Mental Health in Residency

Dr. Frances Mei Hardin: Welcome to this week’s episode of promising young surgeon. We have Dr. Ellie DeJong on with us today, who is an elite pediatrician and anesthesiologist, having completed a peeds residency at UCSF followed by an anesthesia residency at Stanford. She is a hardworking genius. If the double residency didn’t tip you off to that, a wife and mom to daughter Poppy. Her family also features three leash trained cats, Bess, Cece, and Finn. Her accolades include being voted best witty banter from her co residents and faculty at graduation, as well as person most likely to read an entire novel in the duration of one lap. Happy. She is a prolific knitter, ceramic artisan, and snowboarder. Thank you so much for joining us today.

Dr. Ellie DeJong: Thanks for having me, Frances Mei.

Abia and I met in high school; now we work in the OR

Dr. Frances Mei Hardin: So, just diving right in here, I kind of figured that we should start with how we met Abia, which, like.

Dr. Ellie DeJong: Yeah. That we were little 15 year old trolls together.

Dr. Frances Mei Hardin: Yeah, I mean, I was not going to phrase it like that. I was obviously going to polish it up a little bit for the listeners, for the viewership. yeah, and I was 13, so I had, to learn real quick when basically for everyone else. we met in high school. We went to a boarding school, the Illinois math and science Academy. And Ellie was, like, the coolest person in our class. I pretty much just followed her around, know, tried to read what she was reading, which is actually how I got into a six month Harry Potter fanfic side journey. Well, thank you so much. I wanted to publicly thank you for those six months. I’m not going to get back for the.

Dr. Ellie DeJong: You’ll never get back.

Dr. Frances Mei Hardin: Yeah, but, I mean, I was thinking back because I was like, how did we literally meet, though? I have no idea. I don’t think we took classes together or anything like that.

Dr. Ellie DeJong: well, first, to amend the record, I will say that you were far cooler than me. And, I think we met through my sophomore year roommate, who was like, oh, yeah, there’s this girl, Frances Mei, that I’ve been hanging out with. She’s cool. She’s a little, mean.

Dr. Frances Mei Hardin: Who was your roommate?

Dr. Ellie DeJong: It was Faye Raven.

Dr. Frances Mei Hardin: I was going to say, I have to get my list out.

Dr. Ellie DeJong: And then we just became emotionally tethered to one another. and you were my north star because you were so tall.

Dr. Frances Mei Hardin: Yes. That’s mean. You know, the podcast is not about this. We won’t go into it. But there is a night at a, you know, frat party several years later where Ellie, who is like, a beautiful doll and very petite lady, is almost getting carted away by some guy, and I just body him, and I just pick her up and kind of like, take her out of this CD basement.

Dr. Ellie DeJong: You’re welcome. Oh, yeah. Thank you.

Dr. Frances Mei Hardin: I’m a very good bodyguard.

Dr. Ellie DeJong: Ah. well, remember, we would play volleyball together and you would just hit the most savage hits at me, and I would try and dig them up. Yeah.

Dr. Frances Mei Hardin: I have a lot of notes for my high school self, including, how would you think that that is an appropriate way to socialize? I would. I’d be like, oh, do you want a pepper? And I’m just like, get this volleyball. We’d, like, go outside. And I’d just be like, I’m just going to spike this at you, like, 300 times.

Dr. Ellie DeJong: I thought it was me or not. Yeah. Which is clearly, it’s not surprising that we both went to med school and love suffering.

Dr. Frances Mei Hardin: yes. Not shocking that now we just work in the OR.

Dr. Ellie DeJong: For sure.

Dr. Frances Mei Hardin: Anyway, that’s how we met. And I guess that, of course, over the years, what was really shocking to me and so impressive is that when I was in residency, doing my five year ent residency on and off, at times suicidal, just absolutely going through it, I saw Ellie announce that she was about to complete her peeds residency, and she announced this second residency. And, I mean, you could have knocked me over with a feather at that time. I was like, this girl Alex for more of this. And so I really love to get into that with you.

It’s hard to find stories of people taking nontraditional routes in medicine

Plus, just, like, we really love to hear anytime that a physician takes a nontraditional journey and things like that, I mean, it just opens, up the path for other people.

Dr. Ellie DeJong: Yeah. And that’s, like, the reason why I’m so enthusiastic about doing this is because I think it’s really hard to find stories of people taking nontraditional routes in medicine or taking a break in their training, that the path is difficult and stormy in some ways or isn’t the most rosy ending because there’s so much shame in doing things, not the 100% traditional way that then you just get stories of, like, oh, I left medicine very early in my career for industry, and I’m rich and happy, or I dropped out and I’m miserable, and this is my secret shame. Like that sort of thing. Totally. and that was, like, the whole time that I was thinking about switching, and then my mental health break later on, it was really difficult to, find other role models who had been through the same thing.

Dr. Frances Mei Hardin: Yeah, I really agree with that. And what resonates is that even when I was looking for voices out there that would talk about either nontraditional paths or just, frankly, how difficult medical training, surgical training can be. It is a lot of self selection, and so the stories out there, the ones published or maybe like, publicly spoken about, they are still, at the end of the day, heroes journeys. And what I care a lot about and, am trying to put out there is just this much more real and, I think, appealing story, which is not the classic physician hero’s journey archetype.

Dr. Ellie DeJong: Yeah. That, I think is really difficult because there’s this very human nature. But I think also with our profession, this urge to put this very positive, uplifting spin on it, where it’s all nice and rosy in the end, and there’s very little about the squishy lack of dignity in the middle. And I have zero dignity. So I’m here for it.

Dr. Frances Mei Hardin: We’re going to call it that. We have candor and we have charisma that the people want to hear. But, yeah, again, another way to put it, I’m going to pr train you after this. don’t call it the ugly, squishy middle parts like that. Oh, my gosh.

So I guess start with telling us what your Pete’s residency was like

So I guess start with telling us what your Pete’s residency was like and what led up to that transition.

Dr. Ellie DeJong: Yeah. So, I started Pete’s residency thinking that I wanted to do pediatric critical care, and thinking that was, like, the most physiologically interesting, intellectually demanding thing that really appealed to me. and I liked that acuity and intensity and the need for procedures, and using my hands. And so I spent the first year and a half or so of Pete’s residency pretty focused on that, while also at the same time, just slowly tamping down more and more of a mental health problem that, was getting increasingly difficult to manage. I think a lot of, young physicians, I used a lot of anxiety and perfectionism, and a paralyzing fear of failure as a way to propel me forward through medical school, and it really served me well. I graduated at the top of my class, and really, it was kind of sailed through medical school, externally, because internally, I was just, like, beating the crap out of myself. and then when I got to residency, it’s like the reward system just almost, in a way, drops out from under you. You can get the right answer over and over and over again, get the wrong answer once, and then you just feel like crap. and the weight of what I was doing really started to settle down on me. Like, oh, my God, these are other humans. Lives, which obviously I knew in the abstract, but not so much in the concrete. and so I think I was just slowly taken over by this horrible impostor syndrome. Like, oh, my God, I’m the worst doctor on the planet. I don’t deserve to be here. I am a danger to society, et cetera, et cetera. And, it was getting to the point where on the one hand, I was like, I can’t psychologically handle really any career in medicine, probably, but then, on the other hand, I was like, but I think everything outside of the ICU was boring. and I was having, from a personal standpoint, I was really kind of careening toward this huge anxiety induced breakdown, which I did ultimately have. in my second year of residency, right around the holidays, I, was on, one of our hemoglob rotations, where most of the kids, have either very serious malignancies or are awaiting or immediately post bone marrow transplant. So really uplifting stuff to be doing over Christmas. And then also, the kids are sick as hell and really stressful, to take care of them. And I was, like, crying every day on rounds, like, just spontaneously weeping while I presented, which is what every parent wants to see in the doctor taking care of their child. and then it got to the point where, I was working q two call over New Year’s, and I called my chief and was like, I can’t do this. I’ve been having a panic attack for, like, three days straight. I’m going to drop dead if I just keep doing this anymore. And so I took four days off of work, and, the chiefs were nice about it, and the program director actually offered me more time. But the way that my peace residency was kind of structured was if you took time off, your friends would get called into work and directly suffer from you being off. And so, while the program itself was really close knit and, very much like a family, it was in some ways, like a very dysfunctional, occasionally toxic family. And so, I knew that people were talking about me behind my back, because externally, I’m very good at hiding how depressed I am. but internally, I was a disaster.

Dr. Frances Mei Hardin: It’s heartbreaking to hear, and obviously, I get it. So many of us are very high functioning, even when we do feel like we’re at the precipice of totally losing it. And I guess my question would be, do you think that anybody thought anything of it or saw any of your anxiety or what you were dealing with that first year and a half? Because I guess that you describe like at this certain point you took the onus on yourself. You reached out to your chief, you said, hey, I’m at that limit. Would anyone have known beforehand?

Dr. Ellie DeJong: Oh my God, yes. Well, yes. the crying every day on rounds.

Dr. Frances Mei Hardin: Was that a tip? I mean, did people intervene?

Dr. Ellie DeJong: Yes. Well, no, of course not. No. I think one of our younger attendings at one point had asked me and my co resident on that rotation, what do you want to be when you grow up? Ah, what fellowship are you going to do? And I was just like happy. And I started and she was just like, ah, total crumpling into herself, like, I’m not going to enter this. And then, the, head of the oncology department had also been my attending and, he’s a notorious poop, and had, told. Given me the feedback in my evaluation without actually addressing it with me in person, is obviously going through some serious personal issues, which is like, thank you, I’m well aware. but yeah, I think even then my chiefs had known, but it was just kind of like. And I talked to attendings about it routinely, but it was never like, ah, I’m going to pull you aside and try and get you more help. It was more like, you good to do the work, you’re good, I’m worried about you, but keep working.

Dr. Frances Mei Hardin: Yeah, exactly. And that is like, I can totally picture every attending I’ve ever known doing that. The finger guns, everything. Just like, for those of you who didn’t see that, it was like a spot on impression of just somebody totally clearly brushing a big problem under the rug and they were doing finger guns with it. I feel like even in my own experience, by the time I was a chief and I had a lot more ability to stand up for myself and things like that. And I was reflecting back on things like my 2nd, 3rd years, especially fourth year too, there were attendings who were like, I remember you saying something about how because of workplace bullying and abuse, you were going through it a little bit. I remember you saying something to the effect of like, you weren’t doing that well, in terms of mental health, like maybe possible suicidal ideation. And I was like, yes, go on. So you heard me when I said that. They were like, I thought you were kidding. And I was like, whoa. I mean, I probably said it in a slightly humorous way so as to not be carried away by the net, but it’s not a funny joke. I wouldn’t joke about that. There’s like this fine balance that I think a lot of resident physicians have to play, which is like, don’t get carried away by the guys with nets and also receive help. Like, express that you need help and then receive it.

Dr. Ellie DeJong: Yeah. And I think that was really difficult. Not to jump ahead too much, but even with, then in my anesthesia residency, when I took a break, for my own mental health, it was so difficult to get it. I think my program itself was, very reassuring, or very supportive of me taking a break, mostly because they had enough warm bodies to sit in an or and cover me, that it wasn’t a huge deal. But then I remember the psychiatrist that I was going to, a told me I was, too high functioning and not mentally ill enough to sign up for an intensive outpatient program. And then after I had already told him that I was having passive suicidal ideation, was far more concerned about what my prolonged absence would have on our call pool, than my actual mental health. and this is a man who, was not actually a Stanford affiliated psychiatrist. Yes.

Dr. Frances Mei Hardin: That’s even more unusual. I mean, I can’t make that make sense, but, yes, no, I want to get to second residency. So I guess just kind of the moment that you.

Dr. Ellie DeJong: Yeah. And, yes, the moment that I knew. So I was like, basically we all had to do anesthesia rotations as second year residents in pediatrics residency, mostly to get airway and iv experience. and I was at the very end of my second year thinking like, okay, I got a lot of spiders in my brain, and I don’t love any career that is available to me. What am I going to do with this pediatrics residency? Because I cannot fathom a career that I love, or even like, a little bit. and then anesthesia residency was like, oh, my God, this is it. it’s like all the things I like about the ICU, like the acuity, the procedures, but far more soothing to my anxious little brain. I can control most things in the or, and I have one patient in front of me. And so, then thinking about the training, it was like three. I was planning on doing three years of fellowship regardless, so three years of anesthesia residency. And at the time, one year of Pete’s anesthesia fellowship was like, okay, that’s one extra year of training to not go crazy, to have a better work life balance, and to make twice as much money. Why is this even a contest? And so that was, like, from there on out, that was my plan, was to do a second residency.

Dr. Frances Mei Hardin: That definitely makes sense. And, yeah, I feel like there’s like, girl math. There’s all these viral memes about it and stuff.

There’s definitely trainee math, or we’ll call it like med student math

There’s definitely trainee math, or we’ll call it like med student math. Resident math. That’s what you just did. Because you’re like, man, this barely adds any time. I mean, three years, in kind of like what some would call, like, peak years of our lives. but again, you had already kind of written off those three years, so it’s like sunk cost fallacy. And really, you did some girl math and you were like, that’s no time at all before you know it. Yeah, it’s just almost equal. And it’s so funny, too. And, I mean, we could probably talk for a while about how you fell in love with the or environment, which I have such a beef with, standing on the other side of the blue drape that’s hung up. So that’s a fun thing that we can maybe talk about, later on.

You matched at Stanford and you started anesthesia residency

But I want to get to anesthesia residency. So again, you did it. You killed it when you matched at Stanford and you started anesthesia residency. Like, that is such an incredible know.

Dr. Ellie DeJong: Yeah, I don’t know. It was, like, it’s a cool program. I’m very grateful to have trained there. and they’re very cool, laid back people, despite the fact that it’s, got a very fancy name attached to it. And that was like, one of the things that drew me to it was that, it’s a really big program and they’re really flexible, and just kind of open to, different life paths, which was really nice.

Dr. Frances Mei Hardin: How many was it per year?

Dr. Ellie DeJong: About 30 residents per year? yeah, it’s a big program.

Dr. Frances Mei Hardin: 30 per year. Oh, God. Insane.

Dr. Ellie DeJong: Yeah, that’s like why? I was like, so I’m going to take a four month paternity leave, and then I’m going to come back for two months, and then, oh, guess what? I’m crazy. And that was not a problem.

Dr. Frances Mei Hardin: No, you guys had a lot of bodies. Oh, I totally see what you’re saying now. Because, I mean, for reference, obviously I’m in a surgical subspecialty in my head. When somebody even says a big program, I’m like, what is that, 50, 60 heads total across all years? Something like that is already huge. Wow.

Dr. Ellie DeJong: Yeah. that size and the department in general, with all of our faculty, just offered a lot of flexibility and diversity and thought, that’s really wonderful. Ah, yeah.

Dr. Frances Mei Hardin: And of course, again, just for reference, I experienced the opposite of that, because we were two per year and three per year alternating. And so at any given time, it was like eleven residents in the program. And by a certain point, we were outnumbered by attendings. And imagine that level of scrutiny and just kind of maybe backseat driving and things like that. I mean, there’s just no escape. And when you talk about diversity of thought, it’s like, yeah, I could imagine people could really find like minded people within that program. If there’s, eleven people and people are drawing lines in the sand, it feels a little bit like you’re going to war every day.

Dr. Ellie DeJong: Yeah. The degree of scrutiny is something I didn’t think of before, because in my program, it was kind of like the Duggars, where it’s just like there are too many children that you’re like, which one are you? But then with this one, it’s truly the only child. Only none of them had probably the portrait of you in your fencing uniform.

Dr. Frances Mei Hardin: They didn’t have the portrait, but they also didn’t have incredible parenting skills. It did feel like that sometimes. I’d come home and I’d be talking to my husband. I’d just be like, my attending dad is so shit to me. He went on this tirade in the OR, and it just really know when you talk about dysfunctional family, I get it. And I think that that’s quadruply true in these small programs because there is no hiding. I mean, yeah, maybe it’s like the Duggar family, but in mine, it was just like a toxic, tight knit, dysfunctional.

You took maternity leave during your anesthesia residency because of postpartum depression

I guess I think that it would be helpful for listeners to know, and it helped me personally so much to know when you shared your story about what it looked like, practically speaking, when you did take time during the anesthesia residency. In my experience, no one had ever done that in my program. I doubt at that institution, my program director would not have really known what that would look like or how to make it work.

Dr. Ellie DeJong: Yeah. so basically what had happened to give a quick background was, I had a baby in March of 2021, and then I took m maternity leave until August, late March. And then from late March to, the 1 August I took maternity leave and I came back for a few months. And, due to just kind of baseline mental illness plus very severe postpartum depression, I was really not doing well psychologically. really struggling with balancing the role of, mom and resident and just feeling like a total failure all the time, which kind of weighs on you after a little while. and so I was so deep in that pit that I didn’t even think of asking for an extra break. especially because you’re in that again, the training math of, like, I’m just going to keep swimming and I am going to slog. So that way this training doesn’t last any longer than it possibly can. Never mind the fact that you are going to be completely eviscerated by the time that it’s over. so I emailed an attending in my department who is very, heavily into wellness, and is very loving and supportive and just kind of like the sort of person who you want to work with when you’re having a bad day. She’s like, you’re so powerful. You’re just so wonderful. And, I emailed her because she’s also a mom. And I was like, hey, I am struggling with balancing being a mom and a resident. Can I talk to you? Thinking that I would mind her for tips on how to totally fix my brain. And then I sit down in front of her and I just completely lost it. Snot from orifices that I didn’t think could produce snot. but you’re an ent, so maybe they can. And I’m just behind, and then, like, hiccuping and all this. And then she’s clearly like, oh, holy crap. and then she’s like, okay, well, what do you want? And then I was like, hot bread. And then I got it, which was very nice. Basically, once I had finally communicated that to her, she helped facilitate. And basically, I emailed our program director and our chiefs, and I was like, it is not safe for me to be at work. I am barely safe in my own little meat sack of a body right now. I need to take more time. And, our program director was very generous and immediately was like, yes, of course. Take all the time that you need. To the point where they communicated with the chiefs independently m of me. And I had a really difficult rotation coming up that was going to be like two months anyway. And they’re like, yeah, it would be weird for you to come back in the middle of this rotation and really mess up the schedule anyway, so just take the next two and a half months. which was like, I was floored and I thought I was going to get like a week, tops. and then I got that, and it was very nice, to say a in gross understatement. it was like the whole thing was, because we had so many warm bodies.

Dr. Frances Mei Hardin: Yeah, exactly. I mean, it’s tough because it’s hard to imagine what a little program would do in that situation.

I guess one thing that I’d be interested in knowing is what mental health care you received

I guess one thing that I’d be interested in would be what type of mental health care you did during the period. And then also, did you have to set that all up, or did the department provide resources?

Dr. Ellie DeJong: Yeah. So this was all me. not to toot my own crazy lady horn, and also, really, I would say, also the help of my therapist. I think the whole reason I can’t advocate enough for trainees to get therapy however they possibly can. and I was lucky and privileged enough to find someone during my Pete’s residency who I saw on and off in Pete’s residency, and then picked back up again after having, like, to find a therapist who works primarily with physicians, and also loves doing evening hours. I think therapy as a trainee feels really intimidating because it’s like, my program will find out, and how will I get to actually have sessions. But I literally facetime with this woman, and I pay her through Venmo, and she’s phenomenal. But anyway, she really helped me advocate for myself. But, the resources I took advantage of were, so I reached out to my primary care doctor, M. and told her that I was having some severe issues with postpartum depression, requested, a referral to a psychiatrist who, as we discussed, was supremely unhelpful, and if I still remembered his name, I would name and shame all the way on this podcast, because I’m the queen of petty. anyway, I digress. so I basically demanded that I be placed into intensive outpatient therapy, which was something my therapist had recommended. and I did that program for about a month, three times a week, in the mornings, it was like a three hour session, and then also had bi weekly meetings with my therapist. But really, a lot of it was just, like, time to sleep and just focus on not directing all my own energy toward hating myself.

Dr. Frances Mei Hardin: Right.

Dr. Ellie DeJong: Yeah. did you take a break or did you?

Dr. Frances Mei Hardin: I did not.

Dr. Ellie DeJong: You were forced to soldier through.

Dr. Frances Mei Hardin: I did the thing that you so appealingly described as, like, just slog through it, squash it all down.

Dr. Frances Mei Hardin: Yeah, but I totally agree with your point, because basically, it’s like, had I taken a break and added a little bit of time on at the end, then maybe by the time I had pushed through and finished, I wouldn’t be like an empty meat sack. I could be like a human girl at the end of training. But instead, the worst thing in the world, when you’re a resident is the idea of more residency. And it was for me, at least. So, yes, I was like, I would do anything, not really understanding what it would cost me and what I was giving up and really the ways in which I was betraying myself every day that I didn’t stand up for myself, just took it and squashed it down and kept showing up to work every day. so, no, I didn’t take a break. But also, like I said, there were, like, ten to twelve of us at any given time, so it would have been pretty catastrophic for a resident to take a break. the class behind me had one resident get fired and the other resident was held back a year, so then they didn’t get replaced either. So there was a missing class behind me. That meant, as you can imagine, so my class had three residents. We then became whatever year we were, plus the year below. Like, when we were PGY threes, we did the job of twos and threes. When we were fours, we did threes and fours. And when we were fives, we were the only senior residents.

Dr. Ellie DeJong: Oh, my God. So you were, like chief, but also chiefing, like an imaginary shadow version of yourself?

Dr. Frances Mei Hardin: Yeah, just like chief of yourself. And so, yeah, there were these weird, like, when you’re a fourth year resident, you are a senior resident, so you should just be on senior call. However, we had to also help out with junior call as seniors. So just like, some nights you’d be on senior call, some nights you’d be on junior call. And like I said, I think that it says enough about the department. Like, we’re not naming and shaming. It says a lot about the department that that even happened, that we lost an entire class of residents under very contentious circumstances. And there were claims made against the department for things like discrimination based on mental health and discrimination based on race. So for a long time, I worked in this environment where not only were there issues of senior residents bullying the juniors when I was a junior, attendings just truly being verbally abusive every day towards the residents, especially seniors. But then, in addition to all of that, there were periods where I had some residents who were junior to me recording rounds on their cell phones every morning so that it could be turned into a lawyer. And in those situations, I wasn’t leading rounds. I was just a person on rounds. But, I mean, imagine what, the general vibe and environment was if that’s what you’re showing up to work for every day.

Dr. Ellie DeJong: Yeah, it’s, very taxing and God I’m so sorry. That is just unbelievably.

Dr. Frances Mei Hardin: Yeah, it really was unbelievably awful. And obviously, it’s unusual that something like that would happen. But I guess what I find troubling is how there isn’t a lot of recourse for it. So all the residents who were affected by the craziness over this several year period just had no one to reach out to. We didn’t have any really neutral third bodies at any point. by the time that I was a senior, there was an AcGme investigation of the program. And, I don’t know how much or what change even really came from it as I graduated and moved on. But I will say that just the retaliation, like, the retaliatory comments that went on for months between announcing the AcGMe site visit and when it actually occurred, I don’t even know that it was worth it. It was a lot of just, like, continuous, comments of, you guys have really done it now. Like, you’ve ruined your lives. They’re going to come do the site visit. They’re going to shut down the program. You’ll all be unemployed, you’ll never be employable again, because another program is not going to take you. And obviously, no one would hire a partially trained ent. and so I had junior residents coming to me in tears, being like, are they shutting down the program? All they announced was an AcGMe site visit. Is that true? That site visit equals shutdown of the program. And what’s so funny is that, of course, this is like a process shrouded in relative secrecy. And so when you’re looking it up online, there’s not enough proof that that isn’t true.

Dr. Ellie DeJong: Yeah.

Dr. Frances Mei Hardin: But let me, on the record, say, they didn’t shut down the program, nor was that ever, like, on the table. The only place where we were hearing that from was from attendings in the department.

Dr. Ellie DeJong: Yeah. I think so much of medical education is just carried on the backs of people being silent. And there’s a lot to complain about in residency, and residents are really good at complaining. but at the same time, I don’t know. So much of it is just dependent on everyone just being like, okay, this is how it is. And it’s really wild. I think your example is way beyond the pale of awful, but at the same time, there are echoes of it in pretty much every program. I think my Pete’s program had a situation where, I think my intern year, our, graduating senior, like, the way that it was painted by the program leadership was. The graduating seniors are burnt out and very bitter. And so they intentionally made us look bad on the ACGMe survey. And so now we’re going to have a site visit, and this is going to get the whole program in trouble. And so now you have to do all this work to. This is why all of the things that the seniors complained about is wrong. It was wrong with them to make these complaints, and now you have to fix it. and even in this program that was supposedly loving and pediatric and very tight knit, we had so much heady, resentful retribution. Just like, shouldn’t the program leadership be like, this is designed to deliver patient care and help other people, but it’s also designed to instruct and support trainees who are going out into the world, presumably as minimally broken human beings. But here we are, and it’s just like ACG. The program leadership in general is so focused with maintaining its own status quo that any deviation from it is just a huge inconvenience, and they feel personally threatened and victimized by it.

Do you think people are hesitant to change the culture of medicine

Dr. Frances Mei Hardin: Yes, I love that point, and I wanted to ask you this question anyway, so thank you for that segue. Because do you think that one reason why people are hesitant to change the culture of medicine is because saying this is problematic amounts to saying, I, who have helped build this world, am problematic?

Dr. Ellie DeJong: Yes. Oh, my God, yes. I think so much of medical training, I think, is abusing yourself and sacrificing things, even if you’re not really cognizant of it, to fit into this structure, and it becomes this intense pressure to maintain that structure once you’ve finally broken enough bones that you can fit into it. and then to feel like.

Dr. Frances Mei Hardin: I.

Dr. Ellie DeJong: Think especially because everyone else we work with is, like, admirable and high achieving. So that way, when someone. And you want to look up to them and compare yourself to them, and then when they say, like, hey, the system is broken, the system is wrong and awful and hurting people and not doing good, then you really feel personally threatened. And I think there are echoes of that in all sorts of training, like residency education, the debate between leaving academic medicine and going into community or private practice. All this stuff is like, when people feel like the thing that the relationship between their weird, toxic marriage of themselves and medicine is threatened, then they get weird. Like, really weird.

Dr. Frances Mei Hardin: Totally agree. Well, yeah, it is like the marriage to their identity and their identity within the system. And so they are invested in how things are. For instance, like an attending at their residency program, in their own department. So any change would mean confronting decisions that they’ve made that either created or sustained the problematic reality. And so I do think that part of, at the core of changing the conversation and changing this culture, like 1 meter on the dial at a time, is that we have to get over things like that and be able to examine ourselves without a crazy ego and, be open to that conversation.

Dr. Ellie DeJong: Yeah. And I think that culture of victimhood, it’s so easy to be like, even as a resident, or you’re like, this fucking patient with the fucking bleeding tonsil is ruining my life when it’s like, whoa, hold up. The patient has a bleeding tonsil? That sort of thing. and I think that just continues. It’s just like this knee jerk response, I think to feel like a victim, even when you’re high up, in medicine and taking your own ego out of it, is so difficult.

Dr. Frances Mei Hardin: The way I would phrase it is that a very high up person in our department pre acgme site visit, but post survey brought all the survey answers. They’re deidentified. But in a program of eleven people, that’s not super deidentified. because you can make an educated guess. But he basically put up this PowerPoint slide and corralled us all into the conference room. And he was like, okay, we’re going to look at this question by question because obviously site visit coming up, which is like shocking news because we’re doing an amazing job here. And it’s like, yeah, sounds good. Next slide. Just like, tell us whatever, we’re here to be told. And he would put up a question. It’d be like, have you ever witnessed discrimination in your workplace based on race, gender, anything like that? And it was like five out of eleven people had said yes, for instance. And he was like, that’s it. He’s like, that’s not even the majority. I wanted to be like, do you know how he was like, so not even that many of you. Five is not that many. It’s like, What are you talking about, man? First of all, take out the people who didn’t feel safe to respond honestly, because it might be ten out of eleven or eleven out of eleven. And then also take out the people in denial who are just like not seeing maybe what’s going on, or they have the luxury of not seeing what’s going on because of their position and demographically who they are. But, yeah, I mean, just five out of eleven, that’s not nobody. He’s like, this is almost no one. So he girl mathed his way to. I’m killing it.

Dr. Ellie DeJong: Yeah.

Dr. Frances Mei Hardin: And very few of you are salty. I agree. It’s a very interesting, inability to extricate one’s own identity from that, the program or the culture of the department and things like that. But it’s too much fun to talk about, and we’re going to probably also get in trouble if we say too much more. until next time, but I want to transition to, our closing segment, which is called, do you believe in karma?

Do you believe in karma in medicine? Frances Young says she does

Dr. Ellie DeJong: M. Okay. Do I believe in karma? like I said earlier, I’m like the queen of petty. yeah, three years of training in pediatrics can make you very, So, in my mind, real karma would be like Judge Judy. Like judge Judy justice. Like someone publicly either rewarding you or ripping you a new one while I sit in the background and go te. So, having been a doctor now for almost eight years, unfortunately, that type of karma doesn’t exist. as much. Yes, maybe I can be that judge Judy someday for the world of medicine, when I feel like I can just burn all my, Then, you know, I think in a more subtle, like the Martin Luther King Jr. The moral arc of the universe bends toward justice. That I do believe in, that I think is real. I don’t know.

Dr. Frances Mei Hardin: Do you believe in karma?

Dr. Ellie DeJong: Are you allowed to say, I will?

Dr. Frances Mei Hardin: Yeah. I like kicking around with people. So we’ll talk about. I would phrase it as, I need to believe in karma. It’s like a faith of necessity. And so that’s one of the things that got me through residency. If I really didn’t think it was real and I went full nihilistic, then I could not have dragged my carcass across the finish line after five years the way that I so handsomely did.

Dr. Ellie DeJong: It’s, a beautiful meat sack.

Dr. Frances Mei Hardin: Yeah, I did it. To what end? We’re going to find out. But I just think that at a certain point, of course, we put our faith into stuff that we can’t see or prove all the time. This is like one of those where I do need it. It’s not satisfying. I haven’t seen anyone get judge dutied yet. And, I think that as long as we don’t challenge the norm or these cultures in the hospital that are toxic and abusive and those people continue to remain in power, nothing’s, going to change. So maybe it’s like karma is real, but not on the timeline that you want. Or at least my therapist has said that to me, which obviously set me off the handle at one time.

Dr. Ellie DeJong: I was like, I don’t want to hear that. yeah, I get that the karma is real, but not on the timeline or degree of petty retrofit and not.

Dr. Frances Mei Hardin: In the way that you want, because, yes, we want Judge Judy, but they’re know, maybe in another fashion that won’t know tangible to you, which. That’s totally fine. Obviously, I’m not the moral arbiter of this. I’m just, like, a reformed dirt bag. So I’m not claiming I should get to see that. But I will say that, I didn’t make my junior residents cry. And so that is my one tiny ivory tower that I do get to live in. You know, when I was a junior resident, everyone was like, when you become a chief, you’ll see what it’s like. You, too, will be like this. Like a complete monster. I was like, I don’t think so, but I can’t prove it. So maybe, But now looking back, I sleep fine at night. There are always times where you’re short with someone or it really is an airway emergency and you’re curt or whatever it is. And I’m comfortable enough with myself, and I believe in this enough to then go to that person and be like, hey, I’m sorry.

Dr. Ellie DeJong: I was curt.

Dr. Frances Mei Hardin: Yeah, I was stressed, but that’s not an excuse. Shouldn’t have been like that. So we can then kind of move forward. Still with a fresh slate every day.

Dr. Ellie DeJong: Yeah. No judge duty coming for you.

Dr. Frances Mei Hardin: Well, yeah, 50 50. thank you so much for being here. Like, such a joy to just chat with you and reminisce. But next week, we will have Colin Royal on the podcast to discuss strategy for physicians to succeed in residency and beyond. Yes. Thank you. Give it, up. As my husband, he has had a front row seat to the nightmare job that is being a surgery resident. We will share in depth strategies and frameworks for organizational dynamics that help me survive residency. Follow me on Instagram at at Francesmei, MD, and at rethinkingresidency. Visit my website, rethinkingresidency.com, to learn more about resident physician stories and ways that residents can most effectively navigate the game of residency. I cannot wait to connect with you on the next episode of Promising Young Surgeon.