My ego needs some fentanyl, stat

July 18, 2009 at 6:19 pm | Posted in Uncategorized | 1 Comment

It’s been a long couple of weeks.  Longer because I stayed far later than normal a couple of times in order to learn some new things.  Like invasive line placement, a skill at which my lack of experience was apparently quite unexpected.  UW doesn’t give its interns much opportunity to place central lines or arterial lines.  But as it turns out, it’s not actually that difficult.

I’m not keeping very close track of my overall hours, since it really doesn’t matter.  But I think the schedule I’m on involves alternating 100- and 60-hour weeks.   Which isn’t bad, compared to what my schedule might have been like elsewhere.

Right now, I’ve got several very irksome problems:

1. It’s been over a year since I worked as a physician, and the mindset is completely different from that of a pharmacist.  Granted, it’s a better fit than pharmacy, but there’s still an adjustment to be made.  Another aspect of this is my habitual use of weasel words.  I got in all kinds of trouble in pharmacy school for making definite statements in response to drug-related questions.  And I remain persuaded that few things in medicine (or surgery) are truly black-and-white.  But there’s no Heisenberg principle in surgery.  Either it’s operative, or it isn’t.  And either you operated, or you didn’t.  There’s no shadow world where it may be either case in the future, or could be both at once.  So the weasel words have to go.
2. There’s also a huge difference between being a trainee and being a fully independent professional, legally responsible and expected to make my own decisions.  I’ve spent the last year making my own decisions, answerable only to my own conscience and a court of law.   It’s hard to regain the balance I had finally struck as an intern, between knowing when to simply do something I knew was correct, and knowing when to ask permission anyway.  So right now I’m getting very mixed messages on how I’m supposed to behave: I don’t run things past my seniors enough AND I’m not independent enough.
3. On top of this, there’s a lot of stuff I flat out still need to learn.
4. There’s also a lot of stuff I know, but can’t recall with enough facility at the moment due to the stress of all these other things I’m trying to get right.

So, you know, the going is a bit tough right now.  And there are some days when I understand why residents quit or transfer into other fields with such frequency.  It’s hard to face seven years of feeling like an idiot about some thing or other every day.  Much easier to break it up into smaller pieces, like a medicine residency and fellowship, where at least in the middle you get to feel like an almost-attending.

But I’m not going to be one of those people.  For one, I have an abnormally well-developed tolerance for delayed gratification.  And secondly, I can’t really picture myself doing anything else.  At least, nothing else that doesn’t require a residency that would make me go postal (integrated vascular spots are too scarce to be a realistic option).

And don’t even talk to me about ENT.  Blood, guts, vomit, stool, smushed brain: none of those bother me much.  Earwax, however, nauseates me to the point where I have to put the scope down and leave the room.  It makes no sense, but we all have our kryptonite, and that’s mine.

I’ve learned a lot already, in just three weeks.  And now I have this weekend free to do some actual book-learning.  Hopefully it’ll make the next two-week sprint a little less painful to my ego.