OK. I wanted to wait til I had some time to sit down and write a thoughtful response. As some background, I'm a PGY-10 currently in a pediatric craniofacial fellowship. I did a general surgery residency at a fairly traditional Northeast program, then a plastics fellowship, and now this fellowship. FWIW, I'm also a woman, although I think for the most part a lot of what you are going through is a somewhat gender neutral experience.
This is going to be a little long and rambling. I thought a lot about your post, and did some reflection about where I was emotionally during the first year or so of my training.
So let's start with the fact that intern year SUCKS. For everyone. Especially this time of year. As an intern, you are literally the lowest person on the totem pole in the entire hospital. Everyone, even the janitor, knows more than you do. You have to do the jobs no one else wants to do. If you are in a program where you get to go to the OR a fair bit, at least you can start to see the payoff, but otherwise you can often feel like you have forgotten what drew you to the field to begin with. People tend to say intern dysphoria hits around Jan/Feb, but honestly I think March/April was the low point for me. By this time you now know how to do "intern things" and are ready to move up to the next level, but you still have THREE MONTHS of being the service whipping boy, and by this point the senior residents are starting to check out emotionally, and everyone is kind of ready for the year to be over and it sucks.
Everyone has a different response to stress like this....mine is often to stress eat, drink too much, stop working out, and convince myself that I "deserve" to spend all my free time on the couch binge-watching netflix. Cue weight gain, emotional lability, and general feelings of worthlessness. I remember sitting in the locker room crying after a case, hiding in the bathroom to cry after rounds, and at one VERY low point basically bursting into tears at the nursing station when my awful chief resident yelled at me in front of the entire team and told me I killed a patient (I didn't). I gained 10 pounds on easier rotations, then lost them again on trauma and vascular. I was told I was disorganized, too tentative, technically inept, weak, sloppy, etc etc. I think my absite that year was 40th percentile.
So all of this is to say that what you are going through is NORMAL for intern year (and not just for surgery, medicine intern year is no joke either). And yes, the things that made intern year miserable for me did get better. I started operating more, getting more responsibility, I started to see my skills (at things like central lines, gallbladders, hernias, etc - not discharge summaries and TPN forms) improve exponentially, and suddenly everything got much more fun. I ended up being one of the more highly-regarded chiefs of my year and got a great fellowship. This will happen for you.
BUT there are things that will not get better. The hours you are working may improve SLIGHTLY when you don't have to pre-round, but you're still going to be getting up early and getting home relatively late. You probably aren't going to get a ton of positive feedback. People are still going to be upset when "minor details" get missed. And they should, because minor details in surgery can become major ones pretty quick. You're training to develop the neuroticism to check each patient's flowsheet carefully once you're an attending, to double check postop orders, to confirm that every task on your to-do list is done before you go home, because if not, people die. And honestly, while this is true for a lot of medical specialties, it's particularly true for surgery, in which most of our patients undergo a huge physiologic insult and we need to carefully ensure that they are recovering appropriately from it. And like
@dynx and
@dpmd alluded to, this isn't necessarily specific to surgery (Although surgery is a little more fast-paced and demanding), you are going to have long hours and little appreciation in pretty much any residency program that isn't something like dermatology. Not to be dramatic, but you are training to develop the mental and physical fortitude to be able to make quick decisions, think logically, and be attentive to details when you are tired, your kid is sick, your dog just died, you had a fight with your spouse, whatever.
So here comes the tough love part. I think you need to do some introspection, with a mentor or a friend, about why you chose surgery. You say that breast surgery particularly resonated with you - if that is because you enjoy women's health, working with a multidisciplinary oncology team, and guiding patients through their cancer treatment, then yes, you can probably find that same satisfaction in another field like medicine (with subspecialty in oncology perhaps). If you enjoy being in the OR and doing some procedures, anesthesia may also be attractive.
But if you really do love surgery, and operating, then I don't necessarily think you will find that elsewhere. For me, no matter how bad things got, I knew that surgery was the only thing I would ever be happy doing. And if you want to be a surgeon, you need to accept that becoming a surgeon comes with an intense training regimen. You SHOULD be in constant anxiety about missing something, not because "someone will yell at me" but because in just a few short years that is going to be YOUR postop patient and if you miss the fact that the urine output has been dropping for the last few hours, that little old lady is going to go into renal failure from ATN. Your seniors are teaching you to develop that hypervigilance that makes us wake up in the middle of the night and double check that repeat H/H got drawn. That's why they are beating you up over missing little things - the devil is truly in the details in surgery (and honestly, in most medical fields too). It does get easier, as you will start to learn what are the important details and what aren't, and as you transition to a more senior role you will develop more "big picture" thinking. But it's not going to go away, and it's not because people are being mean or unfair.
Your evaluations and ABSITE performance indicate you're doing great, keeping up with reading, and performing at a strong level which I promise you puts you ahead of a lot of your fellow terns (and me when I was your year). So keep that up!
Now. Let's talk about this whole gender thing. You say "I wasn't going to let my gender deter me" from your surgical dream. Yet your entire post reads like you're defining your performance and your difficulties by your gender. Let's be realistic here - female financial executives on Wall Street work 16 hour days on a regular basis and they have to do it in heels and a power suit. You are not struggling because you are a girl. You are not defying some stereotype by being a surgical resident and a girl. No one is going to give you extra sympathy because you're a girl. You can still be a well adjusted and happy young woman and a surgical resident. Yes, you have to get up early. Yes, you have to hit the gym after work when you're tired. Yes, you have to meal plan ahead, pack your lunches, take the stairs on days you can't work out, get up twenty minutes earlier to do your hair and put on some makeup, smile when you're tired and cranky. You need to plan ahead when you need time off, go through the proper channels, and then take it and ignore people who make snide comments. You have to do all these things as a professional woman no matter what field you are in. I think we (and I'm including myself in this) sometimes tend to over-dramatize how hard we have it as girls in a stereotypically male dominated field, but let's be honest. It's not 1950 any more. Your male colleagues for the most part are going through the same stuff you are. I think one of the worst things we can do as women in surgery is complain about how we have it so much harder than the boys, and I really try to stop myself any time I do it. It's a self-defeating path with no positive outcome. I promise, you can still be a happy, healthy, emotionally fulfilled woman and be a surgeon.
I'm going to sum all this up by saying I don't think you should quit. I think you are experiencing a lot of intern blues that are very common at this time of the year. However, I also think you need to reflect a little bit on if you are in surgery for the right reasons. Then, if you decide you do want to pursue surgery, you need to stop apologizing for your lack of a Y chromosome and just push forward to be the best surgeon (not female surgeon) you can be.
I am always available to chat by PM if you like, as well.
Anyone a little jealous? I heard some people are jealous. But that's just me. I mean, something for dynx and I. Too bad about the _____, so sad.
