9- Homesick at the Hospital?

I Want to Be a Doctor

Welcome to the I Want to be a Doctor Podcast where insider information about what it takes to become a physician is available for anyone. I'm Dr. Robin Dickinson, a board-certified family physician and I will give honest answers to your questions. Today's question is from someone who is just starting medical school who asks “Did you get homesick when you had to keep staying at the hospital all night?”

You know, that’s something I worried about too. And yes, I did get homesick. But it also wasn’t as bad as I thought it would be.

So for those who don’t know, when you’re a 3rd or 4th year medical student or and intern or resident, you do a lot of rotations in hospitals. People who are in the hospital or have just arrived at the ER don’t just have problems during the day, they have problems overnight too. So every single role in patient care has to have staffing overnight. You need people to clean the rooms, push patients around in wheelchairs and beds, people to take xrays, people to draw blood, nurses, doctors. What’s different for medical students and residents is that their shifts can be 28 hours or longer. There are certainly other professions where this is the norm (firefighting springs to mind) but for people going into medicine, it’s rarely their goal to work 28 hour shifts for the rest of their lives so many people either haven’t thought about that happening during training or have felt anxious about it.

In the United States, depending on your rotation, you may be having a 28 hour shift as often as every 3 nights. In some countries there are stricter duty hour rules and in some countries there are no rules at all and students and residents may be on duty for days at a time.

When I was in medical school and residency, we were usually limited to 30 hour shifts. When a doctor is responsible for patients overnight it’s called being “on call.” Depending on your situation, being on call can be as easy as taking a couple phone calls overnight from home. But when I was training, being on call for medical students and residents always meant being in the hospital overnight and planning on working all night and sleeping if we were lucky. I rarely slept and often worked 80 hours or more a week.

What sets doctors apart from other types of clinicians such as nurse practitioners is the huge amount of training and experience we get. I read in a book by Malcolm Gladwell that doctors have 10,000 hours of training by the time they practice independently. I did the math and I certainly did! So there are benefits to this and also hard things.

So to get back to your original question...yes, I did get homesick. The first time was actually one of the worst for me because it was new and different and I recognized that this was the beginning of years of this sort of schedule. I felt like I was leaving home forever and never seeing anyone ever again. Of course, I wasn’t really. But that’s how it felt. I wish I’d heard more about how fun call can be and that you still have time for what’s really important to you.

My low point that night was around 11 pm when the resident in charge of me was quizzing me on all sorts of things that I might have known earlier in the day, but I’d been working about 15 or 16 hours at that point and I was brain-fried. I almost cried but I kept trying. I remember sitting there in a room with flickering fluorescent lights and no windows and feeling like I was trapped in this crazy prison.

Finally I just said that I wasn’t okay. My resident completely changed. He showed me where there was a fridge that always had pieces of chocolate cake. He showed me the resident rooms where some of the others were watching a movie and had made popcorn even though it was against the rules. A lot of hospitals have a rule against microwave popcorn because of the problems it causes if a smoke alarm goes off. And he showed me how fun it is to take care of patients at night when there aren’t very many attendings and we got the opportunity to do things we usually couldn’t do during the day. He introduced me to some of the nurses who worked the night shift and were fun to hang out with.

And those are really the things that helped me for the rest of my career. I found that small treats always helped, whether that was new yarn to knit, a favorite snack, or a magazine. Focusing on the patients and what I could do right then, staying focused on the moment instead of thinking about what could be. And spending time with other people. The hospital is full of people who have to be awake anyway and have the time to visit for a bit.

I often brought something comforting from home. A pillow, stuffed animal toy, or a blanket. If I was feeling sad, I could hold my little bit of home for a minute.

Ultimately, if the homesickness is just too hard, ask for help. When I was in internship (the first year of residency) and working up to 120 hours in a week, I started struggling to function. I felt more and more anxious and depressed, which was not fun at all! But I reached out for help and started therapy for the first time in my life that was really helpful and I wish I’d done sooner. I did end up taking an anti-depressant for the rest of my intern year and I’m so glad I did. It didn’t make everything better, but it made everything bearable.

In retrospect, knowing that I struggled with homesickness, I wish I’d gotten more help with it before medical school so that it wouldn't have been such a problem. Some homesickness is normal but my whole life it always hit me harder than other people and lasted longer. I was so worried that it would prevent me from being a doctor that I pretended it wasn't a problem. But that doesn't make it not a problem. Instead, getting the help I needed would have made it less of a problem later.

So first, know that homesickness is normal at any age. That’s why we have a word for it! And second, if you, like me, struggle with more severe homesickness, know that it doesn’t mean you can’t be a doctor (which I worried about!) It means that you’ll have more compassion for your patients who struggle in various ways because you’ve struggled in this way and it’s something that you get help to manage so that it’s not overwhelming.

For most people, the mild feelings of homesickness will go away quickly as you get used to the new routine and find all the ways that call can be fun and how to still get enough time with your family and friends

That's it for today. Subscribe, share with your friends and mentors; and remember to live the life that is right for you with your personality interests and values.

Please send your questions to me at [e-mail]. That's podcast at d-o-c Robin like the bird school dot com.

Show notes are available on the podcast website linked below.

This episode was sponsored by Dr. Robin's School the first pre-medical curriculum for kids, and recorded in beautiful, downtown Englewood, Colorado.