About an hour ago, I hit the halfway mark. The trouble
is, I was asleep.
It's 1:12 a.m. on New Years Day. As my Federal Hill
neighbors continue launching fireworks from their rooftops
while loudly proclaiming their love of cold beer, the
number 2006, and one another, I remain comfortably
tucked in the bed where I'd collapsed yesterday afternoon
when I arrived home. Two thoughts cross my mind: How
is it that I can now take nine-hour naps? And is it
really possible that I now have less of internship
ahead of me than behind me?
No single story can capture my residency experience.
Any single patient, call night, or work day could provide
fuel for an entire column. But there are a couple of
memories—one amusing, one serious—that help tell the
story of what kind of a ride this has been.
One of the responsibilities of any resident includes
cross-cover, where overnight you care for not only
your patients, but your whole team's as well. On this
particular night in early fall, I made a point of stopping
in to see Mrs. J. She was in her mid-80s and a pleasant
little woman from East Baltimore. She was admitted
to the hospital with an angry-looking skin infection
on her right hand after being scratched by her cat.
The infection was sufficiently concerning that we decided
to place her on intravenous antibiotics rather than
oral medicine. Worried that her condition could deteriorate
overnight, I wanted to check on her early in the evening.
Mrs. J was all smiles, with no pain complaints. In
fact, she said she was feeling all right. And her hand
looked reassuringly better—less red, less swollen.
We talked for a few minutes about her hand, then for
about 10 minutes about how much fun she was having
being a grandmother. I wished her a good night.
“You know, you doctors just keep looking younger and
younger every day,” she said as I prepared to leave.
Feeling good that the slog of intern year was perhaps
not readily apparent in the lines on my face, I responded
enthusiastically, “Thanks, Mrs. J.” Then, rather than
graciously accepting the compliment and being on my
merry way, I got greedy. “How old do you think I am?” I
asked, beaming at her with my most disarmingly boyish
Mrs. J smiled back and uttered a response that perhaps
best sums up my intern year. “Baby, you can't be any
older than your early forties.”
My heart sank, followed swiftly by my ego. For the
record, though at times this year I have felt older,
I am 27 years old. And yet I have to chuckle a little
when I think about Mrs. J.
The second memory involves the value of having good
crewmates when your ship hits rough waters. Come late
fall, interns are on call on their own, admitting new
patients to the Medicine service overnight. We no longer
enjoy the warm, nearby comfort blanket of in-house
senior residents. That reassurance is replaced by a
sense of autonomy both motivating and intimidating.
On any given night, five to six Medicine interns staff
the inpatient wards, each admitting patients to their
respective teams. For two weeks in October, my call
schedule and that of my friend and former medical school
classmate Russ Hales were similar. Both of us also
had a particularly ill group of patients.
On the first night, I had to devote much of my time
to an actively unstable patient with end-stage liver
disease. At a critical moment, Russ just sort of appeared,
offering an extra set of hands or just another mind
to bounce ideas off. It was neither his patient, nor
technically his responsibility, but he showed up anyway.
We constructed a plan together, weighing the diagnostic
and therapeutic options for this poor woman. What was
perhaps most meaningful was that none of the help Russ
provided to me got him any closer to finishing his
own work that night.
The next call night, it was Russ who had the unstable
patient. And now it was my turn to provide whatever
assistance I could. This pattern repeated itself over
the next two weeks. And through it all, I came to value
just how critical it is to have colleagues whom you
can trust implicitly. I never had to call Russ to ask;
he never had to call me. Both of us just showed up
to assist when that was necessary. Perhaps most importantly,
I think our patients benefited from our collaborations
as much as we did.
From the silence that has descended, it sounds as
if my neighbors have finally gone to bed. Their day
tomorrow will likely start around noon, and involve
ibuprofen, coffee, and sweatpants.
My day will start in four hours, with an early morning
drive to the hospital.
But with patients like Mrs J
and teammates like Russ, I'm oddly okay with that.