Have I mentioned how much I’m looking forward to getting back to my own hospital?

And yet, with the anticipation, I’m starting to think again about the responsibilities I will resume. After all, my chief complaint (as it were) at this hospital has been the lack of responsibility – being treated again as an intern when, in my own mind, I’m ready for more than that.

Perhaps a little more humility would be in order. How many times here have I concluded something – the abscess needs or doesn’t need drainage; the patient doesn’t have a surgical abdomen – and turned out to be wrong (the abscess needed the opposite of what I thought; the child had perforated appendicitis; the patient needed more or less iv fluid than I had provided). Sometimes I found out I was wrong simply because a senior person came and looked and recognized something (specific details, or even just a gestalt) that I had missed. Other times the senior person expressed puzzlement where I had been too certain, and obtained further tests, or admitted the patient for observation, and thus found the correct diagnosis.

The only major category of being wrong that I haven’t explored extensively here has been whether a person needs intensive care, and how aggressive to be with a patient in intensive care; and the only reason I haven’t hit that one is because I was insulated from the critically ill children. Children heal so well, and have such resilience, that if they’re stable enough to be sent to the floor in the first place, between their reserves, and the nursing care, which is a little more flexible than in an adult hospital, they almost always pull through without needing to be transferred to the ICU.

Sure, I was trying to draw the right conclusions with very little experience: a total of only 6 weeks exclusively with surgical pediatric patients (whom I never encountered in medical school). I do have more time than that with adults – but 18months is so little compared to the chiefs, let alone to the attendings who’ve been in independent practice for a decade or two. Suddenly I’m a lot less confident about going back to junior call and night float.

Surgery residents have a refrain which we use to comfort ourselves on many occasions: There’s a reason it’s a five year program.

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