I began my second year of my Internal Medicine residency exhausted, fatigued from more than 60 sleepless call nights of intern year. The nights by this time felt indistinguishable, with punctuated moments of clarity. The thrill of signing my first prescription, the hollowing silence left after a final breath.
While I had overcome the fears associated with the firsts of intern year, the second year marked new challenges. I was now a senior resident, at an inner-city hospital nestled in the heart of downtown Toronto. Senior residency marked more responsibilities, including overseeing a ward of patients, leading resuscitations and, most daunting of all, serving as the most responsible physician overnight.
My residency cohort was large, and it was a new set of us who had been assigned to work together. There were familiar faces, but most of us were largely acquaintances, strangers to one another’s inner lives.
Our walks home began by chance. Like most residents, we happened to live near the four major downtown hospitals. But soon the walks became more intentional than not. When I found myself caught up after work, I was surprised to find my co-residents waiting for me. This pattern continued, the group waiting until the last of us had finished. Sometimes we waited longer than the actual duration of the walk home, which was only 15 minutes.
Why do you do that? a friend asked me, after I told her I’d be delayed. I shrugged at the time; I wasn’t then able to articulate a good enough explanation.
In the middle of August, another moment rose above the haze of the long, languid, summer days. It was my first day holding the Code Blue team lead pager when I heard an announcement on the overhead. On cue, the pager went off, high and shrill. Code Blue, on the 6th floor.
When I arrived, the room was loud, frenzied. The nurses had already started CPR; I could hear compressions cracking ribs. I quickly learned he did not have a pulse, and the monitor showed a deadly rhythm, ventricular tachycardia. We shocked him, watching his body shudder before becoming listless again. I stood in the centre of the room, running through the algorithm I had so carefully memorized. As the code went on, the room became more crowded and the heat felt like it was swallowing me. I continued, following the algorithm mechanically – compressions, epinephrine every three minutes, attempts to address any reversible causes.
The rest of the code had a dreamlike quality to it. I was there but I was not there. At minute 15, I asked if he had family. He’s here alone, I was told. In the moment, I felt relief. I would be spared from the guttural sounds of grief; I would not have to stitch together empty platitudes, mourning a man I never knew.
Later, as the nurses began to clean the room and everyone filed out, I would realize what a tremendous burden this was. I would be the last person to hold his memory.
At minute 40, after more than 20 minutes of pulseless electrical activity, we decided to call the code. “Good job,” a staff member told me as the room became silent. I struggled to formulate a response.
A terrible thing had happened; a man had died, and I could not bring him back.
A few of my co-residents were there during that code, watching, helping with CPR and securing an airway. That evening, they walked me past the point we usually diverged and sat with me in my apartment lobby. They sat as I cried. They listened. And then, they consoled me. Their words were not meaningless or empty, but full of resonance. The memory of his face stayed with them, too.
There were other moments our walks held special, personal meaning.
Early in the year, I received a call from my aunt, who lived oceans away. In a calm, steady voice, she explained that the spots in her liver, incidentally picked up during an ultrasound investigating her acid reflux, were metastases from a stage 4 neuroendocrine cancer. The grief I felt in the subsequent months crept over me with every text about a worsening CT scan, or another fever with low neutrophils. After keeping the news to myself for a while, I shared it with my co-residents on a chilly autumn walk home.
During the chaos of the wards, I felt comfort that there were people who knew the invisible weight I was carrying. That I could be honest when I was having a bad day. That I could say I was not fine. And as rain turned to snow, we discussed other topics integral to the experience of being 20-somethings – aging parents, hopes for the future, the gutting ache of heart break. These stories became routine. No matter how the day went, there would always be a walk home.
As I begin my third year of residency, I’ve spent the last few months figuring out the answer to my friend’s question: Why do we do this? Why, even during our busiest days, filled with errands not yet done, papers not yet submitted and texts not yet returned, we still wait for each other. It seemed like an ordinary occurrence, a walk home. It was a solitary task, easily done alone.
In medicine, there’s a concept we often use with our patients called bearing witness. It exists beyond just listening or holding space for suffering. The act of witnessing is more powerful than that. It lies in connection. We do this for patients, whether it be a 40-year-old woman with metastatic cancer, or an 80-year-old man with decompensated heart failure. We tell them, “You did not suffer alone. I saw it. I was there.” But sometimes, amidst caring for others, we forget who bears witness to our own lives.
In 2021, the Canadian Medical Association National Physician Health Survey indicated that nearly half of medical respondents screened positive for depression. Medical residents are particularly vulnerable to burnout. As residents, we see each other’s lives in a way that no one else can. We witness each other’s successes and failures, our personal joys and regrets.
So, maybe the reason we waited for each other was because all it took after a difficult day was a walk, side by side, and two words from the only people who could say them: I understand.
Acknowledgements: Thank you to all my co-residents for their friendship and support throughout residency, and especially to Dr. Camilla Parpia, Dr. Nawazish Naqvi, Dr. Raumil Patel and Dr. Jami Kronick for always helping me find my way home.
