Day 1: Orientation
Date: Early July, 2019
The sympathetic engine is churning at near-maximal revolutions [sympathetic nervous system: fight or flight response, fear]. At first, it was energizing. Now, I'm learning to ignore the steady trickle of catecholamines and glucocorticoids in my bloodstream. A constant nuisance of fire trucks and police sirens wails in my head. A new threshold has been set. Now we begin.
Residency has begun. Orientation is underway. It is a day that has been long in the making. Nobody could predict how I would end up here, least of all I. A promising, inquisitive, and immature medical student graduated several years ago and began a surgical residency. If not for delays, he would be finishing up and moving onto a fellowship now. Today, he is back at square one: hopeful, invigorated, anxious, and slightly confused. (Have you learned your lessons? If not, life will teach them despite all your cries to stop.)
How should I begin?
I began...residency a few years ago. No, that's not right. Let me rephrase. Well, yes, that's right. I'll go on. What was the question?
It's been back-and-forth like this all day in my head, spinning around and coming back to the same thing over and over again. Reeling, I stop the noise in my head and turn my attention to outlining the steps of 'basic' operations - chest tube placement (tube thoracostomy), appendectomy, cholecystecomy, and central lines. As I go over these, speakers from HR or Risk Management lecture the auditorium full of incoming residents and fellows on various administrative responsibilities, blasting the fear of God into us about making sure we perform our duties in an unflappable, medicolegal manner (without outright saying so). I wonder to myself how the patients' well-being plays into the intended message, and like clockwork, "at the end of the day, we are all here for the patients." I raise my head briefly and smile a wry smile. Yes, there it is. Everything is covered now.
I go back to rehearsing the steps of tube thoracostomy and fumble in my imagined depiction of it. "It is critical to have tight documentation of every encounter, and consultation with..." dammit, how can I forget this? It's a simple horizontal midaxillary incision along the 5th intercostal space. You can't pause to think up the right steps, or go back a step, when asked by an attending or chief to properly outline the operation. You must be precise and thorough; cannot bumble or stammer. Seeking reinforcement, my attention flickers to other procedures, and it begins to stall again. The residues of internal failure build up one step after another, until I am too overwhelmed to think of it any further.
Suddenly, I feel like a tabula rasa, freed of all my life's knowledge. I cannot think to think. "There are strict penalties for improper or deficient documentation." How long should my daily notes be? What about appendectomy? Let's go through that again. No, wait, stop. Stop doing this to yourself. You know fully well that incessant worry reduces performance, and what are you worried about, anyways?
Lunch time comes around. It's time for the incoming crop to commingle. I'm not hungry. We sit down to socialize, ask questions, and feign interest. It feels awfully familiar but is accentuated with a new undercurrent of something I can't quite pinpoint. Something else is on my mind. I eat as if ravenous and finish before the others at my table. They talk merrily, with an orderly dispassion well-practiced by doctors. The resident next to me asks about my background. I hem, haw, and idle, then stutter into an answer. Having sized me up, he ignores me for the rest of the session. 45 minutes remain for the lunch break. Why'd you have to eat so fast? Nobody else in the room has finished. I sit and look at the remnants of lunch - plastic wrapper, sandwich crumbs, brown bag crinkled into a ball - smiling occasionally when somebody says something that somebody else seems to enjoy. I take comfort in knowing that, for the next 45 minutes, my fate is sealed. I know where I will be. I will be at this table, bored, slightly intimidated, and resigned to the fact that I have nowhere else to be. This is a necessary step. We are all taking it.
Young doctors sit and chat idly now, but in a week we will be in the full swing of things. This leisurely lunch will seem foreign in its utter lack of responsibilities - to our patients, our colleagues, and ourselves. I look forward to that, because it gives me the power of distraction. Most of the others in this lunch room can exhale comfortably with the assurance that their futures are bright. I am in tryout mode. The distribution of outcomes for me is decidedly binary - pass or fail. I have been given the gift of not being able to relax, of having to prove myself with every action, however small. I do not have the luxury of stagnating. The tables have turned; or, as Michael Scott from The Office says, "how the turntables."
This is the American Dream.
The sympathetic engine is churning at near-maximal revolutions [sympathetic nervous system: fight or flight response, fear]. At first, it was energizing. Now, I'm learning to ignore the steady trickle of catecholamines and glucocorticoids in my bloodstream. A constant nuisance of fire trucks and police sirens wails in my head. A new threshold has been set. Now we begin.
 |
| Johns Hopkins Mediccine |
Residency has begun. Orientation is underway. It is a day that has been long in the making. Nobody could predict how I would end up here, least of all I. A promising, inquisitive, and immature medical student graduated several years ago and began a surgical residency. If not for delays, he would be finishing up and moving onto a fellowship now. Today, he is back at square one: hopeful, invigorated, anxious, and slightly confused. (Have you learned your lessons? If not, life will teach them despite all your cries to stop.)
How should I begin?
I began...residency a few years ago. No, that's not right. Let me rephrase. Well, yes, that's right. I'll go on. What was the question?
It's been back-and-forth like this all day in my head, spinning around and coming back to the same thing over and over again. Reeling, I stop the noise in my head and turn my attention to outlining the steps of 'basic' operations - chest tube placement (tube thoracostomy), appendectomy, cholecystecomy, and central lines. As I go over these, speakers from HR or Risk Management lecture the auditorium full of incoming residents and fellows on various administrative responsibilities, blasting the fear of God into us about making sure we perform our duties in an unflappable, medicolegal manner (without outright saying so). I wonder to myself how the patients' well-being plays into the intended message, and like clockwork, "at the end of the day, we are all here for the patients." I raise my head briefly and smile a wry smile. Yes, there it is. Everything is covered now.
I go back to rehearsing the steps of tube thoracostomy and fumble in my imagined depiction of it. "It is critical to have tight documentation of every encounter, and consultation with..." dammit, how can I forget this? It's a simple horizontal midaxillary incision along the 5th intercostal space. You can't pause to think up the right steps, or go back a step, when asked by an attending or chief to properly outline the operation. You must be precise and thorough; cannot bumble or stammer. Seeking reinforcement, my attention flickers to other procedures, and it begins to stall again. The residues of internal failure build up one step after another, until I am too overwhelmed to think of it any further.
Suddenly, I feel like a tabula rasa, freed of all my life's knowledge. I cannot think to think. "There are strict penalties for improper or deficient documentation." How long should my daily notes be? What about appendectomy? Let's go through that again. No, wait, stop. Stop doing this to yourself. You know fully well that incessant worry reduces performance, and what are you worried about, anyways?
Lunch time comes around. It's time for the incoming crop to commingle. I'm not hungry. We sit down to socialize, ask questions, and feign interest. It feels awfully familiar but is accentuated with a new undercurrent of something I can't quite pinpoint. Something else is on my mind. I eat as if ravenous and finish before the others at my table. They talk merrily, with an orderly dispassion well-practiced by doctors. The resident next to me asks about my background. I hem, haw, and idle, then stutter into an answer. Having sized me up, he ignores me for the rest of the session. 45 minutes remain for the lunch break. Why'd you have to eat so fast? Nobody else in the room has finished. I sit and look at the remnants of lunch - plastic wrapper, sandwich crumbs, brown bag crinkled into a ball - smiling occasionally when somebody says something that somebody else seems to enjoy. I take comfort in knowing that, for the next 45 minutes, my fate is sealed. I know where I will be. I will be at this table, bored, slightly intimidated, and resigned to the fact that I have nowhere else to be. This is a necessary step. We are all taking it.
Young doctors sit and chat idly now, but in a week we will be in the full swing of things. This leisurely lunch will seem foreign in its utter lack of responsibilities - to our patients, our colleagues, and ourselves. I look forward to that, because it gives me the power of distraction. Most of the others in this lunch room can exhale comfortably with the assurance that their futures are bright. I am in tryout mode. The distribution of outcomes for me is decidedly binary - pass or fail. I have been given the gift of not being able to relax, of having to prove myself with every action, however small. I do not have the luxury of stagnating. The tables have turned; or, as Michael Scott from The Office says, "how the turntables."
This is the American Dream.
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