The Real Thing
By Melissa Sparrow
three tough years, Melissa Sparrow has finished her residency and taken
a job as a full-fledged attending physician. It's exciting -- and it's
scary. Here's her last column.
On my very first
day at my new job as a pediatric hospitalist, I was called in to see a
newly delivered baby boy who was not pink but gray, who was not taking
the kind of fast and comfortable breaths that well new babies take but
tugging so that all of his little ribs showed and his sternum sank way
down deep into his chest. I remember very distinctly the words rising
up in me, "CALL THE ATTENDING!" I almost looked over my shoulder,
expecting a fellow or attending to show up and stabilize not only the
patient but also my fear.
Fortunately, I stifled those words, as they wouldn't have instilled great
confidence in the nurses who were just getting to know me, or in the baby's
parents. New, terrifying words rose up and flooded my mind: I AM THE ATTENDING.
The rest of the day, until I was able to transfer the baby with acute
respiratory distress syndrome to an intensive care unit in another hospital,
I kept thinking to myself: what would doctor so and so do? I felt like
a substitute, of sorts, for the real thing.
When I returned home the following morning, I had an opportunity to think
over what had transpired in just 24 hours and to experience the magnitude
of the change: I had gone from being a physician-trainee in a large academic
hospital with multiple levels of medical backup at my fingertips, to being
the only pediatrician in a community hospital, fully responsible for the
lives of numerous children. No substitute. The real thing.
Certainly I had known this change from being a resident to, dare I say
it, an attending was just around the corner. And as all of us residents
do, I had looked forward to my new role, anticipated it with eagerness
and excitement. But I also feared it. During the last few months of residency,
I began to ask questions of my teachers in a different way, energized
by a new concern. It had become frighteningly tangible to me that my walking
resources would not be at my beck and call forever.
"What if I come up against this problem in a new setting, where I
have no one to go to?" I would ask myself. My cocky early and mid-third
year demeanor disintegrated, and I became a deer in the headlights again.
What I could not anticipate about this change from being a resident to
a full-fledged attending physician answering only to my patients, their
families and my own conscience was the all-consuming nature of this newfound
responsibility, its capacity to energize action and organize thought.
Or how good it feels to know that I can rise to an important medical occasion,
even when unaided and unsupervised.
My respect for the quality of my training is something I am only now coming
to realize. I find myself thinking back to my very first experience at
a delivery where something went wrong with the baby. I was a third-year
medical student doing my Ob/Gyn rotation at another hospital. It was my
first rotation, and I was both clueless and useless. I was also pregnant
I watched as the baby was delivered by C-section, because of a complete
lack of variability of his heart rate and likely intrauterine compromise.
My job was to hold the retractor as the Ob/Gyn doctor cut through the
mom's multilayered abdominal wall. As the baby was handed to the pediatricians,
he looked blue and limp as if he were already dead. Then, I watched in
amazement as they resuscitated him.
Shortly after the delivery, I excused myself from my retractor job, letting
another one of the scrubbed-in students take over, and hustled to a small
side room where I both cried and threw up (because of my panic over the
baby's well-being and the smell of cauterized flesh, respectively). I
remember thinking to myself then: I will never be able to do what those
pediatricians do, bring a baby back to life.
"You've come a long way, baby" is the trite phrase that comes
In retrospect, I am not able to distill out which part of my residency
training helped me to develop competence or which parts were dispensable.
Would I be less of a doctor if I hadn't taken 36-hour call, or would I
be just the same? What if I hadn't learned to do my own phlebotomy? What
if I had learned how to do it better than I do now?
I cannot answer these questions, and fortunately, I don't have to right
now (as must those physicians concerned with redesigning residency training
to meet new laws and an outcry over long work hours).
What I can say very simply is that I am grateful for my training at Hopkins,
for every nugget of wisdom that was passed my way, for the endless (yes,
endless) opportunities to witness patients both sick and well, for the
generosity of my many teachers and the countless hours they devoted to
Yes, my three years have taken their toll-it will require a gradual recovery
process before I feel like a complete human being again. But I thank you
Hopkins for helping me save this boy's life.