Reclaiming Joy

It was April of my intern year when I decided that I had finally had enough. I was tired, irritable, distant from my family and friends, and most importantly, I didn’t like who I was becoming. I had an infant at home I rarely saw and a husband who was carrying the weight of our household entirely on his back. And I couldn’t figure out why I was enduring all this emotional suffering when I couldn’t see the joy in medicine. I knew that something was wrong when being in the patient room exhausted me more than excited me. I kept hoping it would pass, but when it didn’t, and all my inner turmoil just turned into anger, I knew I needed a reset. So, I took one.

When I decided to take a year away, many people were supportive. Still, some couldn’t understand why I didn’t just push through. Intern year is notoriously difficult, they said, but it gets better. And while I do agree with them, my concern wasn’t about the external environment of residency. Rather, it was about who I was, as a doctor, a wife, a mother, a daughter, a sister, a friend, and a community member. So much of my life had been spent looking forward to becoming a physician, so much of my identity had been wrapped around being a doctor that when that world started to crumble, so did I. As a result, I needed to rebuild on more stable ground.

I spent my time healing, exploring, and re-learning how to care for people as people, not just as patients. I shed the layers of expectations and thought about what I truly valued. I grew in self-confidence. I grew in presence, by which I mean the ability to stay focused and engaged on the present. I found joy again in people, in community, and in my physical environment. And even though I was still anxious about coming back to medicine, I knew that things would be different this time around. Because I was different this time around.

Now, starting my third year, I’ve tried to document some of the life lessons that helped me rekindle my love for patient care and to keep that flame burning even amidst a pandemic. I had to learn these lessons the hard way, and likely all of us need those types of difficulties for these things to stick. But for those who have been struggling with the hard way for a while and need some new ways to reframe the journey, maybe these lessons can be of service.

Commit to bringing your authentic self into patient encounters.

Whether you are a person who likes clear boundaries between doctor and patient roles or you are a person who thrives in more of a bidirectional relationship, Medicine is big enough for multiple personalities. I used to think that I was supposed to emulate the communication styles of people in high positions. Then the tension between by authentic self and my performance self nearly broke me. Now I have learned that there is no one right answer when it comes to patient care (though perhaps there may be a few wrong answers). Our patients are diverse just as we are. And when we bring that to the table, beautiful things happen. This doesn’t mean we each don’t have places to grow or that we shouldn’t push ourselves to become more comfortable in our places of discomfort. But it does mean that if I’m a lily and you are a fern, how we interact with the world does not have to be the same. Spending my time trying to be like a fern is only going to frustrate me and it’s just going to frustrate my patients in the long run.

Let go of the savior mentality. Embrace a gardener mentality.

Many of us enter medicine because we want to help people. I definitely did. But what is often unsaid, at least early in our professional journeys, is that we want to help people in ways that make us feel good about ourselves. We want to feel like it was our diagnosis and treatment that made all the difference, our motivational interviewing that caused the transformation. And there’s nothing wrong with that! It is part of the joy of this work. That said, if we are only there for the savior moments, we will be tired very quickly. So instead, I have started to think of Medicine like a garden (I can’t seem to let go of this metaphor). Some of us are called to plant the seed, some are called to water the seed. Some are present when the first bud sprouts and others are present when harvest time comes. So many of us want to be the harvest time people, present when the diagnosis is finally made, the smoking finally stopped, the weight at last lost. But the truth is that most of us are waterers, doing the work even when the result isn’t clear. Each time we take care of someone in alcohol withdrawal in a caring and nonjudgmental way, we water. Each time we deprescribe unnecessary medications, we water. Each time we talk with a patient about barriers to medication adherence, we water. Perhaps someone else will see the fruit of our labor, but that’s alright, for there will be times in which we too will reap where we did not sow. The patient on your service will decide that they finally want to get on suboxone during this admission and we will celebrate even though there were dozens of people ahead of us who did the work to get the patient to this point. Or the patient in clinic will finally start losing the weight that they have been trying to lose for years while under the care of previous PCPs. And that’s alright too.

Invest in community.

Medicine is a busy place. Many of us are trying to do new and innovative things, which takes a lot of time, effort, and emotional fortitude. There are more than enough things we want to accomplish and not nearly enough time in the day. What’s often left behind in this journey to make a name for ourselves is connection. Connection to acquaintances, friends, and loved ones in the interwoven ways that form community. As much as we practice in a field guided by a sense of purpose, this work alone is often not enough to hold us up through the ups and downs of life. Rather, it’s that sense of connection and community that give us life in the midst of the work. It’s that community of things like family, faith groups, intramural sports teams, knitting clubs, book clubs, and so on, which anchor us to the humanity in ourselves and in our patients. Those topics we discuss in our communities are the things that enter our conversations with patients and allow us to form connections we could not have otherwise. Communities give us the space to bear witness to the fullness of life so that when life enters our patient interaction, we’re prepared to respond with compassion.

Live in the moment.

As clinicians, we know how to play the long game. We start thinking about cardiology even we before we get into medical school. We’re taught to have long term plans as proof that we’re serious and that we’re going somewhere. As such, we hang onto goals, projects, and expectations even when they’ve outlived their welcome. Our minds are always on the next patient, the next grant, the next paper. Even as a resident, when I walk in the door, I’m already thinking about sign out. What if we were to be really present in our todays? In this patient room right now? In this lecture right now? In this phone call with family right now? In this project as it is right now? What if we decided that what we’re doing right now is just as important as what we think we’ll be doing in the future? Perhaps we would start to ask different questions of ourselves. Maybe we would take on different projects. Maybe we would sleep more and worry less. Maybe we would begin to imagine a different life altogether.

Get out in nature.

Even if you’re not a very outdoorsy person, there’s something about walking among trees, listening to birds sing, watching kids play with dirt, and breathing fresh air. I remember walking through Patterson Park in Baltimore one morning and looking up at a tree whose branches were in a complex and awe-inspiring pattern. Here stood this large oak, of unclear age, creating such beauty, all without a 10-year plan or grant funding. It simply followed its inner design, responded to its environment, and took its time. I found such delight in this work of art, in something so small and seemingly insignificant. Finding delight in nature became a practice so ingrained in me that it started to bleed into my time on the wards. I would have an elderly patient with delirium who was taking a while to improve, and rather than feel impatient, I would value the little changes with genuine excitement. Ms. S was able to tell me the month today! Woo! Mr. A was able to drink a few sips of an Ensure today! Woo! My joy was no longer beholden to anyone else’s timeline. I could watch nature play out right there in a patient room.

This piece expresses the views solely of the author. It does not represent the views of any organization, including Johns Hopkins Medicine.