Saturday, June 30, 2007

Hiatus (mostly) over

What, without asking, hither hurried whence?
And, without asking, whither hurried hence!

Orientation is finished. I'm not sure how these things work at other hospitals, but it seemed to me that my orientation consisted of a solid two hours of information crammed into two weeks of lecture. The obligatory instructional lectures on our computerized records system, kindly lectures about the importance of sleep, etc. And then the barbecues, dinners, lunches with residency directors, fellowship directors, directors of directors...I can say with certainty that I'm thoroughly oriented.

Which isn't to say I don't feel more than a little nervous. One of our lectures was on the importance of teaching the medical students rotating with us, and I got to thinking, given the slacker attitude of my fourth year, I'm really only about 6 months ahead of the fourth years students in learning, maybe 3 if you count the extensive attrition of knowledge that remains unused for an extensive period of time. I want to go into cardiology (I think) and my EKG reading skills are still not the greatest. The words "electrolyte management" still bring a cold sweat to my forehead.

I am pleased with my intern classmates though. Generally they seem a pretty sharp bunch, which will be important as we watch each other's backs through this next year.

One thing is certain though, my uneasiness will be rapidly dispelled. My first two months are the hardest rotations of intern year so I should be well on my way to at least an intern's level of confidence by the end of that time. At least, I'll find out, starting at 7am tomorrow morning.

Friday, June 15, 2007

Steak and residency

Captain Jack Aubrey, the chief character in the Master and Commander series I just finished, is a nearly invincible sea captain. He takes undermanned and underarmed ships against nearly insurmountable odds, and succeeds where no one else can. Part of of his success is being able to tell what his opponents are thinking, as he views with practiced skepticism the subterfuge of his opponents. Once off the water though, he is rather more gullible than other men, and at one point in the series he spends nearly his entire fortune on a shady mining venture.

In crafting such singular, but realistic characters, Patrick O'Brian is portraying that facet of our nature which can make even the most cynical man or woman a sucker, given the right circumstances. For "Lucky Jack" Aubrey it was a mining venture. For me, it was the door to door steak salesman.

I view most salesmen with a skepticism I usually reserve for other drivers on the highway at rush hour: generally they want something I have and they're willing to use any amount of deceit to get it. Drivers want my place in the left lane, salesmen want my money. So the pest control guy, the "I'll paint your house number on your curb for the fire department" guy, and the bottled water guy all left my house empty handed. But Joe, the friendly guy from the steak and meats sales company, had a different tactic: flattery. See meat is a bit like wine, in that you can spend a ridiculous quantity of time and effort learning all the cuts, what part of the cow they come from, how best to use them, etc. And if you've devoted just a little time to this, like I have, and someone makes you feel that your knowledge is pretty extensive, like Joe the meat man does, and you have a pretty strong need for affirmation of your intelligence, after say, starting residency orientation that day and freaking out over the fact that you don't remember anything you've learned in the past four years, like I have, then the situation is dynamite. For your wallet that is.

It fairly makes me long for residency, when I won't have time to be at home and get suckered by such tactics. Of course, as I mentioned above, the orientation process, in which we get accounts for the electronic medical records system, sit through lectures on our responsibilities as interns, and get to know our classmates, is slowly driving home the fact that I'm a doctor, and that means I'm going to work harder than I ever imagined possible for the next several years. It hadn't really sunk in until one of the nurses, making sure my N95 mask (for tuberculosis) had a good seal, called me "doctor." Always before is was just a shorthand, or a compliment to my competency as a medical student. Now it is real, and I don't feel ready. I'm just hoping none of my patients know Joe.

Tuesday, June 05, 2007


I haven't yet received my official schedule, but my residency program has a online application to check call schedules for the month in advance, and so I've discovered at least the beginning of my year. It looks like I start on inpatient cardiology, which is, as regular readers of my blog know, both my intended specialty and one of the hardest rotations of the intern year. Despite the fact that I want to end up in that specialty, I'm quite nervous about starting there. It's a bit like the first day of school. Except I don't remember Math Expressions being as thick as Harrison's. And Mrs. Simmons was pretty uniformly encouraging.

Looks like I follow cards up with the MICU, so I'm starting with a bang here. A huge part of me doesn't want to embarrass myself and wants to start off with a great impression, but the realistic part of me quietly insists "this is the first month of your intern year. You're going to look like a royal idiot no matter what you do." A major consolation is that my schedule appears to be a bit front loaded, judging from those two months, so maybe the later rotations will ease off. And it also looks like call on cards has gone from q3 to q4, so I might get a little sleep. Orientation starts next week, so I'll find out for sure soon.