By: Nina Honeycutt
December has been a rough month for me. I’m sure it’s been rough for you, too.
This month has solidified that being married to a resident can be really hard. Though this blog is oriented to the mental health of medical trainees and attendings, the mental health of trainees, and the construct of the medical education system in general, is inextricably linked to the mental health of their family members. I am married to a surgery intern, parenting a toddler, still learning a new job, adjusting to a new home, and living in the times of covid-19. All of these things are, in and of themselves, stressful. Currently they’re knotted together and it’s been exceedingly challenging to untangle them. I’m beginning to think it’s actually impossible, which is a huge improvement from where I was a few weeks ago. Let me explain.
The details of my month don’t really matter because the stressors are so universal: unfairness, unmet expectations, uneven distribution of labor, persistent uncertainty, and inadequate support. With the presentation of each stressor I could feel tension building in my body and righteous anger dominating my thoughts: I cannot believe this is happening! Why do I always have to handle everything? Why is there no one to help me even though I help everyone? I hate this! I imagine a resident in the thick of training could identify with many of those thoughts, too.
Righteous anger is a tricky emotion. It’s the kind of emotion that tends to generate a lot of support and sympathy for the individual while also helping them to avoid experiencing more tender emotions like loneliness, disappointment, and sadness. Righteous anger can feel good. It feels like a restitution for having been wronged and like a release of rage, but it is neither. Righteous anger is exhausting and ultimately unproductive. But if righteous anger is unproductive and yet one’s anger is justified, what is the next step? Enter: radical acceptance.
Radical acceptance is the act of accepting reality exactly as it is even (and especially) when it is painful. It is not giving up or accepting without action and it is not wearing rose colored glasses. When we practice radical acceptance, we can acknowledge our feelings, accurately assess situations, and then respond effectively, thereby preventing the suffering that comes with wishing, resisting, and striving for things to be different. It should go without saying this practice is easier said than done.
How would this have looked during my own difficult month? When I learned last minute that our weekend childcare was falling I spiraled into cataloging the various difficulties of being married to a resident. Instead of spending many hours stewing at my own misfortune and limitations I could have first acknowledged my feelings of frustration and unfairness, and taken stock of the resources I had at my disposal to solve my problem. Instead of scrambling to try to rearrange my schedule I could have simply used the paid time off I’d accrued and then gotten on with my day. Because I leaned into the righteous anger I spent hours feeling really unhappy when I could have shifted to viewing the issue as a minor annoyance instead and fixed it with a few quick decisions.
Because radical acceptance can decrease suffering it is a skill that can be particularly useful for medical trainees. Picture this: you’re an intern and there is a patient on your service whose family can be distrustful and argumentative, and every interaction takes considerable time and resources. Oh, and this is one patient of 20 on your census, you’re getting hammer paged by nurses, your senior is wondering what’s taking you so long, and you haven’t eaten in several hours. Your tension rises throughout the day and by the time you get home all you can do is rant to your partner about the unfairness of it all: Why did they even come in for care if they don’t trust the team? Doesn’t my senior remember what it’s like to be an intern? I can’t believe I spent four years and $250,000 to run around doing paperwork all day! What a waste of my life! Without realizing it two hours tick by and you slide into bed frustrated and downtrodden. The righteous anger hasn’t been helpful and if anything, it’s made the day even worse.
Here, radical acceptance can at least alleviate additional suffering and may even help you better manage stressors. It could look something like this: I feel unappreciated by my patients and team. I do not like this aspect of training but I can’t skip it, and it will not always be this way. Accepting that difficult and disappointing phases of training are unavoidable and also acknowledging that they are temporary validates the experience of frustration while instilling a sense of calm about the present and hope for the future.
Perhaps accepting your patient and their family exactly as they are can free up mental space for you to create effective communication strategies and boundaries that alleviate pressure on staff. Maybe decreasing tension in your mind and body helps you to not overreact to every terse page or snide comment. Hopefully at the end of the day you return home feeling able to connect with people or activities that are restoring, rather than using your precious off time feeling angry and powerless.
Medical training is hard enough without layering on self-inflicted suffering. Radical acceptance offers an opportunity to temper emotional distress, validate one’s own experiences, and then thoughtfully and effectively move forward. Though not a panacea for the many problems associated with medical training, it can help trainees decrease emotional pain, strengthen resilience, and enhance self-efficacy. And that’s pretty radical, isn’t it?
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Nina Honeycutt is a clinical social worker, toddler mom, and resident spouse who has been on the medical training journey for nearly a decade. Her personal experience with medical students, residents, and their families has driven her interest in physician wellness. You can find her on Instagram @the.residents.wife where she shares snippets of training life and thoughts on wellness, mental health, and ways to support trainees and their families.
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Posted on December 29th, 2020. Follow us on Instagram at (@medical.minds.matter).
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