Aug 31, 2011

The reboot

Hi boys and girls, it's me, your bipolar blogger.

So, lemme see how I can sum up and still get to bed in time to not be miserable during lecture (yes, we still have lecture in residency)...

It sucks. Then it doesn't. Then it sucks worse, then someone jumps on your back when you're at your lowest moment of suck and you feel like it sucks worse than it EVER sucked, and then a few people throw you a life preserver and you get some peace, and then you can't get your stupid character to climb the first stupid rock cliff in Shadow of the Colossus in the ten minutes that you're "taking a breather", and you want to start crying because your video game avatar isn't respecting you and your animated horse ran away.

It's not that I'm miserable all the time. It's that I'll be REALLY happy or even moderately content, perhaps when I'm pouring steaming liquid nitrogen over a piece of uterus while going "MWA HA HA HA" since it's impossible to play with liquid nitrogen without feeling like a mad scientist, and then I'll feel like I'm really a bus ticket away from leaving. Like taking off, leaving, like walking into my program director's office and being all "Sorry, you've been cool, but I am flat out not equipped for this" and then getting on a bus somewhere else and just... waitressing in a border city or whatever people that make decisions like that do on tv.

Also? I'm weird. I get weirder when I get stressed, and I am at my weirdest when I'm stressed-but-putting-a-good-face-on-it, which leads to interchanges like the following:

Histo tech: Dr. Sancho?
Me, taking a minute to realize that means me: ...
Histo tech: (politely rattles off a hundred things I have to do, about fifty of which I don't really understand)
Me: ... uh... I totally know what you are talking about. Here's my tray of pathology things. You are welcome.


Me, thoughtfully: That's the first time in my life I've actually been called 'Dr. Sancho'.
Histo tech: Oh! I'm sorry! Do you prefer 'Dr. First-Part-of-Hyphenated name'?
Me: Actually, I prefer 'Batman'.

(long awkward silence)

Me: But 'Ishie' is fine.
Histo tech: ...Batman... got it.
My brain, to me: What the f***, Ishie. Seriously.

Yeah, that happened.

First month, full on training month. We were never really allowed out without a handler. We spectated a bit, and did stuff, but if we broke down, we had a senior to bail us out immediately. I mentioned this before.

Second month, as I also mentioned before, is when you're somewhat in charge, except you don't know anything. I spent a lot of this last month feeling like I had conned my way into residency and was absolutely not smart enough to be a doctor. I kept reassuring myself that everyone feels as dumb and unskilled as I am, but then had a fellow jump down my throat, question my commitment to everything and say I was unskilled in pretty much every way, which made me cry for half a day. Which is not only demoralizing but frigging embarrassing. Since Irene was chilling off the coast waiting to put the extremely publicized cinch on all my friends and loved ones up north, I blamed it on allergies, specifically the type of allergies that make you sob uncontrollably.

Since I live in the South, which is known for its politeness, the response to this was favorable. Additional note, gender stereotypes be damned, anger + exhaustion + self-loathing = unexpected waterworks. As someone that has belly laughed through Benjamin Button, not a fan of this response.

I honestly toyed around with quitting, like not next year, but just two weeks notice, flat out. I felt unique in this response before talking to My Friend, the Pediatics Resident who not only tried the same thing but was waylaid by the three people that tried it before her. Apparently, residency is hard. Who knew?

I took the advice of one of my peers and approached the next day with my "head held high" which I think took on the appearance of a gargoyle grin the whole day, but it was an effort. The "I'm happy, keep moving" day was punctuated by an unexpected moment of credit to counteract the unexpected beat down. I was staying late trying to get all my stuff done, helped by an attending, and out of the blue, the guy that hadn't said anything in twenty minutes, tells me how he felt awful his first month of residency and that I was working hard and doing a good job.

To my credit, didn't start crying again. Said a "thank you sir" meekly, with ABSOLUTELY NO MENTION OF BATMAN, and went home.

I took the weekend to reboot, and went at it again on Monday. I was greeted with the chief that's been helping me tell me that as the end of the month ritual, he was going to leave me to it and I was going to be in charge of entering all the diagnoses in without help on that either.

Oh, and today, I'd been signing them out officially with the fellow that hates me.

Holy matrimony, Batm... NO MORE BATMAN.

Guys, I actually did it. Yesterday, on the announcement that I was for real on my own, I felt the panic rise, but I was like "I'm just going to do the best that I can", cranked the headphones and the pseudo-happiness up and just pretended I knew what I was doing, walked into sign out today with a smile on my face, prepared to get verbally dismembered or fired or whatever, and frigging did it. I didn't get every diagnoses right by any stretch of the imagination, and I did a couple things that were flat out stupid, but I smiled the whole time, didn't cry, and didn't feel like a complete incompetent. And I went home feeling pretty happy.

Given my residency cycles, this is likely to descend into chaos by the end of the week, but hey, baby steps, right?

In other, related news. They gave me a medical student. Which is the worst idea ever. It's like dangling a vial of crack in front of a junkie. I'm brand new, so I'm not very helpful for teaching, BUT I do have tons of stuff that I take extra time to do because I'm still inefficient and this stuff has no educational value whatever, particularly if someone doesn't want to go into pathology, which 90 percent of people don't. This is known as "scutwork" and it's the bane of medical education existence. So you are going to give me a medical student, who is supposed to do whatever I tell her to, that I can run all over the hospital fetching paperwork to save myself time, that then gets her out of my hair if I scut her, so I don't have to reveal that I have nothing to teach her because I'm a frightened idiot?

GODS. I'm being good, I swear. And this isn't a fourth year crashing into interview months that is more comfortable with disappearing on an August intern. We're talking brand new clinicals, which if my background is any indication, means you think anyone with "Doctor" before their names can and will call every place you hope to apply to tell them you suck while probably talking the USMLE people into taking ten points off your looming Step 2 exam if you take more than 45 seconds to answer a courtesy page.

I even got the "I'm still keeping my options open" answer, which on this end, is adorable. I got asked if it was okay to leave to attend a scheduled lecture. This was the first time in my entire medical education that I realize residents truly don't care if you're there. I got a pager number. I realized that interns really don't know med students' names. I got someone eagerly looking at me for deep medical knowledge and being all "Don't cut yourself on the cryostat. Seriously, that blade has been places that would make Rambo puke."

In my quest to not be a terrible person, I'm trying to do stuff that I would have wanted done for me at the beginning of my third year if I were in a pathology rotation, other than my sage advice of: Get UWorld now. Seriously. Do it while I'm standing here. I'm currently going with "play with the cryostat" (CAREFULLY) since that enticed me pretty early on by being a big machine with a big knife in it. Any other suggestions? I tried "be let out early to study" but they have the afternoon lectures. I remember from third year that "Go study" is helpful to an extent early on, but you don't feel the Step 2 crunch as heavily, and being dismissed for hours when you still have to be at the hospital is tedious.

Laypeople, chip in as well... I'm not around the forensics cases this month, so that's not an option since it's the most obvious "let the student do something fun" choice.


Spice Island Queen said...

Well, I haven't done path and I don't know that your student is interested in said field (but maybe since he/she is there for the rotation) but as a newish 3rd year I am not actually bothered by scut work (well, at least not yet and I'm going on 4 months now.) I know my residents are working hard and if I can do something to help them (even if boring or non-educational) I would rather that than be dismissed to "go study" or "go eat" for more than an hour at a time. The hospital and all is still new and exciting so as long as you are nice and thankful don't feel bad, ask for help, even if it is running paperwork over the hospital, etc. If you see a cool case or have something fun to share then by all means teach but you don't have to teach all the time, we know you are busy and new too. And maybe this is just me but I appreciate being given something to look up. It can even be something you need to review as well. Then you can both talk it over the next day, etc. Some of my favorite residents have assigned me a topic to review and then talked me through it in relation to a case or pt the following day... So much better than random pimping questions. And I may even retain the info for more than 5 mins too! :)

Anonymous said...

Thank you so much for this post. Means a lot. I too am a MS3 from SGU on my first rotation.I have followed your blog religiously and still do - checking frequetly for updates. Your blog is treasure trove of information - you are great at telling it like it is without being negative. Thanks again.
BTW, are you upto some step 2 questions or do you not want to deal with this now. I totally understand.

Ishie said...

Thanks guys; I'm using the feedback, we get periodic med students, and now they're sending us over to help with small groups (AHHH).

What sorts of Step 2 questions? I'm happy to answer general ones. We can't answer specific ones because the NBME will hunt us down and kill us with sticks.