Resident Stockholm Syndrome: The Original RSS?

Photo by Jeff Cleary Tarayn (Grizzard) Fairlie

It’s been about six months now since I began residency—the cruel, life-altering shadow long seen on my personal horizon—with all of the usual fits and starts that go along with it. For me, at least, it’s been an abrupt transition, going from quaternary and tertiary medical centers to a community hospital, from a school composed largely of “-ologists” to a group practice of family physicians, from Boston to suburban Connecticut. I’m now settled in Connecticut and making good headway through the year. I’ve assimilated the basic information, figured out the team structures and hierarchy at three different institutions, and delineated my immediate and nonimmediate responsibilities from the myriad tasks assigned to me. I know how to write a few sets of orders for common conditions, what to do at a code, and how to discharge a patient from the hospital—all without leaving Stage 1 sleep.

Given the learning curve I faced at the beginning of July—and the inestimable differences between medical school and my community-based program—I guess it’s OK to feel at least somewhat pleased with myself for making it through without any major incidents. I should feel some pride, I suppose, just for doing it and living to tell the tale—although, of course, I’m not the first. In fact, I’m just one of many new housestaff in the United States, a cog in the wheel of a huge system designed to shape, mold, and finish off new doctors. And like the vast majority of new housestaff everywhere, I’ve learned not only to adapt to my surroundings, but also to enjoy the experience.

Granted, it’s not like I’ve been enjoying the overnight call, or our unusually busy days in clinic, or the pile of paperwork that awaits me every morning, but I have found myself—strangely enough—looking forward to work and the chance to be with the attendings, faculty, and upper-level residents. It makes no sense, honestly. Why wouldI enjoy spending time with the very people who make up our punishing schedule and mandate that I spend more of my waking time with them than with my new and oft-neglected husband? In fact, I should probably not like them at all, considering the impact that the minimum 12-hour days have had on my personal life.

In a moment of insight brought on by two consecutive 24-hour periods without work and some extremely unscientific consultation with friends from medical school, I have finally decided that my warm and fuzzy feelings toward my colleagues must be a planned part of the internship experience. It’s like the Stockholm syndrome—the condition in which kidnapping victims, for instance, become sympathetic to their captors—but one specific to medical training. It guarantees not only that interns survive the experience, but also graduate believing that the intensity of the experience was in their best interest, as opposed to the interest of the system and the senior physicians who trained them.

I think, in general, that Resident Stockholm Syndrome (RSS) is probably a good thing. Without it, we’d all be much more out of sorts, and (as I’ve been told by my superiors) wasting even more valuable time fretting over inequities—time that would be better spent working or sleeping. I’m actually glad that I’ve learned to care about my colleagues this much, especially in the midst of a draining month on service. The internship would be barely tolerable otherwise.

But I’m equally sure that I would never feel as loyal to any work colleague or hierarchical system in any other setting, save perhaps the military. And, on second thought, I’m not so sure that in the final assessment, this loyalty is such a good thing. It certainly helped to perpetuate unsafe resident work hours for years based on those graduates who believed that there was some benefit to making others endure what they had endured.

Now, midway into my first year of residency, I’m more worried than ever that any loyalty to the system and belief that it’s in everyone’s best interests will lead me to defend practices that are focused on neither trainee education nor patient care but on reimbursement. I’m concerned that I may perpetuate some of the less-than-optimal treatment I’ve received as a resident simply because I survived the experience. Most of all, I worry, poised on the edge of many 80-plus–hour weeks and winter volume increases, that I won’t have time to remember or reflect on any of this until it’s too late. I can only hope that time spent after residency will help me remember the experience eventually and not be a cog in a system that doesn’t always turn in step with patients’ or trainees’ needs.

—Tarayn (Grizzard) Fairlie, HMS ’06, is a family medicine resident at Middlesex Hospital in Middletown, Conn.

The opinions expressed in this column are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.

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