May 26, 2010

• Maturing? or Chipping Away?

  I am one week away from my last R-service. Or wards. Or general medical floor. whatever you choose to call it, I am on the countdown to the countdown.

  4…3…2…1

  Then I move on to ICU. Intensive care. codes and lines, the dead and the dying and the slowly rotting away. The last minute saves, the miracles and the tragedies. And one month after that, I complete my intern year. Year one of three. One third of the way through my residency.

  I had to step back outside myself the other day and ask how did I do it?

  It was a steep learning curve. The first month or two, I was still trying to learn the computer system, the hospital layout, figure out who was a friend, who was a colleague, and who could be trusted. Patient care was terrifying and exciting. How could these people trust anything I say just because of the length of my coat? How do I present to an attending and come up with my own plan-what if its wrong? what if i kill somebody? what if someone catches me in a mistake?

  As time went on, things settled into a routine. You hear all the time that most dangerous month to get sick is july, when all the new interns come on. I said it myself. It’s not true. sure new interns start, but the old interns, now become residents, have been through the meat grinder and spend the extra time, staying later, double and triple checking every order, making sure things go smoothly. November, December however…hospitals get overcrowded with the holiday hearts and people taking less care of themselves than usual. Residents check the interns a little less closely, figuring they have learned the basic ropes. Interns check with the residents a little less often, figuring they have the basics figured out. Gaps appear in care depending on the knowledge level.

  By spring, those gaps have been closed after occasional feedback and private conversations here or there. As an intern class, we have bonded, we look out for each other and pick up each others slack. We may not all be friends outside the hospital, but inside, it’s a whole other world and you depend on these people on a daily basis. Whether or not you like them, so it’s better to make the extra effort to be friendly. Those of us who figured out that this also applies to ancillary staff like nurses, janitorial staff, and cafeteria workers have a much easier time of it, as we get paged less, have our call rooms cleaned more regularly, and discover a whole host of small benefits to being generally likeable.

  I’ve had days where i’ve felt burned out. Days where I just dont care, and dont want to do medicine, and can’t complain to anyone but coworkers because no one not in the field could understand. When you wear the coat, the perception people have of you isnt of you. It’s of some omniscient figure who can never be allowed to make a mistake, or dislike someone, or can be blamed for telling you things you never wanted to admit to yourself. Days where I feel like a punching bag, and coming home to try and talk about it just earns me concerned lectures about how maybe i didnt choose the right field if i am feeling burned out this early and complaining about what this stupid person did or how i hate dealing with such and such a patient.

  So I stop talking about work to anyone not in the field, wondering if something IS wrong. Maybe everyone else is right and I am the one person sick of it.

  But then there are days when I feel on top of the world. Getting a perfect spinal tap, 15 minutes with no complications and the traditional accompanying bottle of champagne. Having a patient I saw for less than 10 minutes in the ER ask if I would be his primary care doctor as I seemed trustworthy. Figuring out from my history alone that one of my clinic patients had cancer, and following her from the diagnosis to whatever the ultimate treatment ends up being. 

  The days that I feel competent, the days I am not forced to be just a documentation machine are the days I feel like a doctor. And with the end of year one in sight, there are still more of those than not, for which I am thankful.

  That said, why have I not been posting stories like I used to? I dont know. Maybe it’s harder for me to see the same fascinating excitement than it was when i was a student. Maybe I have so many patients its hard to figure out what I find interesting versus what you would. Maybe I am just so exhausted when I come home that I dont have the energy or inclination to sit down and write yet another note on a computer. I could promise I will try to be better. But ultimately no matter what kind of claims I make, I will continue to just be me.

  So for now, I am going back to just keeping a record for myself for a little while. I will continue to leave it public, and that is mostly for the benefit of those of you who have followed along since i was a wee student and continued to offer encouragement-agenteric, justgotpaid, grrshnguyen, professortom and slightly late to the party but no less appreciated jillstar and wonderland7386. Basically internet guilt is what drives me back here feeling that I have neglected you all, not that we have ever met (except for grrshh) and I hope one day we can. 

  That’s all for now. I have a morning report to prepare for tomorrow, and I will see you all on the other side of the ICU when I am officially a resident. And who knows? I might even find time for an entry or two along the way.

  • 12:54 am
  • 1 Comment