Finding my way toward wholeness

(A.k.a., how I developed even more admiration for event planners)

I had heard rumors about residents “living the dream” during the fourth year (PGY-4) of residency, but this sounded facetious when I was a junior resident. I was decidedly skeptical given how my PGY-3 year unfolded, and how heavy it eventually felt. In my residency PGY-3 is a year devoted to outpatient work, with a numerical reduction in call shifts compared with the PGY-2 year, but still a substantial call burden. For better or for worse, my PGY-3 call shifts were stacked in the first half of the year, which meant that by the time January 2022 came around, I had more free time but was also tired. The learning curve of full-time outpatient work was quite steep, mostly in constantly calibrating my sense of responsibility in a context where my patients continue to be my patients even when I am “off the clock” (i.e., not responsible for checking MyChart or voicemail messages).  From a pandemic perspective, my memory of 2021-22 was that wearing masks, filling out health screeners, and thinking carefully about my risk tolerance for each activity had become my normal, though I know we all have yet to fully comprehend the allostatic load we have carried since 2020. These aspects aside, I knew that I was enjoying outpatient work. I particularly treasured the connections I was forming with patients through interactions lasting more than a couple days or months, as well as the opportunity to dig into psychotherapy learning and practice. 

Beyond psychiatry, what made the second half of PGY-3 unexpectedly difficult were the non-clinical responsibilities I intentionally took on: a leadership role in my resident community, followed by the transition to becoming a Chief Resident during the last couple months of the academic year.  In the spring of 2022 two co-residents and I began planning our annual residency gala, the first in-person gala since 2019. I naively thought that as a highly organized person, being the lead planner for this large-scale event would be busy but manageable, even fun! In large part because our residency budget didn’t extend to an event planner, I gamely chose to forget the many reasons why event planners are (often) highly paid professionals with honed skills and not full-time medical residents. And so began months of collaboration to pull off a gala for over 100 guests in a brand-new building that had hosted very few large events and had stringent rules to prevent damage to the building’s shiny newness, and also following campus pandemic event guidelines that evolved during the planning process. My residency director, who had also led planning of this event years prior when he was a resident, sympathetically pointed out that we were  planning a (stringently budgeted) pandemic wedding minus the wedding party. I learned a lot about tablecloth sizes, catering options, and loading docks. I learned that it’s important to have more trash cans than you think will be needed, and that I can become quite obsessive about double-checking RSVP lists.

On the evening of, even though my multi-page color-coded setup schedule was partly disregarded (and, let’s face it, was never going to be fully read by all parties involved), everything still came together: the guests were festively dressed, the drinks were cold and plentiful, the food was warm, the decorations were glittery, and there were plenty of smiles, funny videos and heartwarming speeches, broad smiles and rounds of applause.  Blessedly, no one balked at the pre-event testing requirements, and no one contracted COVID from the event!  I felt like I was in a dream state, too preoccupied with the logistics and timeline to feel present. At the end of the night, after the custodial staff had left, and after I had finished boxing up the decorations and doing a final walk-through, I knelt in the building lobby to scrape and wipe away the bits of red velvet cupcake that had gotten smashed into the metal grates inside the building entrance. Then I went home, drank some leftover Prosecco, finally ate some of the cupcakes whose flavors I had painstakingly selected, and cried tears of exhaustion and relief in the shower.

A week later, I started experiencing stress-induced gastrointestinal symptoms.  They lasted for a full week and then gradually improved, but as PGY-3 ended in June and PGY-4 began in July, I felt a physical and emotional brittleness that was difficult to accept, and a seething frustration that planning a party—to be sure, an important residency tradition, a celebration of the program and welcome of the new interns, and great to have in-person again, but still, wasn’t it just a party?—had taken such a toll on me. So fierce was my inner critic and sense of duty that I chastised myself for not being resilient enough, for letting myself get so worn down by the tasks associated with my leadership role, instead of reminding myself that it was more than a party, that all the emails and budgets and decorations and cupcakes added up to something consequential and valuable to have created with and for my colleagues.

I couldn’t feel a difference at first, and at the start of PGY-4 I suddenly felt apprehension and fear that I hadn’t learned enough during residency and wouldn’t be competent enough to practice as an attending. Gradually I settled into a schedule with much more self-determined and flexible time for my chief resident work and scholarly work, also with very few call shifts. I got used to working with greater autonomy in my clinics. I received (and continued to give myself) repeated reminders that residency is only one stage of a physician’s growth, and as I continued to learn from my mentors and clinical teachers and simultaneously took on more mentorship and teaching of junior residents, I began to feel more confidence in my clinical skills and my ability to continue growing as a psychiatrist.  By the middle of the year, I felt a noticeable strengthening in both body and mind.  The inner critic remained, of course, but so too arose a more assertive sense of self, a confidence in my values and choices. As my work with patients, my psychotherapy training, my process group with colleagues, and my own psychotherapy all deepened, I became increasingly appreciative for the training experiences of the prior three years — even the gala planning process, because it was a litmus test for how I responded to a certain kind of stress and external demand at that point in my life. And, I was certain that I chose the right career path for me.  I love working with my patients, and I believe that my work is a calling and a source of great meaning, even as I am learning how to work in a way that does not define or monopolize my life.

Since the start of 2022 there have been some painful times for my family and me, and there remain uncertainty and strain that we are navigating. (Last March, I was in the middle of our residency retreat when I found out about a death in my family. This is a story I have not yet figured out whether or how to tell). One of the greatest blessings of my life remains my enormously supportive partner, with whom my connection has also been strengthening and growing. I have also felt bolstered by intentional time spent with people I care about, including family, old friends, and newer friends. At the start of intern year, I did not expect more than cordial or friendly relationships with my co-residents, but one of the unexpected joys of the past couple years has been the transformation of working relationships into richly meaningful friendships.

And, it is with genuine pleasure that I slowly been finding my way back to writing (I’m writing again!), and to my other great love, that of music. Since I was four I have played the piano, and I took lessons throughout college, but after the first two years of medical school my playing rapidly dwindled. It felt difficult to play as a hobbyist instead having the identity of music student, and I missed having time carved out in my schedule for practice, lessons, chamber music rehearsals, and performances. After graduating college I bought an entry-model digital piano on Craigslist, and I set it up on an X-stand in each of my subsequent apartments.  Finally, in 2020 my birthday gift to myself was a Yamaha Clavinova. Though I don’t play every day, I have become reacquainted with some favorite pieces by Beethoven, Chopin, and Schumann, have found myself noodling around or playing by ear again, and have started slowly learning more music.

In January, I attended my first SF Symphony concert since before the pandemic. I turned my phone off completely and got fully immersed in the program of Messiaen and Villa-Lobos. In February, I was blown away by a performance at SF Jazz by vocalist and trumpeter Bria Skonberg, and later on by ukelele virtuoso Jake Shimabukuro.  In March, I attended SF Ballet’s production of Giselle. At all of these events it felt indescribably good to be present, to in the music and artistry, to turn the person next to me and marvel with them at the magic of what we were seeing and hearing.  

My work as a psychiatrist and chief resident continues to have its demand and challenges, as is my personal work of healing and growth in psychotherapy.  But, I am grateful to discover what it is like to have the time and space to firmly set my work down. I have felt nearly giddy to learn that I still have the capacity for play, the ability to hold beauty and lightness. Even a year ago my inner critic might have called these pursuits frivolous, but I now know they are anything but: that having found some capacity for rest and play means I am becoming less brittle, more resilient, more expansive, and more whole.