STARTING TO PANIC... did I make the right decision??? Please help!!!!!!!!!!

[Looking4Info]

I am a US med grad who matched into OBGYN and am in the process of packing for my move to begin residency. Each day this week I have had NO APPETITE, been crying, feel freightened, overwhelmed, and like I have made the biggest mistake of my life. Why am I a doctor? Is OBGYN right for me? What if I can't handle the hours or the work load. What if I'm sick and can't work (I suffer from cluster headaches)? What if I experience the same euphoria/hallucinations after being up 24+ hours as I did as a medical student? What if my I miss my family too much? What if I hate every part of this and wish I never started and just want out but can't leave and feel trapped? I don't want to be like all those horror stories you read about residents becoming depressed/suicidal because they hate it so much.

Are these normal "adjustment/change" feelings or am I truly losing it? I feel like calling my program and saying I can't come. I don't want to move, be away from my family, experience these anxious feelings for the next 4 years.

ANY FEEDBACK IS WELCOMED. I would love to hear from anyone with similar feelings and what your outcome was.

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[Law2Doc]

I am a US med grad who matched into OBGYN and am in the process of packing for my move to begin residency. Each day this week I have had NO APPETITE, been crying, feel freightened, overwhelmed, and like I have made the biggest mistake of my life. Why am I a doctor? Is OBGYN right for me? What if I can't handle the hours or the work load. What if I'm sick and can't work (I suffer from cluster headaches)? What if I experience the same euphoria/hallucinations after being up 24+ hours as I did as a medical student? What if my I miss my family too much? What if I hate every part of this and wish I never started and just want out but can't leave and feel trapped? I don't want to be like all those horror stories you read about residents becoming depressed/suicidal because they hate it so much.

Are these normal "adjustment/change" feelings or am I truly losing it? I feel like calling my program and saying I can't come. I don't want to move, be away from my family, experience these anxious feelings for the next 4 years.

ANY FEEDBACK IS WELCOMED. I would love to hear from anyone with similar feelings and what your outcome was.

I think you ought to experience a bit of internship before you get to this level of angst. Cool it with the "what if"s. You will find out what if, when you get there. Really no point stressing out and talking yourself out of residency before you start. There is an adjustment period and a very steep learning curve, but very very few US med school grads wash out. In all probability, you will do fine if you control your anxiety. The loss of appetite and incessant crying might be an early sign of a depressive psych issue -- you may want to talk to someone about this (but not on SDN, which is not meant for medical advice). Some degree of nervousness is normal. But this is really supposed to be an exciting step in your career progression, not a reason to pack things in.

 

[ozzidoc]

It's a fairly normal response to the anticipation of experiencing a stressful event.

You are moving to a new place, starting a new job, starting at a new workplace, starting a new career, earning money when you weren't before. Furthermore, you are expected to know how to manage sick patients.

I suspect that you feel that the lack of familiarity and lack of control of your life are partially the cause of these feelings.

Have you anyone at your med school with whom you can discuss your situation? Like, a mentor? Or some of your friends or people who know you well?

This is going to sound flippant - I don't mean it to though. Basically, think about all of the above in the same way as one would approach eating an elephant...one little bite at a time.

Think about the (little) things that you can control, and that you are familiar with, and how you'll be able to integrate these into your "new life".

I'll drop by this thread again in a few days with more suggestions.

Hang in there

 

[ShyRem]

Breathe. Now think of all the idiot doctors you have met in your life (come on, we all know some). Certainly if they can make it so can you.

As for whether OBGYN is right for you, if you decide you can't stand it there are ways to switch residencies. Don't panic.

Breathe. Have a beer. Do some yoga. Some relaxation exercises. Have a nice long bath. And breathe some more. One day at a time.

(Or maybe I'm just too busy freaking out about my house not selling and having to move, pay a mortgage AND rent to be too freaked out about internship itself. But I've certainly felt over my head before and have come out ok.)

 

[error404]

You can do it.

I agree with what everyone has said so far-- its normal to be nervous. You made it through med school, you can make it through this. Sure, there will be some adjustments, and it won't always be easy, but take it one day at a time. Go in with an open mind and give it a chance. Programs tend to know that interns are nervous, need some orientation, and most of them try to pacify the raging terror when you first show up.

And let us know how you're doing.

 

[peppy]

Give it a chance. You might be pleasantly surprised. My internship really was not as bad as I expected. Even if it turns out to be a bad experience, all you have to do is make it through the internship and then you can try to switch to a different program next year.
You have nothing to lose by at least giving it a chance and seeing how it goes.
Also, think of it this way, unlike med school, most of your rotations in residency will have relevance to what you actually like and want to do. That may make it more tolerable than you expect.

 

[notinkansas]

Are these normal "adjustment/change" feelings or am I truly losing it?

The questions you are having are normal. Transition from med school to residency is a big one- you can't say "I"m just the student" any more.

I think your reaction to the questions you have is outside the bounds of "normal". Do you tend to react to stressful situations with such extreme anxiety? If so, now would be an excellent time to learn some coping skills. I see some potential here for your anxiety to actually create the situations you fear.

The truth is, the vast majority of people complete their original residency program on time and do fine. While many do not love it, they can cope with it. I might add that most of us who feel trapped in medicine feel trapped by financial obligations such as student loan debt or a family who has become accustomed to a particular lifestyle. If you are mindful of this now, you can save yourself potential pain later. (eg if you can't make your full student loan payments, try to at least pay the interest do that in ten years you are paying a much larger balance due to interest on interest on interest...)

 

[ozzidoc]

The questions you are having are normal. Transition from med school to residency is a big one- you can't say "I"m just the student" any more.

I think your reaction to the questions you have is outside the bounds of "normal". Do you tend to react to stressful situations with such extreme anxiety? If so, now would be an excellent time to learn some coping skills. I see some potential here for your anxiety to actually create the situations you fear.

The truth is, the vast majority of people complete their original residency program on time and do fine. While many do not love it, they can cope with it. I might add that most of us who feel trapped in medicine feel trapped by financial obligations such as student loan debt or a family who has become accustomed to a particular lifestyle. If you are mindful of this now, you can save yourself potential pain later. (eg if you can't make your full student loan payments, try to at least pay the interest do that in ten years you are paying a much larger balance due to interest on interest on interest...)

Agree. Nicely explained

 

[IMdocT]

OP is 5 days old, so i wonder how OPer is doing. i just wanted to pipe in, because i had the same feelings recently. while some nervousness is normal for everyone, mine was abnormally intense in a way i had never experienced before. i had symptoms mentioned in the OP and then some. i think all of a sudden it finally sunk in that I was no longer a full time student, and I was going to have a big change in roles, responsibilities and expectations. i started thinking about what if i'm not happy, if i couldn't take intern year, if i had picked the right career, and it scared me. i thought there was something wrong with me, because i should be excited about moving up to another phase of my journey. i wasn't sure if i was the only one feeling like this.

i talked to friends and family, and i did a lot of introspection and my anxiety has calmed down. some things i've kept in mind:
1. the amount of anxiety i was experiencing was way out of proportion to circumstances, and it wasn't helping so i had to find a way to control it
2. internship is tough for everyone, but most people get through it OK, and there's an excellent chance that any 1 intern will be OK too
3. all interns start off not knowing much about how things actually work, especially in a new place, and good seniors/attendings know this and should help out especialy in the beginning
4. i am there to learn and try to be the best intern i can be. i will make mistakes and i should learn from them, and may get yelled at but i should try not to take it personally or it may hold me back
5. i do feel a bit trapped, after signing a contract, taking out loans, and having family expectations following me around. but i have to remember that even if there were ever a situation where i decided i didn't want to do this anymore, it's not the end of the world. if maybe i didn't enjoy the specialty, there are others i can always try to join. maybe the PD could help me out and i could take a breather. or there are non-clinical jobs for MD's, as mentioned in some other threads, but harder to land. or i could even do something completely non-medical. people have done it, so it's not impossible
6. i was probably having "grass is greener" syndrome, as i'm younger than most of my class and never really experienced or strongly considered other careers. there's no use of me regretting the past as i've gotten this far already, and there's no much use wishing for a completely different path as there's no way to know if i would enjoy it either (unless it came to a point where i needed to create an exit plan)

i think internship won't be as bad as my fears lead me to believe. the only way i will know if i won't like it is to go there and experience it, and there's a good chance that, although tough, i may enjoy it. orientation, for many, begins next week. i will do my best and hope for the best. i wish you and all of us starting interns good luck

ps: i would like to know if any seniors/attendings felt this level of anxiety too, and how they handled it. i feel like i'm in the minority because i posted something similar in another section and everyone was like just chill and enjoy your time off and i don't think i clearly stated how scared i was

 

[335230]

ok

 

[Doctor Bagel]

You know, this is a huge change, and I'm agreeing with the others in saying that what you're feeling is pretty normal. I'm starting internship in 2 weeks and am not quite where you're at, but I'm feeling some of it. And I'm probably not exactly feeling the same anxiety as you because I'm going into a lower stress specialty (psych) and just moved back to a city I loved where I lived before. If I were moving to a totally new town and starting anything other than psych, I'd probably be exactly where you are.

Your feelings are normal and aren't really indicative of anything about whether you're not you made the right career decisions about medicine and ob/gyn. And internship is just one year of your life, and even if you're in the wrong specialty or in the wrong program, you can fix that.

Change is always hard. The key is to not make any rash decisions right now. As the Grateful Dead said, "well, the first days are the hardest days, don't you worry anymore."

 

[Jwax]

I was freaked out starting 1st year, and I was freaked out before starting 3rd year. I'm sure before starting internship next year, I will have the exact feelings you are having now. Transitions are the hardest thing to cope with. Fortunately, the only remaining transition after starting internship will be becoming an attending/starting life in private practice. My thoughts are if you can make it through each of the tough transitions thus far, you'll probably get through these final two as well. Try and get through the first few months with humility and gratitude and you'll probably wake up in November realizing you are comfortable in your new role. Good luck.

 

[Captopril]

Breathe. Have a beer.

This is the best advice here. I'm being serious, too.

 

[Ronin2258]

This is the best advice here. I'm being serious, too.

I concur with this statement.

Take a deep breath.

Have your favorite beverage.

You are almost to the summit of Everest here; don't stop at the Hillary step.

 

[PharmaTope]

maybe you need some Stuart Smally motivation (SNL skit)

I personally recommend you watch Full Metal Jacket. Think of how that drill seargant is. He makes the recruits hate him so they will be better.

Honestly, intern year is tough but think of the training Navy seals go through. The sleep deprivation and forced to physically exert themselves on top of mental challenges.

There are people doing this everywhere, why cant you? Have some faith, hit the ground running, You need to think like a machine like you are going to war every single day and morning. that is what would personally get me through it. Everyone is different.

 

[Kris1]

maybe you need some Stuart Smally motivation (SNL skit)

I personally recommend you watch Full Metal Jacket. Think of how that drill seargant is. He makes the recruits hate him so they will be better.

Honestly, intern year is tough but think of the training Navy seals go through. The sleep deprivation and forced to physically exert themselves on top of mental challenges.

There are people doing this everywhere, why cant you? Have some faith, hit the ground running, You need to think like a machine like you are going to war every single day and morning. that is what would personally get me through it. Everyone is different.

Yeah... I'm not so sure I agree with your comparison. I've been through some of the training that you mentioned above and would take it again any day over what I'm about to begin. At least if I made a mistake before the only person who suffered was me. If I make a mistake in the hospital then other's lives are affected.

 

[335230]

ok

 

[Looking4Info]

Hi everyone. I am the OP and wanted to give an update.

First, thank you all for the insight that what I am experiencing is normal, albeit more intense. Most importantly, thank you to those who sent out encouraging messages about faith, being able to do it as others did, etc.

I think that the hardest parts are: change, the unknown, serious responsibility --> lack of self-confidence. I am hoping that after orientation week, most of this will diminish. But the person who said it's "I'm not a student anymore" hit it right on the head. As a student, if you were sick, ill, had an emergency, etc... you could leave. NOW I FEEL TRAPPED. (And for further insight, I have a long history of agoraphobia with panic attacks hence the fear of being trapped and unable to leave.)

To the person who posted above to is also experiencing similar feelings, please PM me. I would like to chat... perhaps we can help eachother through. I know that these messages have helped me feel so much better already... knowing I'm not alone. I just have one question... at one point, or any point, should I seek out an upper level or my PD or someone at my new program and confide in them about my anxiety and cluster headaches? I'm not looking for special treatment nor do I want to appear weak. But I feel that compassion comes with you are honest, no? (Of course this is program/person dependent). Any thoughts????????

Finally, just want everyone to know that I completed my move with my spouse and we are all settled into our new home. This stability, at least, is offering some well-needed solace.

 

[notinkansas]

I'm not sure it's wise tell anyone I work with about your medical issues. You should establish a relationship with a primary card doc now, though- make sure they are controlled as best as they can be. No need to be in a hurry to reveal them. If, in any way, they interfere with your job performance, then you should reveal. If not, no hurry, or need to.

 

[Law2Doc]

I don't think this advice addresses the real issues here:

1) Enormous debt
2) Stress and long hours
3) Moving away from your family
4) Not being sure if you are in the right field

Oh well..best of luck anyways..

Then look at it this way. (1) Enormous debt -- by intern year you've already borrowed it, no real turning back now. (2) Stress and long hours - it sux, but for the most part programs try to give you a schedule that makes the 80 hour work week average feasible. You can survive this -- almost everybody does. (3) Moving away from family - there comes a time when everyone has to move out of the nest. Many folks did this in college or med school, so you have a few years of an edge on these folks in terms of "being ready". There is great value in having your own independence. (4) Not being sure if you are in the right field - well, there is no better test run than internship. You will learn a lot by doing, and doing, and doing. If this year doesn't help your decision making process, I don't know what will. Just approach it with an open mind and excitement, and you will do fine.

 

[DaveinDallas]

OP ---

I don't know if you've ever had a job in the corporate world (i.e. not your typical college 'filler' job)....but you're experiencing some of the same things that come with starting a new position -

You're leaving one company (college/medical school) where you have a performance history, know the routine, know what's expected, etc. Probably had good reviews (i.e. passed exams/boards) and were quite comfy....

Now you're leaving that company for a promotion into a new position with greater responsibilities and liability. You're going into a 'jr. manager'/'independent contributor' position where you'll have responsibility and be expected to perform at a certain level. Others WILL be watching you and checking your work to be sure you don't eff it up and cost the company a lot of money. You'll get performance reviews with the new set of expectations. You should probably expect some bumps and bruises along the way in terms of getting ding'ed on your performance with an eye towards improving. What will cause problems is if you don't improve or act like you're blowing things off.

On top of that comes the stress of moving to a new city and all that that entails - who do I call for plumbing, where do we shop, where are the parts of town to stay out of, we don't know anyone except colleagues here, etc.

So the normal amount of performance anxiety is to be expected. They wouldn't have hired you if they didn't think you could do the job at least from an educational perspective. What they can't gauge, even with LORs, is work ethic and how you take responsibility and correct your FUps.....that's what YOU can control and really all you should be worried about. You've got enough medicine behind you if you graduated and passed boards - no matter how many tries it took. Yeah, you may get pimped into submission and ragged on if you show weakness as lions hunt for the weak ones or those that are trailing the herd.....

But most programs are non-toxic or they don't fill, so just drink a tall, cool glass of 'I don't know everything but I can do this' and hang on for the ride......Most people are successful....and you should be also....

 

[Bito42]

Being 1 week into internship myself, I would offer 1 piece of advice: use your chief residents. Re: your cluster headaches, anxiety--they are great people to know this. not only have they been through residency very recently and can talk to you about it, but they are the schedulers too! so if you get a HA, you would tell them anyway. I have migraines and i'm thankful i have such wonderful chiefs who i wouldn't be scared to approach with a need for a day off.

finally -- it'll take you a few days to get into your groove. Today was day 5 for me. and I'm exponentially more 'in my groove' than i was 5 days ago. and i have a lot more to go.

good luck!

 

[Law2Doc]

... i'm thankful i have such wonderful chiefs who i wouldn't be scared to approach with a need for a day off.
...

This is not the norm for many residencies. For the most part chiefs are good people, but in most residencies they really truly don't want to hear anything from an intern other than "no problem, I'll take care of it". Their job involves a ton of responsibility, a lot of headaches of their own, and they want to have the administrative stuff run smoothly so they can focus on the doctoring aspects and fellowship search etc. They would rather your problems not be their problems. Unless it's a big department, there probably isn't someone readily available to cover for you if you have to go home sick. If you manage to trade with another intern, that's usually fine, but for the most part, they aren't going to be amenable to saying, "oh you have a migraine, go home".

So IMHO many of us would never think about approaching a chief for a day off unless you were truly incapacitated. And even then I'm not sure I would ask to go home, but rather might ask to go to the ED or occupational health or something still on premises. I think a lot of residents have experienced illness while at work and the culture tends to be such that you wouldn't ask to go home. Heck, I've spent an overnight in the wards puking my guts out and I know others who had nurses in the ED put IVs in them so they could finish their shifts. You get along much better with the chiefs if they never hear that you need to miss a shift. Doesn't matter how nice people they are, they have to make sure everything is adequately staffed, and in most cases they are depending on you to be there.

I suspect that while things seem like a love fest to you "being 1 week into internship", the expectations are going to increase dramatically as the year progresses. And the chiefs simply aren't going to want to hear reasons why you can't be there, they are only going to want to hear "no problem, I'll take care of it".

 

[ANCAdoc]

So IMHO many of us would never think about approaching a chief for a day off unless you were truly incapacitated. I think a lot of residents have experienced illness while at work and the culture tends to be such that you wouldn't ask to go home. Heck, I've spent an overnight in the wards puking my guts out and I know others who had nurses in the ED put IVs in them so they could finish their shifts.

I always laugh when this stuff gets written. This is bad business, not good for you nor patient care. When you are sick you are doing the bare minimum for your patients, plain and simple. Patients don't want a sick doctor taking care of them. We shouldn't debate this here, it's been done in the past, and not the topic of conversation.

Times are changing, L2D. This misguided "culture" is slowly being reinvented, and thank god.

 

[Law2Doc]

I always laugh when this stuff gets written. This is bad business, not good for you nor patient care. When you are sick you are doing the bare minimum for your patients, plain and simple. Patients don't want a sick doctor taking care of them. We shouldn't debate this here, it's been done in the past, and not the topic of conversation.

Times are changing, L2D. This misguided "culture" is slowly being reinvented, and thank god.

Perhaps at some places the culture is changing, but I can tell you from experience it sure hasn't changed everywhere. And it's not the interns who have any ability or role in changing the culture, it has to come from above or not at all. So no, times are not changing. There may be pockets of change but in many regions and specialties it hasn't budged an inch. I sure wouldn't tell new interns to expect to call in sick, ever, unless seniors in that program/field tell them that's the way things work. At a LOT of places it isn't.

And it's not because I am saying this is something I think is the right approach, or that I even have a vote. Cultures exist. You don't get to come in and change them as an intern no matter how silly or "bad business" you think it is. The folks at the top (chairmen, department heads, to a lesser extent chiefs) can create culture. Everyone else gets to live within that framework. Anyone who thinks these cultures are not widespread simply needs to see what goes on at more programs. It's very much a military approach, there's a hierarchy, you have your place and do your job and they really don't want to hear about why you can't.

 

[cartoondoc]

I agree with Law2Doc. I don't think it will hurt you to tell your chiefs about your medical issues, but don't expect them to be understanding about needing days off. There are some rotations during internship where you can be sick, but if you're on a wards rotation, you just have to power through unless you're close to dead.

One thing I would tell the OP is that you should remember that if things are really bad, you are not stuck. If it turns out ob/gyn is not the right specialty for you, it is not that hard to switch. I thought it would be pretty hard, but it honestly wasn't.

 

[hippiedoc13]

(And for further insight, I have a long history of agoraphobia with panic attacks hence the fear of being trapped and unable to leave.)

I strongly second the above suggestion to establish care with a primary care doc (and/or a psychiatrist) in your new location NOW. When you know that you have a pre-existing health condition, it is so helpful to have an established relationship with your doctor before you are in the full swing of internship. Maintaining and optimizing your own health will be important to reaching your best performance in residency.

As others have said, you will get through this! Good luck.

 

[ANCAdoc]

It's very much a military approach, there's a hierarchy, you have your place and do your job and they really don't want to hear about why you can't.

True statement. Many would be ill-advised to call in a sick day. If the program allows it, don't be afraid to use it.

Luckily, I haven't had to call in sick yet. I came in once with viral gastroenteritis and was promptly sent home by my attending. If I had to miss a day for whatever reason, we are lucky to have a jeopardy system (if I miss on a call day). If I'm gone for just a day the team adapts, there is inherent redundancy.

I do think the new generation of docs are not similar in values, ethos as the old guard. Change is coming slowly, as the younger generation creates change. It is slow, but very real. We would not recommend the same working conditions we have (30hr shifts) to any of our patients (regardless of their job), so why expect that of ourselves? (rhetorical)

 

[plainolerichie]

Well, you're not alone. I'm not as intense (mainly since I always have an appetite, no crying, etc.), but I'm definitely anxious! I feel like everyone has to be very afraid of starting internship. To those who claim not to be think of Star Wars:

Luke: I am not afraid
Yoda: You will be, you will!

 

[cfdavid]

OP, you're not alone. I really think this is a matter of perspective.

First, I really think you'd be abnormal if you didn't feel SOME sort of anxiety with starting residency. I start related activities tomorrow, and feel a bit anxious.

I think a tendency that many of us have is that we expect ourselves to know (after all we're MD/DO's now, with the diploma to prove it!) everything and to be 100% competent all of the sudden.

That's where we err. Sure, this is a new challenge. We'll be held to a higher standard, to be sure. But, if we were expected to know everything, than why would there even be such a thing called residency?? Hell, you should just jump in there, run the L&D board, teach medical students, run the C-section....... You see the problem here?

*****A very important tool is controling what YOU ALLOW into your head. And it's NOT easier said than done. You can do it. If you focus on all of the scary stuff, then your response (disproportionate levels of anxiety) will reflect that. But, if you focus on the positives, likewise.

An example; We all know it's gonna be hard work with greater responsibility. But, focus on the learning opportunities. Focus on the kinsmenship you'll feel with all of the other interns at your program. Realize that (aside from certain malignant personalities that ALL programs have and which EVERYONE must cope with) as a general rule attendings and senior residents will realize you are, well, an intern!

Everyone knows interns will have a steep learning curve. SO, you need to ALLOW YOURSELF THAT. That is, allow yourself to KNOW that you're NOT supposed to know everything. You will not be expected to know the EMR system IN AND OUT. You will not be expected to know dosages of all meds. You will not be expected to know the names of all of the consultants in the hospital. You will not be expected to know your way around even (if you haven't rotated where you're starting). There's lots more that you will not be expected to know.

I often think about, "what if" I'm strolling down the hall and someone codes and their are no senior residents around. Well, f.ck it! If that happens, you're not going to be expected to run a PERFECT code. Just do your best (I hope I'm not adding you anyone's anxiety here....LOL). You'll do just fine and help will arrive.

So, many may chime in and suggest, "yeah cfdavid, but you'll be expeted to know all those things in short order!" Perhaps. But, the point is that you'll be able to rise to the learning curve just fine as you've done all your life.

Internship will be a challenge, for sure. But, you're there to LEARN. Again, the reality may be that you're really there to WORK. HOWEVER, you have the moral authority to learn. That's really what residency is about. So, asking questions (not TOO unlike you did as a med student) is perfectly o.k.

Interestingly, an MICU attending at a hospital I rotated at suggested (to med students and residents alike) that you should have at least 3 questions PER PATIENT. Now, clearly that's not going to be every attending's style (obviously), but let that shed some perspective on it. What did he mean? That he knows you don't know it all!

And, when you ask questions (let's face it, medicine in general is very GRAY) it shows curiosity, and interest. They'll be expecting that anyway. That being said, if it's not your cup of tea, then don't STRESS about not asking questions. I only bring it up because it's perfectly NORMAL not to know it all as a newly minted intern.


O.k. I hope that helped everyone. It sure helped me......


cf

 

[335230]

ok

 

[cfdavid]

Once again, many of the replying posts (though obviously well intentions from caring people) seem to be about creating delusions in order to placate serious issues including debt, anxiety, and not being in the right career.

I don't think that delusions will last in the long term, but oh well..I offered some solutions above including the IBR / ICR which gives you future financial and career flexibility

Peace brothas / sistas

Those are serious issues. But, are they causing a new physician to REALLY second guess their career decision? I'm not so sure.

I think it's the anxiety speaking and those issues are a manifestation of that, which is normal to some extent, and thus any attempted advice that aims to decrease such high levels is just as valid as offering detailed solutions to debt/career decisions. I don't think they are aptly characterized as "delusions".

cf