Fairly recently someone asked about where exactly I am in my training. "So what is a resident? Are you a doctor now?" he asked, "or not a doctor?" The answer is yes. I am technically a physician now, and yet in so many ways I am still more student than professional. This is true in both the philosophical sense - I still have a lot to learn, I need a lot of supervision so I don't make mistakes, etc. - and in the concrete sense - I can't sign prescriptions for narcotics yet, I need to have formal supervision, etc. So I am a doctor because I graduated medical school, and just like a doctor I see patients by myself in the clinic and the hospital. But I am in the postgraduate training phase, and that means during this time there are limits on what I am allowed to do, especially what I am allowed to do unsupervised. I've reached journeyman status, I suppose. For people training to be family physicians (meaning me), this period lasts three years. If I choose to pursue more specialised training after that in OMT, psych, ER, OB, whatever, it would add another 1-2 years of postgrad training.
So I'm a resident now. July was my first month. And it was... I can't even tell you how it was. I wrote some (terrible) haikus my first week that, looking back, I still think are fairly representative:
patient is acidotic
with high bicarb and high CO2?!
acid-base, you bring despair
a drug seeker yells
you doctors never help me
rage his only wealth
small cell carcinoma
how do I tell them he's dying?
I am just an intern
I can tell you this much
one day I will love being in charge
not today. but one day.
the alarm says five
OH MY GOSH THAT'S WHEN WORK STARTS
THERE IS NO POETRY FOR LATENESS
CRAP
The last month was really an extended exercise in fear, uncertainty, and depression. And somehow it was also an exploration of sacrifice and worship. I can't say last month was fun, or that I liked it to any degree. And it's hard even for me to say it was good because there was so much bad stuff in it. But somehow... it was right. It was right that I be there, working all the time, feeling insecure, starting to learn what medicine even means. It was right that I have to struggle with how to show compassion to drug addicts and angry families and the slowly dying (and the acutely dying), again and again and again. I sound crazy, don't I.
I have to be honest, though. After all the years of college and medical school where I refused to give up on my dream, three weeks into this thing I woke up and was like, "This is medicine?! I want out. So long, and thanks for all the fish.*" It was a sobering moment. In school I would get fed up with people who said that, but now I'm wondering if everyone has that moment (or several of those moments) on this journey.
I ended the month by taking care of a manipulative alcoholic and persuading a patient, in progressive stages, that 1. his organ failure was terminal, and 2. getting on more transplant lists in other states probably wouldn't help, because 3. he was no longer a surgical candidate. I also had my first experience with trying for several days to get some kind of help for a patient, only to have every possible avenue of help closed to me. We prayed together over the unavoidably terminal diagnosis, and then that person essentially went home to die. Alone.
Walking all day through other peoples' misery is really exhausting. And it's worse when you are crippled by near complete ignorance of everything from the computer entry system to the specifics of the treatment plan you want to implement (I told you I'm still part student). Calls from nurses, for example, are generally terrifying. How much insulin should you give? Can you give that person pain medicine? How should I know?! Oh, because I'm the doctor. Well. When you put it like that. A nurse called me one day to tell me one of my patients had a critically low platelet count of 16,000 (you want it over 150,000). I thanked her and put the phone down. Then I put my head in my hands and said aloud, "I literally have no idea what I'm meant to do about that." A very kind attending who was sitting nearby put her hand on my shoulder and said, "I remember being there. You'll figure it out."
I didn't, though, because after much research it turned out that issue was unfixable. I sent that patient home to die, too.
:/
I don't think I have formed a very good perspective on all of this yet. But I haven't quit. And God has given me a breather in the form of working in the ER this month. He knew what I'd need after my first month on the floors. Next time, Lord willing, will be better.
*If you don't already know that this line is from The Hitchhiker's Guide to the Galaxy, you need cooler friends and you should probably read more.
