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This story is from the Anamnesis episode called Breaking Point: Why We Become Activists at 32:09 in the podcast. It's from Chris Thipphavong, MD, a psychiatry resident at Maimonides Medical Center in Brooklyn, New York.
I'm a regional vice president for CIR New York, private region, and that means that I work with several hospitals, five programs that cover about 2,500 different residents that I represent within the union. I was elected by them and I represent their interests and serve on the national board.
I was not an activist, I was not a labor person, I was not involved with politics or anything prior to starting residency. I considered myself very much like a scientist and like a healthcare person and I think a lot of us view ourselves as sort of apolitical and impartial when we're in that field, until you really get into the practice of medicine, which doesn't really happen until you're out of medical school and starting residency. And then sort of the realities of the world and the system like hits you in the face and you're sort of at a loss as to like what to do with that.
In my particular case, I came into residency immediately during like the height of the COVID pandemic. I finished medical school in February, which was just as the pandemic was getting going. And I didn't start residency until July. And in the interim, I volunteered at a public hospital here in New York. All of the hospitals were inundated. Staff were, you know, out. The hospitals were overrun. It was all the things that you heard about and read about in the news, the freezer trucks, the saving your N95 in a paper bag for a week. It was like an inspiring experience and a terrifying experience, but I walked away from it feeling like I had done something.
For the First Time, I Felt Hopeless
And then I started residency and the pandemic's still going, but things have changed. Like the sort of height of the first wave of the pandemic had tapered off, but we were still there during the second and third waves and hospitals were still understaffed and overrun, and residents were asked to be doing things that they don't normally do. And I remember for the first time in my life feeling like giving up, feeling like hopeless. And that wasn't a part of my personality or my experience prior to that.
And I remember a specific day just walking down the hall and thinking, if I could quit now, I would. And that was a scary thought because ... I had sacrificed so much and worked so hard and so long to get here into medicine, only to find out that, like, it wasn't the way that I thought it was going to be. So I was looking for support and looking for answers during that time.
Simultaneously, my wife was diagnosed with a very serious illness. Glad to say that she's recovered and we're back to life as normal now, but still hard to talk about. So that added to just my feelings of being overwhelmed and not having the support and the resources that I need.
I remember just walking from the subway to the hospital and it's dark out and it's cold out. And just knowing that I'm gonna get there and there are gonna be people who are sick, who I can't cure, and there are gonna be family members who are worried about their loved ones.
And there's gonna be people with expectations about the way that things should go because they had seen a news story on TV where a nurse had let them use an iPad to call their family or whatever and we can't do any of those things. We don't have enough hands. We don't have enough people to do that and I knew that I was going to have to answer to patients and family members who were asking like really reasonable questions, like, you know, why wasn't my bed pan emptied? Why didn't I get that CT scan yesterday? What's taking so long? And not having answers to those questions.
There Just Weren't Enough People
Like the bottom line is there just weren't enough people working in the hospital. There weren't enough people who were healthy and available to come in to work. And so we just sort of cobbled things together as best we could. And the things that residents complain about doing sound trivial now, like, oh I had to transport this patient to get their scan or whatever, and that sounds like a pretty trivial thing, but when the reason that you had to transport them is because they've been waiting 12 hours to get this scan that they need and there was nobody to transport them or they transported them there, but the person who was supposed to run scans, they had called out sick or whatever, there was some sort of delay in care, and we were sort of the last stop to say, like, something has to happen, whether it's a test or a blood draw or a procedure or whatever.
And we have to do it. And it doesn't matter how much time we stay extra or how exhausted we are or how much it takes us away from another responsibility at the hospital. It has to be done. And we also have to explain to this patient and to this family why it hadn't been done, why it took eight, three, four times longer, why it took an extra, two extra days, why am I staying longer in the hospital, why isn't my loved one getting better? And we're the ones who have to explain that. And that was heartbreaking every day.
And simultaneously, I also sort of had this commitment to changing things, to making things better. I think doctors in general are people with a strong sort of moral and ethical compass and a desire for public service. And so this was also in the wake of George Floyd's murder. And even though I hadn't been an activist or political person prior to that, I participated in demonstrations and marches. And I never thought that I would do that.
And you sort of walk away from those thinking, like, wow, that was great. Like, we did something for a night or for an afternoon. But it's sort of like, now what? Like, now that you're back to real life, now that you're back in residency, now that you're back in healthcare, like, what do you do with all this? And I sort of told myself that, yes, like I'm trying to change the system by providing quality care for people in underserved communities, all of which is true.
We Don't Have the Option to Say No
But the thing that I really came to realize is that the people providing the care -- the physicians, the nurses, the residents and fellows in particular -- are really, really vulnerable people because we don't really have the option to say no. We don't have the option to walk away from our jobs. We don't have the option to walk away from our patients. Residency is in many ways a really predatory experience.
You're locked into a contract of 3 to 6 years. You don't get to choose where you work because of the rank, the match system, and you don't get to choose where you live or how much you make, and you don't get to choose how much work you do, whether it's a 60-hour or 80-hour or 100-hour week. It's really exploitative. So I was feeling really sort of lost and hopeless during that time.
But I was a union member. My hospital was already unionized when I came into it and I didn't really know anything about unions. My mom had been a union employee her entire career. She was a dietitian who worked in hospitals and dialysis units and I knew that she was in a union, but she never talked about it and I never really did, never really heard much about anything. But I signed up and I was, I remember the thing that actually got me interested in the union was following the union's Instagram and seeing just all the spicy memes, honestly.
There was a negotiation that was going on at a hospital in California, and I remember just hearing and watching and feeling the residents who were speaking up for themselves calling out to the things that were unfair and just not reasonable that were going on at their hospital, I was like, wow, people are fighting back and people are speaking up about this. I don't remember what I had done. I don't think I even messaged them. I had probably like ... given a hand clap or a thumbs-up reaction to one of their stories. And then shortly afterwards, got a direct message back from, I don't remember if it was the president or vice president at the time.
And I was like, whoa, what is this? And I was sort of taken aback by it. And I asked one of my chief residents, who was a union delegate at the time, who is this person? Is it OK for me to be talking to them? And I wasn't really sure about that. He's like, yeah, look, this is whatever you want it to be, I'll add you to the WhatsApp group, you can be as involved as you want or not, and sort of take it from there.
And so from that point, then I was more in touch with the leadership in CIR and attended my first meeting for our diversity, inclusion, and anti-racism group. And sort of from there, then I started to feel like I had found my place and found something that could really make a difference for me and for a lot of my residents, a lot of my co-residents who I knew were struggling.
I love my job. I love being a psychiatrist. I love what I do. I love doing psychotherapy. I love taking care of people with mental illness and people from underserved communities. And so I walk in with hope and optimism every day. And the vibe of the hospital has changed too, in the sense that like when you walk in the beginning, especially given the conditions that I walked into when residency started, you feel like this tiny, tiny person in this huge, huge machine without any influence or impact whatsoever.
And now I walk around the hospital and it's like people recognize me and people say hello and people say, you know, thank you for negotiating them or supporting them through this tough time when they were, you know, in a sticky situation or whatever. And I feel like it's a much stronger community now, and I feel like I know that I have a lot more hope and a lot more optimism and I think my coworkers do too.
Check out the other stories from the Breaking Point: Why We Become Activists episode, including "Telling My Story at the National Nurses March" and "Nurse Sees Other Side of Unsafe Staffing."
Want to share your story? Read the Anamnesis Storyteller Tip Sheet and send us an email at anamnesis@medpagetoday.com.