On responsibility and engagement (or halfway through Women’s Health/Pediatrics)

We began this week, the final week of inpatient pediatrics, without a senior resident.

Over the weekend, the second year pediatric resident fell ill with the flu. Hospital-acquired illnesses are a common occurrence in pediatrics. Additionally, the intern on the service began on Monday, a family medicine first year. And finally, a fresh attending rotated onto the service. In short, no one on the team knew these patients all that well. The intern and the attending relied on my fellow medical student and I to pick up the slack and help manage the floor.

Rounding, which is usually a passive experience, became a six-hour blur with phone calls, answered pages, and patient encounters. To participate in the patient care, even if it just printing prescriptions and handing them to the mother of a baby, felt rewarding in a way that I haven’t felt during third year.

These essential, but not necessarily important, tasks are what you learn during residency: the invisible steps required to manage a floor full of patients. Battling the electronic medical records system to place the proper type of contrast swallowing study. Explaining to the mother of a recently discharged patient that the medication we prescribed must be compounded at a specific pharmacy, not locally available at your CVS. In an ideal world, these tasks would be unnecessary and solved before they arise, but they are part of the modern medical practice.

During medical school, we learn what we should do. If a 16yo presents for dark urine and swollen lips, what diagnosis do you suspect? What are the next steps in management?

During residency, we will learn what we need to do. How do you place the orders for the diuretic to keep her kidneys functioning? How do you coordinate with nephrology to follow-up on other possible causes of her glomerulonephritis?

This hectic week with phone calls and pages provided a peek into the clinical duties of a resident. Of course, I didn’t have the same patient load or responsibilities, but I got an idea of life on the other side of the MD. Long days bouncing from one minor emergency to another, never staying settled for too long to get bored, and somehow making time to document and chart appropriately.

The experience both gave me appreciation for the lack of true responsibility now, during medical school, and anticipation for the next step, a residency in psychiatry. I look forward to this style of chaos. The farther away from the classroom and the deeper into my medical education that I find myself, I am more at ease with the demands and expectations. Less like playing chicken against folks with no sense of self-preservation, and more like joining a team of misfits.

I need to finish third year without any missteps. I’m far closer to the end of the clerkships than I ever thought possible. And soon, very soon, I will begin the journey of finding my own team of misfits in residency.

For now, I have a stale to-do list and outpatient pediatrics next week.

Emotionally, I am feeling well. Better than I have in a while. Lots of self-care over the past week and a day spent with Mackenzi has done wonders to my psyche.
Physically, I feel strong. I have returned to the rowing machine and treadmill. I haven’t spent much time rowing since the days of crew in high school and college. Haven’t run much in the past five years. I feel more like myself than I have in months.
Spiritually, I haven’t practiced much and haven’t felt like I have lost ground. The week of long days in clinic have rooted me back into a desire for medicine. Cannot ask for more.
Relationally, I could reach out to more folks. Instead, I am simply glad that I have my partner to love and that she takes care of me. I have to start at home before I can go out into the world. And things are good at home.


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