Her first week, she worked more than 80 hours on a general-surgery rotation, charting for her attending physician, checking patients’ vital signs, and trying to restart exhausted hearts long after her shifts ended. “There’s no way to get all of our work done in 80 hours,” she says. “Our supervisors can’t make the work go away.” When her pager beeped with a reminder to clock out for the day, she ignored it, she says, while the more senior physicians looked the other way. Like many of her fellow residents, she went entire days without eating. She was so drained that she was halfway out the door one day before remembering that she’d left an IV in a patient’s arm.

Within her first month, she crumbled under the pressure. After she went to visit the hospital counselor—sobbing through the appointment—a few of her fellow residents told her to suck it up. Feeling frazzled and helpless just comes with the first year territory, they said. It’s a rite of passage. In his memoir Intern, the New York cardiologist Sandeep Jauhar describes residency as “brutal, like a kind of hazing.”

Choosing whether or not to share these concerns with supervisors can be difficult, says a resident in family medicine at a New England hospital. She cites a common fear among residents: that their honesty will lead more senior doctors to write them off entirely. “They don’t want you to show any weakness,” she says. “You almost need to be a robot.” Her anxiety is affecting her daily work. “I’m exhausted because of the existential crisis playing out in my head every minute.”