Breaking Point

I hesitate to use this word sometimes because of how often it comes to mind during my training- “breaking point”. I am not quite sure where I picked up this idea, but in my head, breaking points should only happen a few times within someone’s lifetime.

In my training thus far- I have used that word nearly every other day.

Today was one of those days.

The powers that be gathered in their lofty seats and decided to radically change the EHR- electronic health system. While this newer system offers the promise of easing the flow of day-to-day clinic, so far it has succeeded in causing a multitude of frustration and several concerning instances of confusion.

You see, I expected the chaos and mayhem, but what I didn’t expect was to reach another breaking point. Between precepting patients, getting patients in and out of their visits, and mitigating wait times as much as possible I started to get pleasantly disgruntled over the minor frustrations I was running into. From not being able to prescribe medications to not being sure whether or not I was reviewing the most up to day patient information, one thing started to add on top of another.

Being questioned by my preceptors, listening to the complaints and concerns brought by others, and ensuring each patient left the clinic with what they needed was about all I could take before I realized I was losing my grip on being the “nice and agreeable black resident”.

Being a black woman, I have learned to master the skill of not allowing myself to be too expressive, particularly when negative feelings arise in a professional setting. I have learned that there are very few people I can openly trust to be vulnerable with and have adapted by creating a strong exterior pretending all is well.

It took about all I had to keep replaying in my mind the following phrase: do not break.

Patients added to my schedule without me being informed- do not break.

Preceptor asking questions about small details that don’t seem relevant- do not break.

Medical student requesting to see patients, knowing that the process will delay me for at least an hour- do not break.

Needing to take a lunch break after finishing a pediatric sick visit (seen nearly an hour before the scheduled time) when I notice afternoon patients are starting to come in only to have your preceptor chastise you for not following-up with a small detail (which should have been appropriately followed-up by the patient’s PCP) related to the pediatric patient seen prior to having lunch- do not break.

Having a medical student’s expertise be recognized, while my efforts appear seemingly subpar- do not break.

Answering side-line questions about an EHR I have yet to master- do not break.

Having a patient thank a medical student graciously for his service while walking away from me without as much as a second look- do not break.

Delaying patient care for a teachable moment by an EHR expert for my preceptor who was on vacation during the first week of the EHR launch- do not break.

Another preceptor complaining about the frustrations of the EHR, while I listen and offer empathy- do not break

Behind on notes- do not break

Gradually feeling overwhelmed- do not break

Starting off already on an unsteady footing, not wanting to be at work that day- do not break

Feeling unseen- do not break

Feeling burned-out- do not break

Wondering if this is a sign that this is not the place for me- do not break

Questioning whether I am good enough- do not break

Frustrated with myself for not being on my A-game consistently enough to feel confident- do not break

Smooth over any ounce of anger, alternating between a soft, empathetic tone and an assertive, slightly passive aggressive tone when communicating to hide my boiling frustration- do not break

Being constantly interrupted while asking a question only to not have your question answered and to be repeatedly have others "speak over you"- do not break

Have a co-resident noticing something is up, but not fully trusting the safety of confiding in him- do not break.

Repeating “it’s all good”with every obstacle I run into- do not break

Watching your preceptor go to lunch after she adds a patient to my template without informing me- do no break

Not wanting to burden anyone with the weight of the tears burning behind my eyes- do not break

Having background thoughts such as not having enough money and needing to find an alternative source of income to survive- do not break

Trying to heal and grow while desperately reminding myself not to revert to maladaptive coping techniques in real time- do not break

Dealing with the subtle disrespect of being a black female as opposed to a minority male- do not break

Knowing very few will ever understand my day-to-day struggle- do not break

Do-Not-Break…

A phrase I am learning to continue to internalize because as much as “advancements” have been made in medicine, as a black physician I need to watch where and how I step. Yes, I belong and (should I choose to continue) I am capable of both succeeding and overcoming, yet I also realize the world I am moving in.

I can feel very lonely at times, even though I know I am not alone. It can be hard to feel like I am doing good work, especially without needed external encouragement, reminders, and support during the harder days.

Still, I continue to hold it together and fight my way through. For now, while it may not be the best, holding onto my armor without revealing the cracks is the only way I feel safe in this professional space (and perhaps the world in general).

So even though it takes all that is within me on most days, I choose, and sometimes need, to remind myself: do not break.