Friday, February 5, 2010

The Light at the End of the Tunnel

First of all, I would like to apologize for my last melodramatic post.

I had a hard day, and was discouraged, and lost my head for just a moment. Between your comments that I can indeed hold on for just one month and Hubster's amazing support, I've come to my senses. There is always a light at the end of the tunnel.

To answer a couple questions...

Internal medicine is what most people think of as general medicine. Dr. House is an internist. These physicians are not surgeons, not OB/GYNS, not pediatricians. If you get pneumonia and need to stay in the hospital, you will be taken care of by an internal medicine team. Same as if your liver is failing, or you have a stomach bleed, a severe electrolyte abnormality, or a kidney stone. As long as you aren't having a baby, under the age of 18, or need surgery, the chances are you will be cared for by internal medicine.

As for my particular experience...internal medicine is hard. Most of the patients are incredibly complex, are taking many mediciations, and always, always have more than one issue.

The last week has been hard. I worked 42 hours in 3 days. I'm taking care of 6-10 patients by myself. My pager goes off between 60-100 times a day, all of which are pages that require me to make phone calls. And then there are the pages that I need to send, to consult services, to social work, to the lab. Add in needing to place orders and write notes for 6-10 patients a day, and it all equals an insane amount of work. From the moment I arrive at 6:30 am to the moment I leave at 6 pm on my early days, to 9:30 pm on my normal days, I feel like I'm at a full out run. No time to check e-mail, catch up on my reading, or even go to the bathroom. I spend most of the days fighting back the panic attacks I feel at the back of my throat.

To top it off, my atttending makes sure every day he pulls me aside for some "constructive critisism." As in comments like "It's obvious you don't do much reading. Maybe you should try getting here early before you see your patients to do some reading. New England Journal of Medicine has great reviews. I'd start there."

Or, there's my personal favorite. "Let's go over how you write notes. Your notes make it obvious you're not an internal medicine resident [Really. Was that the first clue?]. I'll just show you how I like it done. I like the vital signs and lab work to be in size 10 font, while your assessment and plan should be in size 12 font. And I would bold each problem, and then indent and bullet point each aspect of your plan."

Yes, between all the other real work I have to do, I'm supposed to find time to format my notes in complicated ways according to someone else's obsessive tendencies.

And then there's the other intern on the team. Who is the most efficient, smartest person I've ever met. He has all his notes done before 9 am rounds. His pager seems to never go off. I never see him sitting at a computer, frantically typing as if his life depended on it. He's always just sitting at the table in the team room, reading a journal article about the latest techniques of diagnosing biliary disease. He even makes handouts with algorithims for approaching community aquired pnemonia, or differential diagnosis for acute renal failure. I can't compete with that.

My first day of this, driving home at 9 pm, I cried the entire way home. I thought about how wonderful it would be to get in a car accident and spend the rest of the month on a ventilator. That seemed like a better option than having to endure an entire month of this.

Hubster was standing by the door as I walked through it and just caught me in a hug. "It's okay. Only 27 more days," he said.

And it's true. It IS going to be okay.

So far, residency for me has been easier than medical school. I was overworked and emotionally abused during medical school. And after that, anything seemed easy.

The darkest time for me was during my pediatric sub-internship during fourth year of medical school.

Right now, I'm working harder than I did on that pediatric rotation. And even though, after only 5 days, I'm already exhausted and discouraged, I don't have the same sense of dispair I had during that time.

At that time, I thought I was going to do pediatrics. And all I could see was q4 call and no sleep and endless days of work stretching out in front of me for the rest of my life.

Now, I know that I'm doing anesthesia. This month of internal medicine is only that. A month. There is a light at the end of the tunnel. And it's called March 1st. And then I never have to do this again. That thought consoles me as I'm criticized by my attending, hounded by nurses, and yelled at by patients.

Every day, Hubster and I go over the things that I truely am thankful for.

- This is only one month.

- It's February, which means 28 days, instead of 31 had I done it in August.

- I'm doing this month during the winter, which means, even though I get home between 9:30 and 10 pm on long days, I didn't miss a gorgeous summer day.

- I only have three call nights instead of the typical four.

- Despite everything, I still care about my patients. Which means I'm still human.

See? No matter what, the optimist lives on.


  1. Wow, I knew becoming/being a doctor was difficult (it should be, I suppose) but your description of a regular day is unbelievable. I've been in the ER with my mother several times over the last few years and I always pay close attention to what I can see the docs doing when I can see them. But I had no idea that it was as difficult as you write. Thank you for what you do.

  2. I'm sure March will be better for you. What rotation do you have to look forward to in March?

  3. You are interfacing with many other services, each service increasing your patient load. So instead of 8 patients you may have twenty or forty depending on how many services. You doing well. A doctor I know had some good advice to relieve some of the burden. You might call him. So glad you have Hubster and a big hug at the day's end!

  4. Sometimes I wonder if I should have been a doctor. But I know I could never do what you do. I admire you for carrying on. There are always things to be grateful for, but I definitely understand the need for an occasional freak out!

  5. I watched my dad go through all of this. It's hard. But worth it. Because we desperately need more doctors who hold on to their humanity.