The Department of Internal Medicine’s Diastole blog encourages residents like Sarah Lee, M.D., to use writing as a chance to reflect and build resiliency.

The patient lay in her hospital bed and stared into space, unable to make eye contact with the doctors who had come to help her.

Battling end-stage HIV/AIDS, the woman seemed unable to come to terms with her condition.

“I’m not sure if she could hear us, or if she was in denial and chose not to respond,” says Sarah Lee, M.D., a second-year resident in the Department of Internal Medicine. “It was frustrating and sad. That was my first year, and it was tough to deal with something like that so early on.”

Lucky for Lee, she had help. For the past two years, first-year residents have written reflective blog posts with the hopes of normalizing reflection and increasing resilience.

“That first year can be pretty jarring,” says Megan S. Lemay, M’11, assistant professor of medicine in the Division of Internal Medicine. “It is overwhelming for the best of us. As they face extremely difficult tasks, we are teaching the residents skills in resilience so that they can keep themselves well.”

Diastole, the relaxation phase of the heartbeat, is the perfect name for the blogs, Lemay says.

“If the heart does not take time to relax and then fill up, blood won’t be pumped out,” she says. “In the same way, if you don’t take time to relax and reflect, you have nothing to give.”

Interns have reflected on a variety of assigned topics, including the role model whose traits they want to emulate and the challenges they face in treating patients with mental illness. When Lee and her classmates were asked to reflect on their lowest and highest day in haiku form, she shared her experience with the non-verbal patient by writing,
She won’t look at me. 
Only nods and sighs out loud. 
Wonder what she feels.

Her haiku along with others from her fellow residents are featured in the latest issue of the Medical Literary Messenger, a web-based journal that strives to promote humanism and the healing arts through prose, poetry and photography.

“Sometimes it’s easier to try to forget a difficult experience,” Lee says. “But to share them, as well as your good ones, is healthy.”

Interns have also written about the embarrassment they feel when they make a mistake, the stresses of long hours and the sadness of losing a patient.

“They are identifying with each other and building empathy,” says Lemay, who is also an associate editor of the Messenger. “When they share their emotions the feedback they are getting is, ‘I didn’t realize anyone else felt that way.’”

The blogs are part of a larger resiliency program that includes monthly meetings and workshops that help interns cope with the demands of residency. Lemay oversees the blogs and meetings that are part of the overall resiliency curriculum created and run by Stephanie Call, M.D. M.S.P.H., program director, and Rebecca Miller, M.D., assistant professor.

“I don’t think people realize that taking the time to reflect on the challenges they face is normal,” Lemay says.

Lemay has been writing and publishing prose since she was a resident. When a patient she had been visiting throughout her first year passed away, she doubted her career choice.

“I wrote about it four months later as part of a workshop, and it lifted this burden from me,” she says. “It was extremely powerful.”

She hopes interns today experience similar benefits.

“I think 20 years ago the attitude was to suck it up,” Lee says. “But today, it’s OK to talk about what you are feeling. It’s great we can focus on our wellness too.”

By Janet Showalter