Freya Bleathman, who is now a second year doctor training in paediatrics, takes us through the highs and lows of internship to help us better prepare for the challenges of our first year of practice.

She believes in being open and honest about the daily challenges we face as doctors, so we can feel comfortable in discussing them and addressing the issues that need changing. 

I wasn’t a crier until I started internship. On reflection, it was partly being overwhelmed by such a huge workload; having self-doubts “confirmed” by the occasional harsh words of colleagues; the worry about making mistakes when making significant clinical decisions with minimal experience; and the general sadness (and sometimes joy) about aspects of the human experience I was witnessing on a day to day basis.

In preparation for this article, I have spoken with many colleagues. We debriefed, commiserated and, funnily enough, laughed while reflecting on some of our experiences in internship.

Below are some of the main triggers of the tearful moments we experienced. I hope sharing them will help you feel less alone during the low points, give you some language to help dissect, understand and resolve some of that upset, as well as highlighting some of the issues we as an industry need to work on.

OVERWHELMED - “It’s all too much”

Ah, the therapeutic stairwell sob many of us experienced. These situations were especially prominent earlier in internship when we weren’t as experienced at triaging the urgency of jobs and asserting the importance of having something to eat and drink during shifts. Much of the time, it was also a result of genuinely having a very high workload and the niggling sense of unease from making lots of complex decisions quickly.

“I was on a weekend cover shift and one of the residents was sick and the other got called away to assist in an emergency operation for 5 hours so I was left covering over 100 acutely unwell patients plus admissions.”

“I was on the MET team and there were two emergencies going on at the same time so I had to lead one while the registrar led the other. I felt totally in over my head.”

“I finished a busy day shift and as I started walking out, I got a call from rostering saying they had no one for the night shift so I had to come back that night.”

BULLYING - "High pressure environments don't always bring out the best in people"

A study published in 2018 in the Australian Health Review identified that over half the junior doctors who participated experienced bullying and nearly one-fifth experienced sexual harassment. Sadly, bullying continues to be a common workplace experience in the medical profession despite our acute awareness of its potential impacts. Yet, junior doctors are often reluctant to speak out. Part of this is because of the hierarchical system, the need to maintain working relationships, the reliance on colleagues for references annually and a reluctance to “cause trouble”, especially if others before them have tolerated similar behaviour. In reality, those I spoke with who did speak up about bullying were glad they spoke to someone and experienced help with subtle de-identified management or escalation when required. Some of the supports they found useful were the employee assistance program, chief resident, junior colleagues and trusted seniors.

“I did a rotation with a consultant who was notoriously awful. I would cry before work sometimes because I didn’t want to face her.”

“I heard a nurse criticising me to a patient.”

“I shared an office with 3 other interns and they did a secret santa without me and exchanged presents in front of me.”

FINAL STRAW - “It was a minor event but exhaustion had finally got to me”

These are the cries that often seem like an overreaction in hindsight but are a product of built up emotional stress that come pouring out at seemingly minor triggers.

“I was strutting around my brand-new fancy work shoes and a delirious patient told me to ‘take your shoes off, you sound like a bloody horse.’”

“I was having a bad day and went to buy an ice cream on my lunch break. When I went to pay, I didn’t have cash and they didn’t have eftpos, so the lady threw my ice cream in the bin.”

“I turned up to work for a day shift when I was meant to be starting in the afternoon.”

GUILTY - "Making a mistake" 

Doctors are human and no-one is immune from making mistakes, especially when inexperienced, overwhelmed or overtired. I found that sharing the mistakes we made is often quite cathartic and everyone will have their own stories to reassure you with. The vast majority of the time these mistakes are minor or fairly easily rectified. If they are more serious, seek help from a senior, medical indemnity and perhaps the AMA, early.

“I accidentally ordered a CT for the wrong patient.”

“I prescribed the wrong kind of laxative for a constipated general surgical patient and the registrar yelled at me.”

“I finished a 12-hour cover shift and forgot to handover an important test to chase.”

“I missed a cannula and the patient made a formal complaint against me.”

SAD - “But there is a process to manage”

There are days that truly test our professional resolve and these moments don’t ever become easy to deal with. Talking about it is often helpful, either with colleagues, family, friends or mental health professionals. Some people prefer to debrief early but others prefer to give it some space before addressing any ongoing emotions. Conversely, if you are part of a sad case and you don’t feel at all upset by it, this is one of the early signs of burnout.

“I had to tell a patient that he probably had lung cancer. His wife just started screaming.”

“I was in ED and saw a baby who came in critically unwell as a result of neglect.”

“I was doing a follow up appointment for a young cancer patient at the 2-year mark of remission. She mentioned some weird symptoms so I ordered some scans. The cancer was back and it was everywhere.”

HAPPY - "The events make it all worthwhile

I’ll end with something slightly more upbeat - the tears of joy, laughter or gratitude that we often have the privilege of experiencing with patients or colleagues.

“I still tear up at births sometimes when I witness the pure joy of the family.” 

“I once almost cried during a gruelling 14-hour cover shift when a lovely nurse gave me a cup of tea and a biscuit.”

“I swear half the ward cried after seeing the emotion of one of our patients who was finally discharged home after 6 months in hospital.”

There are many reasons we cry or become unsettled, particularly during our first year as a doctor. What I learnt from my first year was that sharing my experiences with colleagues, professionals and family and friends often reduced the burden of the emotions that I was experiencing. Talking to colleagues also made me realise that it is okay – in fact very common – to cry. It also helped me identify some of the system issues that we need to continue to work on, thereby paving a less tearful path for junior doctors in the future.

Shedding a few tears occasionally is quite okay but if you feel low for extended periods, feel depressed or suicidal or don’t have anyone to talk to please seek professional help. Doctors are notorious for not seeking assistance but it is most important.

Check out your local Employee Assistance Program, see your GP, or call a phone support line like LifeLine (13 11 14) your local AMA Peer Support line or Beyond Blue on 1300 224636