Residency Ends. The Conditioning Doesn't.

A few days ago, my husband and I were talking our dog through the neighborhood when a child came barreling down the street on a bike towards us.

A walkie-talkie crackled and I spotted another young girl at the top of the street, yelling into her own walkie-talkie. “It’s the red fire hydrant! Repeat, the red fire hydrant! Over.” The girl raced down the street towards the hydrant and I reflexively jumped back. It was loud, there were flashes of movement. I sensed urgency and too much activity.

“What are they doing?” I asked.

My husband looked at me.

“They’re playing.”

Playing.

It sounds ridiculous now, but the idea genuinely hadn’t occurred to me. 

I knew, intellectually, that children play. I was not under the impression that this six-year-old was conducting a military operation (although I couldn’t 100% rule that out). But when confronted with a scene I didn't immediately understand, my brain skipped right past the possibility of play and moved directly into fight or flight.

What’s happening? What’s the objective? Is there a problem? Is there danger?

If you know anything about me, you would know that I did not have a typical childhood (or maybe it is somewhat typical for this audience). I spent most of my childhood alone or with adults, and primarily pursued academics. I wouldn’t say that I played very much. So when my husband explained that these girls had likely just made up some sort of game and were acting it out, it took me a moment to accept the idea.

And the more I thought about it, the more I realized that I may truly not have the capacity to simply, play.

In my life, everything that I do needs to have a purpose. An outcome. Residency did not create this tendency (plenty of driven, ambitious people that end up in medicine arrive with these predispositions), but residency does have a remarkable ability to reinforce them. I suspect that even if I did arrive at medical school as a person who enjoyed playing, my residency experience would have ground that out of me.

I never really subscribed to this, but I could recognize that in medicine, simply being busy became evidence of commitment. Exhaustion was a sign of dedication. Sacrifice was seen as the only way forward. Missing weddings, running on no sleep, staying late for extra cases, working through illness - these were the badges of honor. And even if I resisted them, I began to internalize all of it. 

Things that felt easy must not be worthwhile. But if it hurts, and I don’t like it, I’m probably at least doing something right. 

I left surgery over a year ago. I no longer work in a hospital. I don't have a chief resident checking on me or an attending auditing my productivity. No one is asking where I spent every minute of my day. Yet I still catch myself behaving as though someone is. 

When work goes well, for example, I do not experience uncomplicated satisfaction. If a project takes less time than expected or a problem that once consumed an entire afternoon can now be solved in thirty minutes, my first instinct is not relief but suspicion. I find myself wondering whether I missed something, whether I could have done more, whether I should immediately fill the recovered time with another task. Even now, there is a persistent sense that productivity should feel difficult, that worthwhile work ought to demand a certain amount of suffering.

Sometimes I’ll work from 8am - 10pm, have no idea where the entire day went, and maybe not even have something concrete at the end of it to show for it. Everything I’ve done throughout my life has conditioned me to ignore hunger, thirst, exhaustion, headaches, and basic bodily needs, and up until now, it was completely acceptable amongst my peers and colleagues. Unfortunately now my main colleagues are my dog and cat, and they don’t like to skip meals.

Changing jobs didn’t change any of that. Leaving medicine certainly didn't erase it for me. The tendency to overwork, to ignore physical cues, to view my worth through the lens of output, survived the transition rather completely intact. The hospital is gone, but many of the habits remain.

That’s why I can’t stop thinking about those kids on their bikes. They were just…biking and laughing. They weren’t following any specific instructions or working on their biking form to become the best bikers in the neighborhood. They weren’t doing it because it would pay dividends later. They seemed to just be doing it because it was fun. 

The older I get, the more important that idea seems to me. I am starting to understand, not just the benefit (although I do genuinely think more unplugged enjoyment makes better doctors (sorry couldn’t help myself by mentioning a specific positive outcome)), but the necessity to stop evaluating every activity according to its usefulness. We became so accustomed to asking what something would produce that we forgot there are experiences whose value lies entirely in the fact that they produce nothing at all.

Medicine teaches many lessons worth keeping; discipline, responsibility, persistence, service, to name a few. But I am no longer convinced that relentless productivity deserves to be on that list. It may take me years to actually unlearn many of these habits, and you probably won’t catch me racing around on a bike any time soon, but I suspect that the most important skill I can develop is the ability to occasionally do something for absolutely no reason at all. And trust that my world will keep on turning even when I do.