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[quote=Anonymous][quote=Anonymous]OP here, again. I guess I'll keep coming back.

I guess I'm at a loss as to what to say.

Personally, I'd love to be a physician! In my field I deal with on-the-ground fieldwork abroad, but there is obviously no "healing" or direct community service. I just died of boredom in organic chemistry in college so that was the end of that.

But, returning to the original point: "hang in there" or variations of "it will get better" (actually, what this thread and conversation with a physician ex-GF have made clear is that for the next three years, it in fact will not...) are not validating or helpful with her.

During her rotations, she would call me fascinated and super excited about what she was learning, the diversity of knowledge/experience, and also go on and on about how she loves (loved?) dealing directly, long-term with patients on cases. We spoke for an hour this morning (she's off today), and what's clear is that she seems to be really projecting her angst/anger at the hospital system, state of the medical field, and capitalism:

"Dude, how am I supposed to actually care for a patient when my resident calls me out for spending more than 10 minutes with them?! I want to get to know people as people. Not as a f***ing series of lab results. This is not medicine, this is a business.”

What am I supposed to say? What she is saying is in fact true.

Thinking out loud earlier on the phone, I suggested she consider kickboxing (face-palm, I know), because what I'm starting to realize is that it may be anger/ frustration with how the medical industry is configured that is alienating her from being able to actually connect with patients. She did a lot of service work at clinics in NE/SE DC in HS and in college, but that was through the aegis of an independent school and college. So it's not like she's not worked with underserved populations before, it has just been a different setting.

Also, there are in fact Gen Z dynamics,, which seem to be universal, based on what I’ve read about generational changes in the medical industry:

Sister: “No one, in any situation, should be punched in the face in their line of work. That is my boundary.”

Me: “Look Sister, you have to remember that patients are not only terrified and alienated when they enter the ER/hospital – particularly if they are coming from an underprivileged community – there is also a natural element of regression because they come to you for care…”

Sister: “I do not endorse violence in any circumstances. My friend got punched in the face. Was given 10 minutes to compose herself in a storage closet, and then had to go back to doing rounds and keep charting. How is that OK?????”

Me: “Wow. I can’t imagine – that sounds terrifying. It’s not OK. And you know if that ever happened to you, I’d want to beat that person up. But remember, they are your patient. Even as a resident, you are the physician. And, remember that they are in PAIN.”

Sister: “Mmmmm.”

To wrap-up this blast, my big concern, which I haven’t really unpacked before, because I personally don’t know how to address, is the fiancé, with whom there is a class dynamic at play. Backstory: neither fiancé’s mother or father went to university, and though her future FIL worked a physically demanding job, it was punch-in, punch-out. MIL-to-be was a stay at home mom. She baked her kids super elaborate birthday cakes, put notes in their lunchboxes, et cetera. This is not a statement invalidating emotional labor or “blue-collar” labor – union workers and mothers are the engines driving this country; it’s ultimately a concern that the fiancé may project low-key trad-wife, take-it-easy expectations on her. His mother’s kitchen literally has a plaque that reads “Don’t worry, be happy!” (or similar)...

So, while her fiancé is very, very supportive (e.g. takes on 70-80% of the household load... I myself would not do this. My sister can do her own laundry) and also relocated with her to an apartment walking distance to the hospital she works at (bad decision IMO; there should be some geographic separation between work and life), my concern is that he is unconsciously projecting trad-wife expectations onto her. Our mother, on the other hand, had a research career spanning several countries. So the dynamic I worry about from my future BIL is: “why put yourself through this, if you’re so miserable?” Dude is great otherwise. Values education. Government worker with terminal degree. But definitely not the grind.

Again, this is not to pass judgment on his mother’s class position; in fact, it speaks a great deal towards her love for her son and the great amount of [unpaid] emotional labor she did engage in while raising fiancé, but I’m worried this will make my sister eventually come to the conclusion: why am I bothering with this?

This morning, me: “Sister, look. Its three years. If you wanna specialize, you could do ID and transition to research; if you want, you can go group practice and treat people at some plush practice in Chevy Chase or Bethesda”.

Sister: “I would never do that. Rich people have enough doctors taking care of them already.”

Me: “Well………..”

I think at this point, I’m just venting. I’m also frustrated/annoyed because I recently took a tenure-track position in another city six months before she graduated medical school/matched and before, I literally would have been in the same city as her and been able to provide more in-person support. We come from a culture where siblings are very close, and were raised by our parents to mutually support each other. I just can’t tell if the conversation I had with her on Saturday (which really alarmed me and led to my rather rambling original post) is venting, or true, long-term concerns. And I’m also weary of over-stepping my role as older brother, because at a certain point, she must make her own decisions.

I did tell her to go into IB or consulting when she graduated college, but she insisted that capitalism is evil, and she wanted to serve and work hands-on with patients. She also has an instinctive, knee-jerk aversion to anything deemed “élite” or “high-prestige”, which is somewhat a product of our faith which places a huge premium on community service and social action. So, I think she ultimately feels that she is not practicing medicine; she is working for a university hospital that is at the whims of a corporate/board structure, so there is that element of broken idealism. That is what really worries me. Because broken idealism can spiral into nihilism very, very quickly.

So I’m trying to maintain credibility, but it feels hard because like I said, I was incredibly lucky – needless to say, privileged too – but literally, in my field, it was just luck; a prof emeritus died, so now I have a job.

TLDR: How do I address the fiancé issue? His mother has made comments at lunch like “Oh, don’t worry, I’ll do the dishes. I wouldn’t want X to damage her hands!”

(I was livid). [/quote]

First, the fiance issue is not yours to address.  Do not get in the middle of someone else’s relationship.  You are endangering your own relationship with her if you tread into those waters.

Second, I think the big picture here is that her idealism is meeting reality.  This is part of growing up and maturing.  The world is a flawed place.  She has limited ability to change that.  She can only do what she can do.  In some ways, this is a grieving process.  She has to get through it and face the reality of modern medicine in our current society and figure out a way to navigate the system that makes sense to her.  Maybe it’s slogging through this current path, maybe it’s finding a different specialty, maybe it’s finding a different place to work when she finishes residency.

I assume she has typical student loans for med school?  Medicine is unique in that burden. I’d encourage her to be realistic about the financial implications of getting out of medicine now.  And I’ll just say, she’ll have the same disillusioning experience if she goes into teaching, and end up paid a tenth of what she’ll make as a doctor.

Honestly, I just think she needs to grow up.  I’m not saying that to be mean.  She’s facing reality and that can be a painful experience.  And her fiance probably hates seeing her in pain which is why he’s suggesting something else for her.  You’re both doing the typical guy thing of trying to fix her problem.   Try just listening instead.  Let her vent.  Stop trying to change it or take her pain away.  Let her process it by talking about it.  [/quote]

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