Residency Diaries Series #2
It has been about 3 months since I became a 3rd year resident aka an official *senior resident*. I’m just starting to get settled into my role. Today’s post is a collection of entries from my early days as an intern. Everything was so scary, tiring, exciting…
The other day, one of my attendings asked me if I can start “chiefing”- a terminology not used by my own residency but basically meant acting as a 4th year resident and taking on a pre-attending role. This meant hearing presentations from my juniors (first and second year EM residents or other off-service residents) and giving input on patient management and disposition. It’s really hard to believe that I’m in the latter half of my training and in 2 years I’ll be the attending listening to ALL presentations and taking on the responsibility for every patient in the emergency department bay. Given that many of the EM residencies are 3 years it means that in another program this would have been my final year of training. A truly scary thought but something I can kind of see happening in the near future. It’s really amazing how far I have come in the last 2 years. Reading these journal entries gives me such an interesting perspective about what life was like for myself just 2 years ago. Hope you enjoy!
6/22/2018 Friday 11:09pm
Yesterday one of my male co-residents made a comment implying that I was bothered/grossed out by DRE (*digital rectal exam) joke mentioned in a podcast we all had to listen to as homework. The comment was made in a small group of 3, and I was the only female. Immediately I felt like I had to defend myself-- no, I’m not grossed out by DRE, I’m comfortable with much gorier/grosser stuff than DRE, etc, etc (mostly unsaid defense). I spent the rest of the day ruminating on that comment, feeling like it was directed at me and not the other male member in the conversation because I am a woman. Would he have said that to another man? Maybe. In the setting in which all of us are emergency medicine physicians, I felt like the comment was so misplaced, bordering on sexist, offensive, ignorant. Or maybe it was just a playful comment in efforts to make a joke.
Later in the day, during a simulation my team was briefly arguing over who was going to be the team leader with most people quickly opting out of it. I said (albeit quietly) that I didn’t mind and was about to volunteer when the entire group turned to another male resident and insisted that he be the leader. He initially said no but quickly accepted the role. I thought about whether I should have spoken up earlier, louder, firmer. I wondered why it bothered me that they didn’t look to me.
The two experiences weighed rather heavily on me last night and I tossed and turned thinking about the encounters. I came up with two conclusions after discussing it further with A today.
I have insecurities about being considered weak, incapable, incompetent, soft-spoken, etc. Comments made in jest or actions by others with no particular thought may affect me more significantly than intended. This is especially true when it comes to comments or actions that have to do with my work or my ability to deal with patients/emergency situations.
There are deeply rooted, inherent bias/sexism within all of us
Anyway, orientation is almost over. I start shifts next Thursday.
8/25/2018 Saturday 1:24am
I’m about 3 months into residency and I basically feel like I’m living off days to off days. I had a similar feeling in medical school when I felt like I was living from exam to exam. Every shift, there’s a ton of learning and it’s incredibly very tiring.
Today I did a central line (for the first time, not on a mannequin) on a young woman in DKA. I also learned to reduce a shoulder dislocation. Days like today keep me going. Days like today make me feel like I’m learning and I will one day become a competent doctor.
There are also days that make me want to cry. Earlier this week, I had an infuriating back-and-forth with a neurosurgery resident who made me feel like an absolute shit for not being experienced enough to fight for my patient. WHOSE service did you think would admit this patient you just recommended Q1H neuro checks on? On a patient with traumatic brain hemorrhage no less? How can more senior residents be so forgetful about what it was like to be an intern-- clueless and intimidated by literally everyone?
On the other hand, I feel so incredibly blessed by A. Today I came home to find that A has laundered my scrubs (original plan for my off day tomorrow) so that I can spend my off day doing things I actually want to do. It was the sweetest thing anyone has ever done for me, I wanted to cry. A has been dropping me off and picking me up from work everyday which, even as I experience it, is so luxurious I can’t believe it.
9/28/2018 Friday 2:58am
DOMA: Day Off My Ass
My sleep schedule is all fucked up. In our residency (and likely others) there is a terrible arrangement where sometimes (a lot of times) your one day off falls between when you are coming off of nights and starting a string of days the morning after. So your week looks like this:
SATURDAY NIGHT ~ TUESDAY NIGHT: work from 8pm ~ 8:30am
WEDNESDAY: Get off work at 8:30am and get home around 9am
WEDNESDAY: Sleep most of the day since you have just finished a string of 4-5 night shifts and your body has now adjusted more or less
WEDNESDAY: Wake up around 4-5pm, disoriented
WEDNESDAY: Spend the rest of the day doing whatever it is that you do when you have 1 day off. But remember, you must be able to sleep at night despite having slept into the afternoon because…
THURSDAY Work again at 8am
Work 5 day shifts in a row before another day off
I don’t know if I’m adequately conveying just how terrible this all feels. Yes, you technically have 23.5 hours off not counting commute times, but somehow you’re supposed to change your circadian rhythm to do a 180 and flip back to daytime schedule. There’s no worse feeling than waking up and realizing more than half of your precious day off is gone. At the same time, there’s nothing else you’re really supposed to do during your day off other than catch up on your sleep. Maybe laundry, maybe finally going to the gym, maybe making some food for the week so you don’t eat out everyday, maybe seeing friends, maybe seeing your significant other...
Residency schedule just gets me down and I can tell A is worried for my wellbeing but also tired of my shit. I can’t remember if I was ever a very optimistic person but I certainly feel like I spend so much of my time complaining now. Sometimes it’s literally all I can think about. On my way to work I think about what I would give to not have to go into work. When I’m at work I often think about what it must be like to be a patient- to have all day to just lie around. Of course it sucks to actually be sick- but sometimes you just come across that one person who is probably less sick, less tired than you- and you just look at them like, seriously? I came to work today- why can’t you just leave?
Despite all these terrible thoughts, I do have moments of clarity and moments of true appreciation for what I get to do. There is nothing better than being able to send a patient home and having them express their genuine gratitude for your attention and care. Even if all you did was give them some fluids and GI cocktail and let them ride out their abdominal pain for hours while you attended to actually sick/dying patients.
So far- procedure counts:
4 intubations: 2 DLs, 1 glidescope, 1 McGRATH
1 central line
1 US guided IJ line
1 observed reduction of rectal prolapse (with sugaring and all)
2 truly scary ICU transfers: one patient with transvenous pacing who would literally go asystole with decreased mA, another patient who vomited a liter of blood while in transit
1 patient whose profound hypotension (to systolic 50s) I happened to just catch because I was walking by while a major resuscitation was taking up most other staff’s time
Several simple interrupted lac repairs, 1 horizontal mattress lac repair