Real life on the floor

Ward rounds, OT, casualty, the hostel room after. This section is about the parts of residency that nobody puts in the logbook: getting shouted at, 36-hour calls, the patient who didn't make it, the drink that became a habit.

A lot of it is the system, not you. Where there are numbers, they come from the NMC's own 2024 survey of PG students, and they're cited.

This is for everyday coping. It is not a replacement for professional help. If things feel heavier than a bad week, go to When it's time to talk to someone. Tele-MANAS is free and 24x7: 14416 or 1-800-891-4416.

Each card stands on its own. Read the one you need tonight and skip the rest.

You were presenting a case and the consultant tore into you, in front of the patient, the relatives and the sister. Your face went hot. You finished the round on autopilot.

That hurts, and it is supposed to hurt. Being humiliated in public is not "part of training", and you don't have to pretend it didn't bother you.

Some things people find useful afterwards:

• Say it out loud to someone. A batchmate, a co-PG, your roommate. Venting the same evening is not weakness and it is not "keeping the wound fresh". It's how most of us process a bad day.
• Separate the two parts. If there was a real knowledge gap, you can note it and read it up later, when you're calmer. The humiliation is a separate thing. Fixing the gap does not make the shouting OK.
• Watch the replay loop. If you're still rehearsing the scene at 2 am, write down what happened in five lines and close the notebook. Getting it onto paper can stop it circling.

If this is happening often, or it's aimed at you in particular, read the next two cards.

Residency has pressure built in. Not all of it is abuse, and not all of it is fine. A rough way to tell them apart:

Usually normal pressure (even if unpleasant):

• Being questioned hard on a case, or asked to redo a workup
• A senior being blunt about a clinical mistake, in private or in a teaching setting
• Heavy work that the whole unit is carrying together

Starts to look like mistreatment:

• Shouting, name-calling or insults, especially in front of patients or staff
• Being singled out again and again, while others get a different standard
• Your leave or weekly off being refused as a punishment
• Work dumped on you that has nothing to do with learning, week after week
• Threats about your thesis, logbook, stipend or exam
• Anything sexual, any touching you didn't want, any physical threat

If several items on the second list are true, it's not you being "too sensitive". The NMC's own task force report says leave "should not be unreasonably denied". You're allowed to take this seriously.

The next card covers what you can do about it.

This card can't give legal advice. It lists things that residents can do, so you know they exist.

• Write it down. Date, time, what was said or done, who saw it. Keep it off the hospital computer. Notes written at the time are much more useful than memory later.
• Tell one person you trust. A batchmate, a senior you like, a consultant from another unit. You don't have to decide anything yet. Saying it to someone breaks the isolation.
• If it's ragging by seniors: the national anti-ragging helpline is 1800-180-5522, toll-free and 24x7 (www.antiragging.in). It takes ragging complaints. It is not a mental-health line.
• Sexual harassment: the POSH Act 2013 covers hospitals, and it counts trainees as employees. Every employer has to have an Internal Complaints Committee (ICC), so ask who sits on yours. Women can also complain to the National Commission for Women, on its helpline 14490 or online at ncw.gov.in.
• DNB/DrNB trainees: NBEMS has a two-level grievance route. A complaint against your hospital goes first to the hospital's own Grievance Redressal Committee, then to the NBEMS Grievance Redressal Committee if you're not satisfied. A complaint against NBEMS itself goes through its Communication Web Portal. NBEMS says skipping level 1 only delays things.
• MD/MS/DM/MCh in NMC colleges: we could not find a national NMC complaint route for individual PG residents, apart from ragging. Ask about your college's own grievance committee.
• Other formal channels in your college or hospital. Before you file anything, quietly find out how complaints work where you are. Someone who knows your college's process can help you plan.

If you are in danger right now, or someone has assaulted or is threatening you, call emergency: 112. You can also call Tele-MANAS on 14416 or 1-800-891-4416 (free, 24x7) to talk it through with a counsellor.

Whatever you decide, the stress of it is real. You can get support for that even before you decide what to do about the person.

36-hour call, rounds the next morning, and the weekly off that exists on paper. If you feel wrecked, that's a normal response to an abnormal schedule.

The NMC's 2024 task force surveyed 5,337 PG students. What they reported:

• 45% work more than 60 hours a week, and 56% don't get their weekly offs
• 84% report moderate to very high stress
• 64% say the workload hurts their mental health
• "Continuous duty for 2-5 days" was listed among the stressors

The same report recommends that residents work "no more than 74 hours per week, with no more than 24 hours at a stretch", with one day off a week and 7-8 hours of sleep a day. It also notes that the older limit under the Residency Scheme 1992, 48 hours a week, was never implemented.

So if your week is far beyond 74 hours, you are not failing at time management. The schedule is beyond what the regulator itself recommends.

This card won't fix your roster. It might help to know that feeling exhausted is the expected result, not proof you're weak.

Post-night, the sun is up, the hostel is noisy, and your brain is awake in the wrong way. Some practical points from the CDC's NIOSH training on shift work:

• Sleep as soon as you get back. NIOSH advises that on work nights you "sleep as soon as you get home ... and sleep as long as you can". The "let me scroll for ten minutes first" plan usually costs an hour.
• Naps count. Any chance to sleep, including a short nap during or after duty, helps.
• Try to keep one fixed block. Where you can, keep a few hours that are sleep time every day, on duty days and off days alike, for example 8 am to noon.
• Don't stay up all day before or after a night block. NIOSH warns that you will then be "awake for too many hours", which raises the risk of accidents and injuries. That includes the drive or ride home.

Curtains or an eye mask, earplugs, and the phone face down all help with daytime sleep.

The NMC report calls 7-8 hours of sleep a day "crucial". Most rosters don't allow that. Getting closer to it on the days you can still counts.

When you're about to snap at someone, cry in the duty room, or decide your whole life is a mistake, try one question first: am I Hungry, Angry, Lonely or Tired?

HALT is a self-check from addiction-recovery practice. Two of the states are physical (hunger, tiredness) and two are emotional (anger, loneliness). There's no trial behind it. Treat it as a quick check, not a treatment.

On the floor it looks like this:

• Hungry: last meal was the 8 am chai and a biscuit. Eat something before the next decision. Keeping a dabba, water and a protein snack in your bag helps.
• Angry: say what you're angry about, to yourself or a batchmate, before you reply to anyone.
• Lonely: text one person. It doesn't have to be about how you feel.
• Tired: if you're 20 hours in, a big decision about your career, your relationship or your branch can wait until after sleep.

Often it's two or three at once. Fixing even one can change how the next hour goes.

You did the CPR, or you were the one who called it, or you had seen them on rounds that morning. Then you went back to the next patient, because the ward doesn't stop.

Some people cry. Some feel nothing and then worry that feeling nothing means something is wrong with them. Some keep replaying the last few hours. All of these are common reactions.

Things that may help:

• Talk it through with someone who was there. A senior or co-PG who can go over what happened, clinically and otherwise.
• Ask the "could I have done something" question to a senior out loud. Answered alone, at 3 am, it usually gets the harshest possible answer.
• Sleep and eat before you judge yourself. See the HALT card.

Dr Scott Pasichow, an emergency medicine resident in the US, went through burnout and later thoughts of suicide after a patient's unexpected death. His programme pushed him towards help, and treatment and peer support got him through. He is now faculty. His advice: "Lean on your support structure and make sure you have somebody you can talk to about your struggles."

If the images or guilt don't ease after a couple of weeks, or you have any thoughts of ending your life, please talk to someone now. Tele-MANAS: 14416 or 1-800-891-4416, free, 24x7. Emergency: 112.

You gave the wrong dose, missed a finding, or something you did or didn't do harmed a patient, or nearly did. The first hours after that can feel like the floor has dropped.

The patient comes first. Tell your senior or consultant as early as you can, so the harm can be limited. Hiding it almost always makes things worse, for the patient and for you.

Then look after the person who made the error. That is also you.

• Guilt about what happened is normal. It can go on to "I'm a bad doctor, I shouldn't be here". That second thought is a feeling after a bad event, not a verdict.
• Talk to someone you trust about it, ideally a senior who has made mistakes too. Most have.
• Learning what went wrong is useful. Punishing yourself every night is not the same thing.

Dr Jessi Gold, a US psychiatrist, describes how a mistake during a patient session made her finally face her own burnout. What helped was real time off and therapy. Her words on coming back: "it was important that I didn't just go back to the same ways of coping with a bad system that I did initially."

If the guilt is taking over your sleep, eating or thoughts for more than a couple of weeks, go to When it's time to talk to someone.

Your room is next to twenty other residents and you haven't had a real conversation in a week. Everyone is on different duties, everyone is tired, and your family is a phone call away but "sab theek hai" is all you say to them.

Many doctors who have written about their hardest times describe exactly this: lonely while surrounded by people. It's common, and it's not a sign that something is wrong with you.

Some small things that may help:

• One person, not a friend group. Pick one co-PG or senior and check in on them. Often they're feeling the same.
• Attach it to something you already do. Chai after the evening round, a walk to the canteen, the same table at dinner.
• Keep one thing that is yours. A game, a sport, music, a hobby. In one Indian survey of 185 residents, those who kept up hobbies or exercise had significantly less burnout.
• Peer support has some evidence behind it. A review of resident wellness programmes found that peer support improved well-being, though most of the studies were of poor quality.

This won't replace a proper friend group. It might make this week less empty. If the loneliness has turned into feeling low most days, see When it's time to talk to someone.

You're a second-year now. The junior forgot the sample, the intern didn't chart the vitals, and you heard yourself shouting the way your senior used to shout at you.

Being angry at 3 am on hour 22 makes sense. What you do with it is the part you can change.

• Notice where it's coming from. Often it's HALT (hungry, angry, lonely, tired) plus the pressure from above landing on the person below you.
• Assertive, not aggressive. Compare "What kind of idiot forgets a sample?" with "The sample didn't go. I need it sent in the next ten minutes. Tell me if something's stopping you." The work gets done either way. Only one leaves the junior able to ask you something next time.
• Repair it. "I was harsh earlier, that was the tiredness, not you" costs you nothing and earns you a lot.
• Vent upward or sideways, not downward. Complain to your batchmates about your day. That's healthy. Taking it out on the intern isn't.

Being kinder to juniors may help you too. In an Indian multicentre study, residents who mentored juniors had significantly lower stress scores.

Speak to your juniors the way you wished your seniors had spoken to you.

Some anger is useful. It tells you something is unfair, and a lot of what residents put up with is unfair. You don't have to talk yourself out of it.

It becomes a problem when it starts running you:

• You're replaying arguments for hours after duty.
• You're sleeping badly because of it.
• You're snapping at people who have nothing to do with it: family on the phone, juniors, the canteen staff.

A few things people try:

• Move. A walk, the stairs, a game of anything. Physical activity goes with less burnout in Indian resident data.
• Separate "what I can act on" from "what I can't". If it's harassment, the harassment cards list options. If it's the roster, it's the system, and you can stop blaming yourself for being angry about it.
• Say it to a person, not only to your head. Venting to a batchmate is allowed, as many times as you need.

If the anger has become a constant state, or you're worried about what you might do or say, talking to a counsellor can help. iCall (TISS): 9152987821, Monday to Saturday, 8 am to 9 pm. Tele-MANAS: 14416, 24x7.

After a brutal week, the drink, the cigarette or something else can feel like the only thing that switches your brain off. You're not the only one. In the NMC survey, 19% of PGs said they felt the need to relieve stress through substance use, including tobacco, alcohol, cannabis and other drugs.

No lecture here. You already know the pharmacology better than most people. Knowing doesn't stop anyone reaching for it when they're exhausted and alone.

Some honest questions you could ask yourself, only for you:

• Am I using it to sleep, or to face duty?
• Do I use more than I plan to?
• Have I tried to cut down and found it hard?
• Am I hiding how much from people close to me?

If a few of those land, that's not a character flaw. It's a sign that the stress has found a way out that may start costing you, and it's treatable.

A small step could be one substance-free night a week, or telling one person the real amount. The next card has confidential places to talk.

The biggest fear most doctors have is that someone at work will find out. That fear keeps a lot of us from asking for help early, when it's easiest.

Places you can start without involving your college:

• Tele-MANAS: 14416 or 1-800-891-4416, free, 24x7. It's a government mental-health line outside your college. Calls are confidential and not audio-recorded, but not anonymous: your number is stored in masked form.
• iCall (TISS): 9152987821, Monday to Saturday, 8 am to 9 pm. A counselling service run by TISS.
• Vandrevala Foundation: +91 9999 666 555, call or WhatsApp, 24x7.
• National Drug De-addiction Helpline: 14446, toll-free and 24x7, run by the Ministry of Social Justice. It offers basic counselling and referral.

The NMC task force has recommended that colleges offer confidential counselling with a "firewall" between counsellors and faculty. Whether your college has done this varies, so ask about confidentiality before you start.

Recovery happens, including for doctors. Dr Peter Grinspoon, a US physician, was addicted to prescription opioids from medical school into practice and lost his licence. With treatment and time, he got it back. He now practises and teaches at Harvard and helps other doctors with addiction.

If you've used more than you meant to and feel unsafe, call emergency: 112.

For the moments when your chest is tight, your thoughts are racing, and you need to be back on the ward in five minutes. It works in a washroom, a stairwell or the duty room.

Start with a few slow, long breaths out. Then, without rushing, notice:

• 5 things you can see
• 4 things you can touch (your scrubs, the wall, your phone, your shoes)
• 3 things you can hear
• 2 things you can smell (yes, hospital smell counts)
• 1 thing you can taste

The point is to pull your attention out of the spiral and into what's around you. It comes from clinical practice, not from trials, so treat it as a coping skill. Some people find it takes the edge off, and some don't. Skip it if it's not for you.

If you're needing this several times a day, or the panicky feeling doesn't settle, see When it's time to talk to someone. Tele-MANAS is free and 24x7: 14416.