Friday, January 13, 2012

8 Things to Know About Resident Physicians

My old roommate wrote this and posted it on her facebook, and it's too good not to share... So here you go, enjoy:

Yesterday, my friend sent me this blasphemously hilarious article called, “5 Things to know before dating a scientist.”  Not to be outdone, I decided to write this 8-item blog because studying for Step 3 is boring and let’s face it, dating a resident physician is terrible.

1. Page us if you really want our attention.
It is frankly rude for us as residents (aka underlings) to pull out our cell phones 90% of the time we are at the hospital.  We are either presenting a patient on rounds, sitting in a lecture, or pretending to listen to a patient.  Please understand that we are in a service industry and a learning environment that takes no text breaks, snack breaks, pee breaks, or lunch breaks.  Very often, textswill not be checked or replied to in a timely fashion.   So if you must communicate a dire need / clarify a dinner plan to us… please page us.
It is much easier to read a page at the hospital because it appears to be work-related!  Many of us have mastered the “I am communicating important patient information to another colleague” look while we are paging other resident physicians emoticons and pages about where to get free food.  Most likely, our response time will be much better on the pager because while we are not a slave to you or our phones, the pager is our ball-and-chain.  However, if you get an automatic response, such as “Yes/OK, Thank you, or In 15 minutes,” then just know we are supremely busy and we apologize for the curtness.  So don’t take it personally.

The caveat is that some resident physicians do not like using their pagers for non-hospital communication.  So just ask yours if you should page / text / call them.

2. We love sleep.

We adore it, worship it, love it, and crave it.  All the time.  Since our second year of medical school, we have had a yearning for it.  It is precious to us.  When you’ve been up 34 hours straight and have half-slept on a hospital cot clutching a pager, you will understand our love for our beds.  I’ve heard of residents sleeping on the kitchen mat before their kitchen sinks while doing their dishes, residents sleeping through their friends’ weddings, and residents falling asleep talking to their significant others—you.   Sorry.

If we have the chance to be uninteractive for more than 10 minutes, then we will invariably close our eyes and drift into REM sleep.  What we want is uninterrupted, un-anxious, fulfilling, undeprived sleep.  Most of the sleep we accumulated in medical school was drunken hangover sleep and dreaming of test material, and most of the sleep we experience now is with a dysfunctional circadian rhythm.

So please do not wake us up early on days we can sleep in.   Most of us only get sick during residency because we do not sleep enough.   An early 6:00 am morning walk on the beach to see the sunrise is akin to a non-urgent page at 4:30am— tolerable, but annoying.

3. We love to ask questions.  Please ask us questions too!

Most of us resident physicians have been learners for 20+ years, heck, some of us even have PhDs and Masters degrees.  We have evolved to learn, memorize, analyze, and think critically extremely quickly.   If it is rude to you that we whip out our cell phones to wikipedia every building or foreign food or new drug being advertised, consider us sorry—but not really.  Our jobs require us to keep on learning, so it is only natural we apply the inquisitive approach to whatever seems interesting to us. 

Our brains were beaten to a pulp to learn each minute, relevant and irrelevant detail so that we could somehow catalogue those tidbits into a useful, accessible database.    As a consequence, if you say something remotely fascinating, please don’t be offended by our follow-up interrogating.  It is our way of interactive learning.  Blame Socrates.

So, broaden our horizons by teaching us something.   And ask us if you don’t understand an acronym or the jargon we’ve just spewed out.  We generally like teaching you too.

4. Don’t ever lie to us. 

Been anxious? Not sticking to your diet plan?  Didn’t really like the dress?  In pain?  Don’t really know the directions?  We can usually tell.   It’s a good thing though, because we would do anything to help ya.  But if you have an ulterior motive—don’t think I’m a naive nerd who made it this far by studying.

Our job as physicians is to find the truth in the patient’s history, symptoms, lab results, and imaging.  We love to believe you, but if what you says seems fishy, we will inadvertently turn to objective data to corroborate your story.

We see enough pathologic liars at work.  Believe me, you don’t want to be lumped in with the pain-med seeker who has 10/10 headaches and can still sleep soundly in the ED, yell at the triage nurses, and eat a full meal while sitting under bright fluorescent lights.

5. We are not medication or medical imaging vending machines.

Please tell us if you aren’t feeling well.  Feel free to refer your family/friends to us for an informal conversation re: their low back pain or new rash.  Let us know if you have been in an ER waiting room for hours.  We want to help you, but generally, we cannot give you stuff other than medical advice that is better than WebMD.  If we can help you, we will offer to.

In addition, it is unethical for us to prescribe your mother’s Xanax and impossible for us to give you a free MRI.  In addition, we as physicians are taught to never treat who we're dating and to never date who we're treating.  It is an ethical issue.

6. Color us cynical, but we still have feelings.

The things we hear, the diseases we see, the people we touch, the emotional burden we bear, the hours we work, and the medical responsibility we have—those are things you will never experience.  So please don’t say you understand how difficult my job is or how my patient feels.

The painful, ugly, humiliating, and private things that make you gasp on TV, we’ve probably seen ten of them in living color and had to touch them.

Most of us have healthily coped with the stresses and situations by becoming a bit cynical and numb.  If we cried for every cancer patient, if we felt sorry for every drug abuser and homeless man, if we were mad for every hour we worked “overtime,” we would be so emotionally spent that we could not function as a person.

But still, every resident still has feelings that the day to day coping mechanisms cannot compensate for.  For me, when I hit rock rock bottom, I just need to spend lots ofalone time with my dog on my bed. Find out your MD/ DO's means of escape from the hospital and make sure you R-E-S-P-E-C-T it.
Thank you.

7. Non- hospital food and coffee is ALWAYS superior to hospital food and coffee.
We would love some—homecooked, deli, leftovers from a restaurant.  Anything.  Anytime. Anywhere.  You can totally make our day with a Chipotle burrito or a morning donut/ coffee.  When we sip that Starbucks coffee cup at work, it is a pleasant reminder to us that we are still somewhat normal human beings in touch with the outside world.  Life becomes very lame when all of your fluid intake/output is at the hospital.  Remember, jellos and saltine crackers are not dinner.

8. VERY IMPORTANT: Don't ever complain about your work hours and your salary.  We have it worse.
But if we complain to much, please kindly remind us that it was way worse 30 years ago. 

(Thanks Eileen! This is awesome!)

Tuesday, January 3, 2012

The One Where I Confess I'm a Horrible Person...

*** sorry, it's long and I don't have time to proof read, please forgive the errors and just be surprised I managed to get something out into the blogosphere***

Despite weekly reminders popping up on my phone, and inconsistent (but nonetheless, copious) comments from my parents about my negligence in regard to this blog, I confess, I have been abhorrently horrible about updating my blog. Although I can rationalize my absence in the blogosphere as residency being too taxing and my false claim that my time too precious, we all know that I could have found a few moments to update you on the life of this general surgery resident. So, to the few and proud still lurking around, I beg for your utmost and (hopefully), expeditious forgiveness.

I believe the last time I was here was the end of August, at the end of my most favoritest rotation to date: pediatric surgery (yes, the verbose proclamation of love for pediatric surgery happens on an almost weekly basis, but I'll spare you, for now). That being said, I do believe I owe you all some recaps (for those of you not friends on Facebook or following me on twitter):

September: September found me on the endoscopy/ nutrition service. It was a lovely, and very low key, month. I didn't have to arrive to the hospital until about 6 or 7 on any given day and was usually done by around 3pm (this is unheard of for most surgery residents). I spent 2 mornings a week doing upper endoscopy (EGDs, or putting a camera down the throat and into the stomach and first part of the small intestines). 2 other days I would head over to the VA hospital and do colonoscopies in the afternoon (camera up the butt to look at the colon). The rest of my time was spent rounding on the nutrition support service and learning the intricacies of different tube feed formulas and how to give nutrition through IVs. On Saturdays you could find me covering the burn ICU, and having a plethora of free time to read. It was a thoroughly enjoyable month.

October: My October started with a week of vacation, which started off with the wedding of one of my best friends from college, who married his middle school crush. I then headed to my parent's house in Michigan and enjoyed the beautiful fall that happens in Michigan. I went to the apple orchard with my mom and had gloriously delicious apple cider and enjoyed the changing of the leaves (if you've not experience a northern fall, you are missing out... and, although I've very biased, I believe Michigan has one of, if not the best autumns). I returned to work the following week, were I started working on the general surgery service at a private hospital east of the city. My days started between 3:30 or 4, and the days were long... but I loved my time at the hospital (with the exception of the horrible EMR they have). I learned a lot, got to observe some really amazing and advanced surgeries, and even got to operate (almost daily). During this rotation the PGY-1 residents spend a lot of time with the program director doing breast surgery. Although the procedures may seem small to many, it was the first time I really got to do surgery on my own (the program director was there the whole time, but she just redirected and taught). Also, it's an amazing feeling to be able to tell a women you got rid of all the cancer we could find. I also, despite of the long hours, was able to get a lot of studying done during the month and spent a lot of time with my residency best friend studying at coffee shops and having weekly dinners.

November: Can I just say that I still REALLY like trauma and the intensive care unit?! I loved the complexity of patients that I took care of during November and really enjoyed the chance to be involved in the trauma resuscitations. I didn't get a lot of chances to operate, but I did get a few, and it was wonderful. But in spite of not operating, I had a wonderful time taking care of the ICU patients, having to think through all the problems, and really digging deep into the literature about different conditions and treatments. The month was also fabulous because one of my favorite coresidents was there with me; we had a system worked out so that I would bring her coffee in the mornings and she'd bring me tea at night when we were both covering the unit. We had so much fun complaining to each other about what was going on (venting is really good, especially when you have a friend right there with you... and we knew that a lot of it meant nothing). One of my other favorite coresidents was the floor doc during the same shifts I was in the unit, so we had time to hang out in between the crazy busy moments. Overall, it was a wonderful month!

December: I'm not going to lie, this past month was a rough one for me. I was on vascular surgery, which at it's roots is the exact opposite of pediatric surgery. The patients are generally old and have about a bazillion different medical problems. Also, I hate feet. Needless to say, I did not have a very good month at work and many times found myself questioning not only why I went into surgery, but also why I even became a doctor. At more than one time I postulated that it wasn't too late to drop out, until I remembered the massive amounts of debt I have from medical school. The month was hard because more than half of it was spent on night shift, covering about 5 services and never really feeling part of any team. Despite being the vascular intern, I only ever saw one of the attendings and spent most of the month by myself in the hospital at night (which aint fun). The week that I was on days wasn't horrible, however, and I found that I didn't mind the rotation nearly as much as I hated it while on night float.  The one great thing about the month was I managed to finagle about 11 days off between a week of vacation and a holiday schedule that got me 4 days off at Christmas (best idea ever!)

During my week off my mom came to visit me. We went to all the sites, saw part of a show (before we left, because, while the acting was great, the script itself was horribly unbearable), went to the zoo, went shopping, decorated my Christmas tree and made holiday cookies. It was wonderful, and exhausting. After my mom left I spent about 2 days on the couch recuperating from all the excitement.

At Christmas I actually managed to get home to Michigan. I got to see my entire family (almost, I didn't see 4/21 cousins) and spent quality time with my best friend and her family (whom I hadn't seen in almost 6 months). It was a wonderfully excellent Christmas.

Things to come: January: This month I'm on the transplant service, while I hear it's a busy service, I'm excited. I think transplant is fascinating and I'm looking forward to caring for pseudo-ICU type patients. The truly stressful aspect of this month is that this is ABSITE month. For you Grey's Anatomy fans out there, this is that big test that they have to take each year; or rather, the ABSITE is the year in-training exam all surgery residents must take. It's 250 questions and is a big predictor on what your options are for fellowship (kind of like the SAT for college, or MCAT for medical school, or USMLE for residency). Needless to say, most of my free time this month will be taken up by studying for the exam, which occurs on the last Saturday of the month.

Reflections: Despite of the intermittent horribleness that can be any residency (specialty or institution), I am glad that I chose to do surgery. The highs are great, even though the lows can be rather low and dark. Most of the time has been a great experience. I still love operating. I still love the diseases and complexity that occurs with surgery patients.

I'm glad I'm where I'm at for residency. No matter where you end up for residency, you'll be able to find issues or attending that you maybe aren't a huge fan of... but for the most part, I love my program. I think the attendings are rotations are great and I've learned a lot over the past 6 months.

I love my new city, even though I've not had a lot of time to explore it. I love my friend here, they're all awesome people.

That being said, residency is hard. Residency is exhausting. Residency sometimes wants to make you buried your head in your pillow and not wake up. I think this has been made harder by the fact that I'm at least 12 hours away from my family and all my friends, and the fact that communicating can be difficult with the limited hours of free time to get ahold of people. Someone told me to pick a residency close to home, I'm not sure I would do that even now, but I can understand why people told me that often.

Anyways, I'm half way done with my intern year, and that to me is a huge accomplishment. As far as I can tell I'm not floundering too badly and I'm having fun more days than not.

Resolutions (because, you know, it's a new year... Happy 2012!):
1. Be better about blogging (I promise I will try)
2. Be better about communicating with the most important people in my life
3. Be better about studying everyday, no matter how tired I am or how soon I have to be back to work
4. Make 1 new recipe every week
5. Work out (I don't know where I'm going to find the time... so I'm not going to designate a number of times per week... we'll just leave it as, work out at least weekly)
6. Read (or listen) to my Bible more consistently
7. Work on my bad character traits (impatience, getting frustrated easily, etc.).
8. Pay off my credit card debt
9. Buy a house??
10. See Newsies on Broadway with the best friend

On that note, I'm post night shift and still have beacoup d'etudiant.
Paix et benediction a vous tous pour la nouvelle annee (Peace and blessings for the new year to you all)