By Guest Columnist Amita Sudhir, MD
July is drawing to a close and with it the new interns’ first full month as practicing physicians. They’ve been taught a lot of new things by attending physicians, senior residents and nurses alike, and hopefully they are feeling more confident and comfortable. Their new long coats are looking a little less blindingly white. They’ve dried so much behind the ears that even Dr. Reiser has allowed himself to work a few shifts with these no-longer newbies. They know where the bathrooms are, where the cafeteria is, and how to dose painkillers. It’s summertime in Virginia so they’ve seen snakebites and heat exhaustion, and maybe even a heart attack or two. They’ve probably had lectures on sleep deprivation, and they’ve been admonished to document their work hours correctly and comply with restrictions.
But there’s one thing I’m not sure anyone has warned them about, and that’s Medical Stockholm Syndrome. The scourge of the hospital, it claimed its victims long before they arrived here at the threshold of doctor-dom. Some fell victim on their first clinical rotation as medical students. Others began to succumb when they found the specialty that they love. Still others waited for the onset of residency for it to prey on them.
This is no communicable disease of the wards, or at least not one that follows Koch’s postulates. It’s the simple phenomenon of captives forming an emotional bond with their captors, redefined for the medical training environment. Stockhom syndrome was first described in hostages taken in a bank robbery in Stockholm, Sweden ,in 1973. They felt affection towards the robbers and did not want to be rescued by the police.
In Medical Stockholm Syndrome, or MSS (we medical types love acronyms), observed anecdotally but yet to be described in the medical literature, the captives are usually medical trainees—sometimes medical students, more often residents—and, more occasionally, even faculty. The role of captors is played by senior residents, supervising physicians, and the hospital itself. Residents affected by MSS, although “rescued” at the end of their shift by work hour restrictions, night float teams, and the exhortations of attendings to “just go home now,” choose to linger long after they could, in good conscience, leave. Their patients are signed out, loose ends are tied up, every one is tucked in for the night. And yet, they just can’t go home. They decide they need to tell the oncoming resident just one more thing about that patient in bed 32. They stop to chat with the attending about the movie they both saw last weekend. The hard institutional mattresses in their cells, I mean their call rooms, are as welcoming as the lightest feather bed, so they decide to just sleep in the hospital instead of going home.
My first experience of MSS occurred before I even knew what it was. I was a naïve second year medical student, and I noticed that an attending who had taught my class on several occasions was to be found daily reading the newspaper in the library at 5 pm. He had mentioned that he had several children, so what was he doing sticking around the hospital engaging in optional, non-patient-care related activities when he didn’t need to be there? We medical students were befuddled, and concluded that he didn’t really like his family much.
That was before I became affected myself. I found my surgery rotation particularly grueling. The only saving grace was a wonderful resident who was fun to be around and always teaching. The day I woke up with the half-eaten remains of a bean burger on my chest on one of my rare forays into my own home, I decided that the life of a surgeon was not for me. But then, on my first real break from the hospital in six weeks, I paid a visit to my hairdresser, immediately followed by a trip back to the hospital to show the resultant hairstyle to my resident. To my great surprise, she was not happy to see me. “What are you doing here?!” she cried out, and when I explained, she exclaimed in dismay: “You have Medical Stockholm Syndrome!”
After she explained what that meant, I became forever on the lookout for warning signs of the illness in myself and others. Lingering too long after a sign-out or feeling affection towards a senior resident, who I knew in my heart of hearts was an unfeeling son of a gun meant it was time for me to give myself a stern talking to. I try to squash those tendencies everywhere I see them. In what twisted world is call-room sleep sweeter than slumber in your own home, or a greasy pancake hot off the cafeteria griddle tastier than a bowl of cereal eaten in the comfort of your very own couch cushions? Worst of all, is the company of your fellow harried partners in medical captivity preferable to the friends and family who faithfully await your arrival at a restaurant table not so far away? People on the outside may not understand what it is like to be immersed in the world of the hospital, so sometimes it’s just easier to stay there. But that’s a one-way ticket to a misspent youth.
Or is it? The truth is, a little bit of MSS is what makes residency, and even life beyond that, not just bearable but even enjoyable. Some believe that the evolutionary origins of Stockholm syndrome lie in our hunter-gatherer days, when individuals were often plucked from one tribe and forced to join another. Rather than woefully mourn the loss of their familiar surroundings and people, this little glitch in an otherwise normally attached brain allowed them to adapt to and even enjoy their new surroundings. Irrational it may seem, but MSS makes the long days of residency, away from your family, your pets, your home, real food, real sleep, and real clothing, seem less of a chore when you actually want to be there. While it’s good to have a life outside medicine, it’s also good to miss medicine a little when you step outside it.
I’m long done with medical school and residency now, and I have a husband and two children to whom I’m unequivocally happy to return at the end of the day. I no longer rush in to the hospital to show off a new haircut. But at the end of a shift, when I step outside into the ambulance bay, leaving the bright lights of the ED hallways behind me, I feel a tiny, fleeting, pang of regret that I’m going home. And I hope my residents come to feel that way too.