Meditations on Resilience, Self-Care, and Clerkship

We had our third major exam of the year last week, and historically I would feel a sense of calm afterwards, or feel compelled to give myself a break because being holed up in a library motionless for buckets of hours entitles me to… something? But there was surprisingly little calm or respite that followed. I mean, I went out for lunch with friends, had a beer, treated myself to some shopping along Spadina Avenue. And then I went home and made a “to-do” list for the rest of the week, because clearly I have a hard time compartmentalizing and just ‘turning-off’ the Type A. Then again, how can I blame myself? In many ways the exam felt like the first layer of nuisance in a bitch of an onion — 10 lectures and counting, FMLE, HSR, CBSL, extra-curriculars, keeping my apartment clean, being a good partner in my relationship, finding time to cook meals because eating out is expensive, getting back to reading for fun because surely now i’ll have time, and of course, hidden in the deepest darkest crevice; finding time for self-care.

I keep telling myself to make it a priority, to bring it to the top, dust it off and give it some love and attention, but it keeps getting shafted. Because of this, I’ve been thinking about resilience a lot. How much can I take on? How much longer can I keep this cycle going? I feel drained. Yet I keep pushing. Is that making me stronger, or better able to handle stress?

Resilience is about building your faculties to resist being moved off center, off balance by stress, challenges, and adversity. This type of building and nurturing comes from practicing mindfulness, from reflecting and writing about what’s going on inside, and from making time for activities that rejuvenate you. I know the little things to be helpful as well, like not using a phone during study breaks because I don’t like the cognitive fog it leaves me with. I recognize all this, and still fail to give myself the self-care I need (although, I’m taking time to write this and feel better now, so I guess that fits the bill). If resilience is a muscle it’s certainly not best exercised with blind raging steroidal work-outs that go on for days. The muscle needs time to heal, to rebuild. I think being faced with healthy doses of challenges and stress is one of the most essential driving forces in any type of growth, personal or professional. Well then, what else is at play here?

Resilience is not binary. It’s never ‘on’ or ‘off’, or you have it or you don’t. It’s dynamic. It has reserve. I consider my resilience reserve to be pretty good, as with most medical students since we’ve had to already face our fair share of dealing with stressful situations. The challenge here is developing an awareness of how full or empty your tank is.

For example, I had my History and Physical test for our clinical skills course recently (and it was actually real chill). The morning of I felt myself getting uncontrollably anxious, similarly to how I felt when I had my first panic attack in undergrad. I was jittery, gut-tied, obsessively thinking about the upcoming test, of failing, taking a breath of air but feeling like it went nowhere. But I held it together this time around, took it moment by moment, sat down, took some deep breaths. And that’s it. It passed. I said a mantra to myself, which really helped. I’m almost embarrassed something like our H&P test pulled this reaction out of me. I think it’s because I had a lot of other things going on. Then again, I was also able to handle it, and this may have been because of experiencing an attack before, so I was better prepared. Nonetheless, it almost happened again, and I didn’t realize how expended my reserve was until that point, the gaslight had been on for a while I suppose. I’m fortunate enough to just have school to deal with, but what if I didn’t have my health, or family, or the support from my partner and friends? The importance of having a tight knit group of people you can reach out to in a crisis can’t be stressed enough.

But speaking of stressful… yesterday was the due date for submitting our clerkship rotation rankings. It’s a topic that has permeated even my closest circles of conversation; the ones I try my best to keep medical school out of. It’s uncomfortable being faced with big questions. The first being ‘what rotation schedule do you want because [insert myth about how you can only be a certain type of doctor based on the schedule you get]?’, which is of course the lesser evil half-brother of this question: ‘well, what is it that I want to do? what type of doctor do I want to be”… and wow, hello uncomfortable. Although I felt anxious about it at first, that feeling has since subsided, because (with the exception of a few specialties that will go unmentioned), regardless of the schedule, all of us will be exposed to the various specialties offered. Understandably, there is a fear of knowing early in order to choose electives later on, but those choices will change as well… And I think that’s completely rational and acceptable. Things will change, inevitably, and hopefully for the better. At the heart of our aspirations are some core values that I think will carry us through if we stay true to them; being ruthless in our learning, exercising patience (with ourselves and those around us), being friendly and personable, and working hard.

It’s going to be stressful. I’m already anticipating that. And I want to do what I can now until clerkship begins to exercise and refill my reserves.

I’m optimistic. Which almost feels weird to say. But a lot of this I think is about shifting perspective. Second year of medical school hasn’t been the most fulfilling in terms of course-work or meaningful clinical encounters, and the exams have been doing a great job of making me feel like I miss the point of every lecture, as though there’s some secret Da Vinci code I need to unlock with each slide but I’m the real life Tom Hanks and can’t actually do any of the things his character does in the movie… But we’re still living in the here and now, which is second year med. That’s not going to change tomorrow, or next week. so for us, right now, the best thing we can offer ourselves at this point in time is to enjoy it as much as possible. Take that extra minute to catch up with a friend. Try to really get immersed in the material and make connections clinically where you can (i.e. FMLE, shadowing, ASCM, that uncle who keeps asking you for medical advice because he thinks you’re a fully fledged doctor, etc.)

Anyways, that’s all I have to say about that.

What do you all think?