Emotional Baggage · Residency

Another Letter, Likely Never to Send

I cannot begin to express the difficult emotions that I have endured over the past few months since you disclosed the results of my waiver of training application. However, I am going to try, because I believe in honesty, openness, and human connection. I also feel that this is what I need to to in order to move forward in acceptance and forgiveness.

I had previously expressed to you the seemingly random issue “selected” as the underlying reason for the decision to not grant my waiver. I continue to find this reason to be an unfair explanation for the decision that was made because of the circumstances surrounding the feedback evaluation on that particular rotation. These issues were clearly outlined in my response to the evaluation, and had I known that making verbal agreements with staff whom I worked with often to get weekly evaluations rather than daily evaluations, would have such a lasting impact, I would have never had these collegial agreements. Furthermore, I provided objective evidence (photos of my evaluations) that what was written in my evaluation was not an accurate description of what took place: That I actually did get more evaluations than was stated, and that these evaluations came from a variety of staff members. These factors, as well as my explanation of the situation, seems to have had little to no impact on the decision making process, suggesting that this decision was made more out a desire for penalization of, and control over a subordinate rather than in support and collaboration for a colleague. The unwillingness for an open discussion about these reasons, as well as refusal to accept or consider support of my appeal from other staff and faculty members further reinforces an attitude of subordination. While you may not see this decision in the same way, I hope that you can appreciate how it can appear this way to me.

I am an introspective person and I spend too many days and months reflecting and re-reflecting on events in the past, and this situation has been no exception. I have come to recognize that throughout most of residency, I have had an unhealthy dread of evaluations and I realized this has stemmed from a patters of receiving lack-luster feedback after seemingly well received rotations. This began, as you know, when I received a failing evaluation that was based more on evaluating me as a pregnant resident than it did about my surgical or clinical skills. In that moment, and with the support and encouragement of our advocacy office, I decided to stand up for myself and say “it’s not okay for this to happen.” Unfortunately, I had no one else (particularly in our program) who was willing to stand beside me, advocate for me, and support me. So, I did it myself and was, from that moment, considered the resident who creates conflict.

At that time, as well, I had spent months reflecting on my rotation and what I could have learned from that situation. I came back from my maternity leave determined to ensure that I never missed an opportunity for feedback, even though I feared it immensely. As I pointed out to you, almost every evaluation from my maternity leave to the end of this residency, with the exception of the evaluation in question (and one other that I will come to later), has emphasized how well I seek out feedback, and how well I incorporate that feedback to improve myself. I know that I am good at feedback, and you know that I am good at feedback, which makes this situation feel even more like a farce and a “cover up” for something bigger.

To reflect, yet again, on another evaluation that was less than ideal: you will remember the evaluation I received on a subspecialty rotation where the written feedback was different from the verbal feedback. Again, and at your request, I spoke up about the incongruencies and unfairness of the situation. As you recall, you agreed with me that the feedback was incongruous and you allowed for an amendment of the written feedback to better reflect what was given to me verbally throughout the rotation. At this point in time I was gracious for the way you stood up for me and advocated for “the right thing” to happen. What is similar in these two situations though, is that rather than accepting what I felt to be unjust, I took a stand and asked for fairness and clarification. This is something I strongly believe is missing from our field of work and I cannot sit back and accept that it is okay to keep letting these things happen. I have come to realize that my “standing up” for what I believe in, advocating for myself, and (in other situations) also advocating for my colleagues, I have appeared as though I “do not accept feedback well” as opposed to what it should be viewed as: that I advocated for fairness, kindness, and compassion.

If there really is a problem with how I receive and incorporate feedback, it would be helpful to know exactly how or why this is interpreted the way it is. It also makes very little sense to me that I have not been given any specific objectives on how to work towards any kind of improvement in this realm. Rather, I am being encouraged to leave the program and the province for the remainder of my residency. During this time, I will begin working on research for my fellowship, under the direction of my fellowship supervisors, without being allowed to actually finish residency early, and therefore actually start my fellowship early. There is no benefit to our program to have me do this, and there is certainly no benefit to me with this arrangement. Rather, it feels further punitive because it prevents me from moving forward in my career (and not just by three months, but by an entire year because starting my fellowship in January means that I cannot write my fellowship examination until the following calendar year than I otherwise would have). How can it not be interpreted as a penalization when I am essentially going to be doing fellowship level work without actually receiving credit for my fellowship? Again, I know that this was not the intended fallout of the decision, but hopefully you can appreciate how I could feel this way.

To go back to the emotional struggles that have resulted from this decision, I find it extremely troublesome to think about a group of my colleagues sitting around a tables, debating my “worthiness” from a privilege that has been granted to almost everyone else who has ever applied for it. To tell me that it is reserved for “exceptional” residents, when there is actually no objective and transparent process for determining “exceptional” status is extremely demeaning and hurtful. I know that I am a good, kind, caring, and competent physician – as are most of my other colleagues – and utilizing the term “exceptional” when there is no definition does nothing but suggest that I am lacking in some way. Each resident excels in different realms, just as each resident has deficits in different realms. To suggest someone is “not exceptional” based on one set of (unknown) criteria, but failing to recognize alternative areas of excellence does not encourage or embrace creativity, ambition, and personal development. Rather, it suggests that these qualities are not something desired under the category of “Medical Professional.” Perhaps the argument that such a privilege is reserved for “exceptional residents” would hold more weight if this was something that was hardly ever granted. However, this privilege is granted with such frequency in this department that fellow residents and staff physicians believe that it is a given that time will be forgiven for residents. It is not helpful, and actually more emotionally taxing, when I am the one telling people of this waiver of training process and informing them that I was actually not granted such a privilege when they casually mention that my “time will be forgiven.”

As if all of these thoughts weren’t difficult enough to deal with, to find out that another one of my colleagues had her waiver granted after mine was denied only amplified the anguish I was experiencing because of this decision. This is not to say that my colleagues do not deserve such a privilege. However, the lack of transparency and objectivity in the process is certainly highlighted when a colleague routinely complains about how poorly she performs on certain chief rotations and the criticism she gets from staff (whether she is exaggerating for attention or not, I don’t know), then to hear her say to me: “if yours got denied then mine absolutely will because I almost failed that one rotation,” and then to know that despite her expression of poor performance, she was granted the waiver supports such a belief that this really has nothing to do with being “exceptional” and everything to do with… something else. This colleague continued to elaborate that you requested permission to disclose her situation to the committee to help them understand why she needed time off in the first place, and that you told her there was no reason to believe it would be denied. Can you imagine how hurtful it is to hear this? To know that you had more confidence in another resident than you did in me. To know that you advocated harder for her than you did for me. I believed that I deserved better from you.

For months I have had to listen to my colleagues plan the ends of their residencies and prepare to move onto the next steps of their lives. This is a time of excitement, progress, graduation, and elation for them, and my experience has been clouded by feelings of inadequacy, confusion, and self doubt. During this same time, I have listened to the same colleague as above complain constantly (and loudly) about how unfair you have been to her, how difficult you have made this whole process for her, and how stupid all these rules are (again not sure how much of this is an exaggeration). These comments create so much anger inside of me because she is complaining about something that she was privileged to get in the first place. Although I have been open and honest to my colleagues about my waiver being denied, and despite being extremely hurt, angry, upset, and feeling broken by it, I have never once openly complained about you or this process to people outside my small circle of trust… because as much as I may be angry and broken, you do not deserve to be disrespected and such behaviour, in my opinion, is unprofessional.

Hearing you say that “[you] weren’t the one who made the decision” and that “[you] don’t agree with the decision, but have to support it” only makes me feel worse. I ask myself how you could possibly be okay with allowing something you do not believe in or support to happen to the very people you are meant to advocate for and protect. What if I was your child? Would you be okay knowing that they were being treated unfairly but still let it happen anyway? I know that in some situations there are lessons to be learned, and perhaps in this situation my lesson is waiting to be truly discovered. While I work hard to teach my children that life cannot always be fair and sometimes you just have to “accept that,” I also teach them that they should speak up when something isn’t right, they should ask for clarification when they don’t understand something, and they should always do the right thing, even if it feels hard. In order to teach my children these concepts, I must live them myself and this is why I have asked so many times for clarification and understanding surrounding this. If there is a lesson to be learned, I want to learn it so I can grow as a person and as a physician.

I know you mean well when you check in with me to see how I’m doing and send me cards to tell me to keep my chin up despite this hard time, and I know you feel bad that this has happened. You are a good person, and I do appreciate that you care to check in on me. Unfortunately, you can’t ease your guilt or discomfort, or whatever you feel about what’s happened by trying to pick up my pieces. You can only do what you feel to be the right thing. If supporting this decision is the right thing, then you have to own that decision and everything that comes along with it, including the knowledge that you can’t be the person who fixes my hurt; those two rules, unfortunately, are incongruous.

I will pick up these pieces on my own, I will eventually be okay, and I will learn some kind of lesson, even if it’s not the lesson that you (or the committee) was hoping for. I regret that this is how my time in our program has ended, because although it was rough in the middle and I almost left the program, things really did turn around for me at the end, and I found happiness here. I was never lying when I said that I was your biggest fan and I truly believed you were doing the best you could with what you had. You were my favourite from before I started here: I will never forget my elective as a medical student with you, or that you sent me an email to welcome me to the program almost immediately after the match results, or all the fun I had with you on my MFM rotation (remember the elf hats and Christmas baskets?), or how you did advocate and stand up for me when I needed someone before. Unfortunately, I will likely never forget that despite our long relationship and despite your knowledge of the person and physician I really am, you didn’t stand up for me and advocate for me the way I deserve.

I believe that I am a good, deserving, kind, and wonderful person, despite how this situation has made me feel. I’m looking forward to being part of a community that will support me and value my voice and advocacy rather than try to shut me down, as has happened multiple times throughout my residency. I know that in the 5 years I’ve been in this program, I have advocated for many changes and I’ve been instrumental in supporting quite a few of my junior colleagues. I will never forget the cards, cakes, gifts, thank-you’s, awards, and kind words I have received from these people over the years. That, in itself, makes me feel like an “exceptional person” and I will make sure to take that feeling and those memories with me.

I understand that you were in a hard place and I’m sorry that this is how it turned out. In writing this letter, I hope you can gain some understanding into how and why this seemingly small decision has caused so much emotional struggle for me. Hopefully the next time you are faced with a difficult decision like this, you will advocate harder for the person you wish to support and prevent them from a similar emotional turmoil. As I move forward and make the best of the end of residency, I sincerely hope you also find peace with everything you are dealing with.

4 thoughts on “Another Letter, Likely Never to Send

    1. Thanks. There is no resolution. There is no appeal. This is it. I guess the only resolution is how I heal and move away from this chapter in my life. I am counting down the days to when I can leave here and start the next chapter 🙂

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  1. I am sorry to hear you’re experiencing such a difficult time. I know you say there’s no resolution, but I hope your coming to terms with it is quick and you realize the strengths you have (just described in this letter alone) are commendable. Stay strong, CG.

    -CB

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