Crying In The Bathroom: On What We Forget About Residency

Six weeks shy of the end of residency, I thought I was done crying in the bathroom. 

Turns out, I was wrong. 

I've steeled myself over 4 years of med school and 6 years of residency: adapted to chronic pressure and friction, like the ulnar side of my thumb where my needle driver sits.

But despite all my defenses — and despite the respect and collegiality I feel I've earned over six years of service — here I am, perched in a bathroom stall, trying desperately to quiet my sympathetic nervous system and get back to work.

I took a picture because I know I'm going to forget this part very soon. Everybody does.

It's called betrayal blindness, a theory developed in the nineties by psychologist Jennifer Freyd at the University of Oregon. It goes like this: when you are treated poorly by a system that you rely on and cannot leave (like residency), you tend to forget the betrayal, because that's what your brain needs to do to keep functioning. It's a little bit cognitive dissonance, a little bit Stockholm syndrome.

Combine that with chronic sleep deprivation — another well-studied memory killer — and you've got a perfect recipe for the multi-generational amnesia of our profession.

"Back in my day, we didn't have duty-hour rules, we just worked until we dropped and then regretted the cases we missed while we were unconscious."

Sound familiar? Residents hear statements like this all the time, and each time they are uttered, they shut down any meaningful criticism or conversation about how residency works.

It's sad, when you think about it: the doctor who said this is somebody who went through a traumatic experience that also gave them all of the skills they use every day in their work. Their brain can't accept that what made them great could also have hurt them. So, the brain says to itself, the hurt must be the greatness.

Many people go through bad stuff that makes them stronger, but it can be simultaneously true that the thing was bad, and what you took from it was good. Things like war. Childhood trauma. Radioactive spiderbites.

These kinds of statements are, at best, unhelpful. They are not shared in the name of commiseration or empathy, but rather — consciously or not — as a mechanism for enforcing the status quo. This is what keeps residency going: the perpetuation of suffering as a value within a strict hierarchy. But you can't climb the ladder, because no matter what you give, the person before you always, pieced together by their flawed memory, had it worse.

So you build a ladder of suffering beneath you.

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.

When somebody tells you how much worse they had it than you, recognize that there is a version of them, in the back of their mind somewhere, who is still crying in that bathroom. You're looking at someone with unprocessed trauma, unable to do anything with it except pass it along.

I took this picture because I don't want to forget. Alongside all of the good I will take from residency, I want to remember that this system we all depend on is broken.

I am not going to forget. 

I encourage you not to forget either.