Final Chapter

I just completed the seemingly mundane task of updating my signature for my work email on my iPhone.  For many this may be an unnecessary task or a head scratcher as in "what?" or "you have a signature in your email?"  For me however, it's not.  My email always has a proper intro and a formal ending with of course what else but my always up to date signature.

Today is the last day of my 3rd year of residency training.  End of so far the fastest year of my residency.  I am slightly shocked by how fast this year has gone by and now as of tomorrow I am a PGY-4.  Next year on this day I will finally be done with my training.  So many emotions go through my head when I think of where this year is headed.  I think I don't want to think about it for a few months.

My signature update included changing my PGY-3 designation to PGY-4 and most importantly removing the "Psychiatry Chief Resident" title from the body.  It was a mix of nostalgia, sadness and slight sense of relief.  I am not the chief anymore.

I won't be getting dozens of emails about millions of different little things that I used to do from schedules (until I did them) to class schedules, to putting out little fires here and there, to big things that happen in every group that has 20 different adults of various ages and personalities, to many emails that I had to write to ask for this or that to be done.  I am not doing the orientation this year nor am I responsible for anything else chief residents have to do.  I mean there is no set job description as is and yup still no magic wand.  While I feel like I will miss the daily churn and the feeling of being needed that came with the job, it is probably going to be pretty nice to have a relaxing final year of training and being back in the middle of the group in the meetings rather than at the front of the room.

It is going to be a big adjustment because at this point I have more time as a chief in the program than just being a resident.  I am fully aware of this transition and that it will be a bit of struggle for me because I have a tendency to try to handle things when they present or take upon myself projects to handle things I think need handling.  My title gave me enough autonomy to do so while I was in the role, like figuring out patient hand off between incoming and out going residents or taking on updating our website or changing the ER rotation structure when I felt like it needed changing.  That is a place from where I have to mindfully step back and let the newbies get their feet wet and make their own mistakes and take up their own projects.

If I had a chance to do it all over again, I would probably do it despite of the frustrations and stresses and extra work it gave me.  These past two years also gave me a lot of experience to look back on and learn from my mistakes.  I am sure because of these two years I really want to think about what do I want from my life after this year is over.

I am finally ready to let the responsibility go and enjoy what is left of my residency training.  In the end as I edited my signature today to take my place back in the middle of the group, I realized that sometimes the seemingly little or mundane acts like hitting the backspace and delete keys are all it takes to take a load off and put up your feet.  Of course, it helps that now I am officially allowed to do so.
.  
As some one once said "Don't close the book, just turn the page."  so here I am and I think the final chapter is going to be the most exciting.  

Tis' the season to be Jolly!

Here it is again.  It seems just like yesterday when presents were given and parties were thrown, families got together and emotions were mixed.  Time sure flies when you are having fun.
Sounds like Christmas and for the graduates from all walks of life, it might as well be.  The diplomas that are handed to these graduates all over the U.S. are like the Christmas present you get from your grandparents and you know what is in it because you told them a thousand times what you wanted but now you aren't sure you picked the right present or worst would you be able to use the present as intended?

I have come to love the graduation season almost as much as Christmas because well really what's not to love?  It's not cold and there are flowers (unless you have allergies and then it sucks), sunshine, Facebook feed with a slew of gleaming pictures with grads and their proud families; and best of all Target and Home Goods have stellar sales for the grads.  I mean come on now, who doesn't like a good sale any time of the year?

Just like other academic settings this is also the time of the year when medical students, senior residents and fellows are graduating and other residents are moving up the PGY ladder.  What a great time!  I am going to be a 4th year in about 3 weeks.  When I started writing this blog I was in the middle of my 2nd year of training and here I am now finishing my 3rd year and being the senior most upper level resident.

I am graduating from PGY-3 to 4.  There is a virtual party in my head 24/7.  Well in the background at least.  It also is the last year of my training and I find myself getting sad at times thinking about losing the comfort cushion my program has provided me.

I call my program "The mothership" when I am on an away rotation and all of us have pretty much adopted that term.  Just like a mother, it provokes loving and secure feelings in us; while at the same time we have conflicting feelings towards it, making it what the Kleinians refer to as the bad object.  I have another year left at the mothership before it ejects me in the outer space to navigate on my own.  Talk about anxiety.

There is also the transition of the patients I have seen for a whole year and have formed relationships with.  It has been a hard transition for many reasons.  Some patients I wish I could keep but I am capped and some patients I have struggled with myself.  To find a new resident, that I feel may fit them or vice versa; has been a challenge.  Hand offs in residencies are not well organized for the most part and with mental health patients it can be even more sensitive and chaotic esp. for the patients.

This is also the year I will step down from my position as a Chief Resident for the past two years.  This has been one of the most challenging roles I have played during the residency and I say this with a five year supervisory role prior to starting residency.  Being a chief in a residency program is nothing like being a supervisor.  This is a position of a certain perceived power where depending on your PGY ladder position in the program; you may have peers, juniors and seniors to manage and think about.  I have learned of my weaknesses and strengths and I have made mistakes and done good things for us as a group and hopefully for the program.  The best lesson I have actually reaffirmed for myself is that as long as you do the right thing, and as long as you are willing to step back to look at yourself and your peers critically; you will do okay.

People are generally reasonable if you are fair and honest and by that I mean that you can sleep at night knowing that there is no nagging little voice tugging away at you from somewhere deep inside.  Because your only job at all times, whether you are a chief or not; is to take note of that little voice that we like to call the superego.

So here I am in the last stretch of my chief time and PGY-3, passing the hat on to the next chiefs; and passing a lot of patients to incoming PGY-3.

Next year it will be my time to graduate as we bid farewell to our current PGY 4s next week.

As the lyrics go:

As we go on
We remember
All the times we
Had together
And as our lives change
Come whatever
We will still be
Friends Forever

So if we get the big jobs
And we make the big money
When we look back now
Will our jokes still be funny?
Will we still remember everything we learned in school?
Still be trying to break every single rule
Will little brainy Bobby be the stockbroker man?
Can Heather find a job that won't interfere with her tan?
I keep, keep thinking that it's not goodbye
Keep on thinking it's a time to fly and this is how it feels.      

"Graduation by Vit C."

A Word Less Spoken - Grief !

C.S. Lewis said "No one ever told me that grief felt so like fear."

I see patients every day who are sad, anxious or angry but hardly anyone ever mentions grief, fear, being scared or being afraid.  I don't seem to get those emotions out easily from them, hence many of them remain unaware of their grief and the fear that comes with it.

Grief is tricky, grief is sneaky and grief is scary.  I say it is tricky and sneaky because we generally don't think of grief when we see people for therapy.  The most common feelings we hear are sad or anxious.  I tend to think there is always grief that lurks in the corners of their minds, sometimes obvious, mostly not.  Rage and anger to me are directly proportional to the grief people carry around.

Children need security of consistency, affection, love and care to thrive and become self sufficient, adequately attached adults.  No matter what your inclination is theory wise, an overwhelming majority of professionals do believe in importance of the early year bonds we as humans need.  When these bonds are dysfunctional or absent a perfect storm simmers.  How unfortunate it would be to come to this world and question the reason for being here not because of pure existential concerns but because no one ever made a big deal about you being here?  I wonder how many of us can relate to this feeling conveyed by any number of patients?  

My guess; probably most.  

I always wonder about the people growing up with feeling unwanted, unloved, uncared for or all of the above.  How it shapes them and their relationships?  What is it like to live in a perpetual state of being irrelevant?  It makes people angry, sad, enraged, anxious, worried, doubtful and so on and so forth.  But come to think of it, would all of these feelings not be linked to the feeling of grief?  

Grief for not having what seems so natural and right for us to have when we are born.  It's the sort of grief that lies so deep and is so intense that it almost demands to be acknowledged yet is so intolerable that it's almost always ignored because how can you grieve something you never had.  

But why can't you grieve not having something at all?  Wouldn't deprivation lead to indulgence but without gratification?  Adults with early attachment challenges mostly keep looking for what they never got.  Sometimes in form of one after another dysfunctional relationship, sometimes in substance use and many times in both ways.  The early age deprivations drive people to indulge in relationships with people and/or drugs in such self destructive ways but seldom result in gratification of what they need.  A bottomless pit of despair that always seem to be wanting more.  

I wonder if the grief of deprivation is so immense and scary that people can't seem to face it?  It must be very scary to never know what is it like to trust that one is worth anything.  It must be terrifying to ever think that your being in this world would ever matter to someone else.  May be it's the fear that realizing one's grief would mean staring the deepest darkest moments of despair in their face while at the same time acknowledging the hard work that it will take to own it and learn to live with it.  Grief isn't like sadness because sadness fades away but grief never leaves.  It etches permanently and it always have fear close by.  

To live with grief is to live with fear but to not respect and acknowledge grief; is to live in a constant storm that always simmer, is consuming and unpredictable because the more it is denied, the stronger and scarier it becomes.  

As C.S. Lewis says it's a process not a state, 


“I thought I could describe a state; make a map of sorrow. Sorrow, however, turns out to be not a state but a process.” 

The Couch Reversed

After a long absence I am back.  I have a few thoughts about what made it possible for me to come back today.  Last few months have been a whirlwind for me to concentrate on this blog and muse much.  I don't think there are enough hours in the day to contain what goes in my life on any given day.  I am nearing the end of my 3rd year and it is only 3 months away.  Hard to believe I started here midway through second year.  I have bad days and I have good days.

I worry about my impending cord severing in 17 months to be on my own and it scares me to think I will be on my own.  One would think moonlighting is a good practice to run solo but I still have options to consult, mainly because I am probably quite lucky to have that option.  I am losing one of the best times of my life at the end of these 17 months and I feel like I want to grieve at times.  I am sure, I am starting to.

One of the best things I have done for myself over the last 2 months is exactly what the title of this post says.

Have you figured it out yet?

And if you thought of therapy; you are the winner.  You are pretty awesome at this guessing game.  

So after 8 months of monkeying around this idea of getting in therapy for myself, I finally gave in.  The proverbial couch is literally reversed.  It is quite a transformation and one that I never knew would make me think so much.  

For many psychiatry residents, esp. if they are like me and see or want to see a lot more therapy patients, it is something that just has to be done.  I hope all programs provide supervisors for therapy cases, as they should but I also hope that many psychiatry residents do not end up ignoring the need for their own work to be done.  If you have a supervisor that is open to working simultaneously with you and on you, that is great.  My supervisor on other hand never had a choice and mainly because of me.  I am used to taking charge and in my mind, I had this one hr a week for case consultation, so I would walk in and use every minute of that hour for my patients.  He got to get glimpses in my personality but by the time I brought up the question of my own work with him, I already had a mindset that this is an hour paid by my program and I shouldn't use it for myself.  Not to mention I had 8 cases for therapy and at times 10-15, so I needed this hour more than ever.  

I started noticing my anxiety as a therapist get louder, the more intense therapy with my patients got.  The emotions and reactions in me were what forced me to be very honest with myself about what did I want myself to be able to do when I take on people for therapy.  

I started reading more this year.  Yalom, Bowlby, Beck, Wachtel, Gabbard, Robert Karen and numerous articles here and there.  None of these people that I admire so much and learn so much from, got so good at what they do without having their own work done.  

I want to be half as good as any of them.  That is what I want.  So I can't ignore the need to be the patient in order to be an effective therapist.  

I finally gave in and asked my supervisor to be my therapist.  That in itself was an intense experience from having to process my need to have the safe path to therapy with a known person than to open to a totally new therapist, finding a new supervisor and then realizing I lost my supervisor relationship with my now therapist.  It was something that came so unexpected yet proved to be a great stepping stone into the new relationship.  

Now 5 weeks into it, I have started to understand why my patients, who come sit across from me in my office; keep coming every week.  I understand that they are the ones doing the work and when they ask me questions about what to do, they are not meaning to put me on spot, neither are they looking for a magic formula; but rather exactly the opposite.  They already know what they are asking me, I just help crack the code.  Sitting across from my therapist when I share things that make me question my own abilities, limitations and that frustration that I feel with myself many times; I hear myself say things I only think about but am too scared to admit to myself.  It's like I believe, as if I am superhuman or should be superhuman.  I have started to understand my worries and anxieties in ways I probably already knew.  It is so odd how actually saying them out loud is akin to giving life to something many of us like to keep buried.  Reversing the role makes me see how without this step, I was never going to be able to fully understand the person who sits across from me every week without doubting the process every step of the way; because I never had the experience from the other side.  

Dealing with my own life and facing my own limitations, I have to do it; to do what I want to do.  The proof is in this post.  Took me 2 months from my pledge to write here to actually write this.  The only thing that has changed is that now once a week I get to be the patient.  I get to be able to let it go and face myself without reservations.  Something so hard to do but has a profoundly liberating effect.  Most probably one of the reasons I am back here writing again.  

So if you are a therapist, psychiatry residents or aspiring to be either one of those, keep your work on yourself in your mind; not as an option but as a necessity.  Not because it is cliche; but because it is anything but.  

As Irvin Yalom says, 

"Self exploration should continue throughout life, including entering therapy at various stages of life."

    

New Year, New Resolution - 2015 is here!

Oh dear !! I feel like a broken record.  This was a long break but so needed.  PRITE is done and over with.  Last year it was my disgust with it that started this blog with PRITE scores are in post.  This year I am not as disgusted.  I think it was the last part of my post that kept me going and ah money of course.  What do you know, as a fully licensed resident I do get to moonlight now and my in-service performance makes or breaks my bank.  Talk about motivation.  It worked.

I think my resolution this year is going to be to give myself time to think and actually write here.  It has been a great release writing my thoughts here and I feel that it does good things for my processing of events and emotions.  Six more months till I move on to a 4th year.  It is going to be intense.  Things I want to write about are match/interview do's and don'ts from two years of being through this process, looking back at my chief role for two years, moving on to last year of residency and the new experience of moonlighting and of course I am reading more and more, so may be a few posts about some insight from readings.

So with this post I commit to thee, my musings.  Happy writing to me.  

It's That Time of The Year Again!

Seriously? Why?  Why is it almost October already again?  If you are a Psychiatry resident or any kind of medical resident for that matter in a U.S. residency training program, you don't equate fall with changing colors and crisp in the air; after a long hot smoldering summer.  Fall is literally fall.  Fall from the snoozing horse of daily routine and realizing it is time to hit the MCQs and flashcards.  Even if just for 3 weeks prior to your in-service but now the panic is setting in since "it's practically here."  I almost feel like the Grinch.  Where is my sleigh and dog with the reindeer horns?

Just saying, I have an excuse for being gone for so long.  I am studying or at least am trying to.  I feel like I am stretched too thin with having to read more and more ever since I started outpatient.  I love being in out patient.  To me it is the Utopia that isn't anymore.  I love seeing patients everyday and seeing patients actually get better and show up for appointments.  The never ending cycle of rinse and repeat that is called the inpatient is like a distant memory.  I don't feel stressed out like I used to but I feel more pressured to read more and stay updated more.  Of course this is not to say that while inpatient you shouldn't read but you have more time or luxury to watch your patient and make adjustments to titrate treatment.  Not so much in outpatient.  You have to make decisions based on a limited amount of time you have with them and then see them in a few days, sometimes weeks; depending on your calendar.  So the need to know more and know it then and there is more pressing than when I was a second year.  Now I am having to add prepping for the PRITE and with kids being back in school, shorter days and the need to have some down time in the evening; I feel like I don't have enough hours in the day.  I am never with just myself anymore.

Outpatient is also emotionally more demanding esp. if you decide to take more therapy patients; which I have done.  As much as I love therapy it does takes it toll on me.  Some days I am really beaten down because of what I hear and process all day.  On top of that, as a newly minted 3rd year who is doing therapy; there are many many days I am just not sure what I did or said was even the right thing to say.  I doubt myself and at times I am proud of myself for containing my patient's emotions but it is hard work.  I have to depersonalize at times so I can empathize but stay objective as well.  Thank God for my supervisor.  The importance of a therapy supervisor is actually more clear now even though I had one since I was a second year and had some therapy patient.

But for the time being this PRITE is sucking the joy out of my life as a 3rd year.  It falls in the candy month which is no help because how I will do on PRITE might be a mystery but what it would do to my waistline is no rocket science.  So it is that time of the year again and until the 2nd week of October I probably won't pop in again.  Of course the aftermath will be a post in itself.

So here is to a few more weeks of prep until I check back again.
Stay tuned!!!

Oh Captain, My Captain

"Life is your restaurant 
And I'm your maitre d' 
C'mon whisper what it is you want 
"You ain't never had a friend like me."
I wonder if the genie had a friend when he decided to throw away the lamp forever and take away the magic he had promised Aladdin.  It must have been dark inside esp when he had to light the way for the master without a flicker for himself.
Mrs. Doubtfire is no more, Garp is gone, Dr. Nielsen has left; Dr. Malcolm Sawyer gave up, Alan Parish is lost in Jumanji; may be the hunter got him finally.  Patch Adams isn't laughing anymore, Dr. Maguire and Will don't meet anymore and John Keating won't be in class again.  I never realized until now that how often he was the doctor, the therapist; the teacher, the husband; who was dealing with the pain of suicide and darkness.  He had such passion and vigor as if it was real life.  Little did I realize that in a way it was.
I wish it wasn't true but the reality is that it is.  I had hoped that it was a hoax when the text appeared on my phone but this one time - there was no hoax.  Only the harsh realization that darkness doesn't distinguish between a genius comedian or an ordinary person.  It doesn't leave any doors open when it creeps in the nooks and crannies of a mind, no windows to let the air in; and no secret passages to escape either.  It comes in and takes what it wants and leaves nothing but disaster and confusion in it's wake.  
I am at loss for words so I will just say, 
RIP Genie.  May you finally have the vacation you always wanted.  May you have a friend who has the magic you were giving us and I hope your ship has finally set sail for open seas.  

Oh Captain, my captain - smooth sailing and calm seas.  You will be missed forever.  

Hiatus II

Just popping in to say Hi.  I will be back after July.  Middle of the fasting month, transitioning to PGY-3 and tons of things to do both at home and work.  This is not my ideal state of mind to write.  Stay tuned for more regularity after July is over.

Until than happy summer and happy fasting (to those who are following the fasting)

Willy Wonka and the Golden Ticket

I watched Charlie and the Chocolate Factory with my 8 and 5 year old over this past weekend.  I was having a hard time deciding if it was Johnny Depp or Micheal Jackson dressed as Willy Wonka?  The resemblance was uncanny at various times, yet at times it felt like Lady Gaga was playing some parts of Willy Wonka as well.  I had to keep reminding myself that the movie said Johnny Depp, so my mind must not wonder and focus on the movie.  Unfortunately I haven't watched the Gene Wilder version of the movie but I read somewhere that Mr.Wilder wasn't thrilled about the remake.  I will have to watch the original to compare but for the time being I can safely say I didn't terribly mind watching this one.  

On the other hand the psychiatrist in my head ruined it for me as soon as Willy Wonka started choking on the word "Parents".  It is safe to assume that Willy has daddy issues and daddy had control issue along with obvious inability to express love, care and affection in a more child friendly way, well at least in the movie adaptation.  Enter the five lucky children with their parents and one grandparent.  Charlie Bucket and grandpa Joe, Veruca Salt and her dad, Mike Teevee and his dad, Violet Beauregarde and her mom, and finally, Augustus Gloop and his mom; are the children who found the Golden Ticket hidden in the chocolate bars.  

The eccentric yet quirky Willy Wonka takes his guests on a trip around his chocolate factory with edible grass and chocolate waterfalls and one by one by one all but one child become victims of their own traits.  The last one standing was neither rich nor special with any talents and at the same time he was neither spoiled nor selfish.  

Why did I start thinking about this today other than the fact that I have eaten more candy since the weekend than I did in last 2 years i.e. at least 8 pieces.  Technically it is a lot of candy if you haven't eaten any in 2 years.  I like to keep things in perspective.  But other than the candy dilemma at my hand I think I saw the movie more as a lesson in parenting.  

Parenting is probably the hardest job universally.  It doesn't matter what race, ethnicity, political affiliation or religion you are, being a parent is one of the hardest and most consequential jobs you will ever have.  To make matters worst there is no training, no manuals and there are no do overs or 30 day money back guarantee.  All sales are final and all items are delivered without a warranty.  The flip side of this holds true too.  Children do not get to pick what kind of parents they get nor do they make the choice to be born.  We as their parents make that decision or the decision is made for us when birth control fails. 

No matter how we become parents, by choice or by accident, the moment it happens; life as we know it changes.  The child mother dyad is the foundation of all parenting scenarios.  In cases where mothers are unavailable, for any number of reasons, the dyad has to exist somehow with another attachment figure.  Harlow's mesh wire mother experiment with infant monkeys demonstrated clearly that attachment is not simply driven by internal drives as hunger or thirst.  At the same time it also showed that the soft doll was not a substitute for actual contact with other monkeys.  Monkeys raised in isolation had abnormal social and sexual development, and were eventually neglectful and abusive towards their own offspring.  John Bowlby and Mary Ainsworth have demonstrated that the roots of love lay well above and beyond toys, gadgets and deeply in the realms of mother/caregiver and infant bond.  

Through out the movie there are multiple themes of parenting and for the most part parenting gone wrong.  From Willy Wonka's own longing for acceptance from his harsh and unapproachable dad who forbade Willy a single taste of his Halloween candy loot to overly indulging parents of Veruca Salt and from the avoidant parents of a defiant Mike Teevee to an equally self absorbed and narcissistic mom to Violet Beauregrade.  Let's not ignore the minimally effective mother of the glutton and greedy Augustus Gloop, there is an array of parenting styles or lack thereof. 

On the other hand Charlie Bucket who belongs to a poor family of 4 grand parents and working class mother and father living in a crooked little house, seems to have it all; yet he doesn't seem to have anything tangible to his name, standing among the group of 5 lucky chosen ones. 
The little boy who has nothing turns away from everything when it is offered to him on a platter because he can't fathom to lose what has been his golden ticket all along i.e. his family.  

What is different one might wonder?  Turns out that being a parent is more than providing your children with whatever your resources and wealth can buy, because Veruca Salt is headed right for a life of being a self absorbed individual and an equally unavailable parent.  Parenting won't appeal to her instant gratification need.  It is certainly more than just allowing them to be themselves without discretion or direction because Mike Teevee is learning nothing about self control and definitely nothing about reliable and assertive support a parent provides.  It would be a miracle for him to provide this to his children.  

Parents shouldn't live vicariously through their children because it teaches their children to set themselves up for disappointment, when they learn to follow dreams that aren't their's; without learning how to dream for themselves. Violet Beaurgrade isn't learning to allow herself to follow her passion because life is being modeled as vain and narcissistic, serving a purpose to her mother's need for perfection projected onto her daughter.  Parenting would be a tough challenge because it demands tolerance for complete disruption of normalcy and perfection of life, until the disruption becomes the new normal.  A normal that is not perfect anymore but just right.  That will never be enough for her.  
Being a parent demands being able to be critical of your children without being unkind and setting boundaries without suffocating them.  Augustus Gloop is unfortunate because he parents are too afraid to be critical of his gluttony and are unable to set boundaries while Willy Wonka faced unkind criticism and suffocating boundaries.  He somehow built an empire out of that but Gloop doesn't seem to have that kind of self discipline but he is lucky that dad has a sausage business so Gloop won't have to worry about building an empire.   

Parenting is kindness, love, affection, encouragement and freedom while allowing disappointment, dejection, criticism, anger and above all reliability.  A child who is parented with love that is often tough yet always kind learns to accept, expect and express love the same way which in turn allows tolerance for disappointments and mistakes.  Encouragement doesn't mean anything if there is no room for failure and freedom doesn't teach self discipline and control if it comes without boundaries of critical thinking and at least a small moral compass.  Look where it got Charlie Bucket!!

May be the Golden Ticket Willy Wonka had dispatched was to work the other way around.  May be it was him who needed the final big prize all along and ended up being the winner.  After all he was sitting at a dinner table with a family of his own size and one that seemed to be able to fill his need to finally grow up the way he wanted to.   


I leave you with this thought since this sums up so perfectly what I took so long to write.  

"What a child never learns, he seldom gives back."  P.D. James

Choices Choices

I will be a 3rd year in just two more weeks.  Ack! Time has flown and this means I have two more years left to finish training.  This also means I have to pick a track for the next two years of my training.  Third year of training spans over 12 months of outpatient clinic for all Psychiatry residency training programs.  Outpatient is a different breed.  This is where residents learn to work with patients who are functioning and are able to participate in treatment.  These patients in so many ways help put the inpatient work in a new perspective by shifting the dismal and seemingly hopeless inpatient work to a more stable and predictable one.  Inpatient training teaches residents the art of managing acutely unstable patients from admission to hospital stay and culminating at discharge.  At the same time like any other medical model it seems to have a slew of repeat patients, many admitting multiple times in short periods of time.  That is what sometimes makes many physicians jaded.  I think 3rd year is the perfect time to switch to outpatient so residents can break the cycle for themselves and re-energize before making career decisions moving into 4th year and beyond.  

Like many programs this past year we started assigning PGY-2 residents at least two patients for long term therapy.  I have found therapy to be challenging, at times scary and very rewarding.  What makes it somewhat easier when it seems so hard, is having a supervisor who helps you explore your own emotions and guide you along.  I have to pick a track for 3rd year and I have decided to pick Psychotherapy as my main track, which means I will have at least 9 therapy patients, along with my regular clinic through out the year in addition to the group therapy.  It is daunting and I am not sure if I will be able to handle this but the only way to move forward is to dive in deep and see what happens.

No matter what happens, the bottom line is that I am excited about moving up the ladder, changing work environment and taking up what I love most about psychiatry - healing through words.

Happy PGY-3 to me!!