Heart of EM, Wellness

Heart of EM: Who Are You Competing Against?

Over the past 2 years, the South Zone of my hospital’s ED has become a sort of home. I know the workflows, key codes, and where to find the freshest graham crackers.

Most importantly, I know the doctors and nurses, the clerks, pharmacists, and techs; coworkers who are really more like teammates. At its best, that familiarity is comforting. Other days, it is paralyzing. 

I feel driven to impress. To wow. To razzle-dazzle ‘em. Like a child seeking a parent’s approval, I need to show my team that I am a confident, compassionate, decisive, and highly skilled emergency medicine superstar on the rise. At first, I thought this pressure to awe was the result of years of competition. After all, to get this far, I had to beat out thousands of other students for that college admission, that med school acceptance, that residency match. I told myself it shouldn’t be a competition anymore; I had made it, hadn’t I? But the shame I felt whenever I made a mistake was still there. I still beat myself up for not ordering the antibiotics soon enough, being slow to answer an attending’s question, or not seeing the pathology on the CT scan that seemed clear to everyone else. I watched residents with the same amount of clinical experience lead resuscitations and wondered how they could seem so at ease. I tried to model the same confidence but always fell short.

I genuinely like my co-residents; I want them to do well and I cheer them on. Yet part of me couldn’t stop seeing their successes as my failures. I championed wellness initiatives, taught medical students to suture, ran marathons, and cultivated my personal interests. Still, what did that matter when my other residents were being inducted into national honor societies, or publishing papers, or landing jobs in hot markets? Moreover, what did it matter in the emergency department? All I wanted was for my ED team to see me as equally capable – instead I felt stuck at the bottom of the pile, the last choice when no one better was around.

I’ve come to realize the competition isn’t my colleagues – it is myself I am trying to beat. As an intern, my program director told me I was “stuck in my head.” As I began my third year of training, I was still leaving the hospital feeling like I let someone down. Some days it was myself, others it was my patients or my coworkers. And that feeling – of being a disappointment – was slowly turning into something worse: the feeling that I was a failure. Things might have been better if I could have truly believed the praise that I did receive. Instead, it was easier to let criticism sink into my bones and allow affirmation to run off like water. Stuck in my head, my own worst enemy.

I don’t think I am alone in this sense. 

We all carry a burden, invisible to some but crushing to us who can feel the weight. It can bring you low even on good days, and sink you further on the bad ones. Maybe it is a traumatic case that continues to haunt. Maybe it is feeling caught between personal and professional commitments. For me, it was the feeling of not being good enough to truly belong. Call it imposter syndrome or call it something else, but once you know the feeling, the name is irrelevant.

But recognizing that I struggle with insecurity allows me to face it.  If this is a competition, that means I can win. When I try and fail, I can choose to pick myself up again, dust off the hurt, and get back to work – I can be better. I can refuse to let me beat me. I can continue to dwell on comparisons and ideals, or I can take pride in the skills I have cultivated. It is easy to lose perspective on the road to becoming a physician, but when I let myself look back, I am impressed, wowed, razzle-dazzled even by how much I have grown. I can look at my strengths, accept that they are different from the strengths of my colleagues, and see them as valuable. I have started to ask “What next?” instead of “What if?”

Emergency medicine is hard. As a mentor and colleague once told me, “We are normal people having normal reactions to abnormal situations.” Look out for your colleagues, and look out for yourself. When you sense that you are struggling, I hope you can step back and ask why. I suspect, ultimately, the roadblock is not another person or a workplace. Feel the burden you are carrying and lift it higher. You are stronger for having carried it. Don’t let you beat yourself.

Dr. Busman is a PGY3 EM Resident at Spectrum Health/MSU in Grand Rapids, Michigan. Her professional interests include advocating for resident and physician wellness. As a medical student she served as the president of her school’s wellness committee, and she is currently a co-chair of the GRMEP Resident and Fellow Wellness committee. She is a Wellness Leadership Fellow through CORD and has been invited to speak as a panelist at Schwartz Grand Rounds.

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