Running out of energy

[twotwo]

I feel drained. I feel like biologically I'm past my prime, and all those years going through college, trying to get into medical school, going through medical school, and surviving intern year, on top of all of life's stresses, has essentially drained me and I feel like I'm running on fumes. I don't know how I'm going to continue keeping this up for the rest of residency (not to mention the years after). I see people around me who seem unaffected by all of this when I just feel utterly drained and just yearn for a long long time off to just recuperate, do silly things, and sleep. I feel like I don't have control over my life and find myself longing to be free from all of this. My body isn't getting any younger and I wake up feeling exhausted, go home feeling numb, and repeat the cycle all over the next day. It's also very hard to study and retain things in this state and it even leaves me wondering if my brain is still even able to keep up with all of this knowledge/information that I'm expected to retain. It's now 2-3 cups of coffee/day, which now is essentially just for the taste as I still nod off during conference, coffee or not. I also feel like I missed out on so much and gave so many years of my life due to this tremendously long training period and I'll never get those years back. And sadly for my specialty I still have many years left. Would love to hear your thoughts and experiences.

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[bashwell]

I feel drained. I feel like biologically I'm past my prime, and all those years going through college, trying to get into medical school, going through medical school, and surviving intern year, on top of all of life's stresses, has essentially drained me and I feel like I'm running on fumes. I don't know how I'm going to continue keeping this up for the rest of residency (not to mention the years after). I see people around me who seem unaffected by all of this when I just feel utterly drained and just yearn for a long long time off to just recuperate, do silly things, and sleep. I feel like I don't have control over my life and find myself longing to be free from all of this. My body isn't getting any younger and I wake up feeling exhausted, go home feeling numb, and repeat the cycle all over the next day. It's also very hard to study and retain things in this state and it even leaves me wondering if my brain is still even able to keep up with all of this knowledge/information that I'm expected to retain. It's now 2-3 cups of coffee/day, which now is essentially just for the taste as I still nod off during conference, coffee or not. I also feel like I missed out on so much and gave so many years of my life due to this tremendously long training period and I'll never get those years back. And sadly for my specialty I still have many years left. Would love to hear your thoughts and experiences.

I'm really sorry to hear this OP.

There are essentially only a few options as far as I can tell, but maybe others know more:

1) Find some way to push through it. For example, I don't know if you're regularly exercising or maybe just eating a lot of cafeteria food, but staying fit (no matter what your age) helps in so many different ways, such as by actually giving you more (not less) energy. Maybe you can start something (if you don't already do it) like StrongLifts 5x5? It might also help clear your mind to lift weights in the gym and not have to be focused on everything else. Just one idea among many to hopefully help you push through your grueling residency.

2) Find some way to take some time off. Not sure if your residency program will think, but it might be worth discussing this with your chief or PD or someone else who can guide you, depending on the in's and out's of your program?

3) Find some way to switch to a less intense specialty or a specialty with shorter years. But that's a very personal decision.

 

[Goro]

I feel drained. I feel like biologically I'm past my prime, and all those years going through college, trying to get into medical school, going through medical school, and surviving intern year, on top of all of life's stresses, has essentially drained me and I feel like I'm running on fumes. I don't know how I'm going to continue keeping this up for the rest of residency (not to mention the years after). I see people around me who seem unaffected by all of this when I just feel utterly drained and just yearn for a long long time off to just recuperate, do silly things, and sleep. I feel like I don't have control over my life and find myself longing to be free from all of this. My body isn't getting any younger and I wake up feeling exhausted, go home feeling numb, and repeat the cycle all over the next day. It's also very hard to study and retain things in this state and it even leaves me wondering if my brain is still even able to keep up with all of this knowledge/information that I'm expected to retain. It's now 2-3 cups of coffee/day, which now is essentially just for the taste as I still nod off during conference, coffee or not. I also feel like I missed out on so much and gave so many years of my life due to this tremendously long training period and I'll never get those years back. And sadly for my specialty I still have many years left. Would love to hear your thoughts and experiences.

Depression?

Hit the gym whenever possible? Build up the physical endurance.

Practice mindfulness techniques?

 

[NotAProgDirector]

I would be evaluated. Perhaps you're depressed. Perhaps your TSH is 100. You are certain to burn out without help. So get help.

 

[camkiss]

I agree with aprogdirector- make sure it's not depression or thyroid. I'm fairly certain I was depressed through internship and residency. I had 2 children in that time and don't remember much of their childhood, and then subsequently got divorced a couple years into private practice. Fortunately I was able to crawl out of those feelings (or lack thereof) and am in a much better place now. Just know you aren't the first to feel this way. Take a post call day and go see a PCP. Exercise and find a hobby away from medicine.

 

[Crayola227]

What you are describing sounds *exactly* like burnout, if not depression (not that I am offering personal medical advice to you in either case)

I don't think it's remiss in these situations to seek out medical care. Some of my past posts have ideas on how a busy resident can carve out that time to attend regular doc visits if it comes down to that.

The following are my tips for self-care, not medical advice

Reading this, I can see that some of this will be impossible for you as a resident. Do what you can, it will help, in my experience.

[QUOTE="Crayola227, post: 19112452, member: 576613"
Reposting a lot of my self care tips here

First, I think you might benefit from seeing your PCP. If *they* recommend psychotherapy & medication, seriously consider following through on their recommendation

Second, if there are any responsibilities in your life draining you right now that you can afford to say no to, then feel free to say no to them.

Keep in mind if you are depressed/burnt out some people still need things outside them as responsibilities to help them keep moving/feeling connected.

WELLNESS
This is basic lifestyle advice I don't think violates TOS

I just read something by Dr, Pamela Wible on KevinMD to a med student experiencing burn out
she makes a point that with burn out, "feeling numb", getting back into your body is important
she recommends weekly massage for getting back in touch with your body / relax
Make a point of getting a hug a day.

I recommend psycheducation.org Dr. Phelps' website, it is aimed at bipolar but he talks about blue light's effect on sleep which I find valuable, and most of my lifestyle advice for sleep & blue light is based off his site, he cites lots of research

1) routine, especially sleep
-I don't know if you sleep with a partner, but I would recommend taking whatever steps to ensure your sleep hygiene is good, even if that means you two sleep separate (studies show people physically have worse sleep quality with a partner, but subjective rating of quality is higher, so it's up to you what will be best for how you are doing). Remember, you don't have to sleep together to sleep together
-same wake time, same sleep time, *even on weekends,* allot enough hours. if you can avoid fighting your natural rhythm (morning lark vs night owl) that would be good
-cool, dark room free of pets (I have to have an electronic scat shock mat to keep my cats from scratching at the door at night)
-if needed, invest in darkening shades perhaps, that will block out the light that might wake you in the am, but you could invest in a sunrise simulator (you can even just plug a lamp into a cheap timer) with a daylight spectrum bulb, if this conflicts with partner, consider a facemask
-cut out electronics or tone down the blue light with apps like f.lux after the sun goes down

2) don't skip a good breakfast. Even as a resident, this can be addressed. Microwave packets of oatmeal? I microwave poptarts! (not healthy but better than skipping breakfast). I got good at eating and pre-rounding at the same time.

3) don't go hungry, eat healthy
This is tough. I made a point of having snacks on me at all times. Even if it was just a packet of sugar or peanut butter or graham crackers in my white coat pocket. It's not about just your blood sugar staying up, eating itself does good things for your brain's sense of well-being and function.

4) no caffeine within 8 hours of sleep, or after 2-4 pm,
-some people find they get a midday "slump" from caffeine and feel better cutting it out entirely.
-If you drink regularly and are going to try to cut it out, anticipate possible headache and have a plan with your provider possibly including an OTC med like tylenol or ibuprofen.

This goes back to sleep hygeine. I know residents have a lot of constraints on getting enough good sleep, which is why you need to maximize every variable you can (dark room, etc). You may be in a vicious cycle with caffeine. It has an extremely long half life, which is why none within 8 hours of bedtime is the typical recommendation. It is also extremely disrupting to sleep cycles even in low doses, although some people never have any subjective sx no matter how much or when they drink. Still, your caffeine intake may be disrupting your sleep, making you tired, you reach for more caffeine, disrupting your sleep.... and on and on. Consider cutting back, especially since you may be experiencing tachyphylaxis. If you are not getting benefit from the caffeine, it stands to reason that you are only exposing yourself to potential harm. If it's not helping as you say, cut back.

5) with consultation of a physician consider melatonin if needed
-less is more with dosage, main side effect can be freaky nightmares which often levels out, risk is that it *can* worsen depression in some but that's rare, it can have a paradoxical effect at high doses (meaning opposite to intended effect) so always start low go slow
-don't use herbs for medical purposes without talking to your primary care provider.

In my experience with my hospitalized patients & colleagues on nightfloat, darkness and melatonin were my greatest interventions for restoring some quality back to sleep.

6) drink more water, this is easier to do *with* food, but just carrying some around with you can help encourage intake.
-To encourage myself to drink water (I'm picky) I invested in a Brita filter, make ice using that water, and drink out of a large glass mason jar with lid so my cat can't knock it over (she loves to!).
-You can also do herbal unsweetened tea.
-There is no magic number but I aim for 2L a day.
-Most of us, especially caffeine/soda drinkers, walk around chronically dehydrated, eventually the feedback loop regulating this will turn off your thirst drive, so initially you may have to "force" yourself to drink water, you will adjust

Your caffeine intake is likely contributing to some sense of dehydration, even if you're not feeling thirsty. If you spend time in a workroom, bring a 1 L container of water and try to identify points in your workday to get some water in. Yes, the cost will be needing to piss.

It's easier to get water in with a meal (studies show we drink more water when it's paired with food). You could down some water in the AM with a quick breakfast, drink some on your drive to work, drink some as you pre-round, and then take a leak before seeing patients. Drink some during lunch. If you are done with patients and doing work on your comp, down a bunch then. Camel up (drink up) before finishing your notes or your drive home. Cameling up at dinner might not be a good plan if it wakes you before your alarm clock. Or if you can titrate it, make your bladder your alarm clock.

Do not underestimate just how crappy subclinical dehydration can make you. Achey, irritable, mentally and physically fatigued, downright MDD-appearing.

I find tea is a good compromise. You drink more water to approximate the same amount of caffeine as you would from coffee. It also thereby slows your consumption and stretches it out a bit. It gives me less of a "hate-the-world slump."

7) cut out all alcohol for now.
-if you go out with friends, there are plenty of things you can ask to have "virgin."
-if your friends ask and you don't want to explain, just say you're on a "cleanse" or some hippy thing.
-I buy non-caffeinated root beer in glass bottles so I still get the "treat" / psychosocial aspect of drinking without the alcohol at home. Soda isn't ideal but it's a better choice to substitute for a weekend beer on your porch if you are struggling with mental health

8) no marijuana. Really, no marijuana.
-If giving up these things bums you out, just remember it's temporary.
-In my opinion, booze & MJ don't help feelings of burn out. A single stressful day? Maybe, but burnout, no.
-goes without saying, none of the other street drugs either. Really.

9) I personally see benefit to a multivitamin although I can't say the studies are dramatically behind me.
-Data is mixed but particularly look into vitamin D (90% of us tested above a certain parallel in the US test deficient, don't just rely on the summer to replenish you),
-consider fish oil too, Costco enteric coated from Amazon is cheap, keep in freezer to avoid fish burps, the most common side effect.
-Talk about iron with your doctor and be sure to include good dietary sources.

10) Exercise but I know that can be hard,
-even just getting 10 minutes of walking a day more than what you're doing now, a brisk walk.
-Stretching/yoga!! Netflix has some programs so you can do it from home, or YouTube videos, even just pictures online.
-Stretching by Bob Anderson is my fave resource for home stretching. http://www.amazon.com/s/?ie=UTF8&keywords=stretching,+bob+anderson&tag=googhydr-20&index=aps&hvadid=28618117647&hvpos=1t1&hvexid=&hvnetw=g&hvrand=491951793333905093&hvpone=&hvptwo=&hvqmt=e&hvdev=c&ref=pd_sl_79e40b5ucp_e
-A foam roller does amazing things for my neck, back, IT band. There are large ones and travel sized ones.
-A TheraCane is a nice way to make love to yourself.

11) If you can sit by a window with a view, maybe with a little plant or beta fish to keep you company, sunlight, having plants/pets life that depends on you helps. Gardening, even just a few potted plants.

12) Time with nature, maybe go to the zoo or aquarium.
Sometimes just looking at the animals at Petsmart cheers me up

13) I suggest looking into Adult Children of Alcoholics/Dysfunctional families, you can google them and see if that fits you or might be helpful, even if you don't think it reading my post at least check out the website

14) Look into meditation, mindfulness techniques, guided meditation, relaxing music, biofeedback programs
15) Daily rituals like hot tub, warm bath, candles, incense, herbal tea, aromatherapy
16) Read some comics everyday, something to make you laugh. xkcd is one online example.
17) More ambitious: swimming, camping, hiking, beach, river, bike riding, even just day trips, scenic drives
18) Google Thich Nhat Han. I've found a lot of his writings very inspirational.

When I get really depressed/burnt out, I start at the top of this list, and try to slowly work down it as I can. Doing it all at once can be too much. But as you add each step of wellness and feel better, it gets easier to add another

In my opinion, the best thing for burn out is to basically stop doing/worrying about as much as I can, and start over with self care. Maslow's hierarchy, start with the biological like sleep & food, and work up to pleasurable low stress activities[/QUOTE]

 

[bannie22]

Hey. I feel like I'm in the same shoes. Everything you said echoed loud and clear over here.
You are not alone. I'm sure some of your co-residents feel the same way, but given how long your training is, I suspect you are in a specialty where there is a need to stay "strong".

You spend the entire day at work, completely exhausted, and almost impossible to motivate nor retain any new reading material.
And yes, I agree, there is no getting back those years that you have spent. Your 20s, and maybe even early 30s depending on the duration of your residency, it will be consumed by the monster.

I think finding the opportunity to work-out can be helpful. If you are taking lots of call, perhaps a post-call workout can help you feel slightly healthier. It might not give you any life-years back, but at least the remaining years you can at least convince yourself you tried to extend your health.

If its not unrealistic, I think if you could find a partner, that would also be helpful, to have someone to hang out with and do stuff together when you have any off time. It does seem that work is keeping you too busy for that sort of commitment tho. If that is the case, just promise yourself if you are invited to some gathering that you should make a concerted effort to partake. Do something outside of work ya know?

 

[bannie22]

What you are describing sounds *exactly* like burnout, if not depression (not that I am offering personal medical advice to you in either case)

I don't think it's remiss in these situations to seek out medical care. Some of my past posts have ideas on how a busy resident can carve out that time to attend regular doc visits if it comes down to that.

The following are my tips for self-care, not medical advice

Reading this, I can see that some of this will be impossible for you as a resident. Do what you can, it will help, in my experience.

[QUOTE="Crayola227, post: 19112452, member: 576613"
Reposting a lot of my self care tips here

First, I think you might benefit from seeing your PCP. If *they* recommend psychotherapy & medication, seriously consider following through on their recommendation

Second, if there are any responsibilities in your life draining you right now that you can afford to say no to, then feel free to say no to them.

Keep in mind if you are depressed/burnt out some people still need things outside them as responsibilities to help them keep moving/feeling connected.

WELLNESS
This is basic lifestyle advice I don't think violates TOS

I just read something by Dr, Pamela Wible on KevinMD to a med student experiencing burn out
she makes a point that with burn out, "feeling numb", getting back into your body is important
she recommends weekly massage for getting back in touch with your body / relax
Make a point of getting a hug a day.

I recommend psycheducation.org Dr. Phelps' website, it is aimed at bipolar but he talks about blue light's effect on sleep which I find valuable, and most of my lifestyle advice for sleep & blue light is based off his site, he cites lots of research

1) routine, especially sleep
-I don't know if you sleep with a partner, but I would recommend taking whatever steps to ensure your sleep hygiene is good, even if that means you two sleep separate (studies show people physically have worse sleep quality with a partner, but subjective rating of quality is higher, so it's up to you what will be best for how you are doing). Remember, you don't have to sleep together to sleep together
-same wake time, same sleep time, *even on weekends,* allot enough hours. if you can avoid fighting your natural rhythm (morning lark vs night owl) that would be good
-cool, dark room free of pets (I have to have an electronic scat shock mat to keep my cats from scratching at the door at night)
-if needed, invest in darkening shades perhaps, that will block out the light that might wake you in the am, but you could invest in a sunrise simulator (you can even just plug a lamp into a cheap timer) with a daylight spectrum bulb, if this conflicts with partner, consider a facemask
-cut out electronics or tone down the blue light with apps like f.lux after the sun goes down

2) don't skip a good breakfast. Even as a resident, this can be addressed. Microwave packets of oatmeal? I microwave poptarts! (not healthy but better than skipping breakfast). I got good at eating and pre-rounding at the same time.

3) don't go hungry, eat healthy
This is tough. I made a point of having snacks on me at all times. Even if it was just a packet of sugar or peanut butter or graham crackers in my white coat pocket. It's not about just your blood sugar staying up, eating itself does good things for your brain's sense of well-being and function.

4) no caffeine within 8 hours of sleep, or after 2-4 pm,
-some people find they get a midday "slump" from caffeine and feel better cutting it out entirely.
-If you drink regularly and are going to try to cut it out, anticipate possible headache and have a plan with your provider possibly including an OTC med like tylenol or ibuprofen.

This goes back to sleep hygeine. I know residents have a lot of constraints on getting enough good sleep, which is why you need to maximize every variable you can (dark room, etc). You may be in a vicious cycle with caffeine. It has an extremely long half life, which is why none within 8 hours of bedtime is the typical recommendation. It is also extremely disrupting to sleep cycles even in low doses, although some people never have any subjective sx no matter how much or when they drink. Still, your caffeine intake may be disrupting your sleep, making you tired, you reach for more caffeine, disrupting your sleep.... and on and on. Consider cutting back, especially since you may be experiencing tachyphylaxis. If you are not getting benefit from the caffeine, it stands to reason that you are only exposing yourself to potential harm. If it's not helping as you say, cut back.

5) with consultation of a physician consider melatonin if needed
-less is more with dosage, main side effect can be freaky nightmares which often levels out, risk is that it *can* worsen depression in some but that's rare, it can have a paradoxical effect at high doses (meaning opposite to intended effect) so always start low go slow
-don't use herbs for medical purposes without talking to your primary care provider.

In my experience with my hospitalized patients & colleagues on nightfloat, darkness and melatonin were my greatest interventions for restoring some quality back to sleep.

6) drink more water, this is easier to do *with* food, but just carrying some around with you can help encourage intake.
-To encourage myself to drink water (I'm picky) I invested in a Brita filter, make ice using that water, and drink out of a large glass mason jar with lid so my cat can't knock it over (she loves to!).
-You can also do herbal unsweetened tea.
-There is no magic number but I aim for 2L a day.
-Most of us, especially caffeine/soda drinkers, walk around chronically dehydrated, eventually the feedback loop regulating this will turn off your thirst drive, so initially you may have to "force" yourself to drink water, you will adjust

Your caffeine intake is likely contributing to some sense of dehydration, even if you're not feeling thirsty. If you spend time in a workroom, bring a 1 L container of water and try to identify points in your workday to get some water in. Yes, the cost will be needing to piss.

It's easier to get water in with a meal (studies show we drink more water when it's paired with food). You could down some water in the AM with a quick breakfast, drink some on your drive to work, drink some as you pre-round, and then take a leak before seeing patients. Drink some during lunch. If you are done with patients and doing work on your comp, down a bunch then. Camel up (drink up) before finishing your notes or your drive home. Cameling up at dinner might not be a good plan if it wakes you before your alarm clock. Or if you can titrate it, make your bladder your alarm clock.

Do not underestimate just how crappy subclinical dehydration can make you. Achey, irritable, mentally and physically fatigued, downright MDD-appearing.

I find tea is a good compromise. You drink more water to approximate the same amount of caffeine as you would from coffee. It also thereby slows your consumption and stretches it out a bit. It gives me less of a "hate-the-world slump."

7) cut out all alcohol for now.
-if you go out with friends, there are plenty of things you can ask to have "virgin."
-if your friends ask and you don't want to explain, just say you're on a "cleanse" or some hippy thing.
-I buy non-caffeinated root beer in glass bottles so I still get the "treat" / psychosocial aspect of drinking without the alcohol at home. Soda isn't ideal but it's a better choice to substitute for a weekend beer on your porch if you are struggling with mental health

8) no marijuana. Really, no marijuana.
-If giving up these things bums you out, just remember it's temporary.
-In my opinion, booze & MJ don't help feelings of burn out. A single stressful day? Maybe, but burnout, no.
-goes without saying, none of the other street drugs either. Really.

9) I personally see benefit to a multivitamin although I can't say the studies are dramatically behind me.
-Data is mixed but particularly look into vitamin D (90% of us tested above a certain parallel in the US test deficient, don't just rely on the summer to replenish you),
-consider fish oil too, Costco enteric coated from Amazon is cheap, keep in freezer to avoid fish burps, the most common side effect.
-Talk about iron with your doctor and be sure to include good dietary sources.

10) Exercise but I know that can be hard,
-even just getting 10 minutes of walking a day more than what you're doing now, a brisk walk.
-Stretching/yoga!! Netflix has some programs so you can do it from home, or YouTube videos, even just pictures online.
-Stretching by Bob Anderson is my fave resource for home stretching. http://www.amazon.com/s/?ie=UTF8&keywords=stretching,+bob+anderson&tag=googhydr-20&index=aps&hvadid=28618117647&hvpos=1t1&hvexid=&hvnetw=g&hvrand=491951793333905093&hvpone=&hvptwo=&hvqmt=e&hvdev=c&ref=pd_sl_79e40b5ucp_e
-A foam roller does amazing things for my neck, back, IT band. There are large ones and travel sized ones.
-A TheraCane is a nice way to make love to yourself.

11) If you can sit by a window with a view, maybe with a little plant or beta fish to keep you company, sunlight, having plants/pets life that depends on you helps. Gardening, even just a few potted plants.

12) Time with nature, maybe go to the zoo or aquarium.
Sometimes just looking at the animals at Petsmart cheers me up

13) I suggest looking into Adult Children of Alcoholics/Dysfunctional families, you can google them and see if that fits you or might be helpful, even if you don't think it reading my post at least check out the website

14) Look into meditation, mindfulness techniques, guided meditation, relaxing music, biofeedback programs
15) Daily rituals like hot tub, warm bath, candles, incense, herbal tea, aromatherapy
16) Read some comics everyday, something to make you laugh. xkcd is one online example.
17) More ambitious: swimming, camping, hiking, beach, river, bike riding, even just day trips, scenic drives
18) Google Thich Nhat Han. I've found a lot of his writings very inspirational.

When I get really depressed/burnt out, I start at the top of this list, and try to slowly work down it as I can. Doing it all at once can be too much. But as you add each step of wellness and feel better, it gets easier to add another

In my opinion, the best thing for burn out is to basically stop doing/worrying about as much as I can, and start over with self care. Maslow's hierarchy, start with the biological like sleep & food, and work up to pleasurable low stress activities

[/QUOTE]

good stuff here

1) sleep
i make it a point to sleep by 11pm everynight
just try your best unless you really have something thatneeds to be submitted the next day
otherwise, i try to jsut stay away from any electronics

2) good breakfast
thats really difficult, i tink a good breakfast is important but when you are wkaing up at 430/5am its really challenging. i ahve to say sleep would take precedence in most situations. and its hard to snag a "good" breakfast. something unhealty yeah possibly

3) eating healthy
thats another difficult one. frequently there is no breakfast or lunch, and being seen eating is a sign of weakness. not sure if OP is in one of those specialties. but sometimes esp it seems like he is a pgy2. i have doubts that he would ahve the leisure of having food. but i agree. if u can. please eat as good as possible. thats one of the pleasures in life

4) caffeine
i agree. i dont drink coffee myself, but i like tea. tea has caffeine. but i dont use it as a stimulant. i dont force the body.

5) melatonin
kinda hard core. i would try to stay away from medication unless necessary.

6) water
im not sure how helpful it is. but yeah doesnt hurt ot stay hydrated.

7) alcohol
i disagree with this one. im not a big fan of alcohol, but i tink alcohol is important in social situations, and from the story, OP needs to try and socialize more. i tink moderation is fine.

8) marijuana
another hard core one. stay away.

9) vitamins
i stay away from meds.

10) exercise
i really do think exercise is important. i ahve felt much better about myself mentally since giving it a shot. its tough to start. but make yourself some really easy goals. myself, i have a very long term plan to go along my very lengthy job duration. im not expecting to see any physical results soon. but i sure feel a little bit better than im doing something to perhaps extend the years of life which i wud still be healthy...

11) plants/fishes
u know i never thought of that crayola. i tink if i ever get some time i might just buy some potted plants to stare at.

12) nature
petsmart. another cool one. i think it could defintely work for the pet-inclined

13-18 too serious for me


thanks for the tips. i did find that potted plant thing quite helpful. not sure if its my type of thing. i might just try it out.

if you play sports, join a team!
if you play instruments, pick it up again.

and we are hear to listne to you whine, if u ever need it!

 

[Crayola227]

In my experience, a few of the most easily corrected factors that lead to a resident feeling like total crap:

1) not enough sleep hygeine (I don't pretend that you can get enough sleep. Even if you're in a callroom, a facemask and earplugs can let you achieve a deeper more quality nap even on call. Just make sure that pager can still wake you!)
2) not enough quality food (I guess it's not always hunger, some pack it on with pizza, the so-called "intern 18" for putting on 18 lbs)
3) too much caffeine, caffeine w/d
4) not enough water

I'm leaving exercise off for the moment, because I don't think exercise will make you feel much better unless you're oiling and feeding the machine. It can help with sleep, but it's awfully hard to get started when you're sleep deprived.

Exercise for a body that's seriously deficient in water, nutrition, and sleep.... studies have also shown that is related to more injuries.
Doing something low-key can help your sleep become more quality, though.
When you're hydrated, doing some gentle yoga or stretches can make you feel a decade younger, I swear.

I think a lot of residents end up fitting something in that raises their heart rate, which is great, but the nature of the work leads to tons of muscle aches and strains that can only be addressed with stretches and PT-esque style moves.

Ever hear of being "chair-bound"? Check it out. Even the surgical types among us spend too much time in front of a computer. (or heads bowed) Time to consider spine health, stretch out those hamstrings, work out those dorsal muscles, stand tall, posture.

Basically, if you're too tired to exercise right now, that's OK. Rest up, eat up, camel up. Move your body in gentle ways that feels good.

 

[Crayola227]

good stuff here


2) good breakfast
thats really difficult, i tink a good breakfast is important but when you are wkaing up at 430/5am its really challenging. i ahve to say sleep would take precedence in most situations. and its hard to snag a "good" breakfast. something unhealty yeah possibly

3) eating healthy
thats another difficult one. frequently there is no breakfast or lunch, and being seen eating is a sign of weakness. not sure if OP is in one of those specialties. but sometimes esp it seems like he is a pgy2. i have doubts that he would ahve the leisure of having food. but i agree. if u can. please eat as good as possible. thats one of the pleasures in life

4) caffeine
i agree. i dont drink coffee myself, but i like tea. tea has caffeine. but i dont use it as a stimulant. i dont force the body.

5) melatonin
kinda hard core. i would try to stay away from medication unless necessary.

6) water
im not sure how helpful it is. but yeah doesnt hurt ot stay hydrated.

7) alcohol
i disagree with this one. im not a big fan of alcohol, but i tink alcohol is important in social situations, and from the story, OP needs to try and socialize more. i tink moderation is fine.

8) marijuana
another hard core one. stay away.

9) vitamins
i stay away from meds.

I'm glad this was helpful!

A few ideas -
Breakfast -
microwaved oatmeal packets. Healthier than nothing, and quick. Decent fiber and such. I would add flax seed powder I would grind once a week to get more goodness. You could throw in a handful of nuts and make it even more filling, in a not-bad way. I make mine with milk for more power. I make it in a big mug I can take in the car or walk and eat with.

You can make hardboiled eggs a dozen at a time and even peel them ahead of time.

I can't remember the name of it, but there's this super super dense bread with rye and such in that almost isn't even bread, more like brown pressed bird seed, one or 2 slices toasted with a little honey, very filling and very healthy (if you go by how regular it will keep you).

Yogurt and granola.

Granola bars. You could make your own if you think the store bought ones aren't good enough.

I learned the next trick from an EM resident.
Buy a cantaloupe and a honeydew melon. Cut them into cubes and remove the rinds, and put in tupperware. You can do this with apples too, only it's best to take a little lemon juice and brush it on in a little layer to prevent browning. I would buy a carton of blueberries, raspberries, strawberries, cherries, grapes. Then you can take a tupperware the night before and fill it a handful of each to create this fruit medley, maybe with yogurt and a mini tuppy of crunchy granola to add, if that's your thing. You can eat it at home, or take it with you to work if there's a fridge, it will be great as pre-rounding breakfast, morning report snack, noon conference, or late evening stuck-at-a-computer time. Hell, it can keep to the next day, or eat it when you get home too tired to cook.
Or, you can be a real heathen and find yourself standing in front of the fridge eating handfuls of this and that fruit.

I could never live without breakfast, so I seriously learned how to get a decent one in 10 minutes or less, even on a surgery rotation in med school.

I would point out, that basic vitamins and minerals aren't considered medications. Melatonin is used as a supplement, but it is a naturally occurring hormone in the body. Of course I can't advocate that anyone on SDN use them without the supervision of their personal physician.

Yes, eating is a sign of weakness, which is why I had little things in my scrubs pocket (very smooshed granola bar) or sugar packets or whatever free hospital garbage you can keep on you. I always found a chance to narf them down, even if that meant doing it in the bathroom, a janitor's closet - anywhere I could turn my back for 5 seconds long to inhale sugar.

I also knew an attending that would just climb stairs to get their heart rate up for 10 minutes after rounds to get re-energized before diving into their notes. I knew a resident that did similar at the end of the day before getting in their car. Others lived about 1/2 mile away and walked both ways, adding at least a mile to what you already do running laps around the hospital.

Me, I really like this book
Amazon product
"Stretching in the Office" by Bob Anderson
All of his stretching books are excellent and frequently used by PTs etc so you have likely seen some of his work. I would have like a sheet of his stretches with me that I favored, and would just run through them when the time/sheet was right.

 

[Crayola227]

As far as alcohol goes, it too has very powerful effects on sleep quality, even just one serving.

Socialization, even at bars, does not have to include alcohol. Just want to challenge that paradigm.

I have known TONS of residents that when they go out on an evening before work, will not imbibe. They often say that they just don't drink on a work night because they don't feel as well the next day, and I never had the sense that was poorly received if they were otherwise engaged with the group. Many people feel the same way, and even if willing to pay the next day price, thankfully residency is so miserable for everyone, no one will begrudge you skipping the brewskis to try to feel a little better for the next miserable day. There are tons of virgin drinks to be had, and people don't even have to know that's what you're having. Get everyone an appetizer to share and you'll still be part of the outing.

I'll say it again, you don't have to drink to have fun.

I'm not against moderate social drinking, but it is a psychoactive compound, and I've never met a psychiatrist yet, that when someone's mental health is in question, did not suggest that that person get the milieu in their brain back to balanced before offering it another EtOH challenge.

If you can't socialize without alcohol, or feel uncomfortable doing so, I would really encourage such a person to go to therapy and try to work out why that is. It would be good for personal growth to grow beyond "needing" liquid courage.

OTOH, if it really makes you so miserable not to drink at all, might I suggest keeping it to one or two drinks depending on gender, on a night when you don't have to work the next day? I would keep this to a minimum. Luckily you likely only have 1 day off a week, or weekends.

TLDR:
One can give up alcohol or cut back greatly, *temporarily,* and it doesn't have to impede socialization.

 

[Auntymarkovnikov]

2 things:
The gym will change your life

Watch this

 

[bannie22]

I'm glad this was helpful!

A few ideas -
Breakfast -
microwaved oatmeal packets. Healthier than nothing, and quick. Decent fiber and such. I would add flax seed powder I would grind once a week to get more goodness. You could throw in a handful of nuts and make it even more filling, in a not-bad way. I make mine with milk for more power. I make it in a big mug I can take in the car or walk and eat with.

You can make hardboiled eggs a dozen at a time and even peel them ahead of time.

I can't remember the name of it, but there's this super super dense bread with rye and such in that almost isn't even bread, more like brown pressed bird seed, one or 2 slices toasted with a little honey, very filling and very healthy (if you go by how regular it will keep you).

Yogurt and granola.

Granola bars. You could make your own if you think the store bought ones aren't good enough.

I learned the next trick from an EM resident.
Buy a cantaloupe and a honeydew melon. Cut them into cubes and remove the rinds, and put in tupperware. You can do this with apples too, only it's best to take a little lemon juice and brush it on in a little layer to prevent browning. I would buy a carton of blueberries, raspberries, strawberries, cherries, grapes. Then you can take a tupperware the night before and fill it a handful of each to create this fruit medley, maybe with yogurt and a mini tuppy of crunchy granola to add, if that's your thing. You can eat it at home, or take it with you to work if there's a fridge, it will be great as pre-rounding breakfast, morning report snack, noon conference, or late evening stuck-at-a-computer time. Hell, it can keep to the next day, or eat it when you get home too tired to cook.
Or, you can be a real heathen and find yourself standing in front of the fridge eating handfuls of this and that fruit.

I could never live without breakfast, so I seriously learned how to get a decent one in 10 minutes or less, even on a surgery rotation in med school.

I would point out, that basic vitamins and minerals aren't considered medications. Melatonin is used as a supplement, but it is a naturally occurring hormone in the body. Of course I can't advocate that anyone on SDN use them without the supervision of their personal physician.

Yes, eating is a sign of weakness, which is why I had little things in my scrubs pocket (very smooshed granola bar) or sugar packets or whatever free hospital garbage you can keep on you. I always found a chance to narf them down, even if that meant doing it in the bathroom, a janitor's closet - anywhere I could turn my back for 5 seconds long to inhale sugar.

I also knew an attending that would just climb stairs to get their heart rate up for 10 minutes after rounds to get re-energized before diving into their notes. I knew a resident that did similar at the end of the day before getting in their car. Others lived about 1/2 mile away and walked both ways, adding at least a mile to what you already do running laps around the hospital.

Me, I really like this book
Amazon product
"Stretching in the Office" by Bob Anderson
All of his stretching books are excellent and frequently used by PTs etc so you have likely seen some of his work. I would have like a sheet of his stretches with me that I favored, and would just run through them when the time/sheet was right.

Good stuff.

From a personal perspective the food listed just isnt any appetizing to me. I just cant motivate myself to pursue those options at this time. But I definitely think that it is something OP and others should consider.

 

[bannie22]

As far as alcohol goes, it too has very powerful effects on sleep quality, even just one serving.

Socialization, even at bars, does not have to include alcohol. Just want to challenge that paradigm.

I have known TONS of residents that when they go out on an evening before work, will not imbibe. They often say that they just don't drink on a work night because they don't feel as well the next day, and I never had the sense that was poorly received if they were otherwise engaged with the group. Many people feel the same way, and even if willing to pay the next day price, thankfully residency is so miserable for everyone, no one will begrudge you skipping the brewskis to try to feel a little better for the next miserable day. There are tons of virgin drinks to be had, and people don't even have to know that's what you're having. Get everyone an appetizer to share and you'll still be part of the outing.

I'll say it again, you don't have to drink to have fun.

I'm not against moderate social drinking, but it is a psychoactive compound, and I've never met a psychiatrist yet, that when someone's mental health is in question, did not suggest that that person get the milieu in their brain back to balanced before offering it another EtOH challenge.

If you can't socialize without alcohol, or feel uncomfortable doing so, I would really encourage such a person to go to therapy and try to work out why that is. It would be good for personal growth to grow beyond "needing" liquid courage.

OTOH, if it really makes you so miserable not to drink at all, might I suggest keeping it to one or two drinks depending on gender, on a night when you don't have to work the next day? I would keep this to a minimum. Luckily you likely only have 1 day off a week, or weekends.

TLDR:
One can give up alcohol or cut back greatly, *temporarily,* and it doesn't have to impede socialization.

I agree to a certain extent. Just like there is weakness associated with eating... there is also weakness when not drinking. Dont get me wrong, Id be happy to socialize without drinking, but more often than not the gathering is focused around the drinks and if the a senior on back up home call shows up and drinks, you know what it means if you decline.

Personally I dont even like the taste of alcohol and rather be doing something else, say movies sports food etc. But what brings people together most quickly and frequently at least in the environments i have been exposed to is a few drinks. Usually i try not to drink and it is a well known fact, but sometimes i do feel the peer pressure just like I do when I am eating. Regardless alcohol might be a problem for some but i detest it so much because of the taste and my lack of enzymes i dont think its affecting my overall health. Im sure for some who do enjoy the drink i can envision it as something to completely stay awy from. Admittedly i feel guiltier eating (and starving too) than not drinking lol. I wish i could eat healthier and tastier. Sometimes i am furious at myself consuming graham crackers when its nearly dinner time yet i havrnt had a chance to stop and all i can find are them in the pantry.

 

[bannie22]

Wonder how quickly a potted plant can die if taken care of by me.... hmmm

 

[ThoracicGuy]

if the a senior on back up home call shows up and drinks, you know what it means if you decline.

What does it mean?

 

[rokshana]

What does it mean?

I am really starting to think bannie really is a high school boy...really? You think peer pressure to drink is an issue with adults? Unless your peer group are the RHOC I don't think it's really a thing...

 

[Crayola227]

What does it mean?

that it's time for a grown up professional to grow a sack and not drink if they're not inclined

I mean, the senior *is* the boss of you, but let's get real

 

[bannie22]

that it's time for a grown up professional to grow a sack and not drink if they're not inclined

I mean, the senior *is* the boss of you, but let's get real

i dont disagree. still, the further u get into medicine the more it becomes the real world.
and in the real world, if you dont do what your clients do, you dont get the contract.

i see it as no different. i guess its all about what to make of the context. i see it as investing my time and depending on the circumstances, investing what might not be my most favored interests to bond with my colleagues. cant have it my way all the time anyway, and i definitely dont have it my way at all when at work anyway. the things i do that i would never otherwise do...

 

[ThoracicGuy]

i dont disagree. still, the further u get into medicine the more it becomes the real world.
and in the real world, if you dont do what your clients do, you dont get the contract.

i see it as no different. i guess its all about what to make of the context. i see it as investing my time and depending on the circumstances, investing what might not be my most favored interests to bond with my colleagues. cant have it my way all the time anyway, and i definitely dont have it my way at all when at work anyway. the things i do that i would never otherwise do...

You can go out with your podiatry friends and not drink if you want. It's not going to affect you at all.

 

[Light at end of tunnel]

You can go out with your podiatry friends and not drink if you want. It's not going to affect you at all.

 

[Winged Scapula]

View attachment 221991

Especially since I remove the "pre-podiatry" status (as it was clearly misrepresentation).

 

[Raryn]

I feel drained. I feel like biologically I'm past my prime, and all those years going through college, trying to get into medical school, going through medical school, and surviving intern year, on top of all of life's stresses, has essentially drained me and I feel like I'm running on fumes. I don't know how I'm going to continue keeping this up for the rest of residency (not to mention the years after). I see people around me who seem unaffected by all of this when I just feel utterly drained and just yearn for a long long time off to just recuperate, do silly things, and sleep. I feel like I don't have control over my life and find myself longing to be free from all of this. My body isn't getting any younger and I wake up feeling exhausted, go home feeling numb, and repeat the cycle all over the next day. It's also very hard to study and retain things in this state and it even leaves me wondering if my brain is still even able to keep up with all of this knowledge/information that I'm expected to retain. It's now 2-3 cups of coffee/day, which now is essentially just for the taste as I still nod off during conference, coffee or not. I also feel like I missed out on so much and gave so many years of my life due to this tremendously long training period and I'll never get those years back. And sadly for my specialty I still have many years left. Would love to hear your thoughts and experiences.

When was your last vacation?

When will your next one be?

Honestly, this could "just" be burnout, it could be something like depression, it could be something more serious. I'm not going to write you a book about different lifestyle interventions you can try, because I think you hit the nail on the head with the bolded comment. You need a break.

Assuming you have a week or two of vacation coming up soon, use that as an opportunity to reset. Don't schedule anything strenuous, don't try to get a million things done, pick your favorite location (I love the beach for example) and just go and recuperate, do some silly things, lay around and read a book (or whatever your specific activity of choice is).

Residency is hard, but it's time limited. Recover your energy and it may seem a lot easier when you come back to work. You have to realize that the transition to second year is a unique time that you're now past. I won't say it's all downhill from here (because I have no clue what specialty you are or what your schedule is like), but I think it's fairly universal that responsibilities change at the beginning of PGY2, and it can suck. As you get more comfortable in your new role, it gets better.

 

[Light at end of tunnel]

Especially since I remove the "pre-podiatry" status (as it was clearly misrepresentation).

So you agree that new joke material is needed? I knew we'd eventually agree on something!

Joking aside, the posting was becoming predictably neurotic bordering on harassment. Thanks for addressing.

 

[ThoracicGuy]

Especially since I remove the "pre-podiatry" status (as it was clearly misrepresentation).

That doesn't show up on the mobile version of the page...

 

[ThoracicGuy]

So you agree that new joke material is needed? I knew we'd eventually agree on something!

Joking aside, the posting was becoming predictably neurotic bordering on harassment. Thanks for addressing.

I know something else that is very predictable...

 

[jhamaican]

I feel drained. I feel like biologically I'm past my prime, and all those years going through college, trying to get into medical school, going through medical school, and surviving intern year, on top of all of life's stresses, has essentially drained me and I feel like I'm running on fumes. I don't know how I'm going to continue keeping this up for the rest of residency (not to mention the years after). I see people around me who seem unaffected by all of this when I just feel utterly drained and just yearn for a long long time off to just recuperate, do silly things, and sleep. I feel like I don't have control over my life and find myself longing to be free from all of this. My body isn't getting any younger and I wake up feeling exhausted, go home feeling numb, and repeat the cycle all over the next day. It's also very hard to study and retain things in this state and it even leaves me wondering if my brain is still even able to keep up with all of this knowledge/information that I'm expected to retain. It's now 2-3 cups of coffee/day, which now is essentially just for the taste as I still nod off during conference, coffee or not. I also feel like I missed out on so much and gave so many years of my life due to this tremendously long training period and I'll never get those years back. And sadly for my specialty I still have many years left. Would love to hear your thoughts and experiences.

are you a male or female

carb up and hydrate.

Most people are undercarbed and over caffeinated.

Read Durian riders ebook, will change your life.

 

[Winged Scapula]

Joking aside, the posting was becoming predictably neurotic bordering on harassment. Thanks for addressing.

i'm not sure who you're referring to here.

If you're referring to a poster who consistently posts presumably intentionally misleading or just woefully inaccurate information, then I agree there is something wrong.

 

[Winged Scapula]

are you a male or female

carb up and hydrate.

Most people are undercarbed and over caffeinated.

Read Durian riders ebook, will change your life.

Undercarbed?

Are we talking about the average American with their hundreds of grams of carbs consumed daily? If anything, we eat too many carbs in the form of processed foods and sugary snacks.

 

[Light at end of tunnel]

I know something else that it's very predictable...

Please be less cryptic.

i'm not sure who you're referring to here.

If you're referring to a poster who consistently posts presumably intentionally misleading or just woefully inaccurate information, then I agree there is something wrong.

Definitely not on same page, but happy to agree to disagree.

 

[Winged Scapula]

Please be less cryptic.


Definitely not on same page, but happy to agree to disagree.

so you believe this poster in question accurately represents himself and posts accurate information about residency?

If so, then I suggest you read through his posts and see why the surgery forum disrespects what he writes.

I know you'll consider the above harassment, however this community requires that users represent themselves in an honest fashion and provide others with useful and accurate advice. there is good reason why he's on probation and close to losing his account.

 

[d2305]

Carbs are poison (at least for me). When you're depressed everything seems insurmountable.

 

[Light at end of tunnel]

so you believe this poster in question accurately represents himself and posts accurate information about residency?

If so, then I suggest you read through his posts and see why the surgery forum disrespects what he writes.

I know you'll consider the above harassment, however this community requires that users represent themselves in an honest fashion and provide others with useful and accurate advice. there is good reason why he's on probation and close to losing his account.

Do we verify everyone's posts to be 100 percent accurate? Not so sure we do.

So SDN is an anonymous website, yet as you say this member is on the verge of losing account for misrepresentation? Seems inconsistent to me.

Finally, I'm not so sure that promoting an environment where systemic harassment of one member is condoned, defended and often promoted does anything but show us all to be hypocrites.

It may be more humane to actually ban him than to continue to promulgate this treatment.

 

[Raryn]

Do we verify everyone's posts to be 100 percent accurate? Not so sure we do.

So SDN is an anonymous website, yet as you say this member is on the verge of losing account for misrepresentation? Seems inconsistent to me.

Finally, I'm not so sure that promoting an environment where systemic harassment of one member is condoned, defended and often promoted does anything but show us all to be hypocrites.

It may be more humane to actually ban him than to continue to promulgate this treatment.

SDN is anonymous.

But if I made an account claiming to be a neurosurgery attending, then went around posting about how the modern therapy for things is trepanation, and that as neurosurgery residents we would go about doing it to each other, you can imagine that most posters would be skeptical. If I then went around giving ridiculous advice to people throughout the various forums, you can imagine I might eventually be admonished, suspended, or even banned.

Not because I was anonymous. But because I was flat-out wrong. Lots of people can have opinions many of us disagree with, but the mods only really care about the ones that are flat-out incompatible with reality.

 

[Winged Scapula]

Do we verify everyone's posts to be 100 percent accurate? Not so sure we do.

Of course not, but when someone posts something that is 180 degrees opposite of the reality of other surgeons, it should be assumed that they are intentionally misleading users.

So SDN is an anonymous website, yet as you say this member is on the verge of losing account for misrepresentation? Seems inconsistent to me.

It is clear he is not a pre-podiatry student; he posts about his medical school and residency, so either he is lying about having been a medical student and resident or being pre-podiatry. Take your pick, either is misrepresentation.

Finally, I'm not so sure that promoting an environment where systemic harassment of one member is condoned, defended and often promoted does anything but show us all to be hypocrites.

It may be more humane to actually ban him than to continue to promulgate this treatment.

If anything he is harassing our site, by continuing to post nonsense despite multiple warnings. Please don't assume you are on the side of the tragically wronged just because you believe it to be so.

SDN thrives because a community of like minded individuals who come together to offer advice and information; someone who acts in opposition to this is not welcome as a member.

 

[TooMuchResearch]

I feel drained. I feel like biologically I'm past my prime, and all those years going through college, trying to get into medical school, going through medical school, and surviving intern year, on top of all of life's stresses, has essentially drained me and I feel like I'm running on fumes. I don't know how I'm going to continue keeping this up for the rest of residency (not to mention the years after). I see people around me who seem unaffected by all of this when I just feel utterly drained and just yearn for a long long time off to just recuperate, do silly things, and sleep. I feel like I don't have control over my life and find myself longing to be free from all of this. My body isn't getting any younger and I wake up feeling exhausted, go home feeling numb, and repeat the cycle all over the next day. It's also very hard to study and retain things in this state and it even leaves me wondering if my brain is still even able to keep up with all of this knowledge/information that I'm expected to retain. It's now 2-3 cups of coffee/day, which now is essentially just for the taste as I still nod off during conference, coffee or not. I also feel like I missed out on so much and gave so many years of my life due to this tremendously long training period and I'll never get those years back. And sadly for my specialty I still have many years left. Would love to hear your thoughts and experiences.

If you're committed to sticking it out in the same specialty.

1. Cliche it is, but find some wellness in your life.
2. I was at 1-2 pots of coffee per day, minimum, by the end of residency.
3. It gets better.