Sep 17, 2011

Friday is a better day to write...

If each of my weeks of surgical pathology were presented as a topic of a medical school lecture, it would be presented as a fluctuating graph, similar to the sort of thing you'd see in LH and FSH curves.

Monday: Okay, this week is going to be different. This week I'm going to be more not-terrible at things and not get overwhelmed and I'm totally not going to start crying in front of colleagues/attendings/patients in the parking lot.

Tuesday: Well, Monday didn't go as well as I'd expected, but I'm still kicking and I have the opportunity to get some learning experience and even if I'm here late, I'm going to salvage these cases and not be an incompetent braying jackass. I'm going to ask the chief resident for some advice on time management without cry... well, not much crying.


Thursday: Tomorrow is Friday, I just have to make it for today and tomorrow and I'm going to run damage control, but I can't believe I lost it that badly yesterday, fortunately the transcriptionists haven't mentioned hearing my voice break at 11 PM on the dictations because I realized I still had four liver biopsies left and don't actually know what liver is supposed to look like IS THAT CANCER?

Friday: I'm so tired. Did I seriously not screw up these cases as badly as I thought? Is that attending praising me? Life has meaning! I'm going to go sleep for twelve hours...

Saturday: I'm going to get groceries... and do something today. And I have a little time? I'm studying some lung! I feel like I'm finally getting this!

Sunday: Studying dermpath. Slight impending feeling of doom, but I've done some reading! And rested! Next week's gonna be awesome!!

While I definitely feel like the weakest link right now because my colleagues are suspiciously good at this stuff, the early surge path months could best be summarized by the following scenario:

(In a dead quiet room, an intern stares meaningfully into a microscope, scans a slide, stops, frowns)

"What the f*** is that?!?!????"

(Other interns crack up, both in sympathy, and in the realization that their dictation now has someone else's exasperated exclamation in the middle of it. Ponder that the transcriptionists haven't killed us. Other interns gather at the scope. Several appear puzzled.)

Just-studied-that-topic intern: "Normal breast tissue"

(embarrassed silence)

Yeah. It's not a program problem, honestly. There just seems to be no way to be a first year resident and not feel about as useful and intelligent as a squirrel wearing oven mitts.

Speaking of dexterity impairments, I contributed to *last* week by plunging a contaminated scalpel through my thumb. Yeah, *through*. I don't like to screw up small.

Funny thing? I'm constantly overwhelmed by crippling feelings of panic and inadequacy about my overall competency as a physician, yet having a knife stuck in me largely made me feel really really embarrassed about having arranged myself in such a way to get a knife stuck in me rather than being that concerned that there was, ya know... a knife stuck in me.

Here's the thing too.. we wear cut proof gloves... they do not prevent against stabbing with great force, which should both tell you that you shouldn't use them in a joust and that I was doing something stupid.


(knife plunges straight down, left thumb is briefly pinned to cutting board)

Ishie, to herself: That probably glanced off the glove and is caught on it. The sharp pain I am feeling is likely due to the blunt force hitting my thumb.

(blood quickly spills through cut gloves and two layers of latex)

Ishie, to herself: Oh.

(pulls up scalpel)

Ishie, to accessioner around corner: Um... If there's an... incident, who should we call about that?

Accessioner: Did you spill something?

Ishie: Sort of.

Accessioner: What do you mean?

Ishie: I cut myself.

Accessioner: Badly?

Ishie, evaluating blood puddle on table while applying pressure: Um... pretty badly.

Accessioner, rounding corner: Oh my god!

Attending from other room: What's going on?

Ishie, to herself: Oh good. Let's bring everyone in on this.

Attending rounds corner, pushes Ishie's hand into sink. Ishie experiences sensation of water running from one side of tissue to other. It feels really weird.

Ishie: Sorry sorry sorry, I was being dumb. It's no big deal.

Attending, simultaneously: Don't worry, infection is really really rare, we'll get it taken care of. We'll test the patient. Was there more than one specimen?

Ishie, to herself: Oh right, I should be worried about that.

Why social stress panics me and trauma doesn't remains part of the deep lurking mystery that is my psyche.

Everything got taken care of really quickly, people came to back up my workload, I was off to the ER, everyone was making phone calls, and it was bam bam bam. Very impressive. And I'm fine. Extremely clean cut, sealed with dermabond, a week and swelling is going down with no signs of infection. Also, the ED at this hospital is really nice looking. While I *love* New York, don't get me wrong, the hospitals tend to have a more, let's say, 'lived in' look that doesn't look as clean even when it is.

So I kind of feel like a mess. I do feel like I'm getting somewhat better at things (except cutting stuff), but really slowly. I'm *really* slow at grossing and usually require a great deal of help, and then I'm doing decently on diagnoses, but it takes me a really long time. And I make dumb errors. Dropping stuff, putting stuff in the wrong boxes, forgetting where paperwork goes even when I've been shown fifty times, being completely incapable of recognizing squamous cell carcinomas anywhere.

Seriously, I hate that cancer so much. And it pops up everywhere. And it's frequently so obvious that the other residents, med students, janitors, and elementary school children that wandered into the hospital are like "Oh, that's an SCC", and I'm like "Where??? Is it behind all that red cancery looking stuff???" Gah.

So that's the update... I'm still dumb, but people are being relatively cool about it. Let's hope the idiocy is low-grade and transient.

1 comment:

heyroth said...

"Is it stab o'clock?" =).. Is it sad and geeky of UC Davis NPB alums to instantly remember an LH and FSH curve? Someone steal my lunch money already...

Having "imposter" syndrome is so common you wouldn't believe it. At UCSF, there was a talk on "imposter" syndrome and it had the biggest gathering of the best minds in science in attendance. When asked if anyone felt like an imposter, you'd be surprised who raised their hands. Yup. It was the best minds in science. You think that after several publications in Nature or Science would get rid of those feelings...

Anyway, just wanna do some "rah, rah, rah" over here for you. =). It's funny how things feel like the worst day