Captain of the Team

So much has changed since we moved here.  We are different people, a different family moving back then we were when we moved here.  Somehow I've grown into becoming a father and a doctor, both seemingly impossible feats to a 20 year old me.  

On the doctor side of things, one of the things that scared me the most when I received my medical school acceptance letter was that right then I knew that some way, some how, for me to succeed I'd have to find the confidence and wisdom to lead people, to be a leader.  That is a scary thought to a guy who was consistently picked last on every sports team ever concocted.  I'd pushed myself to run for different positions in college, knowing I had to at least try and be "social", but I was always a failure.  So why did I place myself in a position where I knew I would have to become something I most definitely wasn't...I was young and stupid mostly and really hadn't thought it through.  Luckily, someone upstairs saw me through it.  Looking back at that timid kid who couldn't climb his way to the top of the pile.  My advice to myself would have been to fake confidence and have faith that you are smarter than you think you are.  To smile like a moron and laugh hard at people's jokes. To save up favors like people save up money. To play the game people play and when push comes to shove, if you have to be the leader and someone challenges you, you put them in the dirt (figuratively, not literally).  One of the things I hadn't quite thought through was that I somehow believed I could go through this and not be changed by it.  I walked into the supermarket yesterday and a lady was down on the ground having a seizure, people gathered all around her, so you could barely see her. The college student me would have watched quietly at the back, the medical student me would have done the same even if he knew they were doing something stupid, but the doctor me cuts the crowd and takes control of the situation.  It just amazes me, how training can make you do something so counter to your instincts, how you can mold yourself into a different person if the situation demands.  

Every now and again I meet someone or a friend of someone who is going to medical school.  There is an instant feeling of wanting to tell them what awaits, to make them understand the weight of that decision, the change that they will bring about on themselves and others around them, but you really can't convey something like that and even if you could it would fall on def ears, they often are so determined.  Instead all I can typically muster up is, "You poor bastard".  :)

Newbie-Doc

Am I really an Attending now?

Doctor

I've been two things really my entire life, an artist and a thinker.  I wouldn't say I was particularly great at either, but if I had to describe myself that is what I am, I don't think anyone could argue that.  I remember sometimes taking months to draw a picture, it would start out as a rough sketch and progress to something resembling reality.  Mark by mark on my paper, the image would materialize as if from a fog, as though it had been there all along, just hidden.  A little over a month ago now, I took on a project unlike anything I've created before, but not dissimilar in a way to anything I ever undertake.  It started very raw and it slowly is reaching toward it's final state, whatever that is, mark by thoughtful mark on my chosen canvas.  I was at the fridge, getting a drink this evening, and in a spur of random thought, wondered why I had taken on a project, especially one as vexing as this, after avoiding any and all projects for roughly 7 years...with quick self-realization and a smirk I realized I had never stopped taking them on, I simply was in need of another.  Though I didn't "draw" it in the strictest sense in two months time my training will be complete, and yet another piece of paper will hang from my wall.

Newbie Doc

My Wife/Doctor

Just a quick post to brag about my wife.  I wrote awhile back about passing my in-training exams for the first time after taking it for three years, how hard they are and how great that is.  When my wife took her first in-training exam for family medicine at her residency, she (understatedly) told me that she did very well.  Back when she first told me about how well she did, all she said was that everybody was really surprised at how amazing she did on it, that she scored in a very narrow percentile of all 1st years in the nation.  What I didn't realize (and she didn't tell me) until today was not only did she do "well", but that she had passed her test on her first year, which is basically unheard of.  Not only that but she goes on to lament (she's actually complaining) that over the passed 3 years she has gotten worse at the test and now has scored 40 points lower than when she was an intern...yet when I ask her if she is passing, her answer is still yes!  Back in medical school, you couldn't beat my wife at a test, she was straight A's, which is incredibly hard (not just for me, for anyone)...I shouldn't be surprised, but that's a killer test to slap down your first year without any training, quite an accomplishment. 

A quick intro to medical school testing.

SAT/ACT = College Entrance Exams
MCAT = Medical School Entrance Exam - taken 3rd year of college
USMLE Boards Step 1, Step 2, and Step 3 = M.D. Exam - 4 separate tests taken throughout medical school and 1 year after medical school, a total of ~24 hours of testing.
Specialty Boards = Certifies you as capable to care for patients in a particular specialty (ie.Pediatrics)

The specialty boards costs between 1-2 grand depending on the specialty and last 8 hours.  If you fail you don't get your money back and they are VERY hard, so residencies across the nation (whether it be surgery or pediatrics) have each class of interns take an in-training exam, that scores you against all other peers in the nation and tells you your chances of passing the real exam at the end of 3 years.  My chances for passing the real test, according to my scores on the last test, are about 95%.  My wife's chances are likely somewhere around 100%, if she has passed it all three years without any studying. 

Just between you and me, I don't know what my wife sees in those whining adult patients, the kids of this world are missing out on a phenomenal doctor. :)

Newbie Doc 

The Farmer and the Fighter

There are different factions of medicine acute versus preventative.  In some ways you can compare them to the navy seals versus the farmers.  You need both, both are essential.  The navy seals, they are what you think of when you watch tv, they are the people on the front lines when death comes to claim your loved ones, the standing commanders running the group actively doing chest compressions, knifing in chest tubes, and shocking your hearts back to life.  Then there are the farmers, depending on your frame of reference, while less glamorous  they are equally or one may argue even more important than the Navy Seals they make movies about.  You can't make very good movies about a group of people that consistently stops problems before they even start, it's not very exciting, yet even a Navy Seal will secomb to starvation.   Once back in the dawn of time, the people who did the fighting and the people who did the farming were the same people. It was less civilized, less specialized, but they got the job done in a place and time when you couldn't have your cake and eat it too.  There are places even today, where that still goes on, where the villager is out plowing the fields and in a second, drops his implement for a spear and goes to war.  Just as you might think, those places are not as safe as your perfect, specialized, urbanized world that most of us have gotten used to.  In the medical world, that holds true too.  Out in the small communities there is still need for a doc that can do a little bit of everything and I'm terrified and honored to say that, if I understand my future job right, I'm joining their ranks.  I could intubate a dieing child in the middle of the night and the next morning be giving shots that prevent illness years from infection.  I hope I'm strong enough, I hope I'm good enough to do both jobs to the standard that I've held myself to for the last three years.  The doctors that I'm joining are "old" docs, born of residency before work hour restrictions, before they started "watering" us down.  They pulled 36 hour shifts every 3 days, sometimes back to back.  It wasn't safe, but those who survived came out medical power houses.  I pulled Q4 30 hour shifts (ie every 4 days I worked 30), "they" have since then deemed even that too hard to work, safely.  In my third year as a resident, I feel confident and strong,  yet I know just as I wasn't and couldn't be prepared for internship as a medical school student, there is no possible way I can be prepared for what I face as an attending of "rural" pediatric medicine, I'll be the farmer plowing day in and day out, but even still my spear has to lay sharp and at the ready in my tent for the lions that approach in the night.  What am I getting myself into?  I'll keep you posted, hopefully with my good results :)

Newbie-Doc

Continue To Do Good

One thing I will never get used to in pediatrics is having to "turn the other cheek" so to speek.  We take care of sick kids and despite saving the childs life, the parents often don't see the big picture, they see, instead, the IV pokes, the shots, and the painful (sometimes debilitating) surgical procedures...to them sometimes we arn't saving the childs life, we are torturing them, and no amount of talking diswades them from this very emotional and primitively ingrained notion.  Sometimes, they get the spotlight and lambast you for your actions, and as a doctor you have to keep your head down and keep silent, you're bound by laws of privacy and by your own conscience to do no harm, even if it's only to a patient's/parent's reputation.  The vast majority of the work we have done for a parent's child will never be known to them.  We continue to work when you sleep, when you leave to take a shower, when you scream at us, when one of our other patients dies, when our own family gets ill, sometimes when the world feels like it's falling apart around us, we are still caring for your children and doing the best we can.  A friend has this on the wall of his office, when I was younger I wondered what bad or distasteful experience posessed him to place it there, as a reminder to never faulter in doing good, now I know, it was his experience in becoming a doctor.

God and You
They may see the good you do as self serving.

Continue to do good.

They may see your generosity as grandstanding.

Continue to be generous.

They may see your warm and caring nature as a weakness.

Continue to be warm and caring.

For you see, in the end, it is between you and God.

It never was between you and them anyway.
~ anon

Not feeling so Newbie these days - Doc

Parents

I wish I could take credit for this.  An attending who was once my senior, was supervising my care of a patient in clinic.  She wasn't allowing us to vaccinate her 2 month old child, an act of supreme idiocy...not in my opinion...in medical fact.  Her reasons, as they always are, are misinformed, ignorant, misguided and often selfish.  After politely arguing with her for 15 minutes, behind my mask I'm a red faced maniac.  I walk out.  My attending discusses this with mother longer and he himself comes out very frustrated.  Guessing the end result of his conversation I say, "Well you can lead a horse to water, but you can't make him drink it."  He looks at me for a second and with frustration in his voice, "But you can light one on fire, and he'll be warm for the rest of his life." Parents are often the hardest part of our job.

Newbie Doc

Dragon Slayer

So this same time of year my first year of residency, I was sitting on the porch drinking a beer.  I was depressed.  I had just found out I had a failing score on my in-training exam.  An in-training exam is a test we take to measure our medical knowledge once every year in anticipation of taking the mother of all tests in my particular career choice.  It's hard enough that people who have been out of residency many years, have still yet to pass it, even though they are full doctors and practice pediatrics daily.  You can be a practicing doctor and even function as pediatrician, but this is the test that says you are not only a doctor, but a doctor with the seal of approval to specialize in caring for kids, you are a licensed pediatrician.  It doesn't come with  a pay increase or anything, for me it's a pride-validation thing. I consider kids the most important patient population out there.  I don't care if I got paid in lolly pops and stickers for my work, it's the only medicine I'd practice. It would be a slap in the face if I wasn't officially counted in the ranks of my peers.  It's honestly not notable that my score was failing, everybody fails it in residency (in a given 3 year crop of residents only 10 residents in our 125 person "school" pass this test before they graduate and this is a very competitive, smart residency), but my score was low enough that I was lumped in the bottom group of all the residents in my residency.  That day was a wake up call that none of this was going to be a cake walk.  I changed some things around and started doing daily study, I started teaching other residents, and really digging into my medicine.

When my beginning of year two score came back I eased up my study a bit, I found myself just above average.  I knew my beginning of year three score wouldn't be any good.  I actually planned for it, cause my goal was to kill the monster that laid in wait at the end of residency.  When I went in to do my test, my plan was to go through it one time only without my testing routine.  I usually finish a test and then run through it two or three more times in a particular patent pending way.  Throughout the years, I've developed a routine for testing, as every veteran test taker does, it's something I HAVE to do if I want to do my best.  I've found it typically boosts my scores about 10-15% from what they would have been, it's not scientific but it's what experience with ALOT of tests has shown me.  My plan was to see what my worse case scenario score was on this test.  I figured this would do several things, it would show where my true weaknesses were (the "routine" gets questions right that I don't actually know), my abysmal score would scare the crap out of me and get me back into a hard core studying routine, it would also likely scare my superiors at the program and get them on my back about studying, there would be little chance that I wouldn't study like a dog this year and consequently be ready for this killer test awaiting me after graduation.

So I went in and for the first time in many years, left my routine at the door.  I took the test and left 2 hours early, as I got up WAY early I'm sure my friends either thought I was being an idiot or was really smart, I didn't care, they didn't know what I knew that I was tieing one hand behind my back to make me stronger, that I would likely fail this test HARD.  That was 4 or 5 months ago, it takes some time to tabulate a score like this and compare it to every pediatrics resident in the nation.  Today I opened the email entitled I.T.E. score.  "Here we go..." I thought, preparing myself for the worst.  I scored so high that I actually passed the exam that I take next year...I passed a whole year early?!?!  I've looked over it several times to make sure I'm not misreading it.

There were those few "super-residents" who managed to do such things, my old seniors Mindy, Kelly, and David they were a couple of the very rare few who could actually pass the in-training, am I really one of them?  Usually people study all third year, read a medically dense 2 inch book two or three times, and take a intensive private study course in isolation for a whole week before slaying that monster test...I literally killed that monster on accident?!?! How in the hell did I do that?  All year long I've been feeling like this teenager living under a parents roof, I don't always agree with my superiors anymore, they don't seem like the supermen that I first envisioned when I entered residency. I have this need to get out of the nest and succeed on my own.  Secretly I felt I was getting to big for my britches, that even though I had this feeling I really wasn't ready.  There is more to medicine and treating people than a test, but this is a very unexpected surprise...maybe I'm not ready yet, but I'll be damn if I'm not starting to fit the part.

Newbie-Doc