I'm so sorry to hear that. I know that scenario too well, and I know the pain is unbearable. You learn to keep an impersonal distance with 90% of your patients,

I'm so sorry to hear that. I know that scenario too well, and I know the pain is unbearable. You learn to keep an impersonal distance with 90% of your patients, just put on a good show, but once in a while you connect, and you see it all over again with fresh eyes and it's so painful. My interest is in chronic pain management, by way of psychiatry. I have very strong feelings about the way chronic pain is handled, or mishandled. The american approach to pain is incredibly ... uncomfortable with pain. There's an underlying guilt and discomfort that makes physicians very, very uncomfortable, in a way I think very few are willing to honestly admit or engage with. They turn their brains off when it comes to pain, the better to salve their hearts. When the drug companies pushed hard to market "pain as a vital sign," it gave physicians permission to just throw painkillers at patients to shut them up. Now the addiction crisis gives physicians license to just not throw painkillers at anyone. Either way, it's mindless, and patients suffer for it. Heck, even when physicians are thinking about it, the question is always about addiction, malingering, etc. This isn't helped by the fact that addiction and malingering are common, and addicts and malingerers also get sick and also have pain that requires training. I don't have a good answer for that one. It's just another survival thing. We aren't robots; we can only do so much to retain our sanity in the face of pain. But I am more bothered by pain treated poorly than I am by the mere existence of pain itself. It helps that I'm chronically ill myself, have been in shoes few patients have ever been in, and can meet them heart-to-heart on the topic. Psychiatry residency in the states is pretty merciful compared to others, either because psychiatrists better appreciate psychological distress in general, or because we're the ones our colleagues come to for help and we're loathe to inflict the same suffering on our trainees. It comes with a decent hit to your bottom line - you give up a fair chunk of income in exchange for retaining your sanity - but I am happy to be able to see my loved ones and remain a human being. I used to think I'd want to do critical care, but seeing how critcare fellowships ate alive people far more resilient than I am... thank goodness I didn't do that.