Making Decisions

Well... I feel like I need about 26 posts to update everything that's been going on! I drafted this post back in July, and forgot about finishing it for the past 2 months... But to catch up on events since May.. I graduated medical school, my sister got married, my daughter had a birthday, and I started internship! And those are just the milestone events. I think some other stuff happened in between, but it's all a blur. The whole premise of this blog was "headed to the dock" - working towards becoming a doctor. Now that I've arrived at the dock, maybe I should change the name! But the other part of "headed to the dock" was being a submarine wife, always headed to the dock to meet the sub coming back. I think I'll leave it for now, unless I come up with something new and incredibly witty.

Everyone kept asking me if I was excited to graduate medical school, and oddly enough, the answer was no. It is a really weird feeling... something I have worked so long to get to, and I wasn't excited for it! Of course it feels cool to finally say, I'm Dr. Kramer and hang the M.D. on the wall. But it marked the end of my job as a student. I love school! ...and I don't think I'll ever be in school again. Medical school was some of the most fun years of my life. My job was to learn, and I had little other responsibility than that. Starting on July 1, I suddenly had a lot of other responsibilities. I am still learning, but it's not my main job right now. My job is to admit patients, discharge patients, write notes, answer pages... and now suddenly I am supposed to be able to answer questions and people care what I think!

As a medical student I practiced writing notes, I practiced giving presentations on rounds, I even occasionally put in orders or made a phone call. One thing I did not practice at all was responding to questions from nurses. The first week of internship, every time a nurse asked me a question, my answer was "uhhmmmm lemme ask the resident". Even for questions as simple as, "This patient's leg hurts, can you write for some tylenol?" Having never prescribed medications before, every time I order one I'm thinking.. I don't really know all the side effects of this medication, I don't know if I really know every thing about this patient. What if I am causing them harm? It didn't take but a few days to start feeling more comfortable answering questions and putting in orders, but it is definitely a weird feeling!

I have been told that M.D. stands for Makes Decisions. While I am making small decisions such as prescribing pain medications, and responding to changing vital signs, the big decisions are still left to people with more training than me. While reviewing my discharge summary, one resident told me to use more abbreviations to save hours of my life in the future. The next day the fellow told me not to use so many abbreviations. I guess I'll go halvzies on that and use some abbrevs. Often many different options for treatment are justifiable and left to those with more experience to choose. One day the fellow decided she wanted our patient to take his blood pressure medicine three times a day and told me to change it. The next day the attending told me, that makes no sense and to change it back to twice a day. This repeated for 3 or 4 days in a row. I just say okay and put in the orders.

My first rotation of intern year was inpatient cardiology. I learned a lot and it was really interesting at times! Our typical patient was checking for heart attacks in people with chest pain, but we also had patients with lyme carditis, bacterial endocarditis, and I finally understand what a "high pitched murmur" is. It's a description that I read on tests questions frequently, but hearing it on a real patient was pretty amazing. I also became great friends with my co-intern, and got to work with her this month too! My second rotation of intern year was anesthesia. I have been wanting to pursue a career in anesthesia since I first rotated on it as a third year medical student, and this rotation completely reaffirmed my interest. It offered a nice break from the usual grind of internship with free weekends, and completing the day while the sun was still out. I still love the real-time physiology, being hands on, and everything else that goes with anesthesia. I was happy to get a lot of IV and intubation practice! I will find out in December if I get to start anesthesia residency next year. My third rotation, which I am finishing up now is inpatient internal medicine. This is the default service to admit someone to the hospital, and it is a lot of work. It is emotionally, mentally and physically taxing. I am continuing to make small decisions, but still have little influence on larger things. I have a lot of responsibility, lots of tasks to do throughout the day, and longer hours than I've ever worked before. There is an 80 hour work week limit for residents and I have reached that. The stress of never ending task lists, patients I feel like I can't help, feeling like I've made mistakes, and feeling like I have no idea what I'm doing, has gotten to me a few times. Only once did I have to actually go sit in the bathroom and cry about it for a few minutes before getting myself together. For the first time, I come home from work and I really don't feel like talking about my day to anyone. I usually just don't want to rehash the details, and it's a strange feeling for me, since during medical school I was always excited about every new rotation. I'll be done with this rotation in a few days, and will enjoy a couple free weekends before having to come back for another inpatient medicine rotation. For now, I'll do my best and continue Making Decisions.