Throughout my clinical rotations, I’ve often found myself deeply, deeply exhausted by the end of the day. Some days that’s not a surprise, such as when I’ve been on my feet since 5 AM on surgery, or have spent the last 2 hours being peppered with questions from my attending on rounds. Sometimes though, I find myself feeling that deep exhaustion on days where I wasn’t necessarily all that busy. I don’t know a single medical student who hasn’t felt similarly at some point. So why is that? What is it about just the act of being on a clinical rotation that is so tiring, even at times when we’re not physically working hard?
There’s an invisible requirement of medical students on rotations. Because there is no defined role for medical students, and because we’re constantly shifting not just clinical sites, but also preceptors (who often change day to day), it’s up to us to figure out what to do and how to behave. A “good” medical student is engaged, friendly, eager to learn, competent, and most importantly, not annoying. That’s hard to do when on any given rotation, we’re dropped into a team of strangers who all know each other very well. Within sometimes as short a time as a few hours, are supposed to internalize the working dynamics of the team and find a way to slot ourselves into the group.
When we start our third year of medical school, we’re expecting to work hard. We know we’ll be writing notes, presenting, and calling consults. We know we need to study hard for the exams that are worth at least 30% of our grade. That work takes a large chunk of our time — on some rotations, it takes almost all of it — but we expect it. We’re well prepared for it by the end of second year at UACOM-P, thanks to the tireless efforts of Dr. Moffitt.
But what no one can prepare us for are the dozen ways we have to tiptoe around people all day, every day. I can’t count the number of times I’ve realized my preceptor forgot to come get me when they said they would, or how many times I’ve followed the instructions of one attending one day only to have another tell me the next day that I’m doing it wrong. And of course, always wondering what your evaluators are thinking of you. You can’t just be doing your work — you have to act as if you’re thrilled to be doing it. Nevermind that it’s 3 pm and you haven’t had lunch yet after rounds went for 5 hours — if a new admission comes, and you’re asked “do you want to see this one?” you have to smile and say of course.
There’s a name for this phenomenon. It’s called “emotional labor” — a phrase which has over the last few years come to mean something different in the wider culture than it originally did. The phrase was initially coined by sociologist Arlie Hochschild in 1983, who used it to describe how for many professions, a component of the work is related to the creation of a particular observable emotional display. She was thinking about people in customer service jobs, flight attendants, salespeople, etc. She wanted to find a way to put a name to the fact that for these professions, their work is not just to give people their food, or sell goods, but also to put on a particular face and affect. We would find it strange if a flight attendant, for example, was rude and brusque. We expect them to smile and be kind. Hochschild argues that it’s a part of the work itself, and places additional demands on the worker that other types of labor do not. Over the years, emotional labor has come to mean something more akin to spending time and energy managing other people’s emotions. But I think the original meaning fits our situation a lot better.
So if you’re wondering why you’re so drained after a day at the hospital or clinic, even if you spent the afternoon sitting around waiting for admissions that never came, this might be why. You’re tensing your emotional muscles all day, every day. It’s a part of training that I think is easy to forget, even by the time you become a resident — after all, by that point, you know exactly what’s expected of you and aren’t being evaluated for every minute you’re at the hospital. But I hope our generation of med students, who are more attuned to the toll medical education takes on mental health, can remember how it felt.
Asif Becher is a member of the class of 2024, planning on going into psychiatry. In her spare time she enjoys music, writing, baking, and trying to get her cat to stop ignoring her.