel, where students and residents meet friends, get married, have lives … and work hard. It may surprise the reader to know that medical care is still quite good. The best lesson on the topic came from our requirement to study in a low/middle-income country for two months. So there I was at the Hospital General de Mexico, Mexico City. The department of infectologia was an in-patient service. They were friendly, quiet, and intelligent as they treated mostly tuberculosis and HIV. They considered me one of their own students and expected Spanish out of me, as an American hospital would expect English from a Mexican student. The internos were the quiet heroes. They had to wear all white, pants and shoes too. Their overnights were 36 hours, with only the following 12 hours off. Did they complain? Of course, but they didn’t feel that they had to constantly “out overwork” each other. My next rotation, neurocirugia, was truly enlightening. Mexican culture is different than American or Israeli, but surgeons have their reputations. What I found was a surgical paradigm shift and certainly no lack of discipline. The morning meeting began with the overnight resident greeting the attendings individually with a handshake if the resident was male and a kiss on the cheek, if female. They went down the line, one by one until respects were paid, then presentations began. By the lockers, they were laughing, not stomping around, using grumpiness as a proxy to prove how seriously they take their jobs. The next thing really shocked me: The residents would ask questions without being attacked during the surgeries. The attendings answered the questions, and learning happened. I even got to participate a bit, sawing some skull, collecting the dust to use as mortar when we would reattach the skull fragment. During a coffee break, they asked me what I thought of Mexico. I spoke of how friendly they were, how respectful the residents were to the attendings, but how the attendings showed respect to the residents by teaching them without insinuating that their knowledge gaps were due to character flaws and incompetence. One of the attendings had done his fellowship in the States. A resident asked him about the American operating room. “Como una iglesia (like a church),” he said, very tense and serious. “The Colombians think we’re too serious,” he said grinning at their international resident. I was determined to squeeze all I could out of two months. I even volunteered for a few of those killer 36-hour shifts. At night or on weekends, emergency may be staffed by only interns, not even one resident until morning or until Monday … but those interns know what they’re doing. After 36 hours, it was time for the afternoon’s surgeries. One of the department chiefs was going to let me really participate this time, but I had to admit I was coming from a 36-hour guardia. He put his arm around me, told me to take a nap on an unused operating table, and he would come get me for the relevant parts of the surgery. And he did, take his own time to make sure I got some rest. Before I left Mexico, one of the residents had his birthday and the whole department, me included, went to a club. They danced, they drank, like friends. Meanwhile, back in New York, I assumed they were arguing about who is more overworked. I’m not in a position to evaluate anyone as a surgeon or whether the ICU runs better in New York or in Tel Aviv, but I am confident that competing for ‘martyr of the month’ is not productive for anyone, patients included. I can work a 36-hour shift; I’ve done it before … yet I refuse to pace up and down the corridor to “look busy.” And I’m troubled that neurosurgery residents are afraid to ask questions. The stress of the medicine shouldn’t be self-inflicted. Has this been nurtured by generations of physicians reimposing the pain they were subjected to as students and young doctors? Have the victims become their own tormentors? The Mexican surgeons prove that someone’s success doesn’t have to come from someone’s failure. If we are moving toward the common goals of patient care and a productive work environment, cooperation can only help. The only thing is we may have to sacrifice the notion that in all facets of life, you can’t be a winner if there’s no loser. Not everything has to be a war. The author is an anonymous physician. Source
