On aging

When I do complete these years of residency, these long, seemingly endless hours in the hospital, medicine will have aged me. Filled in gentle wrinkles around the lips, placed faint circles beneath the eyes. It is not just the hours that do this, but the very nature of the work. But I will also emerge from this residency with perspective, and with an unparalleled appreciation for life. You only begin to appreciate it when you watch as it is taken away from those around you, one after another after another. You begin to value it when you realize – and see with your own eyes – what the alternative is. I walk out of the emergency department each day thankful that I can inhale deeply, break into a slow jog towards my car, feel my muscles tense and stretch with each stride. These are the things life is made of. They make each day worthwhile. And I love medicine for revealing this to me, over and over again.

I also love children. Working in the pediatric emergency department makes me happier than anything else in the world. Time flies. More so than on the floors, where time drags while we are waiting, making phone calls, filling out paperwork, and caring for children who are sicker than we would like them to be. My shift this evening was delightful. I am finally starting to teach – I walked a PA student through sewing up a fingertip laceration on a 7-year-old boy. Teaching is another highlight of medicine, and I have only reached the tip of the iceberg in that regard.

Post-Call Addendum

I am post-call and ready for some sleep. This marks the end of my only month of floor pediatrics in residency. A reminder for the future is not to start patients with acute chest on ceftriaxone due to the risk of sludging – cefotaxime is preferred. The next time I take care of children, I will be in the PICU as a second year resident. It is hard to believe that time is flying by so quickly.

The Eleventh Hour of Internship

This is the first post of my first blog. I am an intern, in my first year of a four-year medical residency. The story begins now, in the 11th block of  intern year. My goal, if I can achieve it, is to blog every day for the next year, in an attempt to record the trials and tribulations of residency.

Today is an on-call day in pediatrics. It is gray outside, which makes me feel better about spending a Sunday  in the hospital. There are some good things about working on Sunday: the drive to work is quiet, almost peaceful. More parking spaces are available in the garage, so I can choose a sheltered spot close to the front entrance. The attending physicians are at home for most of the day, so the atmosphere on the floor is more relaxed.

On the weekends, I  leave the white coat at home. I have a strong aversion to the white coat. It is the worst culprit of germ transmission in the hospital, especially since I don’t have the time or money to wash it. The profession of medicine is still heavily influenced by tradition, formality, and distinction – and so the white coats remains part of the all-important “physician image,” for physicians and patients alike. But the image never coincides with reality: residents wear blood-stained, dirt-stained, wrinkled coats day after day, rotation after rotation, month after month.

Five admissions so far. The asthma season is coming upon us, so children are coming in short of breath, in need of albuterol nebulizers and steroids. Allergy season is also upon us, so children with a variety of allergies are also presenting now. The trick of pediatric medicine is that care is family-centered, rather than patient-centered. For better or worse, parents play a critical role in the emotional and physical health of their children. Anxious parents are common and can be frustrating to work with, but they are much less troubling than the disinterested or incompetent parents. We see far too many of those. A little girl ran into my arms yesterday – just after meeting me – while mom sat in her chair and glanced away. Troubling. Even terrifying.

The overbearing parents can also be difficult to watch. I love to ask kids what they want to be when they grow up – it always gives you more information about the child than any past medical history, complete with medication allergies and prior hospitalizations. One ten-year-old’s response was that his mother wanted him to be a plastic surgeon. My instinct, upon hearing this, was to say, “Don’t let somebody tell you what to do. You’re 10! Explore everything, take your time, don’t jump to any rash decisions.” But I refrain, halted by the grim knowledge that he will only realize this in retrospect, years after he has worked hard to achieve the dreams that someone else set before him.

I often wonder whether or not medicine is for me. It is a path I chose years ago, long before I knew what being a physician required. Many physicians regard it as a calling, rather than a profession. I am not sure how I feel. I know that before I got to medical school, I was driven by a burning desire to help people – building houses, donating clothes, teaching children. Over the course of the last year, I have become increasingly tired of helping people. I have reached the point where I feel as though I have maxed out my energy and am ready to turn over the baton, so that someone else can help all of the people out there who need it.

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