The Real Thing

By Melissa Sparrow

After 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 and nauseated.

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 to mind.
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 us residents.

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.