For as long as I can remember, my twin sister and I have existed as a unit. I always said “I was born with a best friend. I couldn’t ask for anything better!” We shared classrooms from preschool through pharmacy school, lived together well into adulthood, and moved through life side by side. Our family is just her, our mom, and me, so we are all very close and an important part of each other’s support systems.

That changed the year we matched for residency in different places. I moved away with my partner. She stayed home with our mother. For the first time, physical distance entered a relationship that had never known distance. I knew it would be hard, but I didn’t anticipate how quickly “hard” would become “heavy and soul-crushingly intense.” In June, just before my PGY1 residency began, my grandmother had a massive stroke. Overnight, my mother became a 24/7 caregiver, and at the same time, my sister was struggling emotionally within her residency program. And here I was hundreds of miles away, beginning my own training, trying to convince myself that daily phone calls were enough.

They weren’t nearly enough, at least not in the way I wanted them to be. I felt terrible that I couldn’t drive my mother to appointments, run errands, or simply sit in the same room and share the weight of everything that was happening. The moment that finally broke me came when my sister and I celebrated our birthday apart for the first time in 26 years. No shared cake. No reminiscing about past birthdays. Just the quiet realization that something fundamental had shifted. To make matters worse, I found out that same day that I had failed my first attempt at the MPJE, which put my future at my residency program in jeopardy.

Missing milestones like that made me feel detached from what I had always considered my support system. It was the one concrete, unchanging thing in my life. Residency is already destabilizing with so many new expectations, new environments, and constant evaluation. Losing physical proximity to the people who had always anchored me amplified that sense of disorientation. It wasn’t just that I missed events (which was bad enough), it felt like I was also missing a key part of me.

At the same time, I understood why I was where I was. Completing residency successfully is essential to my long-term career goals. I also made the deliberate choice to pursue fellowship, committing to 2 additional years of training and, with it, continued financial sacrifice. I feel the pressure many people my age feel: to start a family, buy a home, etc. But these milestones feel further away when I’m also paying for my own wedding and choosing fulfillment and growth over immediate financial comfort. Still, I can’t deny that advanced training has given me opportunities, professional satisfaction, and relationships I would not have found otherwise. The trade-offs are real, but you can’t put a price on what you gain.

As a trainee for 3 consecutive years, I’ve learned that almost every opportunity is framed as a “good opportunity.” And honestly, that’s not wrong. Most opportunities offer something like experience, exposure, networking, or another line on your CV, but that doesn’t mean you should pursue all of them. Too often, trainees are “volun-told” to do projects by well-meaning preceptors or program directors, making it feel more difficult to say no without consequence. Over time, overextension doesn’t just make you miss life’s moments, it can also diminish your professional growth, leaving you stretched too thin to do anything well. That realization forced me to rethink how I made choices.

One thing that helped was practicing saying no to the little things. Boundaries, I’ve learned, are like any other skill: you don’t magically get good at them when a big moment arrives. You have to practice repeatedly, in low-stakes situations, so that when something truly important comes along, you already know how to protect your time and energy.

I also started keeping an honest inventory of my capacity. Every project, responsibility, and emotional demand I wrote down where I could see them. Having that bird’s-eye view reduced my self-doubt. Instead of feeling lazy or ungrateful for turning something down, I could point to concrete evidence of my limits. It shifted decision-making from guilt-driven to values-driven.

Finally, I had to confront my tendency to repress how I felt. As a lifelong Disney princess fan, I often caught myself mentally replaying the Frozen lyric: “Conceal, don’t feel, don’t let them know.” But pretending everything was fine only left me weighed down by constant self-doubt. I eventually learned that “letting it go” was far healthier. For me, that looked like journaling, venting to someone I trusted, or even talking things out loud to myself in private. Naming the grief allowed me to validate my choices instead of living in negativity.

Missing milestones still hurts; however, I’m learning that honoring both the loss and the purpose behind it is part of growing into the life I’m building. For every trainee out there who is struggling with this, everything will be okay. Keep moving through life one intentional decision at a time.

Recommendations:

• Practice saying no to the “little” things to prepare yourself to say no to the “big” things.
• Keep an inventory of all ongoing projects and assignments easily accessible so you know your capacity for new professional and personal things.
• Reflect on your feelings instead of repressing them.