At the beginning of this year, a very wise individual gave me the following advice: “The days are long, but the years are short.”
As for the days being long, I couldn’t agree more. As a surgical intern, my job is to provide sweat and blood to lubricate the machinery of modern medicine. To do everything that no one else wants to do – filling out mountains of paperwork, mollifying angry families, removing feces from rectums, verifying that the orders of others have been carried out, spending hours with the most tedious patients in the clinic, checking endless checkboxes – and facing the wrath of all at the slightest mis-step.
On one particular day, I was paged over 70 times between the hours of 6 am and 6 pm. Since each page requires an average of four minutes of time to address (usually at least 2 minutes just to get the nurse who paged me back on the phone), I spent almost five hours of my day just responding to pages. I had to write forty notes on patients, which is a process that takes approximately 3-5 minutes per patient (again, an average of 4 minutes), for another two and a half hours. All told, I spent nearly eight hours of that particular day either responding to pages or writing notes. In 2014, this is what modern medicine feels like.
Being beneath everyone in the hospital hierarchy – either by virtue of rank or the complete apathy of others- is a daily challenge. When a nurse or technician does not care about their job or their patient, they are never blamed for oversights or errors, but it is always the intern’s fault for not being vigilant, not knowing, or being inexperienced. And it is not worth scolding someone who is truly and completely uncaring.
I’ve learned very quickly to accept responsibility for everything bad that happens, offer no excuses and only give the briefest apologies. One attending surgeon explained it thusly:
The only thing worse than an intern who makes a mistake is an intern who wastes my time telling me why [they did it]. I don’t want to hear that – don’t you think I have more important things to think about? Just take care of it.
It’s not that the job is thankless – because people are constantly thanking you and even blessing you – its just that you are never thanked for doing the things that actually warrant an expression of gratitude. All the behind the scenes hard work is taken for granted – the really tough stuff is never seen. Conversely, families of the sickest patients will effusively thank and praise you for your mistakes, and for their bad outcomes, even after you explain precisely what had happened.
Oh and while all of these things are going on, every once in a while you actually have to practice real high stakes medicine. A few times I’ve been the first physician to arrive at a patient in acute cardiovascular collapse (“code blue”), the principal surgeon in the operating room, the sole doctor taking care of a patient, formulating a treatment plan, and obtaining rubber-stamp approval from an overworked superior. But those times are indeed far between.
I can also confirm that the years are indeed short. I was recently teaching one of our fourth year medical students about some inpatient diabetes management methods, when I experienced a new feeling. I asked him a question I thought to be so basic that everyone must know the answer – but he in fact had no idea what I was talking about. He was three months away from his medical school graduation, 95% of an MD degree completed, and precisely one year behind me in his training. I could not remember a time when I did not know the answer to the question I had asked him – I could no longer put myself in his shoes. It was a great experience for me because I had to stop, think, and remember how to teach this particular concept from the bottom up. For me, it was also clear evidence that this year has passed by with stunning pace.