It’s been an interesting start to the year. I’m finished my third week of attending on general medicine wards (!!) and I’ve finally started to shed a little bit of the terror.
The shock of seeing my name as “Staff Physician” or under the admitting orders. The first week I had to remind myself repeatedly to step back and be the attending, letting the resident run the team, and to step in with the teaching and final decisions. Final decisions — that’s what interesting thing. Residency was truly over for me the first week I was an attending. The layers over the years had slowly peeled away.
MS4 has the intern, resident, and attending as back up.
Intern has resident and attending as back up.
Resident has attending as back up.
Attending has…so many other attendings as back up. That’s what I love about medicine, it’s a team sport at all levels. I run things by my co-chiefs, and other attendings when I’m not sure. It’s a team sport. But at the end of it — it really is now my name under the primary attending for the patient. Do I discharge? Do I admit? That’s my decision.
Oh boy, the first patient I discharged directly from the ED was humbling.
“So the pCO2 is 80, ok…but it’s always been 80, and it’s compensated appropriately…and they are at their baseline…ok–let’s arrange close follow up and discharge.”
It’s a humbling experience where you read when you get home to learn more about what you thought you knew, but want to double check, or review, or learn more nuances.
The humility needed for this job is amazing to me. The “no wait, this person has metastatic cancer? No, that’s not what they came here for…and they don’t know…so we have to tell them…”
“But I didn’t come here for that.”
“No — I didn’t come here for that — I’m fine, I just have a little pain.”
“I’m so sorry — the pain is from the cancer”
You sit there in the necessary silence of the void that exists in those moment just after, and see in their eyes that there will be no more before. There will just be the after. Whether it goes well, or not as planned, there will only be after.
I’m still learning, and I will continue to learn, and that’s why I picked this job. It’s a privilege to get to learn constantly, teach others, and care for people.
A great memory from this week?
“Doc, I like your badge”
“Oh, yeah, it’s a little worn, I have to get a new one before my ID cards fall out”
“No, I mean I like your pin. I like that you’re wearing it.”
*Looks down at the pin, looks up at at patient*
“I like it too. I’m glad you do.”
I bought a Black Lives Matter pin at the beginning of the year and pinned it to my white coat. A coat meant to demonstrate help and healing, and instead for too many demonstrates bias, omission of truth, and complicit repression. In this climate, more than ever, I want my white coat and the white coat of my residents to mean only “do no harm.”
In this time of seeming dark apocalypse in California, my job is a light. This tomato galette helped too.
Tomato, Carrot, and Goat Cheese Galette (Lightly adapted from the amazing JoyTheBaker)