Wednesday, July 22, 2009

This, too, has passed.

I finished my last day as a Children's Wards Senior today.  Last day with my own little team, teaching, rounding learning, orchestrating, helping, guiding, talking, listening, healing.  Ward months there are rough months, long days and longer call nights with the admit pager like a constant time-bomb on the pocket of my white coat next to the ridiculousness of my other TWO pagers on the outside of my pocket about which people comment at least three times per night, "Got enough pagers?"  I always offer to give them one or all three, but never had any takers.  Admit pages would flood in and I'd triage and delegate and strategize and examine and consult on sick surgery patients and review orders long after I'd sent the med students home or to bed and the rest to finish dictating.  Or sometimes not and we'd wander around the hospital.  I'd give them my ventilator talk, or my Peds in Pictures talk, sometimes a little Neurofibromatosis, or show them the x-rays of the patient I saw with rickets or with dermatomyofibrosis or go over line placement, or just how to read a chest x-ray.  

Being a senior, once you get beyond the terror, is really a bit of a high, especially at the beginning of the academic year with all new med students and interns and acting interns and this year even with new co-seniors.   I'd try to balance the admissions by work-load and learning-potential between the interns and med students.  I'd have the students read and give weekly presentations so they would learn about disease, we'd all learn from them, and the attendings would learn who they were. 

It is a small funny world at the Children's Hospital.  Loren told me the other day that I saved a patient's life.  Perhaps I did.  I was the one there; it was what any one of us would do.  It was what I try to teach my students and interns to do.  To learn what is sick and serious and to distinguish that from the other children who can wait until you save this one takes practice.  It always takes practice, but you get better.  I saw them get better this month.  I felt myself be better at my role, more comfortable in it and more confident, and more humble, more supporting. I felt proud of them and the growth they'd shown over the month.  I looked at my med students this month and remembered that five years ago this month was my own first ward month on pediatrics with two med-peds seniors, Dan and Dave, on my team and Jim as mine and Szilvie's intern.  I thought my seniors were geniuses.  I still don't think I'm as smart as they are, but things have completed a cycle.  My acting intern (fourth year med student) from this month is going into med-peds.   

I remember my first patient as a third year student.  Osteogenesis Imperfecta.  I read all about it.  I knew the kinds, I knew his kind, I knew very little about the arc of his care or disease, but I did what I could.  I got better.  Another patient that month had AIDS.  He was very sick, but they let him be my patient anyway.  I looked up his nutritional needs and his antiretrovirals.  He drew a picture one day and handed it to the team on rounds.  One of the seniors took it at first but my patient corrected him, saying it was for me, his "doctor." He's dead now, from complications of his disease.  I learned that during my fourth year in my Medicine and Literature class.  I still have that drawing somewhere.  I remember my first ER patient with tracheomalecia.  I remember the LPs we did on the children with febrile seizures.  

Now I supervised my interns doing lumbar punctures; they both did perfectly.  The med students learned to re-assure parents with a thorough physical exam. We all learned how to do better cardiac and neuro exams.  They learned how to befriend and not terrify the small children, and how to treat the teenagers with respect and firm boundaries simultaneously.  They learned to be excited about the patients and the healing and the learning and teaching we could share.  

I can't believe, not that it is over, that it actually is.  I started my first month as an intern there three years ago yesterday. Lost in the pink corridors with the round, triangle, or bowl shaped lights, sleeping in the daytime social work office turned call room by night (sleeping very rarely still), slow and worried and lost and nervous.  I'm a bit sad, actually.  Nostalgic.  Dr. Bradley says that means I was good at what I did; that that is a good sign.  I'll take that.  

Residency is a long, long, grueling training path and yet it is also a precious time of camaraderie and learning that cannot be duplicated.  I'll miss the time and the team and the trial by long sleepless nights.  I'll miss the dull lull of energy and personal temperature disregulation at 4am (that only a little).  I'll miss the emergency chocolate pudding and grahm cracker snack at 3 am because I missed the cafeteria closing.  I'll miss my interns and med students.  I'll miss chaos of the morning pass offs at the end of the call which precede the drive home and the comatose sleep.  I'll miss the daily teaching and noon conferences and morning report and EBM.  All of the things that seemed so time-consuming and arduous when I started now seem like old friends.  

I don't know if that's good or bad, that it sounds like I have just written my wedding vows to a job I have been dating constantly for three years when we are doomed to separation in another year.  I guess I've only ever been good at serial monogamy anyway.  

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