Tomorrow I’m starting a long rotation at a children’s hospital. It’s a long drive away, and a completely different culture. Not to mention a new hospital to get lost in, a new computer system to learn – and children to take care of, just to make everything extra high stakes. I can’t forgive myself when an adult does poorly; what am I going to do about children with bad outcomes? I haven’t been this scared of a new rotation since two Julys ago.

The legends are that the children get good care, but the residents are miserable. Lots of people have given me advice for the next two months, and it adds up to, You need to start being harsh, because no one will watch out for you. You have to be prepared to push others out of the way to accomplish your goals. Don’t take — from anyone, stand up for yourself, otherwise they’ll walk all over you.

Reportedly the work hours and regulations are a dead letter at this hospital, primarily at the expense of the residents in the position I’ll be filling. So I’ll be back to the old dilemma, do I break the rules and push myself over the limits for several weeks, so that the patients get taken care of, or at some point do I develop some ethical boundaries, and actually report what really happens? I fantasize about putting my foot down and sticking to the rules, but I know I’ll end up doing what I’ve always chosen at this point: take care of the patients, and ignore the rules.

For the rest, I think I’ll stick with my old pattern here too: maybe the other residents who hated this place started with a bad attitude. Maybe there are some new people in authority now. Either way, there are things I need to learn here. (Calculating micronutrients and ccs of iv fluids for neonates a couple of times every day, what’s not to be thrilled about?)

And the old residents’ standby: They can hurt you, but they can’t stop the clock.

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