Remembering your reasons for service: Reflections from a physiatry resident

By Melissa Kirk, MD

Over four years ago, you took an Oath. You made a commitment when you swore, “I solemnly pledge to consecrate my life to the service of humanity.” That was an amazing day when you stood proud as a medical student reciting the Hippocratic Oath. You were one step closer to fulfilling your passion of making a difference in your patients’ lives. It was going to be the best journey of your life, full of smiling patients and daily gratification. Everything was perfect, absolutely perfect!

In present day, your eyes blink while yawning, and your body is fighting to stay alert. You look at the clock and realize you have successfully exceeded 24 hours of no sleep. Your bedtime consists of napping in the hospital break room with dinners composed of cafeteria cuisine. You struggle to remember why you took that leap so many years ago.

I share your experiences and your emotions. According to the Journal of Graduate Medical education, we are not alone. In the December 2009 issue, burnout is described as a state of mental and physical exhaustion related to work or caregiving activities. This is especially high among residents, where prevalence rates may range from 27–75%.

With statistics against us, how does one fuel the passion to practice the art of medicine? I have learned one remedy to overcome the plague of mental and physical exhaustion. The solution is simple, serve your patients and find inspiration through their victories.

On Monday September 25th 2016, I was reminded of my motivation. I vividly remember the morning like it was yesterday. I started my rotation on the Spinal Cord Injury service at the University of Utah. Greeting my patients for the first time and I was particularly looking forward to meeting William Goldman.

William, a delightful 32-year-old male, had a history of achondroplasia resulting in L1-L5 stenosis. He was initially planned for scheduled decompression surgery, but acutely developed worsening leg weakness and bladder incontinence at which point there was concern for cauda equina syndrome. He was taken for emergent L1-L5 decompression with T12-L4 posterior spinal fusion on September 21st. Postoperatively he did well, was extremely motivated to participate in therapy, and was admitted to inpatient rehab three days following surgery.

I knew William’s drive and positive demeanor would take him far with recovery. He gave me daily high fives and cheered on other patients. He uplifted everyone’s spirits on the unit, including the staff. Regardless of long hours, William’s smile brightened my spirit each morning and evening. On October 18th he was discharged to his apartment in a wheelchair, but he had the ability to walk short distances with a four-wheeled walker. Thinking that would be the last time I would see William, I kept the memory of his warmth and infectious happy energy inside me as a fuel to push forward.

Ten months later, following intense inpatient rotations through the winter and an exhausting call schedule, I fell back into fatigue. With sleep becoming a distant memory, taking on extracurricular activities was definitely a low priority. However, a camping trip to East Canyon, through our incredible TRAILS (Technology Recreation Access Independence Lifestyle Sports) program, persuaded me otherwise. I was compelled to attend knowing the event is designed to help patients with a history of spinal cord injury achieve their sports goals.

Despite coming off post call, I arrived at 7am on Saturday morning shivering in the chilly canyon breeze. While setting up canopies and flipping over kayaks, sudden warmth came over me. The warmth was not from the sun, but from seeing William Goldman. This time, without a wheelchair, instead he took long strides down the canyon to the water with a single forearm crutch. Joy instantly overwhelmed me, removing any thoughts of fatigue, as I was reminded of the time I first met him and the progress he had achieved. Flashbacks to my first acceptance into medical school came flooding back. I was reminded of the rewards of medicine. I took an Oath and when fulfilling that promise I am reminded of the joy felt when serving others.

William now lives as my permanent reminder of my passion for the medical field. I challenge each of you to find your William. Seek out opportunities to serve your patients and celebrate in their victories to overcome burnout. As the famous Gandhi once said “The best way to find yourself is to lose yourself in the service of others.”

Melissa Kirk, MD, is a third year resident in the department of Physical Medicine and Rehabilitation at the University of Utah. She also serves as the Secretary for the AAP Resident Fellow Council.

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Resident Fellow Council, AAP

Resident Fellow Council, AAP

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Resident and Fellow Council of the Association of Academic Physiatry (@AssocAcademicPhysiatry)