The surgery I was avoiding is past, and the day wasn’t too bad. In fact, I ended up being so busy with calls to the ER that even if I had scrubbed on the case, I would have had to leave almost immediately. So the attendings didn’t question the fourth year being present instead of me.

The week has been busy. I’ve been spending fourteen+ hours in the hospital every day. One night the fellow and attending stayed till midnight doing a microscopic vascular repair on a crushed hand; they sent me and the students home around 9, since by that time the proceedings had become so tiny that, without benefit of microscope, we could barely even tell that their instruments were moving.

I’m still struggling with the enormity of the concept of actually being a doctor; for all I thought I’d grasped, I still don’t act like it. The fellow, bless his heart, is patiently reminding me, You’re a doctor; you can do that on your own. You can talk to the patient, you can explain to the family, you can decide for the nurse, you can undress and explore the wound – you don’t have to get permission or backup for these little things. I am so blessed that he’s willing to be patient with me, because I know that right now I’m the weakest of all the interns. Because of where I came from, I have a very high threshold for referring to the superior authorities, compared to some of the other interns, who had much more responsibility during their fourth year, and have had more stress this month so far, and are therefore already more independent.

The fact that the grouchy assistant definitely doesn’t regard me as a doctor doesn’t exactly help, though. She’s started tearing up my narcotics scripts on the pretext that I’m not allowed to write them, although every other resident or knowledgeable attending I’ve asked says I am allowed. I guess I’ll just let her write the scripts, if she cares so much about it. I’ll have plenty of work to do next month.

The other day there was a young man with an avulsion-amputation of the tip of one of his fingers. As I was evaluating him in the ER (having by now been told often enough that I did dare to take off the dressing, in spite of copious bleeding, and go digging around in it), he asked me when I graduated from medical school. Since he was being friendly and patient, I opted for total honesty and told him, About a month ago. Astonishingly, he wasn’t too fazed by that, and started asking about medical school and residency. Eventually, a couple of hours later, as I finished suturing up our revision of the wound (per the fellow’s plan, who had now left to go to the OR), he summarized his findings: “So you’re working 14 hours a day, six days a week, and you’re more than a hundred thousand dollars in debt.” There was a definitely skeptical tone to his voice.

It’s kind of sad when someone with a high school education can figure out that their career track is working at least as well as ours, right now. But actually, I was thinking later, the money part is really not relevant. They haven’t even paid me yet, and I’m content to be here for 14 hours a day. I’m doing this because of the thrill that comes from looking at a guy’s mangled hand, and being able to turn it back into something neat and usable; or starting off with a grotesquely mis-shapen chest, spilling blood all over it, and ending up with tiny neat sutures on beautiful (ok, almost; I’m being hopeful) and symmetrical breasts. The salary is just a mechanism.

I woke up later that night worrying about whether I’d splinted his hand correctly. I started going over all the muscles and tendons involved, reciting the definition of the universal splinting position, and playing with my hand to try to remember if I’d gotten his in the right angles. I’m trying not to think about it any more today, because there’s nothing to be done. He lives far away, and he’ll be back in a week for follow up.