Training on the trail: residency lessons learned in the back & beyond

By Zoë Cross, MD

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It is truly a privilege to live within shouting distance of the mountains here in Salt Lake City. It is also a privilege to be a resident physician. Entering a residency program means a young doctor has made it through undergraduate education and medical school, countless tests, sleepless nights, and probably too many cups of coffee to count. It’s an arrival of sorts, and it’s also a bit of a jarring beginning. As a new resident, and as I’ve started taking advantage of the many miles of trails that surround Salt Lake City, I’ve spent some time thinking about the lessons that the wilderness can teach us about residency training…

 

  1. Be prepared…but also be prepared to sometimes be unprepared. Trying to pack everything you might ever need on the trail is an exercise in futility, so you’ll have to quite literally weigh your options. There are diminishing returns with adding things to your pack just because they might come in handy – eventually, you’ll be unable to carry such a heavy weight. Similarly, it’s impossible to fit everything a resident would ever want to know inside a single brain. There’s an enormous pressure to try to remember everything, knowing that one day it could make an actual difference to an actual patient, but we cannot predict every situation. So we will have to learn to improvise, and to rely on our companions to have packed the knowledge we have not, and to learn to trust our instincts.
  2. Learning to sleep anywhere is a skill. If you’re tired enough, you can nap along the trail on a sunny flat rock if it’s chilly, under a shady tree if it’s hot…or on a couch in a hospital lounge, in an office chair in a storeroom, or in your car before driving home after a long shift. Even a ten-minute catnap on the train can be remarkably refreshing. Remember all those naps you refused to take when you were younger? Learn to nap anywhere, and you can start to collect them back!
  3. Keep your eyes on where you’re going. Not watching your feet is a good way to trip. Additionally, sometimes it’s best to keep your head down and focus on putting one foot in front of the other, instead of getting discouraged by the ground left to cover.
  4. …but don’t forget to look around you. You came for the scenery, right? Or the satisfaction of doing something you weren’t sure you could do? Or the excitement, or the wonder, or the people you’d meet along the way? Something brought you here, and it would be a mistake to ignore the route, to focus only on the end goal.
  5. Good footwear is important. Just as you need good hikers for the trail, as a resident you need shoes that are suited to taking care of patients: sturdy, comfortable for hours on your feet, easily cleaned, and that allow you to run in an emergency. (Note:  it’s a scientific fact that the comfort of hospital footwear is inversely proportionate to fashion credibility. Buy the Danskos. You can totally pull them off).
  6. Protect yourself against the elements. Obviously, this is important in the woods: wear layers, don’t forget the rainfly for your tent, pack a dry pair of socks…everything your mother was right about. It’s also important to protect yourself against the burnout and negativity sometimes found in medicine. Medicine, as it turns out, is hard. The cumulative trauma—and I do not use that word lightly—of our experiences, of the sum total of Worst Days in which we are participants, can take its toll, on us and on our patients and on the people we love. It is not really “normal” to work 80 hours per week, or to hold a dying patient’s hand and then to go next door and politely greet the next patient, or to deliver the worst news a person will ever hear, but we do it regularly. No wonder there is burnout. No wonder we are tired. But if we rely on our colleagues for support and shared optimism, to debrief and to go for an after-work run and to tell each other “you did the right thing, even though it was hard” after we do the unthinkably difficult, it will be easier. It will be better. We will keep warm and dry.
  7. It’s okay not to have a destination. Sometimes there is not a map for where you are going. Or perhaps more accurately, sometimes there is a map, and it is still better to explore it for yourself.
  8. Sometimes you just need a snack. Enough said.
  9. Keep going. Have you ever been on a trail that intimidated you? Where you felt out of your comfort zone, or where the path was steeper than you’d expected, or you thought you’d never reach the summit?  This is sometimes the case in residency. It can be overwhelming, and sometimes discouraging, and honestly, scary; most of us question our decisions on a regular basis. Yet we have chosen this path, and even if the only thing to do is to put one foot in front of the other, we can do that.

 

 

These are a few of the lessons I’ve found the trail can teach us as residents, but there is one lesson it can’t: leave no trace applies only in the woods. That is, we should be leaving our mark on every patient—one of optimism and joy and curiosity and passion for learning—the things that brought us to medicine in the first place. We should allow ourselves to marvel at our patients, at their stories and at the honor it is to be a part of them; to bask in the collective knowledge and skills of our entire healthcare team. To do our best to leave no one and no place unchanged, but instead more hopeful than we found them.

zoe-cross

Zoë Cross, MD is an Intern Family Medicine Resident in the Department of Family & Preventive Medicine at the University of Utah School of Medicine.

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