Appendix 80 - Undying

by Michael Greger, MD and United Progressive Alumni

[ Medical School Resources | Appendices | Discussion ]

"Nobody emerges from residency emotionally unscathed."[988]

I'm afraid internship will change me forever; I can feel my soul slipping even now. "My own internship," one doctor writes, "was the hardest, most devastating year of my life. It's been eight and a half years since I finished that year, and some of the pain, the anger, the exhaustion, and the anguish are still with me...."

From The Intern Blues: "Everybody who lives through an internship is forever changed by the experience.... Through the wearing down of the intern's spirit, that person also loses something he or she has carried, some innocence, some humanness, some fundamental respect."[989]

"'My only hope is that, like the Phoenix, I can resurrect at the end if it all," another doctor writes, "but I think it has changed me permanently and not for the best. It has made me more selfish, more inconsiderate in the free time I have, more dependent, and more depressed. No one would believe the effect on my life in general.'"[990]

It is not so much that we need to be taken out of exile. It is that the exile must be taken out of us - The Lubavitcher Rebbe

Commentary in Hafferty's Into the Valley:

[In her book A Not Entirely Benign Procedure,] Klass argues that the most disconcerting part of medical training is not the academic demands, but the experience of being socialized. She sees medical education as a form of socialized amnesia in which many students who began their educational careers vowing to retain their humanity and sensitivity eventually and unwittingly acquire the traits and characteristics they had once sworn not to adopt. The core of Klass's concern is not the change itself but rather the possibility that many students will be unaware that any transformation has taken place or, if aware, will confidently maintain that it will be corrected easily once the pressures of medical school end.[991]

JAMA: "Some think permanent damage is inflicted because... [students] radically readjust their view of what the real world is like, what it means or takes to succeed, or whether it is reasonable to try to fight for change."[992] From The Development of the Medical Student:

Students do not simply become what the medical school wants them to become. Indeed, their own broad and idealistic notions about what they ought to become are pushed aside as they turn their concern to the immediate business of getting through school.... To be sure, they attempt throughout to make use of the school to further their idealistic ends, but this is neither a fruitful nor a rewarding procedure. So they become 'institutionalized.'[993]

Medical student Richard Mularski writes "A Long-Overdue Letter to an Old Friend," starting:

News from the abyss - or should it read as a note from a bottle - lost on a forsaken island, send help!.... Sometimes overwhelmingly, the system is winning; it sucks the life out of us, changing us and challenging every belief we ever had, taking our humanness and trampling it, stretching the limits of tolerance and stamina to render the lot of us sniveling fools.... So I sit, smiling, uncomfortable, unable to reach out for rescue....

He signs the letter "medical student," but crosses it out and writes in "recovering human being."[994]


[988] Fugh-Berman, A. "Let's Stop Terrorizing Doctors-in-Training." Medical Economics 69(1992):27.

[989] Marion, R. The Intern Blues The Private Ordeals of Three Young Doctors New York: Fawcett Book Group, 1990:341.

[990] Friedman, RC, DS Kornfeld and TJ Bigger. "Psychological Problems Associated with Sleep Deprivation in Interns." Journal of Medical Education 48(1973):436-440.

[991] Hafferty, FW. Into the Valley: Death & the Socialization of Medical Students Yale University Press, 1991:18.

[992] Kopelman, L. "Cynicism Among Medical Students." Journal of the American Medical Association 250(1983):2006-2010.

[993] The Development of the Medical Student:418.

[994] Knight, JA. Doctor-to-be: Coping with the Trials and Triumphs of Medical School New York: Appleton-Century-Crofts, 1981:6.

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