The Return

Wow. Was I really this bitter through all of residency?

Testing, Testing, 1,2,3...

I'm not even sure how to do this anymore. And I doubt anyone is still listening. But apparently, Blogger will let blogs lie dormant for 2 years + without shutting them down. Huh. Who knew?

The danger in that is that inevitably, after practicing emergency medicine for 2.5 years, things will eventually wear you down enough that they will come boiling to the surface in a tsunami of resentment, irritation and rage at... well, everyone. At patients, at their families, at other doctors, at various support staff, at administration, at politicians... no one is safe.

And then, even if you thought you'd never blog again, you find yourself longing for an outlet... something that isn't satisfied by the soundbites generated by a Twitter account.

I may be back. Unless I can talk myself out of it.

Miss Me?

It's been a busy time since I last posted. I finished residency. For good. I worked full-time at a walk-in clinic, which made me realize several things:

1. I can deal with uncertainty
2. Walk-in clinic medicine is not bad medicine by definition. It is what you make it.
3. When you have no idea what is going on, have the person come back in a couple of days. If the problem hasn't resolved, it will likely have declared itself.
4. You really do prescribe the same 5 meds over and over.
5. Improving your flow at a WIC will carry over into other areas.

Most importantly, it made me realize that I would NOT want to do WIC medicine for the rest of my career.

Thankfully, I packed up my family and we headed down to our new town. And I started my new job. For the first time ever... I am THE doc. Staff. The buck stops here. The end of the line. Holy... crap.

After much time had gone by and I had no urge to update here, I wondered if it was time to hang up my blogging shoes. It's been a good 3 years. But I don't know that I have much more to say.

Then again, maybe I do.

I'll continue to ponder this one for the next little while. Thanks for your patience, for those of you still checking in here.

You Can't Make This Stuff Up

A gem from my job-search tour...

Here's the scene. I'm touring a beautiful office of the Family Health Team attached to the hospital of a mid-sized community. The physician recruiter, a retired surgeon, is chatting with my husband while I listen politely to the head of the Health Team. At one point, the recruiter says to my husband:

"All but one of the family doctors here are women. In fact, most of the physicians in this community are women. It's okay though... male physicians don't work hard anymore either."

Love it. My husband didn't share this gem with me until we were in the car on our way out of town. I couldn't help but laugh at how ridiculous it was.

Needless to say, this community is no longer on my list.

The Home Stretch

I am 10 shifts away from the end of residency. Finally, I feel like things are coming together. Well, on some shifts I do. Other shifts, like today, make me feel like I'm an incompetent idiot. No difficult patients, no mismanagement, no problems... but a combination of little things that manage to crush any bud of confidence that might have been taking seed in my rookie brain. 

Here's a hint at how my shift went. First I started off seeing a teen with MSK pain. He had injured himself, kept playing sports, and didn't understand why it still hurt 2 months later. Gah. I re-x-rayed him to make sure that his injury hadn't displaced, and sent him out with a referral to the sports medicine clinic. Then I moved on to a traumatic finger amputation. It required a pretty extensive repair of several fingers and took me over an hour once the x-rays were done and the blocks put in (to knock out the feeling to the affected fingers). In the meantime I was working up a possibly biliary colic and an elderly gentleman with syncope. I followed that up with a therapeutic paracentesis, a suicidal teen and a pair of lower GI bleeds. I wrote admit orders (yes, we still do that at our hospital) consulted specialists and arranged admissions. And I did it all with nearly no help. I ran each case by my preceptor before discharge/consultation/admission, but otherwise barely saw him over the course of my shift.

In spite of this, my end-of-shift evaluation was mediocre at best. Among the comments:

• When I was presenting my biliary colic case to him, I accidentally said 'cholecystitis' when I meant 'cholelithiasis'. So apparently, that means that I need to review my diagnosis and management of gall bladder disorders. Regardless of the fact that based on everything else I said I clearly just misspoke and didn't actually think that a woman with a relatively benign abdomen, no fever, no white count, normal abdo bloodwork and no ultrasound findings more compelling than sludge in the gall bladder actually had cholecystitis. But apparently that one brain fart means I'm an idiot. 
• When I asked his opinion on anesthesia for my patient with the mangled hand I asked him if he thought I should do individual finger blocks or simply block the whole hand. On my evaluation he wrote that he thinks that I need to evaluate my anatomy of the hand if I think that a hand block is necessary for finger repairs. For the record, if anyone ever asks me if I want three separate finger blocks or a hand block, I'll take the hand block. But apparently, that question also attests to my incompetence.
• In a 14-year-old with melena stool, I neglected to ask the patient about binge drinking. And when the surgeon asked me about his alcohol intake, my response was "he's only 14!". When I asked him, he did indeed binge drink every weekend. So I looked bad. And naive. Oops.
• At the end of it all when I felt like I'd spent the entire shift being run off my ass, I realized that I had only seen about 1.5 patients per hour. My goal is currently 2-3. Sigh.

It really doesn't take much to knock the wind out of my sails. No matter how the shift went, I can't shake the feeling of incompetence. I feel like a complete impostor, and feel like if people only knew how little I actually knew I'd have my medical license pulled. Even when the shift goes beautifully, I have an irrational paranoia that the staff in my department all know that I had initially expressed interest in staying there after completing residency and was ignored. Like they're taking about me during departmental meetings and laughing that I actually thought I was good enough to work there. See? I told you I was losing my mind.

Not passing the exam really didn't help. It's not like I can justify things by saying to myself "well, the college thinks I'm competent enough in emergency medicine to practice independently"... clearly, they don't. And now I really regret writing the exam when I did. I would have been in a much better place mentally if I had just deferred until I was finished residency. I don't feel like I've gained anything by sitting it once already, and right now it's serving as confirmation of my deepest fears of inadequacy. 

This just sucks.

Time to Fess Up.

I didn't pass. There, I said it. It's official.

I'm okay with it. I know that it was a long shot. It was still a hit to the pride (hell, I think the last time I failed ANY exam I was about 19 years old) but I'm over it. And now I actually feel much better. I'm back to studying, but the stuff I WANT to know... not the stuff I think will be on some stupid exam.

Hopefully, it won't affect my employability. Most people just assume that since I'm not finished residency until December, that I haven't written it yet. I don't correct them.

So where do things stand now? I am 15 emerg shifts away from the end of residency. And in that amount of time, I also have to complete a research project (a study of consultant response times to pages from the ED and how the delay affects ED flow) and complete enough scans to become an independent practitioner of ED Echo.

Oh, and at the same time I'm still working at the clinic, looking for a job and trying to be a mom. Gah.

We're talking to four different communities right now, and visiting three of them next week. I'll keep you posted.

Bitter Barn: Population, Me.

I am SO done with this residency shit.

I am tired of having no control over my life.

I am tired of working my ass off for crappy pay.

I am tired of being the lowest rung on the ladder, and people thinking that they can shit on me as a result of that.

I am tired of having to listen politely while staff doctors bash each other incessantly.

I am tired of constantly being made to feel as though I know NOTHING, even if what I am currently not knowing is not something that I have ever come across before and will never use in my specialty of choice.

I am tired of the feeling that there are not enough hours in the day to do everything I want to do as well as I want to do it.

I am tired of every second of my day being taken up by SOMETHING, leaving me no time at all to do nothing. I miss doing nothing.

I'm tired of people expecting me to show up to things that waste my time, just because I'm told to. Sitting through the same academic half days that I sat through during my maternity leave is NOT helpful, nor is sitting through ICU rounds when the topic is the utility and outcomes of various strategies of hemodialysis. 

I'm tired of living in a place where I don't have any friends to just sit with and vent over a glass of wine. Not that I'd be able to find the time to do so, but anyway...

I'm tired of feeling like the staff in the emerg all think I'm incompetent. Part of that might be paranoia, but when you listen to people bitch about their peers for long enough you start to wonder what's being said about YOU behind your back.

I'm just tired.