Obsession

To work at my trade by the dozen and never a trade to know;
To plan like a Chinese puzzle -- fitting and changing so;
To think of a thousand details, each in a thousand ways;
For my own immediate people and a possible love and praise.

I used to think I was obsessive-compulsive. It was my strong point. My concern for minutiae made me a great medical student, as I had all the labs, all the studies, all the details of the patient histories, going back as far as the hospital records would allow.

Then I became an intern. As a medical student, I had charge over one, two, or at most four patients. These were acquired gradually, over a period of days, and I came to know them well. Now, on cardiology, I regularly admit six patients on a call night, and then I have to know them well enough to present the following morning. Gone is the obsession. Or if not gone, I realize that I cannot get information the way I am used to, cannot use the same organization. I must move faster, more thoroughly, more efficiently.

Case in point, one of the patients I admitted last night was only in the hospital because on his more recent discharge, his medication instructions were not clear. This resulted in him not taking a medication he needed. Now I know the intern who wrote those instructions wasn't intentionally trying to harm anyone, and in fact, he had all the information on the instruction sheet, he just didn't take the time to format it in a readable way. Even I couldn't figure out the sheet, and heck, I'm a doctor. But he probably fell into the same trap I do, having to discharge ten patients in a morning, typing furiously, dealing with the interruptions of pages needing to be returned, residents updated, patients seen.

I never realized the sheer volume of work that goes into being an intern. I was a good medical student, and a good sub-intern, but it is impossible to know what all is entailed in being a doctor, in being an intern, until it is your signature on those late night medication instructions, your fingers entering all those discharge orders, your head running on empty because you've been awake for 30 hours.

Probably I will never be a success in my own eyes. But when I make stupid mistakes, like today in rounds, actually forgetting to write down half of a patient's chemistry panel and asking my resident for the numbers in the middle of my presentation, in front of the cardiology fellowship director, it is easy to sink farther in my own estimation than usual, even. Sigh. The only positive I can think of is the fact that I'm learning the hard way, which tends to make a more lasting impression. I just don't want to destroy my chances of success here before I even start.

Maybe that obsession isn't entirely gone.