Take a look at these pictures and think of some words to describe them.
I see deep and tender and coarse and narrow, but of course both of these pictures are of an elephant. This is the principle behind the famous parable pictured here:
This illustration has been used to clarify a variety of concepts. And I am going to use it to explain my fall from grace. But first…
We all like to think we can read people well and most of us would probably consider ourselves ‘a pretty good judge of character.’ Once we’ve established an opinion of someone, it’s incredibly hard for that person to change it. We filter his/her actions through our initial perception and it catches everything that reinforces our existing beliefs. To change our mind about someone, that person must prove us wrong. And because no one likes to be wrong, changing a perception is a very, very hard thing to do.
In high school – if you built a reputation for being “a good kid” – parents and teachers were willing to excuse minor infractions with extra measures of grace. And if people thought you were “a bad apple,” well – good luck trying to change their minds! I think this is why high school is so miserable for some people. They get pigeon-holed and then it’s incredibly hard to break free from those expectations.
I had a reputation for being ‘good’ and even ‘happy.’ My happiness was so glaring it merited a parody from some students in the grade ahead of me. When they were tasked with creating a utopia, they named their land “Prentiss Island” (my maiden name) and gave it the national anthem, “Happy, happy, joy, joy,” from Ren and Stimpy.
(Don’t worry, this makes me want to gag too.)
College is a fresh start – a chance to be known for something other than who people thought you were in high school. College changed some of my politics, but it didn’t change “me” very much. This was an “award” I was given in college:
(“Most Likely to be Found Skipping through the Halls of the Union”)
If you’ve been following my blog, you know I have a bad case of ‘overshareatosis.’ Well I also have an incurable chronic condition called ‘heart-on-my-sleeve.’ My feelings have always felt too big to hold back. So if I feel the buoyancy of joy, it comes out in beaming grins and twirling spins and even…skipping.
And that brings us to me jumping up and down in heels and a suit when I found out I got into med school. As you know, from my last post, I was the last one (the very last one) to get into my med school class. Fast-forward four years and I had done well enough to be ranked #1 by my chosen residency. That’s right – last to first! But, oh my, how pride doth go before a fall. We have come to the four years that beat me until I was unrecognizable.
Residency is a gauntlet.
- Residents are full-fledged doctors learning to ‘do medicine’ under the scrutiny of the staff at a teaching hospital. And they OWN you. You belong to them and you owe them 80-hours a week and any project or task they demand.
- It is all-consuming. You spend so many hours at the hospital – there is little time for anything else. Weeks will go by where you truly just eat, sleep, and work. Being stripped of simple pleasures is depressing.
- It’s hierarchical. Normal social hierarchies are subverted by the medical one. A 50-year-old intern is subject to a 27-year-old 2nd year resident. Rank trumps everything.
- There is no way out. You HAVE TO finish. If you don’t, you can’t practice medicine. You can’t be board certified. And most med school grads have oodles of debt which means they HAVE TO finish to be able to pay it off. And while not impossible, it is difficult to change course after starting a residency. You can’t just ‘go get a job at another hospital.’
You know the feeling of complete and utter exhaustion? The kind that scrapes away the layers of comfort and exposes raw unchecked emotion? The kind that makes reality TV stars cry uncontrollably during interviews?
That is residency.
And you know how I have heart-on-my-sleeve and emotion oozes from every facial expression and vocal inflection and bodily posture?
Well that isn’t limited to positive emotions.
RESIDENCY + someone who already feels feelings so big they ooze = TROUBLE.
And I found it almost immediately.
In my first month of ob/gyn residency, there were “scheduling issues” and a resident retreat that resulted in 28 days without a 24 hour day off. I have always been someone who needs ample time alone to be able to ‘put my best foot forward.’ And without that time, and stripped of my inhibitions by exhaustion, I was less than my best self.
Early in my ob/gyn intern year, while repairing the perineum of a patient with a tear after delivery, a seasoned faculty mid-wife was trying to do her job by teaching me how to repair it well. She was telling me in great detail how to “fan” lidocaine into the tear through a single stick. I already knew what she was trying to teach me and all I wanted to do was go fast. Gobs of agitation, resentment, frustration and lack of humility oozed out.
She saw someone who was arrogant and unteachable.
It is incredibly hard to like someone that doesn’t like you. And I had given her a reason not to like me. Breaking a cycle of not liking one another takes one person putting in a great deal of effort and my heart was not in it.
I was thankful for the reprieve of a month in the Emergency Department. I had plenty of days off. I had time to cook, and run, and breathe. I even had time to get pregnant. Yes. True story.
That was a good month. I remembered who I was and it was easy to be the best version of myself. It felt good to work hard and the other EM residents said things like, “thanks for your help” and the faculty offered tokens of praise like “nice pick-up,” and “good work today.”
It was salve for my weakened spirit. I felt like “me” again. And I wanted more of it. I wanted the life of an EM resident with fewer days inside the hospital and more time to remember who I was outside the hospital.
There are a whole blog’s worth of reasons for my switch from ob/gyn to emergency medicine, but I would be lying if I didn’t admit that some of it was because of that faculty midwife and a desire to break free from perceptions I felt I could not change and could not accept.
I was beyond lucky to garner a spot in EM outside the Match. With a change of course in sight, my spirits lifted. And with Kharis growing inside me, the remainder of my ob/gyn intern year passed quickly.
I delivered all 9 lbs 1 oz of Kharis one month into my EM intern year. The timing could not have been worse. When I conceived, I imagined delivering at the start of my second year – not as an intern!
Becoming a mom changes your identity. You look at yourself and wonder, “Whose boobs are these?” And for all that is gained with motherhood – there is also loss. Loss of freedom, and selfishness, and even “youth.”
Add a career change to that – and you have the framework for the beginning of a serious identity crisis.
When I returned from maternity leave – I stepped into a whole new life with all new people – only this time the exhaustion of residency was doubled because I was waking up multiple times a night to breastfeed an infant.
During my first educational conference back from maternity leave I was called on during case conference. I shifted in my chair, my backpack of freshly pumped breastmilk at my feet. I stared at the image on the screen, but it just looked like the scribbles of a 2-yr-old to me.
It was an ECG.
Being asked to “read” it was like being asked to read another language – one that was buried under the memory fog of lost sleep and mired in the sluggishness of a “mom brain” that hadn’t recently contemplated anything more difficult than putting together matching hair bows for baby outfits. The room was quiet and full of people who barely knew me.
I stuttered and stumbled and said “uhhhh” a lot. My cheeks were hot as I looked around the room and took in the looks of sympathy on the faces of my fellow residents and incredulity on the faces of the faculty. It was something I should have been able to do, but could not.
With my ECG illiteracy exposed, I tried to make a joke. I said wryly, “And that’s why you don’t ask an ob/gyn to read an ECG.” The chuckle from the room was stopped short by the chairman of the department snapping with disapproval, “You’re not an Ob/Gyn anymore! You’re one of us now.”
The people in that room saw someone who wasn’t invested. They saw someone who was struggling.
Because I had an infant cooing at home for our nanny, I resented being at work. AND I resented working with faculty who expected me not to know answers – not to do well. And that bitterness and resentment seeped out during every dreaded shift.
While working a busy, late-night shift, I saw a 19-yr-old kid who had run out of his inhaler a while ago and came to the ED with an asthma exacerbation. I just wanted to give him an inhaler and some puffs and send him on his merry way.
An experienced nurse stopped me in the hall to ask, “Why didn’t you order him a nebulizer treatment?” I explained that he had completely normal vitals, wasn’t wheezing, and hadn’t even had puffs yet. She said, “Sometimes people are too tight to wheeze.” And although I knew her words were true, I did not think they were true for this kid. But she wanted him to get a nebulizer treatment so he got one. I wondered, “Why am I even here?”
When I went back to check on him a little later, there was a commotion in his room and I was surprised to see this healthy 19-year-old kid getting an ECG. A nurse-in-training had noted irregularity in his heart rate after an albuterol treatment and a walk around the department. I said, “He’s just having PAC’s! He does NOT need an ECG!”
I treated her how I had been treated in that educational conference.
She saw someone condescending and unkind.
That night, the nurse-in-training’s preceptor sent an email to the charge nurse who sent an email to the chairman of the department, the program director and assistant program directors. I got called in for a meeting. It was the official “you are arrogant and unteachable; lacking in knowledge and commitment; condescending and unkind; and clearly unhappy” meeting.
It was 4 faculty members and me. I listened, but did not recognize the person they were describing. I told them that was not me! And I felt very much that if they KNEW ME, we wouldn’t even be there. I was used to the extra measure of grace that comes with a reputation for goodness and happiness.
But I didn’t have that reputation at Vandy. So I sat with a steeled jaw and took every swing. By the end of the meeting I felt like my soul was bleeding out onto the floor. My ego looked like a cage-fighter after a horrible loss.
I tried hard to hide my brokenness, but it appeared against my will with a crack in my voice at the very end of the meeting. The lump in my throat cut through when I asked them for something I hadn’t earned – something I didn’t deserve. Going forward, I asked them for the benefit of the doubt.
I was asking for grace.
The days after that meeting were my rock bottom. It was the absence of happy thoughts. The unbearable weight of everything. The darkness of being unable to see past the blackness of their perceptions to the light at the end of the tunnel – the end of residency – which was years away. It was the naked humility of realizing I needed help.
I went to Employee Health and completed a depression screening questionnaire:
Do you feel agitated? Check.
Do you cry a lot? Check.
Do you feel hopeless? Check.
I checked enough boxes for a psychiatrist to prescribe me Wellbutrin. I knew much of my depression was circumstantial, but I couldn’t imagine surviving without something changing.
I took my first pill the next day. Wellbutrin is different than many SSRI’s in that is has a more immediate effect. The very first day I took it, I felt like this:
Oh, there you are, Kristin!
The anti-depressing truth about happy pills is this: They work.
Wellbutrin gave me back some happy thoughts. It gave me the will to face perceptions I did not recognize.
And now we come back to the elephant…
Residency forced me to look for what other people were seeing. I looked hard and realized:
Holy cow…I have an elephant’s ass!
The ugly attributes those people saw were not misperceptions. They got an up close look at my elephant ass and they were right about what they saw. But they mistook my ass-parts for all of me. An elephant’s anus is only like 1% of its whole. I am 99% not an a**hole.
And with a little help from my friend Wellbutrin, by the time I left Vandy – I think most of the people there thought I was at least the whole back half of an elephant and not just its anus.
Coming out on the other side of those four years, I felt a buoyancy my soul had almost forgotten. It felt like swimming in warm salt-water – after years of swimming in the cold hard waves of Lake Michigan.
The first Halloween after we moved to Savannah, our family dressed as characters from Peter Pan. I was so full of happy thoughts, I think I might have even skipped a little.
The ‘happy, happy, joy, joy’ perception from high school was real too…but as equally shallow and limited as the negative perceptions from Vandy. I am good and not. Happy and not. I am part gratitude and part bitterness.
I am…a whole freaking elephant.
God knew it would take a gauntlet to show me my own ass. He knew it would take the powerlessness of choices limited by med school debt to humble me enough to ask for help. He knew I needed to be stripped of all pride, all goodness, all happiness. He knew I needed to weep about unfairness and impossibility to understand suffering. He knew it would take all this to change my heart and teach me about grace.
I will never forget how much I needed grace most when I deserved it the least. And because I remember how I felt when I made my plea for them to believe that I was more than what they saw – I am more generous with the benefit of the doubt for others. We are all whole elephants. So when a patient’s family member acts like an elephant’s anus, I try to remember that he, too, is a whole elephant – even if I can’t see it at the moment.
And when you starting giving out grace, a beautiful thing happens – you have more to give.
Grace for me. Grace for you. Grace for everyone.
Grace. Grace. Grace.
PS – Thank you for reading all the way to the end! I know this was a long and you making it to this post-script is a gift to me.
PPS – I never went to therapy; THIS is my therapy:).
Elephant photo credits: Flikr Saskia Jansen (cropped), Therobyn (cropped), and Dave Miller respectively, creative commons license.