This should be an interesting post. Not because of the content, but mostly because of the fact that it’s coming to you from the inner bowels of the hospital at around midnight, which means I’m halfway through a 14 hour night shift. I’m surprisingly…hmmm, I’m reticent to say energized, but certainly I’m bewildered at how much energy I do have. The quality of writing within this post might be a useful, objective(ish) barometer of how deteriorated my mental faculties are – and how unaware I am of that decline here in the present moment. Humans were not meant to operate at night nor with sleep deprivation. And yet medicine often demands both. Thank God for nurses that literally just tell me what to order for the 30 patients I cover overnight whom I have barely any idea what’s wrong with them, let alone what they need. But in those rare cases so far where I do have time to think, or where the nursing staff doesn’t have the answer immediately, I gain some satisfaction (as one does in an egomaniacal profession like mine) when I can, with some confidence, use the 1000’s of hours of education and training to make an informed decision and place orders on how best to proceed when I’ve been entrusted to do so. Even if, in the end, it’s a big nothing burger.
So here I am. An actual doctor, into the frying pan fresh into my second week as an intern. Don’t worry, I have another licensing exam to be a fully licensed doctor and 3 more years until I am board certified so I get to be a trainee F O R E V E R. I have resigned myself to using the title “Dr. Duff,” for expediency and ease. Though it’s just as nauseating and cringe as I envisioned it would be before I was bestowed the title. It’s slowly becoming tolerable though. Mostly because I ‘ve said/heard it so much since starting nights that I don’t have the time or the energy to recoil every time that ridiculous alliteration violates my ears. Perhaps it really will stick though. Perhaps my tolerance will evolve into acceptance. Maybe, even, a likening. That’s to say nothing of how undeserved of the actual title I’ll still feel well after the grating aesthetic wears off. Who knows how/if/when that feeling will subside, but I’m not holding my breath.
I’m told that’s kind of normal. At least for a while. I have doubts that it will abate as well as my co-intern however. I’m generally immune to entertaining self-esteeming thoughts at baseline. And to think I’ll bridge the chasm between a markedly low self-esteem before becoming a doctor to that expected of a medical resident anytime soon is a pipedream. But hopefully it’s not even required. Hopefully I can procure the clinical and medical knowledge required of my profession, and the confidence to implement it, that an arbitrary need to fill personally validated or self-assured of my “accomplishments” is tangential to the abilities of being a good doctor. I’m halfway through my first week of nights and so far (granted, with an insanely low work volume and acuity) I’ve managed not to fuck anything up. So I’m hesitatingly reassured of my abilities to do my job without actually feeling I completely belong here. Now, that’s not at all to say I regret my decision to do this job. On the contrary, I love medicine. I love thinking. I love working with my hands. I love the autonomy, and yes I love having the decision making capacity and authority to really change outcomes in other human beings. I love most of all just peoples’ stories. But it is a field that attracts and seemingly demands a particular constellation of attributes that I do not possess. The great majority of these folks are extremely detail oriented. I could (and have) got lost in my apartment building. I have gone to school nearly 23 consecutive years and to this day have not learned how to take notes. I am guaranteed to forget at least 20% of pertinent interview questions during basic patient interviews cause I’m somehow incapable of following a simple format for each one. I absolutely despise writing H&P’s and progress notes because it evinces my unintentional disregard for about a million different pertinent details. These people are also wicked intelligent. I (honestly, objectively) am really not special. I took an IQ test about 2 years ago and think I scored at or slightly above average. I cannot remember names or places or directions well at all. I constantly put my foot in my mouth, my thought process is scattered at best, and usually I can say in 100 words what an intelligent person could say in 10. My fellow doctors seem to carry themselves gracefully, and act with a sober mind and spirit. I am preternaturally clumsy, loud, emotionally volatile, and every 1/4 mile I walk I seem to either trip on something or walk into something or someone. Perhaps my biggest departure in my character from that of medicine’s is my absolute disdain for being uncomfortable. I am writing this post wearing my tie-dye crocs, my XL scrub pants (I LOVE baggy scrubs) and a maroon scrub cap I bought from the U before I left. Oh – and I’m going commando. In essence, unconventional attire. I show-up to work wearing torn sweatpants, flip-flops, and a black tank top because I like to be comfortable – always. I like to be candid with patients, and I will cuss, all. The. Time. Because that lexicon is where I’m comfortable.
Not exactly fitting the bill of an MD. And it’s a consternation I feel daily. And one I’ve felt even since well before getting into medical school when I learned how I divergent I was form the status quo represented by my peers. I enjoyed learning science college for essentially for the first time given my complete rejection of formalized teaching up until then, but I realized I loved working with people and working with my hands and moving like a madman trying to keep up with orders working in food service perhaps even more. In an overwhelmingly white-collar profession, I derive much more satisfaction with the minority of the more blue-collar work that is still necessary for its functioning: doing procedures, examining patients, giving orders, etc. Those were my most fun moments as an EMT: Throwing in IV’S and IO’s, helping with intubations, wrapping wounds, etc. And that is evident in just about all facets of my personality. I like to do far more than I like to think (and I do a lot of thinking – even if mostly nonsensical drivel like you’re reading). I like interacting with people and using my hands more than my head (even if I’m mostly terrible at both). It’s antithetical to my nature to be neurotic over tiny details and approach patients with an intense scrupulousness that almost obfuscates our connection as fellow humans and analytically dissects patients into a set of boxes, lab values, diet orders, I’s and O’s, insulin regiments to the point of near insanity…I digress.
So far, residency has been pretty damn good. I enjoy putting in orders that aren’t co-signed by another doctor. My actions are no longer redundant, and the fear and trepidation over the gravity of that is abating dramatically. Especially on nights. I’m far from having the clinical knowledge necessary to perform anything advanced at this point (obviously), but I’m already feeling a groove in making decisions within my purview. And par for the course of my blue-collar nature, I enjoy actually working again. I enjoy working with co-workers, being needed, doing something that contributes to a goal of some kind. Fortunately, in medicine that goal is worthwhile – albeit our means of achieving it in Western medicine are profoundly limited. And if nothing else, work is providing me a reprieve from life, at the moment. I envisioned a certain level of loneliness moving across the country to a place without a single friend, which would have been difficult enough, but I hadn’t envisioned also having my heart broken and, for the time being, losing my strongest emotional confidant in the process. A double whammy emotionally that is therapized by the deluge of work known as intern year. And the work is good – and made better by the incredible co-interns, residents, and staff I’ve interacted with since starting here. I couldn’t ask for a better support system. I couldn’t ask for a better job, even if I’m convinced I’m not the best person for it. It reminds me of a quote from one of my all-time favorite movies called Cinderella Man, where a depression era boxer named Jim (Russel Crowe) makes a comeback to from poverty and injury. In one of the fights his trainer Joe (Paul Giamatti) is encouraging his beleaguered pugilist in the corner between rounds, and he asks him: “Is there any other place you’d rather be?” Jim shakes his head.
“Good!” Joe says. “Now what are you gonna do about it?”
So even though I’m tired, and probably don’t actually belong here, there’s nowhere else I’d rather be and I’m making the best of it. That’s as much as I can muster here at 4am. Toodles my friends! Much love (and sleep) to you all!
