The world of medicine is like a bubble. A lot of people THINK they know what goes on there, but unless you're down in the trenches it's unlikely you do. So here is my semi-anonymous blog, here to tell you what really goes on in the life of a medical resident.

Tuesday, September 30, 2008

So What Else am I Doing?

Now that I finally have time to talk about things OTHER than my emergency medicine board exams...

I got a new job. I actually started it in late August. Since my hospitalist gig wasn't really working out (I didn't like the one hour drive, I didn't like the fact that half the time my orders didn't get carried out, I didn't really like the 'hospitalist' role in general) when they started pushing me to commit to a more consistent schedule I took the opportunity to bail out.

Then, something better fell into my lap. I was working with one of the emerg docs in August when she mentioned something about a 'shift at the clinic'. I asked her if she did walk-in clinic work in addition to the emerg, and she confessed that she did. I say confessed simply because around these parts (and in most parts, I guess) walk-in clinic doctors don't have the best reputation. At best, they're solely motivated by money and cranking through patients as quickly as possible. At worst they're seen as antibiotic dispensers, willing to give patients whatever the hell will get them out of the office in the least amount of time. But this was an emerg doc that I admired, and here she was admitted that she also worked at a walk-in. Huh. Interesting.

I told her that I had looked into working for one past-time at the beginning of my residency and didn't know how to get into it. She told me that the clinic she was working at was always looking for docs to provide more coverage. She paged the doc who ran the clinic... and boom. By the end of the week I worked my first shift as 'one of those walk-in clinic doctors".

And I liked it.


Well, I can't deny that the amount of money that I can make in one short 5 hour shift is awesome. My $200K line of credit for medical school liked that part. But there were two things that I liked even more...

The first was the fact that I didn't answer to anyone. I didn't have to justify my decisions to a preceptor, and no one had the option of seeing the 'real' doctor instead. I finally felt full accountability and full responsibility... and I loved it.

The second was the fact that I felt appreciated. I never thought that was all that important to me, but it made a big difference. I understand that emerg is a pretty thankless job. You're seeing people at their worst, they're sick, their family members are worried and stressed, they're often angry at being made to wait for hours on end... I get that. But there were a few times... after seeing a woman in early pregnancy after a stillbirth, counselling a guy with first-episode HSV infection, reassuring a new mom that she wasn't doing anything wrong... simple things, really. But the patients were just so thankful to me afterwards. Maybe they expected the typical 'McMedicine' that walk-in clinics are famous for and were surprised that I took the time to sit and listen. But I was actually surprised by how much a simple 'thank you' meant to me. It made me feel a little narcissistic, but it was a stark contrast to the emergency department.

So I have a new part-time job. Emerg resident by day, walk-in clinic doctor by night. And mom at all other moments of the day. No wonder I'm exhausted.

Saturday, September 27, 2008

The Aftermath...

The exam is done. Thanks to a confidentiality agreement signed before we sat down to write, I can't tell you anything but the vaguest of accounts. So here it is:

First of all, to any of you writing an exam in a city where you do not live... as tempting as it may seem at the time, do not attempt to do ANYTHING with that weekend other than write the exam. I made the colossal mistake of inviting Mr. Couz to bring the Bean to COTU for the weekend. That way, I figured, the day that I was doing my written, Mr. Couz and Bean could hang out with family, and the next day after my oral we could enjoy the city. Big mistake. Huge.

Mr. Couz got sick. Bean does NOT travel well, and screamed the better part of both nights. Seeing as how Mr. Couz could barely get out of bed, that left me to tend to screaming baby. So no chance for any last minute review, no chance for clarification of concepts, no 'one more chapter'... hell, there was barely even any sleep. So I did both parts of my exam in a semi-comatose state, with a head cold to boot. I croaked my way through my oral, and blew my nose through my written.

If I fail, I wish I could blame the circumstances. But I can't. I know I wasn't prepared enough.

The oral was actually surprisingly straightforward. Which makes me think that I missed a few 'tricks'. The written, on the other hand, was incredibly vague.

A 60 year old man presents to your emergency department with some mild fatigue X 1 week, malaise and one episode of diarrhea. What is your ONE most likely diagnosis?

Are you freaking kidding me?

What 5 questions (list ONLY 5) will help you to narrow your differential?

Gah. Totally not representative of reality, and a lot of the "guess what I'm thinking" game.

I find out, for better or for worse, at the end of October. I have yet to decide if I'll confess if I fail. Although it's fairly anonymous here (more or less), it's still a huge hit to the pride. Plus, since my program didn't want me to write early in the first place, it will suck to have a big "I told you so" hanging over my head.

But now on to other things. I feel like my life has been on hold for so long I don't know what to do with myself. Although I know I won't suddenly feel like I have tons of free time (having a baby sure took care of that) I can't wait to get some aspect of my life back.