Progress Notes

You’re surrounded by people who know more, move faster, and seem more certain in their decisions. And it’s easy to shrink in those moments; to stay quiet, to second-guess yourself, to feel like you need to prove that you belong.

Recovery after serious illness is often described in terms of return. We seek return to baseline, return to function, return to life as it was before. But for many patients, there is no clear return. There is only reorientation: learning the contours of an altered body, adapting to new conditions, and slowly constructing meaning within a life that no longer fits its previous form.

I've cried in bathrooms for a lot of reasons throughout residency: acute-on-chronic stress, feelings of inadequacy, the relentlessness of morbidity, and just plain exhaustion. What got me this time was this: no matter how much you give of yourself to residency, it will never be enough. We are all highly replaceable, and systems and institutions won’t ever love us back.

If you’ve had the thought, “What if I chose wrong?” That doesn’t mean you actually did. It might just mean you’re seeing the full picture now.

Huge news out of the American Medical Association this week: resident physician burnout is down to 28.6%! Of course, not long ago, the AMA was reporting that 50% of residents were experiencing burnout, but now thanks to this new AMA-exclusive survey and data analysis, the burnout rate has been cut in half in just 2 years!

The Pitt is far and away the most accurate depiction of residency I've seen on TV. But there's a moment in Season 2 where the Internet’s reaction — and what the show itself seems to say —doesn’t line up with what I’ve seen in my 6 PGYs. 

If you’re in medicine and you feel exhausted, that doesn’t automatically mean you’re doing something wrong. It means you’re in a demanding environment that requires a lot from you; mentally, physically, and emotionally.

Many of you may be reticent, given the doomsday landscape outside our doors, to leave your house and family to attend your shift at work. While we empathize and understand, we also want to remind you of your duty as a healthcare employee to show up for your patients and colleagues, including those involved in non-urgent, scheduled elective surgeries and procedures.

I find myself lingering at her tombstone. I must go. More patients to see. But walking away feels disrespectful. What if I get too busy again to come back? I want her to know I remember.

What happens when a residency program closes and is replaced by an army of NPs and PAs? We found out in 2019. The neurosurgery residency program at the University of New Mexico lost its accreditation, leading to a staffing scramble. Replacing 7 residents at $70k per year required hiring 23 NPs and PAs at an average of $115k per year.

One day, a medical student asks me what it’s like to be a resident. I tell them it’s an incredible opportunity to learn at an accelerated pace. They ask if it’s hard. I tell them no, it’s actually very fair. After all, I am not an employee. I am a Learner. A 28-year-old Learner with a doctoral degree, six figures of debt, a full patient load, and just enough authority to be accountable but not enough to matter. It’s just like medical school, except better. They seem reassured.

Confidence isn’t something you magically gain once you reach a milestone. It doesn’t come with your white coat, your acceptance letter, or your residency badge. If anything, new levels come with new insecurities because now you’re surrounded by people who are just as driven and capable as you are.

If you went to medical school, you’ve built a skillset that extends far beyond residency training. You learned how to think critically, learn, synthesize, and communicate complex information, sit with people in vulnerable moments, lead teams, and make decisions under pressure. Those abilities do not disappear because you did not finish residency or left the bedside.

If you are curious about graphic medicine, this will be a front row seat. If you are an artist, a writer, or a healthcare worker who has ever thought about telling medical stories through comics, I hope this will make the process feel a little less mysterious. And if you simply enjoy stories about the strange human drama that unfolds in exam rooms every day, you will probably find something interesting here too.

I am excited for the diversity of patients, the pace, the warmth, the energy. I am excited to explore new neighborhoods and find my favorite coffee shop. I am excited to become a better physician in a new environment.

Every residency program has a villain. In ours, it’s me. I know the reputation. I’ve heard the whispers in the call room and the half-jokes after rounds. “Malignant chief.” “Hard to work with.” “Impossible standards.” It’s become a kind of folklore in surgical training that every service has a Bad Guy, someone whose job seems to be making everyone else’s life miserable. But if you’re waiting for a confession or apology, you’re going to be disappointed. 

The conversation around The Match has been artificially flattened into a false binary. That we can either keep the system as is, or dismantle it entirely. But that’s not how labor markets work. It’s also not how reform happens. Meaningful change to the current system will likely take years, but this is the time that we should be organizing and advocating for better alternatives. Let’s consider some of them.

The Match almost guarantees that programs will not be incentivized to continually improve and raise the standard of training. If there is no risk of missing out on new residents, or very low risk of current residents leaving, then there are no pressures to improve or even maintain a certain level of training. 

At 2:37pm, three pagers went off at once. There was a new pain consult from SICU, a polytrauma arriving in the ED, and a code occurring on the medical oncology floor upstairs that would need an airway. Fries and half-eaten meals were abandoned with intent to return, although unclear what hour that would be, and the team quickly and dutifully dispersed to attend to their patients.

What Plato understood is that the hardest part of the allegory is not leaving the cave, but returning. When the freed prisoner returns to the cave and tells the others what she has seen, they do not believe her. The shadows still make more sense to them. I understand that instinct deeply. I once shared it. The possibility of an entirely other world, other reality, out there feels too enormous to accept. 

I know I am biased, but dermatology truly is the best residency. Not just because it is competitive. Not just because of lifestyle. But because of the people and the impact.

Hamnet does not argue that grief becomes lighter. It suggests something more modest and more useful: that it becomes more shareable. And in that redistribution, the work of carrying it changes. Not because the loss is repaired, but because it is no longer held in isolation.

Sunshine laws require companies to disclose payments to physicians. The public can look up who received what, but there is no database that reveals how higher reimbursement subtly makes one option more attractive in a surgeon’s mind. There is no report on subconscious patterns. 

No one talks enough about the quiet loneliness of living away from your family while you are building your career. We celebrate independence. We romanticize moving to new cities. But there are nights when the apartment feels too quiet and you would give anything for dinner at your childhood home.

When I was in training, I wish I’d had a resource outlining the harms of sleep deprivation. Here is a detailed summary, formatted as a letter, that can be presented to program leadership.

Away rotations are expensive. Let’s just say it plainly. Flights, rent, food, transportation, application fees. It adds up fast. And when you are a medical student already living on loans, the financial stress can feel overwhelming.

Innovation often comes through the synchronization of our bodies, tools, and contexts. These stories provide a reminder that human potential is realized by embracing our ability to shape and be shaped, and in doing so, generate new possibilities for expression, creativity, and innovation.

If you do not secure a position during the early Scramble, the process is not over. Openings continue to appear throughout the year. I obtained my general surgery position outside the match on July 14th and started residency a month later. I was able to make up for this time and still graduate with my medical school cohort by limiting the vacation I took throughout 5 years of residency; anything is possible! 

Once I’d sent an email advocating for myself in the wake of extreme sleep deprivation on home call, I began having conversations with other fellows and early-career faculty members who trained at our institution. Did they have the same experience of severe sleep deprivation on home call that I experienced?

If you are in the thick of applications right now, I promise you this. The anxiety will pass. The waiting will end. You will look back one day and realize that even the uncertainty was shaping you.

By Aristotelian standards, modern residency training stands in direct conflict with human flourishing. The traits Aristotle identified as essential to a good life are frequently treated as liabilities rather than aims: wisdom and contemplation as hesitation, fairness as softness, moderation as lack of commitment.

A good mentor helps you navigate the tension between ambition and realism, offering guidance that challenges you without defining you. Seek coaches, not cheerleaders, and you’ll not only grow as a physician, but learn how to mentor others with the same honesty and care.

"The ACGME says home call “must not be so frequent as to preclude rest,” and I believe this week the volume of calls has truly precluded rest."

Peele’s film offers a similar warning: harm is often perpetuated not solely by overt malice, but by individuals shaped within systems that normalize exploitation and dull moral alarm.

On behalf of every resident, circulating nurse, scrub tech, consultant, and other colleague that you interact with on a daily basis, I want to apologize for horribly misinterpreting your dedication to healthcare and pledge to respect the sanctity of your tantrums.

You are not responsible for managing other people’s opinions. You are responsible for building a life that feels honest to you. Your job is not to be understood by everyone. Your job is to be brave enough to choose yourself.

This leaves an open question that utilitarianism itself cannot resolve: is medical training merely a system for delivering outcomes or is it also a moral practice concerned with who physicians become in the process? 

The version of you who finally reaches the next milestone will still be you. Still human. Still imperfect. Still learning. Still facing new challenges. If you do not learn how to find peace now, the next phase will not magically fix that.

The choice Maxwell describes is not whether pain exists, but how it is held. Whether sensations are allowed to be sensations, emotions allowed to be emotions, or whether they are immediately absorbed into a story about danger, defectiveness, or loss.

The hidden curriculum teaches that endurance is virtue, silence is safer, and that being treated as less than human is the price of admission. Deontology rejects that logic entirely. If residents are people of intrinsic value, then their dignity cannot be suspended for training. Their humanity is not a negotiable cost.

You are not weak for needing support. You are not failing because you feel tired. You are human living in a system that often rewards overwork and neglects well being.

Progress is not a straight line. Some seasons are about building skills. Some are about surviving. Some are about learning from mistakes that feel painful in the moment but powerful in hindsight. All of them matter.

Visual disturbances became a medium for processing perception and experience. Through color, form, and distortion, these works allow us a rare glimpse into the artists’ perceptual worlds and in doing so, we are invited to reflect on our own ways of seeing.

And yet, The Knowledge endures, diminished perhaps, pressured by economics and technology, but still alive. Its persistence raises a deeper question, one that increasingly applies to medicine: Why do humans still pursue mastery when convenience is everywhere?

Portugal doesn’t offer an idealized surgical life. Surgeons work hard. They juggle systems. They sacrifice time.But it does offer something increasingly rare: predictable protections around life events, time off that is respected, and a public mission that remains intact.

I’ll tell you something I learned slowly and painfully: the day you stop apologizing for existing in the room is the day you start stepping into your identity as a future physician.

While she has proved herself as a capable clinician, Dr. Shah still struggles with the culture of our critical care unit, which is deterring her further development as a member of our team.

Perfection is fragile. It shatters under pressure. Realness is durable. When you understand the journey it took to get where you are, you develop the kind of grit that programs trust.

Simone’s story offers both a caution and an invitation. Chronic pain care often centers on explanation, optimization, and sequencing: once I understand, once I control, then I can live. The subtle cost of this approach is that patients may delay engagement with what matters, waiting for certainty that may never arrive.

At first, consistency feels boring. But then something wild happens. The boring things become your advantage.

These days, my calendar fills itself in healthier ways. Friendships and relationships require time and tending, and I’ve surprised myself with how much I want to give both. The old version of me would have resented the effort, would have seen it as another obligation. Now, it feels like life.

Will medicine ever be willing to admit that calling resident labor ‘training’ only makes it easier to underpay, overwork and restrict the people doing it? Probably not on its own. But with enough people demanding change, there may be a blueprint for how the power imbalance can shift back towards the residents themselves.

Chris knows the American surgeon experience from the inside (the hours, the call, the CYA defensive documentation, the pressure to produce) and now he knows, just as clearly, what it looks like to practice in a system built on very different assumptions about labor, time, and professional boundaries.

Because the truth is, your rank list should reflect where you will thrive. Not where you think you should want to be.

Within this landscape, RuPaul’s Drag Race (RPDR) occupies a paradoxical position. The series offers unprecedented visibility for marginalized identities, including queer, disabled, and chronically ill people, while simultaneously transforming those identities into consumable performance.

Five years ago, I left the OR believing that I had failed. That moment became something else entirely- the first crack in a system that demanded silence. Hippocratic Collective was born from that same clarity. Not just to make another small crack, but to push until the walls finally give way.

Welcome to Multi-D, where I interview colleagues in different specialties. We’ll explore common specialty misconceptions, and ask–what do you wish other specialties knew about yours?Today we’re joined by Maheetha Bharadwaj, who specializes in urology!

“To the best of their ability” means, because they are human, that they will make mistakes. In our profession, when we make mistakes, someone gets hurt. In other professions, failure is necessary for growth. 

Soft does not mean weak. Soft means compassionate. Soft means gentle when the world is sharp.

Physicians are some of the most interesting thinkers alive, but we’ve been conditioned to hide our ideas inside academic journals and conference rooms. TEDx is not about becoming famous. It’s about giving language to something people already feel, but can’t yet articulate.

This piece is not an indictment of the French system. It is a confession. And an acknowledgment that, in several crucial ways, the United States treats surgeons - and medicine itself - with a seriousness that France has gradually eroded.

The problem is that life does not follow a checklist. Life is not linear. And trying to control the timing of everything is the fastest route to disappointment.

Residency was never designed with lactating physicians in mind–nor should it be. We're certainly the minority. As medical education and training evolve, it's time to make breastfeeding "okay" for residents. 

Beneath the victory lap in some of these “I proved them wrong” videos lies a deeper nuance worth unpacking: first, the trap of building your choices around “proving them wrong,” and second, the role of a good mentor: someone who tells it like it is and gives balanced guidance, even when the odds are steep.

For a long time, I exhausted myself trying to correct every misunderstanding. I wanted everyone to see my intentions, my heart, my work ethic. Until one day I realized that trying to control how people perceive you is a game you can’t win.

Sitting in a Paris café, listening to Samiya describe a different world: one where residents are not crushed, where surgeons have time to think, where rest is designed rather than stolen, our conversation led to the simple realization...

As pediatrician Dr. Harvey Karp explains, fast-food restaurants actually model one communication skill remarkably well: when you place your order, the cashier repeats it back to you. They do this because clarity and confirmation matter. And, importantly, the hungriest person—the customer—always speaks first.

I wish someone had told me in those early days that confidence isn’t something you unlock once you finally “deserve” it. It’s a skill you practice, especially when you feel small.

For physicians, it’s a reminder that therapeutic relationships can serve both as a lifeline and a site of emotional vulnerability, one that we must honor and care for.

But here’s the truth: you can be humble and still proud. You can be grounded and still celebrate yourself. You can take up space in your own story.

Being on call for Thanksgiving is hard in a way that’s difficult to explain unless you’ve lived it.

Oral & Maxillofacial Surgery (OMFS) combines the art of dentistry with bony reconstruction and soft tissue management. The bread and butter of OMFS - dentoalveolar - entails implant placement, preprosthetic surgery, extractions and orthognathic surgery.

I think everyone in medicine has that moment. The one where you look around and think, What if I don’t belong here?

When moral and political ideologies make accessing care so adversarial, people internalize these beliefs. Pain becomes a personal failure; seeking help becomes immoral. 

The question isn’t how to eliminate conflict. The question is how to relate to one another with integrity while maintaining healthy boundaries and a willingness to engage in necessary, honest conversation.

Even though I won’t be an attending until my late 30s, I don’t consider myself “behind” by any measure. Focusing on what I value, rather than chasing what’s conventional, has made this journey deeply rewarding.

Transparency isn’t just about sharing test results or surgical details—it’s about being accessible, accountable, and human. Giving my email address is one small way to prove that the door is always open.

I’ve learned to see every new chapter as a chance to reinvent myself. To do things differently, to be a little kinder, a little braver, a little more myself. There’s a strange kind of peace in knowing that reinvention is always possible.

I’ve gotten a lot of advice over the years, some of it brilliant, some of it questionable, and some of it so odd that I didn’t know what to do with it at the time. Here’s the funny thing: the weirdest pieces of advice are often the ones I carry with me the most.

Because somewhere between the exhaustion and the uncertainty, there’s still that quiet spark — the one that made me want to do this in the first place.

Shelley’s own experience of medical loss gives this story its emotional force. Frankenstein is a musing of how easily medical advancement and harm can become entangled. Medicine continues to live within that tension.

When people think of medicine, they usually picture the sacrifices: the long nights, the missed birthdays, the student debt, the countless hours spent in libraries and hospitals while the rest of the world keeps spinning.

Welcome to Multi-D Specialty Board, where I interview colleagues in different specialties. We’ll explore common specialty misconceptions, and ask - what do you wish other specialties knew about yours?

Sometimes it’s the sting of a rejection email, sometimes it’s a low test score, and sometimes it’s the quiet voice in your head asking if you really belong here. I remember the first time that voice nearly won.

The idea of art as therapy is often sentimentalized, but in Sesow’s case it feels exacting and unsentimental. His paintings present the raw psychological labor of trauma recovery.

When I applied to Family Medicine, the hardest part was narrowing down over 700 programs.‍ For dermatology, the hardest part was the math: a match rate under 50%, and even lower for prior-year graduates.

"How do you keep joy alive in medicine when the hours are long and the pressure is high?"

“Do you have imposter syndrome? How do you deal with it?”

"How do you keep showing up for yourself when you’re feeling burnt out, especially in medical training?"

‍The terror of Rosemary’s Baby lies in its all-too-human realism. The film externalizes the fears many pregnant people face: of being silenced, isolated, and stripped of agency during one of life’s most vulnerable phases. That’s why it remains a horror classic, and why it continues to speak loudly to the fears and lived realities of today.

“I feel like everyone else is doing more than me! From research, to leadership, and awards… I’m just trying to survive. How do I stop comparing myself?”

Ever since I started sharing my journey switching residencies, the number one question I receive is: “How did you tell your program director? And how did they react?” 

Rotating at a new hospital, at a new clinic, in a new city, surrounded by people who already seem to know each other, can feel a lot like being the new kid in middle school.

When I think of that first month, I don’t remember the chaos of lists or the panic of conversions. I remember the registrar handing me a flat white, the phrase “soft seven” curling into the air like steam. It turns out not everything has to begin with a jolt.

“I love to travel and I am so worried I am going to have to give that up when I start medical school. How did you make time for the things that you love?”

While Succession is widely known as an epic saga of corporate power and media empires, at its core it is a story about family under stress.

When my patients left with new diagnoses, I sometimes felt like I had drained the joy out of their visit. That’s when I started questioning whether I could do this work for the rest of my career.

“I just started medical school and I am in a relationship that I really want to work. He doesn’t have anything to do with medicine and I am scared it wont work out because of how hard it already is.”

Regardless of your specialty, you’ll face moments like this—moments when you must act outside your comfort zone. These moments don’t just challenge your clinical skills; they challenge your self-concept.