Ep. 22 - "Black Clouds"

Ever feel like you’re on a streak where everything that can go wrong… does? This week we unpack the idea of “black clouds” in residency - why they happen, how they can affect you, and how to get through them with perspective and support.

Audio editor: Kaylee Morris

Transcript

SPEAKER_00 0:50

We're excited to have the massive meeting and magic of residency video.

SPEAKER_01 0:56

Welcome everyone to another episode of our podcast. And a special welcome back to Kyla, who's here today.

SPEAKER_00 1:02

Yes, I have been in the thick of fellowship interviews, and so Mary has so kindly maintained this podcast. Doing my best. So, unlucky or learning, we want to reframe the concept of the black cloud.

SPEAKER_01 1:18

Absolutely. It can seem like some people always get slammed, right? Especially in residency. So we want to explore today if this is real or is this a story that we're telling ourselves and what to do about it.

SPEAKER_00 1:30

Yeah. So we want to talk more about what's real, what's a myth, and just reframe the idea of a black cloud in a way that will actually help you grow. I think I personally have had the experience of feeling like I had a black cloud, which was much different than my experience in medical school. There were lots of times where really nothing much was happening when I was on service, and my experience changed drastically as a resident, especially my intern year.

SPEAKER_01 2:01

Well, that is quite a shift, and I guess you can make an argument and we will later if that was a good or a bad thing for you personally. Um, Kyla, do you want to explain what we or other people mean when they talk about a black cloud?

SPEAKER_00 2:14

Yes, so this phenomenon of the black um cloud basically just means that when you are on service, you are always busy, and the patients that you get are incredibly complicated or may unfortunately have um less optimal outcomes. This is often contrasted to what is known as the white cloud, and so kind of the people who are on service that um have a quote unquote easy day, not much happens, or the patients that they do have have really awesome outcomes.

SPEAKER_01 2:46

Yeah. What was your white cloud like in medical school?

SPEAKER_00 2:50

So it was lovely, but I think like reflecting on it, there were opportunities um for learning that I didn't necessarily get that other medical students had, and like experiences that they had that I couldn't relate to. Um, because when I was on service, not much was happening.

SPEAKER_01 3:07

Yeah, you said that when you were on your um OB service. Yeah, there was a stretch of nights when there were absolutely no delivers.

SPEAKER_00 3:14

Yeah, funny enough, when I was a medical student on my like nights block for my L and D rotation, it was like two or three shifts where everybody was just in early labor and nobody delivered and nobody came in delivering, and so um that was considered a white cloud sort of night.

SPEAKER_01 3:31

Yeah, but I could see how that's not an optimal experience for a medical student.

SPEAKER_00 3:35

Yeah, not very eventful.

SPEAKER_01 3:37

All right, so we want to think about are these black clouds really a thing? What do you think, Kyla?

SPEAKER_00 3:44

I would say yes and no. Okay. Okay, so a black cloud, I think the best way to think about it and was and how it was reframed for me is a learning cloud. So lots is happening. Sometimes those things are not great, but ultimately you learn from those experiences. So I do think there are stretches of time where things are pretty intense. Um, but I don't think it should be viewed as black or dark.

SPEAKER_01 4:10

Yeah, I would agree with that. I will say that I think it is this, you know, human nature to focus on things that cluster together, and you can have a string, right, of nights where, you know, you're very busy or you know, shifts that are um have some of these more complicated patients. I will say thinking about it from a program director perspective, as I look at kind of you know, case numbers as folks are graduating, it does seem like things do even out in the end. So it's probably more about some of these clusters or anchoring on some of these, you know, specific patients or outcomes that can perhaps make it feel that way.

SPEAKER_00 4:47

Yeah, definitely. I would agree with that as well. And I think as humans, like even if you are a person that is a glass half-full person, we naturally do kind of anchor and remember like those more like negative or like emotionally charged situations. Like it's just a natural thing to like really remember those things.

SPEAKER_01 5:08

Yeah, that's part of the human condition. And I couldn't quote the the exact study right now, but it's something like you need 10 positive experiences to balance one negative one or something like that. So it makes sense. Yeah. So um we remember the bad shifts and you know the cases that you know make us think or that take longer, right? We we anchor onto those. And I think over time, right, like I said, things even out, but sometimes do have sometimes these events do have the um potential to cluster, and then it feels like a pattern more than it might be if you look at the long game.

SPEAKER_00 5:45

Yeah, for sure. And you know, random doesn't feel so random when you're living it. Definitely.

SPEAKER_01 5:51

All right, so you talked about this idea of a learning cloud. Can you explain how this came up for you and what that uh shift in thinking looks like?

SPEAKER_00 6:01

Yeah, for sure. So when I was an intern, I was having a couple stretches of not so great um shifts, incredibly busy, lots of complications, and I was kind of debriefing with one of our fellows, um, Keisha, who we interviewed in a previous podcast. Hi, Keisha. Um, and Keisha was so kind to listen to me word vomit everything that was going on, but then was able to reframe it for me and said that you know she had had a similar experience, but she was calling it a learning cloud. One, it kind of changes your mindset and like your ability to kind of like persevere through a shift. I think when you kind of frame it in a more positive way, but also it's just actually true. Like when I have those more intense shifts, I learn so much. Um, and I can take that with me into my future patient interactions as well.

SPEAKER_01 6:51

All right, that kind of relates back to what you were saying about your experience in medical school. If you don't have any deliveries, how are you going to learn about deliveries? So more exposure probably leads to faster growth, even if in the short term it can uh feel bad. So, can you think back to any um call shifts or you know, days on the floor that were especially hard? And what did these experiences actually teach you at the end of the day?

SPEAKER_00 7:18

Yeah, I actually can think about a um recent night's block. It was my last night's block. Um, and we had so many emergencies. I don't think I've ever done that many like emergency surgeries or had so many like consulting services come to the labor floor, and it was like it was pretty tough, honestly. Um having that some of those outcomes, but then also your nocturnal, like everything's kind of just disorienting, I would say. But I will say from that experience, I do feel like more prepared going into my chief year, um, having seen so many like complicated cases and just being able to kind of withstand the volume too. I think in a way it's kind of reinforces that you're like ready to progress to the next step.

SPEAKER_01 8:06

Definitely, and I think that also is true when um you're thinking about going out into independent practice, right? You want to see all the things in residency, right? So that you feel prepared as an attendee.

SPEAKER_00 8:17

Yeah, this is your time to learn. But I think you know, it's easy to say that right in hindsight because I'm not currently in a learning cloud, and so it's easy to be like, yes, I learned. But I think in the moment, something that always like helps me get through, also, is just to recognize that it's it's temporary, like even on a shift level, the time is temporary, you will rotate off, and then eventually you'll come back, but you'll have that time to kind of like decompress.

SPEAKER_01 8:42

Yeah, the clock continues, so it will end eventually. What do you think about? I've heard some of my colleagues talk about this, like being labeled as having a black cloud. It sounds like maybe your interneer in the past, you have kind of been labeled this way. Is that a helpful thing that we do to our colleagues or anything that uh any insights you have about that?

SPEAKER_00 9:03

Yeah, I think plus minus, like I have progressed to having less of a learning cloud lately, and so and have seen more junior residents that are having their learning clouds and talking to them about it, and I think it can be like a funny thing, you know, to um think about. But I also think that sometimes it can actually have some negative connotations with like one, the way you view yourself, because you can think like, what have I possibly done to like deserve all of this learning? And it can sometimes feel a little bit isolating, I think, depending on like your role on a team, like if you're like the primary person covering a service and like having all the learning, like it can feel like you're by yourself and having to manage so many things. And I think the last thing that can sometimes happen is that like people anticipate your cloud, and so when you're joining a team and if people feeling a little bit um apprehensive or nervous about how the shift is gonna go based on what your patterns are. Yeah, that's fair.

SPEAKER_01 10:03

I wonder if also you may or may not have experienced this, but certainly when I've been through some of these tough stretches, there's this sense of like dread or impending doom as you're heading into your next shift.

SPEAKER_00 10:14

Yeah, absolutely. That's actually huge. Like the sort of fear, like going in of like what's going to happen, that's um, that's a very real feeling.

SPEAKER_01 10:23

Yeah, yeah. It can also lead to some maybe maladaptive superstitions. So I'm thinking back actually to I had my own learning cloud. One of my years of residency when I was running the labor floor board, so I forget if I was a PGY2 or PGY3, but our team, it was in December, and our team had gotten these very cute holiday scrub caps that you know we were so excited to wear. And we very quickly realized that these scrub caps were not leading to the best agent volumes or um ability to do anything but run around like chickens with our heads cut off while we were um on labor and delivery. So to this day, I still own the scrub cap, but I refuse to wear it because I keep thinking someday I'll be brave enough. But you know, we're almost a decade out and I still haven't. I also thought about gifting it to someone, but I couldn't like give that to someone else, you know? Yeah, exactly. It causes me too much anxiety. So that's funny. I I am curious what would happen if you just wore it just like one shirt. Someday I'm going to have to, but I have to make sure it's a night where I just expect to be up all night, you know, do dealing with emergencies, you know, just in case. I do think it can be somewhat validating though, right? To share the experience and not, you know, just tell someone, you know, oh that's fake, that's not really happening.

SPEAKER_00 11:40

Yeah, I think for sure it's validating. And truthfully, I think all of us in medical training at some point have had a learning cloud. And so I do think it's important to um validate people's feelings about having their own experience with it as well.

SPEAKER_01 11:56

All right, so when you are in the midst of a learning cloud, Kyla, have you found any um coping strategies or takeaways, either well, probably most valuable in the moment or between shifts that that help you to think about it in a more positive, adaptive way?

SPEAKER_00 12:12

Yeah, I think when you are feeling a little bit more overwhelmed by the volume, to kind of take a step back and think about like your priorities as far as you know which patients absolutely need to be seen, what things can wait. Because I think it's easy to kind of get in this downward spiral when you see kind of like all of the things heaped onto your plate, but like you know, digesting things in small bites is I think really helpful. Asking for help as soon as possible. Definitely. Um, there's no reason to kind of do everything on your own when you're working on a team. That's like one of the great parts about being in medicine is that you have a team to like collaborate with and lean on. And then I think, like I said before, just looking at the big picture, like this is your one shift for this temporary period of time, and so this is not like indicative of what like all of your training or all of your career is gonna look like.

SPEAKER_01 13:02

Definitely, yeah. I think that idea of zooming out can be helpful, um, even just to think about okay, I'm having a really bad shift now, but thinking back like over the last six months, I've had some shifts that were totally manageable, and you know, it's some of that averaging out in the end.

SPEAKER_00 13:19

Right.

SPEAKER_01 13:20

What do you do after a really hard shift, Kyla? Any anything that helps you to decompress or um not have entirely negative connotations about that shift?

SPEAKER_00 13:32

I think, especially if there were uh more challenging outcomes, I think it is nice to like debrief with your team and just kind of have some like camaraderie about the experience. I think creating some space from the shift and like taking your mind elsewhere. Like for me, sometimes that might be exercising in some way or like watching TV is always a plus for me. Um, but then I think also just kind of circling back to like what what was the the net positive that I can gain from this shift, like what did I learn, how did I help someone? Um, I think can really help ground you as well. Certainly.

SPEAKER_01 14:06

I think those are those are great ideas, and I think like you said before, right? Normalizing the fact that everyone goes through stretches right like this, and even you know, chatting with other people in medicine, other other co-residents who maybe weren't even on the shift with you, so might have a little bit more perspective, but can still relate to the stress that it that it brings. In the moment, too, just our our usual plug that comes up from time to time the importance of staying hydrated, eating, right, making sure you're able to get sleep before and after, right? Even if you know you're that might not feel like you're able to do it in the moment, it's actually essential, and you need to ask for help again so you can, you know, take the bathroom breaks, refill your water bottle, etc.

SPEAKER_00 14:50

There is always time to attend to your basic needs, and I feel very strongly about that. Even when you're typing a note, you can eat a snack while you type. Oh, multitasking. I like that.

SPEAKER_01 15:01

All right, and then I do think this idea of self-talk surrounding it can be super important. So making some of these cognitive shifts to think about a learning cloud or however you know you can frame it to be um to best serve you.

SPEAKER_00 15:16

So the big takeaways we hope that you gain from this episode is that having a quote unquote black cloud is not a real like personal trait or characteristic.

SPEAKER_01 15:27

Absolutely. At the same time, though, it can feel real and that does matter, and um, we should validate our own experiences and that of our colleagues.

SPEAKER_00 15:36

And to navigate your learning cloud, it's really important to have that cognitive reframing of you know really um identifying it as a learning opportunity and not your actual identity.

SPEAKER_01 15:49

Right, and then even if you're you yourself are not so pro prone to these learning clouds or haven't had one recently, be mindful of you know the way you speak to your colleagues and you know, maybe helping them when they're in one of these stretches to frame it in that more positive light as well. So, Kyla, what is the one biggest thing you would tell a resident if they came to you right now saying that they're in the midst of a really intense learning cloud?

SPEAKER_00 16:14

Yeah, I would channel um Keisha and I would let them know that this is in fact a learning cloud, and although it is stressful and it can be really intense, it is temporary and you'll come out of it that much better of a clinician.

SPEAKER_01 16:32

Agreed. All right, well, I think it's time for a magical moment. Haven't heard one from you recently, Kyla. So, what do you got? Absolutely.

SPEAKER_00 16:41

So I recently had the opportunity to participate in a large mentorship event. Um, it started off with um taking medical students in their third year through lots of different simulations um and kind of hands-on learning opportunities, and then I was also with Mary at the end recruiting medical students as well, and I since then have gotten a lot of emails from them just being so grateful for my presence there and being very inspired by my journey through medicine. And a lot of these uh students were underrepresented in medicine, and so that was like especially meaningful for me because it was a time for me to kind of like reflect back, and I remember so vividly being in their position and wanting to be in the position that I am now. And so, although they were like gassing me up in the emails, it also was like incredibly humbling, and I'm really appreciative that I had that experience.

SPEAKER_01 17:37

Yeah, that was a really cool experience. I was glad I got to be there, and thanks for volunteering your time, Kyla. Sure.

SPEAKER_00 17:43

What about you, Mary? What's the magic?

SPEAKER_01 17:46

Yeah, I had a huge magical moment recently and then um got to revisit it. So I had the privilege of delivering um one of our residents babies, which honestly that's my favorite part of my clinical job is actually, you know, delivering babies for people that I care about. So it's a really, you know, special, amazing delivery. A lot of her colleagues got to be there actually for the delivery, so it was a really cool experience. And then I just got to um do a house visit for them this week, and we shared dinner, and it was it was just really lovely to see her and her baby.

SPEAKER_00 18:19

That's an incredible experience.

SPEAKER_01 18:20

I'm glad you had that.

SPEAKER_00 18:22

Thanks for listening.

SPEAKER_01 18:24

If you have comments, questions, or ideas for a future episode, please reach out to us via email at longcallpodcast at gmail.com.