House Staff View: Gratitude in residency


Gratitude is one of the most important elements in my life. I’ve kept a daily gratitude journal since my first day of residency. Every night before I go to bed, I record what I am grateful for. I’ve found that whether I’ve had the best day or the worst day, having a thankful thought in my mind before I go to bed is a satisfying way to end the day.

Evidence shows that a daily gratitude intervention results in a decline in stress and depressive symptoms over time and helps to improve a person’s sense of well-being. I’ve found this to be true. There are some days where I simply write down one word — possibly what I ate for lunch or the name of a friend. But, there are other days where I write more about a meaningful patient experience or a thoughtful conversation I had with a friend or family member. Once in a while, I look back on my gratitude journal and it undoubtedly brings back cherished memories and puts a smile on my face.

Finding gratitude in residency

Establishing meaningful connections with patients and their families is such a lucky experience.” Residency is tough in many ways. Mentally, it can be incredibly consuming. You are constantly learning about the pathophysiology of your patients, some who have diseases you may have never even heard about. You are responsible for coordinating different sub-specialty consultants in the hospital, writing daily progress notes on your patients, interpreting lab results, speaking to families, and sifting through the many unforeseen events that may occur during the day or night.

In residency, I have always been most grateful for the opportunity to be involved so closely in the lives of my patients, particularly when they are acutely ill. Establishing meaningful connections with patients and their families is such a lucky experience, and I encourage others to actively reflect on this.

Embracing life’s simple gifts

Residency is physically exhausting. In our residency program, particularly during the second year, we are often on call every four days for up to 28 hours, and during that time sleep is at a premium. In many cases, when the service is busy or patients are very sick and requiring extremely close attention, you may end up getting little-to-no sleep. Rounding on patients every morning also involves standing on your feet for long periods of time. On any given day, one may walk for miles around the hospital from the Emergency Department to different patient rooms to a noon conference to radiology and beyond. Basic physical needs like drinking water and eating a meal can be forgotten in the midst of a busy service.

Read other Boston Children’s stories authored by Jessica Tsai, MD, PhD:

There are a few simple things I do when on call that really help. I  enjoy sitting in the same workroom as my co-residents who are also on call. While we may all be extremely busy, there is such joy in camaraderie (especially at 3 in the morning!). I also love playing music (quietly, of course) while working. It keeps the mood light and fun. And, lastly I always make it a point to order takeout with other residents. It’s important to eat, and it’s really nice to order food from a restaurant and share dinner with other residents as opposed to eating from the cafeteria day after day.

Reflection and being thankful

Take stock of everything there is to be thankful for – and you don’t have to wait until Thanksgiving.”Residency can also be emotionally exhausting. There are those patients who spend a short period of time in the hospital, improve and go home. But there are also chronically ill patients. There are patients who have socioeconomic circumstances beyond our control. There are patients who are at the end of life. There are patients who are suddenly very sick and we can’t figure out why. There are patients that die. For me, it is important to talk about these things with other residents, friends and loved ones. It helps me to not keep these thoughts and feelings bottled up.

We are only human and we see things that people in other professions may never have to see or bear witness to. To keep myself grounded, I always remind myself of why I pursued medicine in the first place. So, take stock in everything there is to be thankful for — and you don’t have to wait until Thanksgiving.

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About the author: Jessica W. Tsai, MD, PhD, is a resident physician in the Boston Combined Residency Program at Boston Children’s Hospital and Boston Medical Center. She is pursuing a career in pediatric oncology and has been published in the New York Times, Science, and JAMA Pediatrics. Follow her on Twitter @jestsai.