Post Training Stress Disorder: Life After Residency

As we near graduation day for residents across the country, be sure to take some time to acknowledge the trauma that goes with training and be ok with some awkward starts to your new life.

Fact 1: During training your resident spouse didn't live on the same plane of existence you did. Instead, they lived an adrenaline-fueled existence where often all they could think was "oh my God, do X now or someone might die."

Before graduation we went shopping for something at J. C. Penney. As we waited to check out behind someone returning something, Dani stormed off from the check out, muttering under her breath about it taking too long.  She went in search of another cashier station where no one was being waited on.  I followed her through the store, and finally asked, "Are you in a big hurry?"

"No. I just don't want to wait in line." 

"If we wander the store, though, it's likely someone else will wind up in our spot in line and it will take longer.  Just chill out."

"I can tell I've been on ONC; everything has to be done an hour ago."

Fact 2: You need to put yourselves on common footing by going somewhere neither of you have been before. You're just as screwed up as your doctor spouse immediately post-training.

Our financial advisor made us promise to take a trip after graduation, and we were all too happy to oblige.  We planned a two-week vacation that started in Amsterdam, went on to Berlin, then Warsaw, Krakow, and finally Sitges, Spain.   We'd return from that trip, finish packing up our house, and move to Southern Arkansas. 

We left from Kansas City a few days after graduation.  The first few days after graduation, I noticed Dani became irritable about odd things that normally wouldn't bug her. A simple, "Hey, Dani" resulted in an irritated and abrupt "WHAT?" After the third such reaction, I asked her if there was some other way I could get her attention that might result in a different response from her, as I seemed to be triggering something. It turned out she wasn't aware she was snapping at me,  which actually came as a relief.

Thinking back to the J. C. Penney trip, I realized that for four years when someone said "Dani" on the floor of the ER or OR or anywhere else that it was pressing and was probably a moment where someone was pulling her out of a task that was significant.  I tried to imagine what that was like--where anytime someone said your name you were expected to make a decisive choice or offer a solution/treatment plan. That at any moment, things might crash if you chose the wrong thing or didn't choose fast enough.

I also thought about my own training experiences. While there will likely never be a life-or-death situation where I'll be called upon to save someone by giving a concise analysis of Hawthorne's work, I remember feeling lost after my degrees.  I was lucky (?) that when I defended my dissertation I was already in a full-time job, so I didn't experience that identity limbo that many residents will--especially those moving from an educational hospital setting that is far more fast-paced to a rural/small town practice.  Even still, I don't remember much about my training years. I do remember feeling a bit lost after 12 years of a specific goal.

Graduate education and other immersive, all-consuming experiences are traumatic--even when they are great experiences.  And, those immersive experiences require reprogramming and recovery. 

Fact 3: Things will never be the same. And that's actually good.

I built up the time after training as some ideal fantasy period where everything would just return to the way it was a decade ago--before medical school.  I didn't take into account that we went on our trek across Europe both suffering from PTSD.  So often during training, we'd talk about how things would get better. It took some careful thinking to realize that I was just as impatient to get to the "better" as she was to check out of J. C. Penney that day.   

Once we verbally expressed the anxieties we both had about life after training, we were able to face them together. In the year since graduation, we've gone on a trip, moved house, said goodbye to our beloved dog Trey, I quit my day job and am focusing on my writing, and Dani started her practice.

And, it turns out we really do still like each other. 

Fact 4: Role redefinition is key--for both of you.

As the song "Circles" says, you can't come back the way you came.  You've both changed during the training process. Expecting your relationship to work in a straight line or on a timeline is foolish.

If you were like us, the last 7+ years of training created a dynamic where one of you kept things going at home and in the non-hospital world, sheltering the doctor in training as much as possible from the mundane.  The non-med spouse gets used to handling the dishes, laundry, pets, kids, maintenance stuff that keeps the house from falling down completely, and daily hassles. And while it seems during those years that you'd give anything to have some help on that front, now that the doctor of the house is around to offer input, it's normal to feel a bit put out of your routine.  

Taking time away from the familiar--both the house and the hospital--will force the two of you to work as a team. Eventually, once you both have had some time to exhale and sleep for a few nights uninterrupted, you'll find a new rhythm. 

If you're lucky enough to have some down time when you get back from vacation, you can continue to redefine roles. Dani had several weeks after we moved before she began seeing patients. What that meant was she could process and fully transition from her training identity to what would become her practice identity.  Those weeks also allowed me to transition from being the handler alone to letting go of some control.  Dani's self-therapy involved redoing some of the closets in the house to feature Elfa systems. In those first few weeks, I just let her go--if she wanted to organize the kitchen, I not only was ok with that, but I asked how I could help.

Fact 5: Listening to other people who have been through post-training stress disorder will help you get through it.

I'm so glad to know Donna Rovito of Physician Family. When she asked me how our vacation was, I replied, "great, once we acknowledged the PTSD."  That was all I had to say--she knew exactly what I meant and even though her husband has been practicing for years, she said she still has the talk with him when they go on vacation that he has to stop being a doctor and just be a person for a while.  When I started this blog, I didn't really talk to other doctor spouses much--since then, not only has Physician Family flourished, but other resources like Lara McElderry's Married to Doctors site and podcast exist. Listening to others stories does, as Lara says, "make successful homes happier."

We're well over the six-month mark since her clinic opened, and we've settled into a teamwork rhythm now, working together to organize the kitchen and clean the garage. We're tackling our large open lot behind the house now, and looking forward to our next trip, a CME cruise in August.  Before then, though, we'll return to Kansas City to attend residency graduation for the class after Dani's. I'm so excited to see everyone--Dani's classmates will be there, too, so we'll have time to catch up with everyone. 

Researching for this entry, I found plenty of videos and articles on how to negotiate a contract, how to pick a first job, and various "day in the life of a resident" resources.  What I didn't find was actual discussion of identity-formation and how stressful that is after training--for both the doctor and their significant others. My graduation wish for those finishing residency this summer: Embrace the limbo. Take time off and stop being a doctor for a few weeks. You won't forget how, I promise.

"It doesn't matter to me if the glass
Is empty or if it's full: it's what's left in the bottle." --"Circles" by Krystle Warren