At The End of Your Rope With No Carbs in Sight

Hires_Lives Matter_Villareal

Acrilyc Painting: “Lives Matter” by Daniel Villarreal, PhD

It is not a secret that medical school is expensive and residency is no walk in the park. It is almost as if they make medical school so outrageously expensive just to incentivize residents to finish residency even when it feels like death by a thousand daggers. Any morning that I wake up and reconsider my choice, I remember a quarter million reasons to keep chugging along. Disclosure: a large portion of this debt was used to fund my binge eating tendencies.

Nonetheless, I elect to forge on with residency, and more days than not, I love what I do. Sure, rainbows and butterflies are pleasant moments to recount, but I will use this time instead to take you through the lowest of the low: night-float a.k.a. where reality is to expectations as raisins are to plump, luscious grapes.

Every week of night float begins with my “last supper,” where food wrappers are the only disciples that surround me. Deep down, I believe I will someday eat my way out of my inevitable fate, possibly via a five day bout of food poisoning.

Once I come to terms with not having achieved food poisoning, I begrudgingly walk to work. The soundtrack of this trek varies from Lil Wayne to The Backstreet Boys. Okay I lied, it’s 80% Backstreet Boys, 15% ABBA and 5% Lil Wayne (usually by accident).

By the time I arrive at the hospital to the tune of “I want it that way,” I have convinced myself that I’m a rock star and will 100% crush it, providing excellent-ish patient care. This is the first lie I tell myself.

This lie becomes blatantly obvious when I walk into ten or fifteen patients sitting in the psychiatric emergency room with three waiting to be seen. I imagine storming out in a huff due to the overwhelming nature of the work, but I just put on my big girl pants and get to work.  

Before I know it, it’s 7AM; graham cracker crumbs cover the floor and 18 patients have been seen.  The second lie I tell myself is that the rest of the staff had partial blame for the graham cracker situation.  

The remaining four shifts go something like: eat, sleep, eat, work, eat, Law and Order SVU, sleep, eat, work… you get the gist. To sprinkle in a bit of positivity, there are moments of excitement in those nights. Being the only physician in the psychiatric ER makes you feel a bit like a cowboy in the Wild West, calling shots and making things happen.

I guess you are all thinking, “Nina, you sound a little bit bitter…what’s the point?”

The point is this “path of greatest resistance” has a function: it exponentially increases your competency and capacity to endure stress. This, I begrudgingly acknowledge. The endurance of stress is vital in psychiatry because it’s what sustains you when patients are in crisis, you’re at the end of your rope, and there are no carbs in sight.  

Nina Wylonis is a second year psychiatry resident at Penn.