Halfway through the morning: “Alice, what’s going on with this patient? Why don’t you know?” Alice mumbles something. “That’s no excuse. You’re filling the role of senior resident today. Take care of things.”
Uh, thanks. Thanks for mentioning the role change after I’m already in trouble. I knew I was the senior, I just didn’t realize how much the attendings count on the senior on an every day basis, which means how much they count on me, even when I’m not forewarned.
That was the beginning of the rest of the day. Back to as bad as life was in June, constantly behind, expectations on all hands – attendings, nurses, interns, medical students – that I’m not fulfilling. Patients that are not receiving the amount of care I want them to have. Jobs not getting done, because every time I pick one thing up, three other people call me about something else. And getting berated the whole time.
There’s something definitely broken inside my head. The more I get rebuked, the more I want to do better. Any rational person at this point would say, Who cares what the attendings think, their expectations are unreasonable and their comments are uncalled for, forget about them, I’ll do what I want, and let them deal with it. But no, all I can do is figure that, if they expect me to function as the chief, then I’ll come in earlier and plan to stay later, so I can do everything right. As frustrated as I am, I can’t stand not to beat this. I can be responsible for thirty+ patients, I can know everything about their labs and scans and current conditions, I can be in touch with a dozen different consulting teams whose residents understandably growl at me whenever I page them and change their answer whenever my attending asks; I can. Even if it means working fifteen hours a day all week. The chief does it, right? Why shouldn’t I?
Besides, that’s the only way life will get any better. The attendings sure won’t suddenly decide to leave me alone.
August 11, 2008 at 9:26 pm
I know you surgical types aren’t big on asking for help, but you need to talk to someone (a neutral collegue perhaps?) about how you’re feeling, and try and come up with strategies to allow you to meet your responsibilities safely, without burning out. working 15 hours a day works in the short term, but it’s not a sustainable solution. You are no good to anyone (attendings or patients) if you become a train wreck through being overworked.
I think all of us (medics/surgeons) have been in the same place at some stage in our training – I know I have, and the best thing I did was to talk to someone sympathetic, who could give me realistic, constuctive advice. Attendings/bosses sometimes forget what it’s like to be a trainee – remind them.
I’ve read your blog – you know what you’re about, and you’ll survive.
Best of luck, and hang in.
August 12, 2008 at 1:43 pm
Wow, Alice. I love your attitude. Seriously, very impressive. I totally see myself being like you someday. I mean, confronting a challenge or multiple ones would make me work even harder. Ive always told myself long hours + hard work will not prevent me from potentially becoming a surgeon.
Major kudos to you. You’re very inspirational.
Do take care of yourself, though.
August 12, 2008 at 7:21 pm
Sam – Thanks. I have been talking to another resident, which makes me feel better; unfortunately, we have very similar personalities, and get into the same kind of trouble; so I don’t think hanging out with him is going to fix my problem, but it is supportive. Don’t worry, I don’t plan on being on overdrive for more than a week or so.
Eduardo – Umm, thanks, but I’m not doing anything special. The patients have to be taken care of. That’s basic.
August 14, 2008 at 7:45 pm
Alice, would you consider surgery to be the most grueling residency? What would you consider to be the least grueling residency?
August 15, 2008 at 6:40 pm
Hermione – Neurosurgery is definitely by far the hardest. In terms of hours, amount of knowledge, and degree of commitment, a lot more is expected of them. These guys take their specialty boards during residency, and are ridiculed if they don’t pass during the second or third year of a seven year residency. Their boards include so much critical care that they are essentially double-boarded. They routinely deal with the stress and urgency of making truly life-changing decisions for their patients, more than any other specialty. After watching the neurosurgery residents, I’ll let neurosurgeons put on any airs they want; they’ve earned it.
Orthopedic surgery is probably also harder than general surgery; certainly it requires an ability to do geometric and engineering equations in one’s head, and spout a great deal of facts (types of fractures, anatomic relationships of bones and ligaments) by heart.
Of what I’ve seen, I’d say general surgery comes in third. The other surgical subspecialties (urology, ENT) are probably close.
Medicine, FP, peds, for all they’re thought of as more laid-back specialties, are still pretty hard on residents. Psych is probably the easiest residency, when you’re not doing your medicine rotations, because they keep psychiatrists’ hours, and what could be easier than that? But then, as we know, I don’t think that’s really medicine.
August 16, 2008 at 3:59 pm
What about ophthalmology, radiology, dermatology, or anesthesiology?
August 16, 2008 at 7:02 pm
lol, somebody told you about the ROAD to happiness? You’re right, I guess once you get past internship they’re pretty nice. Anesthesia and dermatology, yes, once you finish the internship (in anesthesia half the people do surgery internship, which is all the more brutal because the surgeons know you’re not “one of us”), it’s fairly decent. But anesthesia residents still take a lot of call. Ophthalmology is a surgical subspecialty, and they manage to work a lot of hours. Even in private practice, they’re in such demand that you can work very long days. Radiology, if you like that kind of thing, is not bad.
I’d recommend anesthesia: procedures, patient interaction which is carefully limited, but the opportunity for more (pain clinic), and a flexible lifestyle – you can work as much or as little as you like.